Vaginal Nerviness and What I would Say Differently If I Made This Movie Now

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So, I found an article that prompts me to let you all know I would probably would have said something in the movie a little differently. It's about the amount of nerve endings in the vagina.

In the movie we say that compared to the vulva, the inside of the vagina has lots less nerve endings, which I'll stand behind. However, we also go on to say that there are more nerve ending in the front (towards the hole) than in the back depths of the vag, which we say has almost none. We also go on to say that this lack of nerve ending allows for surgeries to happen in the vagina without anesthesia. I got that from Alfred Kinsey's classic, Sexual Behavior in the Human Female (W.B Saunders Company, Philadelphia, 1953) pages 159-171 and 577-584. He had done tests where different parts of the vulva were gently stroked with a probe and different parts inside the vagina were both stroked and/or given pressure. Whether the 879 women tested could identify that they were being touched or where exactly they were being touched in each area was noted.  The results of that study, along with studies from the 40's and 50's he cited (one's in German, I think) [1][2] and from histologic data he received from 2 scientists on vaginal innervation [3], prompted Kinsey to make the claim that the vagina is not particularly nervy except for the area that is basically the opening. He also cited that "From our gynecological consultants, we have abundant data on the limited necessity of using anesthesia in vaginal operations" and cited a related study [4].

So that's where it came from. I now think it could be wrong to say there are less nerve endings in the furthest inner parts of the vagina. I found an article in  The Journal of Sexual Medicine called, "A prospective study examining the anatomic distribution of nerve density in the human vagina." 2006 Nov;3(6):979-87. In my defense, this was at the very end of my heavy research for this movie, but who knows if I would have found it anyway. There are tons of little one-off lady-gasm related studies that are either not conclusive or often just kinda bad that I had no interest in using for the movie and it's hard to keep up with checking them all. This one would have been good though.

Although it's small (only 21 women), it is a physiological investigation - a first of it's kind really. Plus, I don't think its claims are overreaching. Basically, the authors had the women take a standardized questionnaire about their sexual functioning (arousal, orgasm, lubrication, satisfaction, pain, etc.) and then took tissue samples from different areas of their vagina (i.e. cervix, front wall closer to hole, back wall closer to hole, and deeper on both front and back walls.). They also took samples from the different layers of the vaginal tissue in all those places. What they concluded was that the vagina had about the same amount of nerves throughout every place they tested, and that there was no significant difference between the women's amount of nerves; not between women with or without Female Sexual Dysfunction, not between with different scores on orgasm, lubrication, arousal, etc., not between pre and post menopausal. The had all given birth, but there was no difference between those with 3 or more and those with less than 3 births. One possible issue was that all the women had prolapse (where some pelvic orgasm had fallen out of place) and that this condition had been associated in one study with women saying they had less sensation in the vagina. However, the study was done this way because these women were going into surgery anyway, so getting the samples was essentially non-evasive and thus the study could actually get done. The researchers did look to see if there was a correlation between less nerves and the further stages of prolapse, but that wasn't the case either.

As Kinsey pointed out in his research and as this study points out, a study of the amount of nerves in the tissue of the vagina does not also necessarily indicate what may or may not be pleasurable to women inside the vagina. The amount of nerves does not also point to the nerve behavior, and there are plenty of other factors that go along with what physical actions feel pleasurable to someone. However, it is solid useful information for further investigation into female sexual response.

Again, this is a small study, but it seems well done, and it would prompt me not to assert that there is different areas of the vagina that are less nervy than others.

This also brings up something related. I have recently realized that discussing the vagina as not-so-nervy and specifically saying that there are surgeries done in the vagina without anesthesia, is a kind of trigger for people and can immediately turn them off to anything else I have to say. It seems that it conjures up a distaste that some people have for the ideals of some 70's feminists (particularly to Anne Koedt and her article The Myth of the Vaginal Orgasm ) who boldy pointed out that Masters and Johnson's groundbreaking (and still completely relevant) research showed that orgasms are caused by clitoral and not vaginal stimulation. I could be wrong, but I think maybe it simply has something to do with a misunderstanding that these feminists were also saying that the vagina is a pleasureless hole and that enjoying intercourse is basically stupid and un-feminist. I, in no way, think that was what they were saying at all, but I also know that sometimes things trigger bad feelings, and I wish I would have known that before I put the statement about anesthesia and vaginal surgery it into the movie.

