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The complexity of female orgasm and ejaculation

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Abstract

The anatomy and physiology of the female orgasm are often neglected. The female orgasm is a normal psychophysiological function to all women, and some even can achieve ejaculation as part of the normal physiological response at the height of sexual arousal. The complexity of female sexuality requires a deep understanding of genital anatomy. The clitoris is the principal organ for female pleasure. The vaginal stimulation of the anterior vaginal wall led women to orgasm due to the stimulation of the clitourethrovaginal complex and not due to stimulation of a particular organ called the G spot in the anterior distal vaginal wall. Female ejaculation follows orgasm. It consists of the orgasmic expulsion of a smaller quantity of whitish fluid produced by the female prostate. Squirting can be differentiated from female ejaculation because it is the orgasmic transurethral expulsion of a substantial amount of diluted urine during sexual activity, and it is not considered pathological. The female orgasm is influenced by many aspects such as communication, emotional intimacy, long-standing relationship, adequate body image and self–esteem, proper touching and knowledge of the female body, regular masturbation, male sexual performance, male and female fertility, chronic pain, and capacity to engage in new sexual acts. Stronger orgasms could be achieved when clitoral stimulation, anterior vaginal wall stimulation, and oral sex is involved in the same sexual act.

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References

  1. Puppo V (2013) Anatomy and physiology of the clitoris, vestibular bulbs, and labia minora with a review of the female orgasm and the prevention of female sexual dysfunction. Clin Anatomy 26:134–152

    Google Scholar 

  2. Jannini EA, Rubio-Casillas A, Whipple B, Buisson O, Komisaruk BR, Brody S (2012) Female orgasm(s): one, two, several. J Sex Med 9(4):956–965

    PubMed  Google Scholar 

  3. Rodriguez FD, Camacho A, Bordes SJ, Gardner B, Levin RJ, Tubbs RS (2021) Female ejaculation: an update on anatomy, history, and controversies. Clin Anatomy 34:103–107

    Google Scholar 

  4. Puppo V, Puppo G (2015) Anatomy of sex: revision of the new anatomical terms used for the clitoris and the female orgasm by sexologists. Clin Anatomy 28:293–304

    Google Scholar 

  5. Pastor Z (2013) Female ejaculation orgasm vs. coital incontinence: a systematic review. J Sex Med 10:1682–1691

    PubMed  Google Scholar 

  6. Frederick DA, John HKS, Garcia JR, Lloyd EA (2018) Differences in orgasm frequency among gay, lesbian, bisexual, and heterosexual men and women in a U.S. national sample. Arch Sex Behav 47(1):273–288

    PubMed  Google Scholar 

  7. Salama S, Boitrelle F, Gauquelin A, Malagrida L, Thiounn N, Desvaux P (2015) Nature and origin of “squirting” in female sexuality. J Sex Med 12(3):661–666

    PubMed  Google Scholar 

  8. Espitia de la Hoz F (2019) Prevalencia y caracterizacion de la eyaculacion femenina. Estudio de corte transversal en mujeres colombianas del quindio 2012 a 2016. Biociencias 14(1): 51–64

  9. Yeung J, Pauls RN (2016) Anatomy of the vulva and the female sexual response. Obstet Gynecol Clin N Am 43:27–44

    Google Scholar 

  10. Ventriglio A, Bhugra D (2019) Sexuality in the 21st century: sexual fluidity. East Asian Arch Psychiatry 29(1):30–34

    CAS  PubMed  Google Scholar 

  11. Anderson RM (2013) Positive sexuality and its impact on overall well-being. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 56(2):208–214

    CAS  PubMed  Google Scholar 

  12. Bhat GS, Shastry A (2020) Time to orgasm in women in a monogamous stable heterosexual relationship. J Sex Med 17(4):749–760

    PubMed  Google Scholar 

  13. Graziottin A, Gambini D (2015) Anatomy and physiology of genital organs - women. Handbook of clinical neurology. Elsevier B.V, pp 39–60

    Google Scholar 

  14. Pauls RN (2015) Anatomy of the clitoris and the female sexual response. Clin Anatomy 28:376–384

    Google Scholar 

  15. Puppo V (2011) Embryology and anatomy of the vulva: the female orgasm and women’s sexual health. Eur J Obstet Gynecol Reprod Biol 154:3–8

    PubMed  Google Scholar 

  16. Jeong GW, Park K, Youn G, Kang HK, Kim HJ, Seo JJ et al (2005) Assessment of cerebrocortical regions associated with sexual arousal in premenopausal and menopausal women by using BOLD-based functional MRI. J Sex Med 2(5):645–651

