Ejaculation Associated With Bladder Muscle Overactivity? - A Journal Article I Read

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Well, my friends, this is another installment of A Journal Article I Read - a segment in which I read a lady-gasm related peer-reviewed journal article and try my damndest to summarize the article here for you without taking away too much of the detail and subtlety, yet making it readable and not too long. I do my best to achieve those goals, and that's all I can say.

In these summaries, you can assume that anything I write is a genuine attempt to reflect what is said in the paper - even if it's shortened or summarized. My opinions, if I have any to add will either be inside brackets likes these [me:], or in a section headed in a way that clearly lets you know these are my opinions. All quotes are from this article unless specifically noted.

You can check out the list of all the past 'A Journal Article I Read' Summaries HERE.

Do women with female ejaculation have detrusor overactivity? Cartwright R1, Elvy S, Cardozo L. J Sex Med. 2007 Nov;4(6):1655-8.

My Quick Summary
In order to identify if bladder abnormalities (specifically problems with bladder control) tend to exist in women that claim to ejaculate during intercourse and/or orgasm, the researchers (who have a urogynecology practice) investigated 6 women that claimed to ejaculate and 6 women who claimed to have never ejaculated. They had them fill out a 3-day journal of their peeing situations, and they also did a test where they filled their bladder up and checked to see if they could hold it while doing things like coughing. What they found was that none of these 12 women had issues with bladder control. Although in their practice they have identified some women who they believe misidentified their bladder control problems during sexual activity with ejaculation, this study showed that not all women that claim ejaculation also have bladder problems. They conclude that if women have liquid release during orgasm or intercourse but do not also exhibit other symptoms of bladder control problems, then there need to be no more medical investigation, and these women should be assured that their release is not a problem.

I think this is a really simple, thoughtful, generally well-done study. Although it's quite small and specific, I believe it adds 1 tiny drop into the already quite small pool of knowledge that can be used to help piece together an understanding of sexual fluid expulsion. I also appreciate that this study does not seem to push any agendas and doesn't carelessly confuse ejaculation with orgasm - because they are not physiologically the same thing.

Introduction

• "Questionnaire surveys have suggested that 40% to 54% of women have at some time experienced an expulsion of fluid at orgasm [1,2]." There have also been references to female ejaculation throughout history and in more recent discussions by Dr. Graffenburd in the 50's and Beverly Whipple in the 80's who "reported that a minority of women passed small volumes of fluid during heightened sexual arousal or at orgasm."
• "Although it is anatomically and physiologically plausible that small volumes of fluid might be expelled from the para-urethral Skene's duct, some sources imply that it is a normal part of female sexuality to discharge large volumes of fluid at orgasm." [Me: "Skene's gland is said to be the female prostate since it is the embryological, yet less developed, equivalent to the male prostate. It wraps around the urethra and can sometimes be felt through the vaginal wall towards the front of the body in the area that is most commonly called the G-spot (although G-spot is also used as a catch-all phrase to describe an imaginary button that causes vaginal orgasms).]
• The authors go on to describe how now there 'ejaculation gurus' that try and teach women to ejaculate and porn that shows large volumes of fluid expulsion. "The most anatomically and physiologically plausible explanation is that such fluid is emitted from the bladder."
• Maybe partially because of those misleading depictions in porn and the like, it remains controversial what the liquid at ejaculation is - urine, prostate fluid, vaginal secretions, a mixture of the two?
• There are some past studies, but many of them have small sample sized and some are not peer reviewed.
• Some studies showed higher levels of prostate enzymes than would be expected in urine
• One study catheterized 7 women who claimed to regularly experience ejaculation. For all of the women, "large volumes of fluid were passed down the urethral catheter, with the timing of fluid expulsion corresponding with the peak of orgasm." [Me: So, in other words in this study there seemed to be liquid coming from the bladder during sexual arousal even though the bladder had been emptied beforehand].
• In the author's urogynocological practice, they often treat women with bladder control issues. A previous study has indicated that orgasm can cause a detrusor (muscle on wall of bladder) contraction that can cause leakage, and women who complain of leakage at orgasm have a high prevalence of detrusor overactivity. However, symptoms of detrusor overactivity do not only include leakage at orgasm or intercourse, but also other bothersome things like urinary urgency and frequency.
• The authors, as female ejaculation has become more commonly known, have treated women with a proven detrusor overactivity diagnosis who rationalized the leakage at orgasm as ejaculation. So from this anecdotal evidence, they wanted to see if they would find a connection between ejaculation and detrusor overactivity - and particularly wanted to see if women that self identified as ejaculating also showed this bladder condition. This was not meant to stigmatize but to help counsel women who presented leakage at orgasm and also to maybe better understand the physiology of ejaculation.