I see now that it can easily be taken as a shorthand for me saying that the vagina is useless. I do say clearly that vaginal stimulation has not been shown to cause orgasms, but I never say that vaginal stimulation is never or never should be part of sexual stimulation and arousal. I believed I had made that distinction clear in the movie, but I didn't say it as clear as it could have been said. Plus, although there are surgeries done in the vagina without anesthesia [5][6], there are also surgeries done with anesthesia. I think the statement I put in the movie is just a bit too much because instead of backing up the idea that the vagina is less sensitive than the outer vulva and that vaginal stimulation does not cause orgasm, it gives the impression that I don't think there is any sensitivity in the vagina at all and that it could not possibly be important to arousal.

So - I was possibly wrong about different areas of the vagina having different amounts of nerves. Also, if I were to make this movie again, I would be more sensitive about the issue of vaginal sensitivity and be way, way more clear about my notion that the vagina, while not an orgasm causing organ, is surely an arousal causing organ...and thus I would not bring up the whole vaginal surgery - no anesthesia thing.

[1] Kuntz, A. 1945, Ed. 3. The autonomic nervous system. Philedelphia, Lea & Febiger, 1 pl. + 687p.
[2] Undeutsch, U. 1950. Die Sexualitat im Jugendalter. Studium General 3:433-454.
[3] "Dr. F.J. Hector (Bristol, England) and Dr. K.E. Kranz (University of Vermont) have furnished us with histologic data on this point."
[4] Doberlein, A. and Kronig, B. 1907. Operative Gynakologie. Leipzig, Georg Thieme, xvi +721p.
[5]Clifton PA, et al. Journal of Family Practice. "Ineffectiveness of topical benzocaine spray during colposcopy." 1998 Mar;46(3):242-6.
[6]Sammarco MJ Hartenbach EM, Hunter VJ. The Journal of Reproductive Medicine. "Local anesthesia for cryosurgery on the cervix." 1993 Mar;38(3):170-2.

A Reply to a Reply: My Continuing Discussion with Skeptic Edward Clint

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A while ago, I read "The clitoris revealed and how i09 got it wrong" by Edward Clint, and I felt that his last 3 paragraphs needed my critique - cause doesn't everything, really? Honestly though, I thought it important to comment about it not because it was crazy off-the-wall idiocy or because I thought Clint was being negligent. I chose to do it because his was such a normal, socially acceptable, some would even say progressive, way of discussing female orgasm. It is right in line with most thoughtful people's way of thinking, but I believe it is incorrect. I decided to dig into this particular article because it was written by a skeptic; someone who cares about how we do science, how we talk about science, and how we understand the fruits of our scientific labor. Usually, when I critique discussions on female orgasm, and I say things like, "there is no evidence for a vaginal orgasm and thoughtful people should stop speaking about female orgasms as if there is," I either get hateful, emotional responses or I get ignored. It was to my great excitement that Clint did neither. He seems to me to be a thoughtful, sensible, and scientifically minded person. His site Incredulous has some interesting articles and is definitely worth checking out. As I wrote in my original critique, the first part of his original article related to scientific reporting and was fantastic. It was really only the last 3 paragraphs that got to me. 

Reading his original article and his reply to my critique, it's clear to me that his main intention was to point out that extreme, politically charged ideology with little to no backing in facts can be quite harmful, and it's unfortunately rampant in the discussion of female orgasm. I fully agree. I think in spirit, Clint and I have the same positive hopes for female orgasm, but I cannot get behind many of his statements because I disagree with him on an important piece of background information, and so I find the way he speaks on this issue to be counter productive. I'd like to think this makes our discussion particularly important because at our hearts, we care about the same things and really could open a meaningful dialogue. 