    PubMed  Google Scholar 

  17. Exton MS, Bindert A, Kruger T, Scheller F, Hartmann U, Schedlowski M (1999) Cardiovascular and endocrine alterations after masturbation-induced orgasm in women. Psychosom Med 61(3):280–289

    CAS  PubMed  Google Scholar 

  18. Davis SR, Guay AT, Shifren JL, Mazer NA (17433) Endocrine aspects of female sexual dysfunction [Internet]. Available from: http://www.nhlbi.nih.gov/

  19. Lorrain DS, Riolo JV, Matuszewich L, Hull EM (1999) Lateral hypothalamic serotonin inhibits nucleus accumbens dopamine: implications for sexual satiety. J Neurosci 19(17):7648–7652

    CAS  PubMed  PubMed Central  Google Scholar 

  20. Wheatley JR, Puts DA (2015) Evolutionary science of female orgasm. The evolution of sexuality evolutionary psychology. Springer

    Google Scholar 

  21. Puts DA, Dawood K, Welling LLM (2012) Why women have orgasms: an evolutionary analysis. Arch Sex Behav 41:1127–1143

    PubMed  Google Scholar 

  22. Jannini EA, Whipple B, Kingsberg SA, Buisson O, Foldes P, Vardi Y (2010) Who’s afraid of the G-spot? J Sex Med 7(1 PART 1):25–34

    PubMed  Google Scholar 

  23. Hines TM (2001) The G-spot: a modern gynecologic myth. Am J Obstet Gynecol 185(2):359–362

    CAS  PubMed  Google Scholar 

  24. Sivaslıoğlu AA, Köseoğlu S, Elibol FD, Dere Y, Keçe AC, Çalışkan E (2021) Searching for radiologic and histologic evidence on live vaginal tissue: does the g-spot exist? Turk J Obstet Gynecol 18(1):1–6

    PubMed  PubMed Central  Google Scholar 

  25. Goldberg DC, Whipple B, Fishkin RE, Waxman H, Fink PJ, Weisberg M (1983) The grafenberg spot and female ejaculation: a review of initial hypotheses. J Sex Marital Ther 9(1):27–37

    CAS  PubMed  Google Scholar 

  26. Ostrzenski A (2019) G-spot anatomy and its clinical significance: a systematic review. Clin Anatomy 32:1094–1101

    Google Scholar 

  27. Kaya AE, Çalışkan E (2018) Women self-reported G-spot existence and relation with sexual function and genital perception. Turk J Obstet Gynecol 15(3):182–187

    Google Scholar 

  28. Ostrzenski A (2012) G-spot anatomy: a new discovery. J Sex Med 9(5):1355–1359

    PubMed  Google Scholar 

  29. Ostrzenski A (2014) Anatomic documentation of the G-spot complex role in the genesis of anterior vaginal wall ballooning. Eur J Obstet Gynecol Reprod Biol 180(1):186–191

    PubMed  Google Scholar 

  30. Foldes P, Buisson O (2009) The clitoral complex: a dynamic sonographic study. J Sex Med 6:1223–1231

    PubMed  Google Scholar 

  31. Jannini EA, Buisson O, Rubio-Casillas A (2014) Beyond the G-spot: clitourethrovaginal complex anatomy in female orgasm. Nat Rev Urol 11:531–538

    PubMed  Google Scholar 

  32. Oakley SH, Vaccaro CM, Crisp CC, Estanol MV, Fellner AN, Kleeman SD et al (2014) Clitoral size and location in relation to sexual function using pelvic MRI. J Sex Med 11(4):1013–1022

    PubMed  Google Scholar 

  33. Battaglia C, Nappi RE, Mancini F, Alvisi S, del Forno S, Battaglia B et al (2010) 3-D volumetric and vascular analysis of the urethrovaginal space in young women with or without vaginal orgasm. J Sex Med 7(4):1445–1453

    PubMed  Google Scholar 

  34. Komisaruk BR, Wise N, Frangos E, Liu WC, Allen K, Brody S (2011) Women’s clitoris, vagina, and cervix mapped on the sensory cortex: fMRI evidence. J Sex Med 8(10):2822–2830

    PubMed  PubMed Central  Google Scholar 

  35. Gravina GL, Brandetti F, Martini P, Carosa E, di Stasi SM, Morano S et al (2008) Measurement of the thickness of the urethrovaginal space in women with or without vaginal orgasm. J Sex Med 5(3):610–618

    PubMed  Google Scholar 

  36. Costa RM, Miller GF, Brody S (2012) Women who prefer longer penises are more likely to have vaginal orgasms (but not clitoral orgasms): implications for an evolutionary theory of vaginal orgasm. J Sex Med 9(12):3079–3088