Subjects and Method

• 6 participants that self-identified as having experienced female ejaculation and 6 that had not were recruited from the researcher's institution staff. They were between 27 and 41 and having given birth between 0 and 3 times.
• They were given a short survey asking about frequency and conditions of ejaculation. All 6 of the 'ejaculating' women said they ejaculated either "often" or "sometimes" and did so either during masturbation or intercourse.
• "Each women completed a 3-day bladder diary, documenting the volume and timing of urinary void."
• Each woman also completed 2 short validated bladder questionnaires; one asking about perception of desire to void and the other asking about bother associated with lower urinary tract symptoms.
• Each woman also underwent 'short provocative ambulatory urodynamics." This is basically a test for detrusor over-activity where a catheter is placed up the urethra and anus, and the bladder is fully filled for about 30 minutes while the participant is asked to do things like coughing and heel bouncing while holding their pee.
• Data was analyzed by a blind 3rd party. There was no difference between the groups and so no extra statistical analysis was performed.

Results

• There was no indication of detrusor over-activity in either group and the bladder-diaries showed no significant difference between groups.
• There was no significant difference between the scores on the validated bladder questionnaires about desire to void. "Almost all the women agreed with the statement, 'I am usually able to finish what I am doing before going to the toilet.'"
• The scores for the validated bladder questionnaires about bother associated with lower urinary tract symptoms were "marginally higher (more impairment) in the female ejaculation group." This was due to 2 women in that group who had given birth that "reported occasional bothersome stress incontinence."

Discussion

• "This study does not exclude the possibility that female ejaculate is coming from the bladder. It does however, demonstrate that women who report female ejaculation do not necessarily have the associated symptoms or pathophysiology of women who complain of coital incontinence."
• This research did not replicate the "symptoms" of an ejaculation. The women were not sexually aroused, so there is still a possibility that for the ejaculating women there is uninhibited detrusor (muscle of bladder wall) contractions at orgasm. A future study in this vein, but with women during sexual arousal and orgasm would be useful and informative.
• Like most female ejaculation studies, this sample size was small, and it is possible there was bias in that women who had incontinence issues may not have volunteered for the study.
• The researchers also wonder if there could be bias because the ejaculating women in this study did not necessarily experience it frequently. Other past studies have used women that were able to ejaculate at most episodes of intercourse or masturbation.

Conclusions
"Based on our findings, we would recommend that women who report female ejaculation, in the absence of other bothersome lower urinary tract symptoms, do not require further investigation. They should be assured that this is an uncommon, but physiological phenomenon."

Orgasm Interviews: ANNA Part II (Intercourse and Non-Intercourse Activities)

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Orgasm Interviews - my basic intro (can skip if you've already read one of these)
Welcome back to this new series in SSL where a women answers questions about her orgasm, masturbation, and sexual experiences. I'm super excited about this because I think women sharing their orgasm experience with fo-realness is powerful as fuck.

At the same time, I think women speaking about their orgasm experiences before they have grounded understanding of orgasm or before they have learned how to have an honest relationship with their sexual bodies, can be misleading at best to the women they speak to and damaging at worst. To be frank and blunt about what I mean here, let me say it this way; I strongly suspect there are lots of women that lie about their orgasms - about how they happen, when they have them and if they have them. I don't think it's a mean or intentional thing. I don't even think I'd really call it lying most of the time because I don't think it's a conscious lie. It's more about not understanding what an orgasm physiologically is before speaking about it with an undeserved authority. I just think we women are so mislead and confused about our bodies, about the physiology of orgasm, and about how we should obtain, express, and speak about our orgasm that we often twist our understanding of our own experiences to fit into how we think things should be, and then we speak about them from that twisted, non-scientifically based view and other people take it to heart.

I say that all to let you know that I will be hand-picking all the women I ask to take this survey. I am choosing women I believe have a grounded understanding of orgasm, have exhibited what I believe is an honest relationship with their sexual bodies, and have shown they are able and at least somewhat interested in expressing their feelings and experiences. So, these are also women I have already had the chance to speak to about their orgasms. This series, clearly, is no scientific-based investigation, but I still would like to make it clear to all of you that this is the bias with which I am coming at this.

What I ultimately hope is that these women's stories and insights bring comfort or insight to the other women reading this.

ANNA 
This is the 2nd in her 3 part installment.
Find her PART 1 HERE.
The following is also the description I have in Part 1, so if you've already read it, you can move onto the questions.