So this, my friends, is my reply to his reply. We decided he would respond on his blog with links to all past writings from the discussion. I would respond from my blog and do the same. You can find his original article HERE, My critique HERE, and his reply HERE. I want to make it clear that I truly respect  Clint's interest in scientific discussion, and I think he is a smart guy with genuinely good intentions. He has been nothing but kind to me, and I feel a little bit bad about continuing to disagree with him. However, I'm serious about this subject, and I crave a serious discussion. To be honest, I was disappointed when I read his response. It wasn't the discussion I was hoping for. I wanted pushback, disagreement, something on my critique's main focus about our culture's (including his article's) insistence on speaking about Vaginally Induced Orgasms (VIO) as if they were a given, and about why (or why not) that is an incorrect way for knowledgeable people to speak about it. However, Clint's response did not really delve into this, and in the end, I felt he focused more on whether he even deserved my original critiques.

Main Points of Trisha's Critiques as written by Edward Clint
In his response, he started by summarizing what he thought were the main points in my critique: 

1 There is no scientifically documented vaginal orgasm with regard to Masters & Johnson’s 1966 definition of orgasm.

2 (He) misrepresented the primary issue re: female orgasm by assuming there is such a thing as a vaginally-induced orgasm, and therefore erroneously present the stock “clit vs. vag” debate as the appropriate framing of the issue. Clitoral orgasm is the only scientifically documented sort, and any other is poorly defined and not in any case documented. Therefore, the appropriate framing of the problem is that women and society in general have been mislead to believe there are other-than-clitoral orgasms as a fact. 

3 (He) was dismissive and flippant about the importance of this debate because it misinforms women and leads to ill effects on their sexual and perhaps emotional heath. The mass-media, books, and pornography commonly depict vaginally-induced orgasms leading to needless insecurity and anxiety when experiences fall short of such hyperbolic fantasy.

and these points were not off base. He actually (and quite thoughtfully) ran them by me first to see if those were accurate. He got my points fairly correct, but I feel like Clint was less interested in addressing them directly and more interested in pointing out that he wasn't really talking about those things in the first place, and that I was asking too much from his writing. I disagree on both points, and we'll get into that soon.

The original "The Myth of the Vaginal Orgasm" article

Koedt and Freud

Let me first comment on what Clint says in a section called "a few other small points" at the end of his reply. He's commenting on my statement, "He seems to play Anne Koedt as some crazy ideologue, but she is not." His thoughts on Koedt and my problem with those thoughts are important because they point out the 1 major disagreement I have with Clint. He says:

I did no such thing. In fact, quite the contrary. My experience writing this blog has taught me that people need points that sound far-fetched to them to be substantiated with a citation. I quoted Koedt to do that. If I thought that she was a crazy, isolated nut, citing her would not substantiate my point. I was depending on Koedt being a respected figure. I do believe she is mistaken on many points, but that is not an insult.

I understand he may not see it this way, but he did do such a thing, and it has nothing to do with whether he thought Koedt was a respected figure or not. Freud is certainly a respected figure, but it doesn't mean Mr. Clint and the rest of the world think his ideas about vaginal orgasm being the only mature female orgasm are any less bat-shit crazy.  Whether a respected figure or not, Clint clearly painted Koedt's point of view that is presented in her article,  "The Myth of the Vaginal Orgasm," as an opposite and equally incorrect point on a spectrum against Freud's crazy-ass ideas. Like I said in my original critique:

To pose Freud's bullshit against Anne Koedt's article, an article that is backed up by good science, is just plain silly.

It is silly for the very reason that it makes her point of view seem as looney and as incorrect as his; as if she was making equally wild speculations in the opposite direction, but she was not. As I also said in my original critique, Koedt's writing was backed by the best (even to this day) physiological research on female orgasm. From this standpoint there is no evidence for VIOs. Her saying that the vagina is low in the ol' nerve department and that vaginal orgasms don't exist, is not a knee-jerk, outlandish backlash to Freud's obsession with the vag-gasms. It is what the physiological science said and still says. Freud was writing with a sexist tone (that, we can all agree he went terribly wrong on), but his ideas are also doubly problematic in a way I don't think Clint and most of society are willing or knowledgeable enough to recognize because there is no physiological backing for the idea of a vaginal orgasm. Not in Freud's day, not in Koedt's day, and still not in our day. Freud had sexist ideas about a thing that is physiologically unsubstantiated. He is so wrong in so many ways. Koedt made sensible comments about female orgasm that are based in good science. She is pretty much on point.