    PubMed  Google Scholar 

  37. Komisaruk BR, Whipple B, Crawford A, Liu WC, Kalnin A, Mosier K (2004) Brain activation during vaginocervical self-stimulation and orgasm in women with complete spinal cord injury: fMRI evidence of mediation by the vagus nerves. Brain Res 1024(1–2):77–88

    CAS  PubMed  Google Scholar 

  38. Pastor Z, Chmel R (2018) Differential diagnostics of female “sexual” fluids: a narrative review. Int Urogynecol J 29:621–629

    PubMed  Google Scholar 

  39. Korda JB, Goldstein SW, Sommer F (2010) The history of female ejaculation. J Sex Med 7(5):1965–1975

    PubMed  Google Scholar 

  40. Anderson Darling C, Kenneth Davidson J, Conway-Welch C (1990) Female ejaculation: perceived origins, the Grafenberg spot/area, and sexual responsiveness. Arch Sex Behav 19:29–47

    Google Scholar 

  41. Belzer EG (1984) A review of female ejaculation and the Grafenberg spot. Women Health 9(1):5–16

    PubMed  Google Scholar 

  42. Levin RJ (2003) The ins and outs of vaginal lubrication. Sex Relatsh Ther 18:509–513

    Google Scholar 

  43. Rubio-Casillas A, Jannini EA (2011) New insights from one case of female ejaculation. J Sex Med 8(12):3500–3504

    PubMed  Google Scholar 

  44. Moalem S, Reidenberg JS (2009) Does female ejaculation serve an antimicrobial purpose? Med Hypotheses 73(6):1069–1071

    PubMed  Google Scholar 

  45. Cartwright R, Elv S, Cardozo L (2007) Do women with female ejaculation have detrusor overactivity? J Sex Med 4(6):1655–1658

    PubMed  Google Scholar 

  46. Wimpissinger F, Springer C, Stackl W (2013) International online survey: female ejaculation has a positive impact on women’s and their partners’ sexual lives. BJU Int 112(2):E177–E185

    PubMed  Google Scholar 

  47. Hilton P (1988) Urinary incontinence during sexual intercourse: a common, but rarely volunteered, symptom. Br J Obstet Gynaecol 95:377–381

    CAS  PubMed  Google Scholar 

  48. Herbenick D, Fu TC, Arter J, Sanders SA, Dodge B (2018) Women’s experiences with genital touching, sexual pleasure, and orgasm: results from a U.S. probability sample of women ages 18 to 94. J Sex Marital Ther 44(2):201–212

    PubMed  Google Scholar 

  49. Wiegel M, Meston C, Rosen R (2005) The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores. J Sex Marital Ther 31(1):1–20

    PubMed  Google Scholar 

  50. Garcia JR, Lloyd EA, Wallen K, Fisher HE (2014) Variation in orgasm occurrence by sexual orientation in a sample of U.S. singles. J Sex Med 11(11):2645–2652

    PubMed  PubMed Central  Google Scholar 

  51. Kelly MP, Strassberg DS, Turner CM (2004) Communication and associated relationship issues in female anorgasmia. J Sex Marital Ther 30(4):263–276

    PubMed  Google Scholar 

  52. MacNeil S, Byers ES (2005) Dyadic assessment of sexual self-disclosure and sexual satisfaction in heterosexual dating couples. J Soc Pers Relat 22(2):169–181

    Google Scholar 

  53. Rosen RC, Leiblum SR, Taylor JF, Bachmann GA (1993) Prevalence of sexual dysfunction in women: results of a survey study of 329 women in an outpatient gynecological clinic. J Sex Marital Ther 19(3):171–188

    CAS  PubMed  Google Scholar 

  54. Roussin M, Lowe J, Hamilton A, Martin L (2021) Factors of sexual quality of life in gynaecological cancers: a systematic literature review. Arch Gynecol Obstet 304(3):791–805

    PubMed  PubMed Central  Google Scholar 

  55. Richters J, de Visser R, Rissel C, Smith A (2006) Sexual practices at last heterosexual encounter and occurrence of orgasm in a national survey. J Sex Res 43(3):217–226

    PubMed  Google Scholar 

  56. Shaeer O, Skakke D, Giraldi A, Shaeer E, Shaeer K (2020) Female orgasm and overall sexual function and habits: a descriptive study of a cohort of U.S. women. J Sex Med 17(6):1133–1143

    PubMed  Google Scholar 

  57. Tavares IM, Laan ETM, Nobre PJ (2018) Sexual inhibition is a vulnerability factor for orgasm problems in women. J Sex Med 15(3):361–372

    PubMed  Google Scholar 

  58. Erbil N (2013) The relationships between sexual function, body image, and body mass index among women. Sex Disabil 31(1):63–70