The first brave lady I have chosen for this is Anna. I met her online because she wrote me with some worry and criticism about a post I had written. Her insight, openness, and thoughts intrigued me, and we began a really lovely discussion. She graciously accepted the offer to do this, and put a lot of time and effort into being as honest as possible. In an email asking me what format to send it to me in, she said,

"I've been spending a lot of time on your survey, trying to be as honest and thorough as possible. It brought back memories and helped me put into words some vague thoughts I have had. Maybe I was too thorough: I wrote more than ten pages. I couldn't separate orgasms from sex in general. I kept adding context. The answers didn't seem to make sense otherwise."

This will be the second of 3 post from her survey. She did, much to my happiness, write a lot - more than 1 post's worth. Please read her interview in detail. Anna is an extraordinary woman, I think, and although her orgasmic life might have taken a slightly different route from many of you, there is
soooo much to relate to and a lot to learn from. I asked a few follow-up questions that I will include as well. The ability to ask follow-up questions I think is an important perk to this kind of direct questioning.

2. Intercourse 
2a. Describe your relationship to and experience with intercourse. 
Well, for one thing, I thought I would never get a chance to experience it. From middle school and onwards it was made very clear to me how ugly, weird and disgusting I was. Bullying is very damaging.

When I was 17, I met a boy who seemed not only interested but enthusiastic, so I took my (only) chance. We had so much fun! Neither of us had any experience (and also, no internet), so we experimented: "Does this feel good? Harder? Softer? To the left? What about if I do like this instead?" When we tried intercourse I was a bit disappointed that it would not bring me to orgasm but it wasn't that big of a deal. We just tried different ways to include my clit. What worked best was me using my fingers during intercourse. (Too bad all we had in common was sex. It only lasted a couple of months.)

I enjoy intercourse. The pressure inside me can feel really good. I like being close to my partner and seeing his pleasure. Intercourse can bring an extra dimension to my orgasm too, but it doesn't cause orgasms.

2b. If you ever orgasm while having intercourse (either with or without the use of hands, toys or other accessories), please describe exactly what needs to happen to you physically in order to get the stimulation you need to orgasm. If there is more than 1 scenario, describe each. Please be as detailed as you can. 
I'm not sure I understand the question. "What needs to happen to you physically"... Frankly, what needs to happen is that he doesn't get in the way.

I used to orgasm during intercourse most of the time. I would do my usual circular rubbing. He would hold back until I was done, then he would come. I have come from being fingered while he was inside me from behind. It was nice, but it's just as good and also much more reliable if I do it myself.

I have had a few sexual partners: some boyfriends, some more casual. (I haven't counted. Probably more than ten, definitely less than twenty.) With most of them, my finger method worked perfectly. With my current boyfriend it just doesn't. If I put anything between us it doesn't feel as good for either of us, and it doesn't feel as good from behind either. I think it's partly due to anatomical factors but mostly psychological.

My boyfriend so desperately wants it to be good for me that he gets stressed and loses his erection. He is 50+ and has some prostate trouble, but what really derails him is his inner model of how sex SHOULD work. He feels that it's his job to give me orgasms, and that I am somehow being cheated if I have to "help" him. It is better for both of us when he relaxes and lets himself enjoy his own pleasure.

My trusty vibrator doesn't work for me during intercourse. I need it to be positioned very precisely. Intercourse makes it move around too much.

2c. How often would you say you orgasm during intercourse? What are your feelings about that?
It used to be quite often. These days, basically never.
It doesn't matter either way. Intercourse is not all-important. I get orgasms with my boyfriend practically every time we have sex, except when we decide that I won't (as part of play, or because we only have time for one of us - and when that happens, it's usually I who get the orgasm and he who waits)

3. Non-intercourse Partnered Sex 
3a. Have you ever orgasmed during cunnilingus (while being ate out / gone down on / given oral sex)? If so, please describe in detail (as best you can since you aren't in the front row of what's happening down there) what you need to do physically and what needs to physically happen to you in order to orgasm this way. 
I have, but it was a long time ago. The mechanics are the same as when I masturbate: consistent, firm, rhythmical pressure.

Cunnilingus can be nice as part of the build-up phase, but I usually don't orgasm from it. Tongue and lips are not firm enough for more than teasing. Also, I tend to thrash around a lot when I orgasm, so the stimulation tends to vanish when I want it the most.

Most of my partners, current included, seem very enthusiastic, but I sometimes get distracted with worry that he is getting bored or that it tastes bad.