His depiction of Koedt and Freud and of the "clit vs. vag-gasm" debate comes from a perspective that does not take into account that VIOs have no physiological backing in science, and my viewing of these things does. That is the base of my problem with his original article, but after reading his reply, I don't feel that came through to him. It is important to me that my criticisms be clear though, so that a real, thoughtful debate can begin. I believe his view of these topics (which is also the larger cultural view) ignores basic scientific knowledge on the subject and is ultimately misleading and harmful, and I think this viewpoint should be seriously reconsidered. That said, I think that our real differences of opinion and the real discussion that I would like to have stems from one or more of the following:

• He disagrees with me that there is no physiological evidence of VIOs
• He disagrees that a lack of physiological evidence for VIOs over the past 50 years means that VIOs are likely non-existent
• He doesn't know that there is no physiological evidence for VIOs
• He disagrees with my definition of VIO and so sees it differently. To be clear, my definition is basically any orgasm caused by stimulation inside the vagina without stimulation of the clitoral glans also. (This does not mean any orgasm that happens during intercourse is a VIO - A more detailed description is HERE).

So, yes, I do believe he portrayed Koedt as a crazy ideologue - at least somewhat as much as Freud, but it's because his base point of view was that VIO's were a given truth of the female orgasmic experience. So Freud seemed less crazy to him and Koedt's insistence that they didn't exist, seemed more crazy. 

Clitoral and Vaginal
This takes me to another of  Clint's points that only makes sense if one were to believe that VIO's were a given physical truth of the female orgasmic experience: his insistence that the vaginal vs. clitoral orgasm debate is two extremes fighting each other and neither are actually right...or actually wrong. In his original article he wrote: 

The modern research tells us that everyone is right! Or, everyone is wrong, however you’d like to parse it, because all of the parts are important.

Again - makes sense if it were true that women orgasm from penetrative stimulation, but if that's not true, and women really only orgasm through clitoral glans stimulation, then all the people who speak about VIOs (whether one thinks these happen because of deep inner clitoral stimulation, something on the vaginal walls, cervix, or G-spot - really any anything other than the clitoral glans) as if they exist actually are wrong, and although all the "parts" might be important, only the clitoral glans is causing orgasms.

He also continues with this clit-vs-vag-is-two-extremes-fighting-each-other-when neither-are-right-or-wrong in his reply to me. He was referring to my problems with his placing Freud and Koedt on two extremes of the female orgasm spectrum, and said

Here I was not meaning to say much of anything about vaginal or vaginally-induced orgasm, but rather that I find both extreme positions, that penetrative vaginal intercourse is all that matters to orgasm, or that it is irrelevant to orgasm, are not correct. The truth is somewhere between...

I fully understood what he was meaning to say, and I still disagree. Well, let me say that I would find his statement to be quite sensible....if vaginal orgasms existed. If they don't exist, as I am claiming the physiological data suggests, then saying the truth is "somewhere between" does not make a lot of sense. His specific wording about what these two "extreme positions" is problematic and I will get to that in a minute. For now, I'll take a chance and assume that he feels Freud's sexist insistence on the higher status of vaginal orgasms is incorrect, but his acknowledgement that they exist is sensible. I assume Clint also feels that Koedt's championing of the much maligned clitoral orgasm was sensible, but her insistence that vaginal orgasms don't exist is bad. Thus the "between" that Clint feels is the truth has something to do with VIOs and clitoral orgasms existing happily together in the female population with one not better than the other. The possibility that VIOs are not even a physiological thing didn't even come into the picture, and frankly I think saying that the "truth is somewhere in between," is misleading. More than that, it's a vague, non-critical, unsubstantiated statement, and it's not novel. It goes right along with 'clits-are-so-so-important-of-course-but-vag-gasms-are-also-so-so-great-too!' mainstream sex advice and with the status quo cultural knowledge that regularly ignores the clear lack of evidence for VIOs. What exactly does Clint or anyone mean by saying the truth of female orgasms are "somewhere between" in the "clitoral vs. vaginal" debate, anyway? Do all women need a little bit of vag stim and a little bit of clit stim to orgasm? Do some women have the ability to orgasm from only vaginal, some from only clitoral, and some from both? If we as a culture (and Edward Clint as a skeptical writer) don't know what it means and can't back it up, why the hell are we saying it? 