    Google Scholar 

  59. Frederick D, Forbes GB, Berezovskaya A, Anna B (2008) Female body dissatisfaction and perceptions of the attractive female body in Ghana, the Ukraine, and the United States part of the gender and sexuality commons, multicultural psychology commons, and the other psychology commons recommended citation [Internet]. Vol. 17, Psychological Topics. Available from: http://digitalcommons.chapman.edu/psychology_articles

  60. Brady JL, Kaya A, Iwamoto D, Park A, Fox L, Moorhead M (2017) Asian American women’s body image experiences: a qualitative intersectionality study. Psychol Women Q 41(4):479–496

    Google Scholar 

  61. Forbes GB, Frederick DA (2008) The UCLA body project II: breast and body dissatisfaction among African, Asian, European, and hispanic American college women. Sex Roles 58(7–8):449–457

    Google Scholar 

  62. Kulaksiz D, Toprak T, Ayribas B, Ozcan E, Arslan U, Dokuzeylul GN (2022) The effect of male and female factor infertility on women’s anxiety, depression, self-esteem, quality of life and sexual function parameters: a prospective, cross-sectional study from Turkey. Arch Gynecol Obstet 306:1349–1355

    PubMed  Google Scholar 

  63. Sater AC, Miyague AH, Schuffner A, Nisihara R, Teixeira DM (2022) Impact of assisted reproduction treatment on sexual function of patients diagnosed with infertility. Arch Gynecol Obstet 305(6):1595–1604

    PubMed  Google Scholar 

  64. Halici BNA, Aktoz F, Kabakci M, Kiran G, Ozcan P (2022) Analysis of preoperative and postoperative quality of life, sexual function, and sleep in patients with endometriosis: a prospective cohort study. Arch Gynecol Obstet. https://doi.org/10.1007/s00404-022-06562-9

    Article  PubMed  Google Scholar 

  65. Shi C, Zhang T, Xu H, Gao Y (2022) Endometriosis decreases female sexual function and increases pain severity: a meta-analysis. Arch Ginecol Obstet 11(306):785–793

    Google Scholar 

  66. Schütze S, Heinloth M, Uhde M, Schütze J, Hüner B, Janni W et al (2022) The effect of pelvic floor muscle training on pelvic floor function and sexuality postpartum. A randomized study including 300 primiparous. Arch Gynecol Obstet 306(3):785–793

    PubMed  PubMed Central  Google Scholar 

  67. Sherlock JM, Sidari MJ, Harris EA, Barlow FK, Zietsch BP (2016) Testing the mate-choice hypothesis of the female orgasm: disentangling traits and behaviours. Socioaffect Neurosci Psychol 6(1):31562

    PubMed  Google Scholar 

  68. Jiann BP, Su CC, Tsai JY (2013) Is female sexual function related to the male partners’ erectile function? J Sex Med 10(2):420–429

    PubMed  Google Scholar 

  69. Kaya C, Gunes M, Gokce AM, Kalkan S (2015) Is sexual function in female partners of men with premature ejaculation compromised? J Sex Marital Ther 41(4):379–383

    PubMed  Google Scholar 

  70. Burri A, Buchmeier J, Porst H (2018) The importance of male ejaculation for female sexual satisfaction and function. J Sex Med 15(11):1600–1608

    PubMed  Google Scholar 

  71. Pascoal PM, Byers ES, Alvarez MJ, Santos-Iglesias P, Nobre PJ, Pereira CR et al (2018) A dyadic approach to understanding the link between sexual functioning and sexual satisfaction in heterosexual couples. J Sex Res 55(9):1155–1166

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Family Medicine, School of Medicine, Academic Vice President Universidad del Valle, Cali, Colombia

    Liliana Arias-Castillo

  2. UROGIV Research Group, School of Medicine, Universidad del Valle, Cll 4b # 36-00, Cali, Colombia

    Lina García & Herney Andrés García-Perdomo

  3. Division of Urology/Urooncology, Department of Surgery, School of Medicine, Universidad del Valle, Cali, Colombia

    Herney Andrés García-Perdomo

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  1. Liliana Arias-Castillo
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  2. Lina García
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  3. Herney Andrés García-Perdomo
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LAC: project development, data collection, and manuscript writing. LG: project development, data collection, and manuscript writing. HAG-P: project development, data collection, and manuscript writing.

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Correspondence to Herney Andrés García-Perdomo.

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Arias-Castillo, L., García, L. & García-Perdomo, H.A. The complexity of female orgasm and ejaculation. Arch Gynecol Obstet 308, 427–434 (2023). https://doi.org/10.1007/s00404-022-06810-y

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