3b. Have you ever orgasmed while a partner was stimulating you with a hand or finger(s)? If so, please describe in detail what you need to do physically and what needs to physically happen to you in order to orgasm this way. 
I have, but mostly I like it as part of the build-up. It's just easier and more reliable if I do the last bit myself.

 3c. Have you ever orgasmed while a partner was stimulating you with a sex aid (a vibrator, dildo, feather - anything like that). If so, please describe in detail what you need to do physically and what needs to physically happen to you in order to orgasm this way.
No. I only got my first toys after I met my current boyfriend. We tried a little bit, but it just works so well when I do it myself.

3d. Have you ever orgasmed while grinding or rubbing against a partner's body? If so, please describe in detail what you need to do physically and what needs to physically happen to you in order to orgasm this way.
No. I have rubbed my vulva on my partner. It feels nice, but it is too indirect to make me orgasm. 

3e. Anything else you'd like to say about these activities in your sex life?
My boyfriend and I discovered the perfect way to make me orgasm. I lie on my stomach and hold my little vibrator on my clit in the same way as when I masturbate. My boyfriend lies beside me and pushes rhythmically and firmly with his thumb on the alleged g-spot area, and when I say firmly I mean as in "Are you sure I'm not hurting you? Are you really certain? I can't believe I'm not hurting you." I get an orgasm every time, and it's usually more powerful than anything I can get on my own.

3e Follow-up Questions 1 and 2 (answered together) 1. Did your orgasms that happened while there was pressure on your G-spot ever include any kind of ejaculation or 'squirting' or anything like that? 2. Have you ever experienced ejaculation or 'squirting'? If so, please explain the situations in detail. 
It has happened but I haven't really thought much about it. I don't know how often it happens. Sometimes everything gets really wet when I orgasm, but it's hard to tell if it's from ejaculating or just a lot of vaginal lubrication if no one sees it happen. I have been told that it looks like a little orgasm fountain. Partners tend to think it's a big deal, like a mark of their excellence as lovers. Maybe they have a point: every time I've been told about has been with g-spot pressure, and the orgasms have been significantly more powerful than average. (I wish everybody knew that vaginal lubrication is a bad indicator of how turned on you are.)

Follow-up to the Follow-up: So, you are saying that you have been told that it looks like a 'little orgasm fountain' when you orgasm. However, the only times you've been told that are when you have received the strong g-spot stimulation along with the clitoral stimulation. Is that correct? Also, is it correct that you haven't been told about a 'little orgasm fountain' or any other squirting/ejaculation during orgasms that did not include G-spot stimulation? Otherwise, you have noticed being very wet after an orgasm, but that could very well be vaginal lubrication - is that correct?
No partner has mentioned a fountain when there has been no pressure.

I just realized something: when I masturbate with a toy in my vagina I get some pressure, and occasionally there is a lot more wetness than usual after I orgasm. It is more water-like, not as slippery. It smells sweet, not like either urine or vaginal fluid. I always thought this was due to the toy stimulating extra lubrication, but maybe there has been an ejaculation? I really don't know. I never thought much about it before you asked.


3e Follow-up Questions 3: Also, can you explain in any more detail how your orgasms with lots of G-spot pressure differed from your orgasms without g-spot pressure?
This is a difficult question. There is a big difference, but how to describe it? The pressure orgasm is more full, more nuanced. My whole body is more involved. If it's a strong one I tend to scream out loud and my back and legs spasm. The first few times with my boyfriend's special technique he thought he had seriously injured me, for sure. Now we just have to be careful to shut the windows and scream into a pillow. I can force myself to be silent and still, but when I do it takes so much effort I can't fully enjoy the orgasm.

Orgasms without pressure are sharper and thinner. My body cramps rather than spasms. I don't make much noise either. This makes it sound like orgasms without pressure are inferior, and they kind of are, but also not. Chocolate analogy: quality is better than cheap, but sometimes the cheap stuff is what you crave. Music analogy: some music is complex and rewards the listener for making the effort, and some music is less complex but just as enjoyable in other ways.

If I'm without pressure and get stuck on the build-up plateau, pressure usually pushes me into the orgasm.

Reverend Hornibastard and the Case of the Male Orgasm

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A little over a month ago, I wrote a long post detailing and defending my stance on the definition of the female orgasm as part of a debate I agreed to do with Edward Clint over at Skeptic Ink. Turns out a guy who calls himself Reverend Hornibastard (because, honestly, why wouldn't you call yourself that), read it and asked me some thoughtful questions in the comments. We had an enjoyable exchange, and a couple days later he commented that he had written something inspired a bit by my blog post.