Now, let me just go back to what Clint described as the two "extreme positions." The first is that penetrative sex is all that matters to orgasm. Yes that is extreme. The clitoral orgasm and all its physical characteristics is well documented. It's well known that all healthy women are capable of them, and it's also well known that easily 70 to 80% of women claim to only have this type of orgasm. No sexpert or researcher worth anything would ignore its importance and it is certainly part of the mainstream understanding of female orgasm. Honestly, though, no one seriously believes that extreme position except Freud and his modern cronies (and there are more than a few). 

The next extreme was that it (penetrative sex) is irrelevant to orgasm. There are two ways of looking at what Clint meant here. 
1. If by this statement he means that penetrative sex alone cannot cause orgasm, that is only extreme if one were to believe that VIOs are a given reality. If one were to look at the scientific data. It wouldn't be extreme at all. 
2. He may not have meant anything about causation because he may not have a clear understanding of Koedt's (and my) position. He said "is irrelevant to" orgasm and not anything about whether or not vaginal penetration alone causes orgasm. In fact I tend towards him not having a clear understanding of the position because he also ends his original article with the following:

We don’t need to invent bullshit stories about anatomy to counteract other people’s bullshit ideological stories about either the supposed frigidity of women or about the denial that vaginal sex can be fun.

He is mixing up the position that vaginas don't cause orgasms with a pretend position that vaginas have nothing to do with pleasure. No one, including myself or Koedt, is saying penetrative sex is irrelevant to orgasm or that vaginal sex can't be fun. Hey, a good ramming can be just the fun, pleasurable thing a gal is looking for. In fact, I'll straight up agree with him that penetrative vaginal intercourse is not irrelevant to orgasm, but it's really kind of a silly statement. Lots of things are not irrelevant to orgasm; good intense kisses, hot porn, a sexy smelling partner, a de-stressed state of mind, nipple stimulation, or an intense emotional connection. These all can lead to pleasure, which leads to arousal, which is necessary for orgasm, and any one of those things on their own can be a good (I mean really good) or fun part of sex. However, none of those things, without some type of stimulation of the clitoral glans happening also, have been shown to cause a physical orgasm. 

This is a real problem with the discussion around female orgasm. Pleasure is not orgasm, and saying that VIOs don't seem to exist is not the same as saying penetrative sex is useless, boring or not pleasurable. He and so many others discuss the vagina and the clitoral glans as if they are two points of entry for orgasm, and that is simply unfounded. Messing with the vagina can cause pleasure, but according to current physiological data on orgasm, it should go in the maybe-try-playing-with-this-if-you-want-to-get-me-crazy-hot-and-move-me-towards-an-orgasm category along with nipples, anuses, backs of necks, ear lobes and perineum. The clitoral glans is chillin' with the penis in its own stimulate-this-if-you-want-to-elicit-an-orgasm category. This constant insinuation that the vagina and the clitoris are (mostly) equal partners in the orgasm business exists all across our culture, without question or qualifications, and it's a problem. It gives women and men an incorrect physiological understanding of female orgasm, and I promise, if it seemed that women and men were untouched by frustration, worry, and disappointment about female orgasm then I wouldn't give a shit about the language and insinuations around this subject, but that's not the case. Men and women both need this discussion to change, and I think it needs to begin with clarity around this whole assumption that "vaginal orgasms" are a thing. 

Didn't Have To But Did

That about sums up my problems with his original article and his reply to points 1 and 2 up above in the "Main Points of Trisha's Critiques as written by Edward Clint" section. His reply to point 3 of that section is below, and I'll speak on that now.

The third point results, I think, from misinterpretation and disagreement of editorial focus. I was not meaning to say the facts do not matter or that misinformation about how bodies work does not harm women and men. Of course it does. I meant to relate that political agendas and bickering about proper terminology does  not change anything about how we experience our bodies, and can itself be harmful if people become beholden to any ideology to the exclusion of facts or prevention of better understanding. Any staunch ideology inevitably leads to these ends. 