He has a blog called Hornibastard's Mad Muse (obviously), and he decided to write a post about the what the male orgasm is. You can find it HERE. He first spoke about my post, and what I really appreciate is that he got a lot of what I was saying - that a clear definition of the female orgasm must be used by everyone from researchers to sex advisers to pretty much anyone who speaks on the subject, if we as a culture are ever going to be able to move forward on the subject. Right now, we're talking around each other more than anything. Anyway, he got that, and honestly, that's a part of my argument that people seem to disregard or misunderstand a lot, so I very much appreciate him saying what he said.

Then he went on to speak about how he defines orgasm for himself. His thoughts are self-admittedly informal and anecdotal, so not exactly great to draw larger conclusions from, but they are personal and he doesn't try to make them more than that. I'm always interested to hear how people view and experience their orgasms and sexual pleasure. I think it's incredibly interesting and important. Here's how he began

All this got me thinking, "What defines the male orgasm?"

This may seem like a silly question to most people. Everyone regards the male orgasm as the point when the male ejaculates. The sudden emission of semen and all the exquisitely pleasurable convulsions of the muscles in the male's erogenous zones that produce that geyser of baby batter defines the male orgasm for nearly everyone.  

But not for me.  

Like almost everyone else, my orgasms almost always coincide with ejaculation and all those wonderful muscle contractions that make the ejaculation happen. But a lifetime of unofficial, informal research suggests that there is more to a male orgasm than the emission of semen. There is also a vital psychological component.

He goes on to describe times when "semen unexpectedly started shooting out of" his kielbasa  when he was only beginning to get excited; times when we woke up having splooged in his sheets without going to bed horny or remembering any erotic dreams; Times when he felt an orgasm but nothing came out.

By the same token, I've occasionally had a "dry orgasm." In those instances, I was extremely happy and felt like it was time to discharge my bazooka. But when those intensely pleasurable reflexive muscle convulsions got underway, absolutely nothing came out. 

Nada. 

Nary a drop. 

Despite the lack of a proper ejaculation, I still regarded those events as orgasms. They felt like orgasms (in both the physical and psychological senses).

He uses all these anecdotes to point out that he doesn't feel as though he can define his orgasm in a clinical way. He concludes with:

I realize my analysis is informal and anecdotal, but for me the physiological markers alone do not define what I call an orgasm. The right emotional and psychological states must coincide with those physiological events. 

Researchers can define an orgasm however they want, but I will always cherish most the orgasms that meet my own personal criteria.

I love that ol' Reverend Hornibastard is thinking and writing about this topic. I think that the discordance people feel between a very clear physiologic definition of orgasm and the way they feel and experience their orgasms and their sexual pleasure is one of the trickiest and most charged parts of the conversation SSL is trying to elicit. Putting labels on anything is generally gross to people, but particularly when talking about something like orgasm which, although a physiologic event, is so deeply intertwined with emotion, love, pleasure, and human contact. It's a hard (pardon the pun) conversion, but an important one to pick through, so Thank You, Thank You Reverend Hornibastard.

Now, I'm going to be picky ol' me and point out a physiological thing that struck me as important to the points he was making. Orgasm and ejaculation are actually different physiologic events for men, just as they are with women. Normally men experience them in perfect tandem, so that the ejaculate is pushed out into the urethra (the ejaculation) and the spasms of the pelvic muscles (the orgasm) propel it with force out of the penis. They can happen without the other though.

From what I've read, it seems like men who can have multiple orgasms do so by controlling their bodies in such a way that they orgasm sans ejaculation until the ejaculation finally happens and puts an end to the fun. There can also be ejaculations without orgasm - for instance with prostate stimulation minus the penile stimulation. I don't really have an data or studies to back this up, but I've often wondered if for men, a significant component to their level of pleasure at orgasm related to how well their body happened to time the ejaculation with it. So, maybe an ejaculation happening just slightly earlier or later than the orgasm could make the whole thing feel quite different. Maybe an early ejaculation puts a bit of a kibosh on the orgasm following it. I don't know, and I don't even have the male junk to test these thoughts on and give you some personal anecdotal experiences. I just wanted to point out that maybe for Hornibastard and for other men too, some of the variation they feel in their sexual releases have more to do with physiological issues and a little less to do with emotion than one might think.

To me, his post made me even more interested in seeing how clear definitions in regard to sexual release could possibly help people - men and women - understand, describe, and pursue their orgasm in better more thoughtful ways.

Sorry I'm always over-analyzing these types of thing, Mr. Reverend Hornibastard, but that's the nature of my blog. Thank you again for writing about this, thinking about this, and for talking about your experiences. Rock on with your self and you Mad Muse blog!