I agree that political agenda, cultural agendas and staunch ideology "can itself be harmful if people become beholden to any ideology to the exclusion of facts or prevention of better understanding." That is why I prefer to go about this discussion by acknowledging facts about the lack of physiological evidence for VIOs. He and I can both also agree that facts and misinformation about how our bodies work does harm men and women.  

Apart from that, I think Trisha felt it was inappropriate for me not to “set the record straight” on female orgasm, having introduced it as a subtopic. I disagree. My post was not really about orgasm at all, but about the low quality of science reporting among the blogs as it pertained to anatomy, not orgasmic function. I mentioned that only in service of larger points. As a writer I am entitled to choose my own focus and topic, and am not required to take up the educational activism that another might prefer. I am not required to recount the history and detailed politics of something just because I refer to it in a post that is not about it.

It is true that Clint is not required to recount the history and politics of female orgasm. It's true that his article was largely not about orgasm at all. However he did use Freud and Koedt to recount history and politics of female orgasm, and his article, in the last 3 paragraphs, did stray from its main subject (which truly was a thorough and level-headed discussion about the low quality of science reporting among the blogs as it pertained to anatomy) to specifically comment on how this all related to orgasmic function. He didn't have to do any of that, but he did, and the problem was that I believe he got both the political history and his insinuations about the nature and mechanics of orgasms wrong for all the reasons I discussed in my original critique. 

You see, that's the thing. He, and others who don't-have-to-yet-do-anyway, often speak about female orgasm without really knowing or caring about the scientific background, and their insinuations give people an incorrect picture of the subject. I don't expect everyone to be experts in the history and politics of female orgasm, and I don't expect anyone besides myself to "set the record straight" on female orgasm. That would indicate I want everyone to be activists. I certainly don't, but I do expect that people (especially those who seem to have some element of authority on science or sex or related subjects)  who take it upon themselves to discuss female orgasm, as Clint did in his final 3 paragraphs, come at the subject with the the correct base knowledge - a knowledge that couldn't help but take into consideration how very non-existent VIOs are within scientific literature. I would expect the same from any person speaking on any subject. 

I know my points about female orgasm are not common knowledge (and frankly, that's why I have to critique well intentioned, unsuspecting, nice and thoughtful people to get these ideas out there), but I don't think it's too much to expect skeptic writers to go a little deeper into the scientific background of subjects they discuss. I will call people on this. In a similar way, I would expect a person discussing the effects of GMOs on human health to come at it with a base knowledge of how GMOs are added into organisms in the first place, how genes replicate and work, and how food breaks down during digestion. If the points a person makes show that their base knowledge is incorrect, then I believe it is more than fair to critique them. 

I'm Almost Done

I fully realize Clint never expected or wanted to be a focus of my activism, and I understand that it might be a bit annoying, but he did make an insinuation, whether he thinks so or not, about what organs cause female orgasm, and he did paint a picture of the vaginal vs. clitoral debate that is wrongly placing Koedt's point of view as an extreme when it is not. If thoughtful people like him are getting this discussion wrong, there is very little hope for the public in general. That is why he's a target, and I hope he can understand my point of view.

Now, given that there are 20 to 30% of women who claim to orgasm vaginally, my statements about the lack of physiological evidence for this phenomenon are surely controversial and deserve some discussion. I would very much like to dig into that controversy and have that discussion. I had every hope that this back and forth would begin to do that, but instead I feel it went in a much less interesting direction. So, what I would really like to talk about in regards to the original article is the following:

• Do we or do we not agree that there is a lack of physiological evidence for VIOs, and if so, does that mean VIOs are likely non-existent?
• Is it sensible to speak casually about a physical "cause" of Vaginally Induced Orgasms (VIOs) when there is no physiological evidence of them? (clearly my stance is no, but I'd like to hear other's thoughts).
• Why is a stance, like Koedt's stance, that female orgasms originate only from stimulation of the clitoral glans and not stimulation of the vagina (the only stance backed by physiological evidence) painted as extreme? Is it actually extreme?

Again, thanks to Edward Clint, and I look forward to his thoughts.

P.S. Edward Clint pointed out in his reply that the title of my original critiques was a bit too harsh. I'll agree, so I went for a much more even keeled title. Thanks for that bit of critique Ed.