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1982 Edition
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The G-spot: Some missing pieces of the puzzle To the Editors:The publication of Terence Hines' article, "The G-spot: A modern gynecologic myth,sup>1 has created considerable controversy and, unfortunately, much misinformation about the existence of the "G-spot,the existence of female ejaculation, and the female prostate. Hines asserts that the confusion over the G-spot and female ejaculation occurs because "the two are often considered together.Actually, the two should be considered together, along with the structure on which the G-spot is located窶蚤nd this is the missing piece of the puzzle. Regarding the anatomic structure, Huffman2 did exquisitely rendered wax casts of the female urethra and the surrounding tissue, identifying up to 31 prostate-like glands, including the two near the urethral meatus identified by Skene in 1880, and described them as "homologous with the [male] prostate.O'Connell, et al3 confirmed that the urethra is "surrounded by erectile tissueexcept for the part embedded in the vaginal wall. This erectile body, running the length of the female urethra, can be easily accessed through the vaginal wall. Many women report that during sexual response they can locate a spot or area along the roof of the vagina that is hypersensitive to touch, pressure, or vibration. This is the G-spot. Regarding the fluid, evaluations so far have focused on proving that it is not urine, with most finding higher levels of prostatic acid phosphatase and glucose in female ejaculate and lower levels of these substances in urine. Zaviacic4 and others have found prostate specific antigen窶蚤 substance that does not appear in either male or female urine窶琶n female ejaculate. Regarding morphology and embryology, it has long been established that the lower one fifth of the vagina and the entire female urethra, as well as the male prostate and prostatic urethra, and innervation of both, develop from the mesonephric tubule, and that both originate in the urogenital sinus.5 The upper four fifths of the vagina, as well as the uterus, tubes, and ovaries, arise from the mullerian ducts. Because the original fetal template is female, the female must possess an embryonic prostatic structure for the male to have one. Ultimately, researchers who have endeavored to illuminate the anatomy and
function of the female prostate may thank Hines and the Journal for bringing
this issue before the medical community. The article would have had more value,
however, if it had been based on a complete review of the literature as well as
on discussions with those participating in ongoing research.
2. Huffman JW. The detailed anatomy of the paraurethral ducts in the adult human female. Am J Obstet Gynecol 1948;55:86-101. 3. O'Connell, HE, Hutson JM, Anderson CR, Plenter RJ. Anatomical relationship between urethra and clitoris. J Urol 1998;159:1892-7.
4. Zaviacic M. The human female prostate. Bratislava: Slovak Academic Press; 1999. 5. Netter FH. The Ciba collection of medical illustrations. Jessup (MD): Ciba Pharmaceutical; 1954. p. 2.
Whipple and Perry's letter:To the Editors:As the two researchers who named the sensitive area felt through the anterior vaginal wall halfway between the back of the pubic bone and the cervix, along the course of the urethra, the "Grafenberg spot,we felt we should respond to Terence M. Hines' poorly researched article "The G-spot: A modern gynecologic myth.sup>1 Unfortunately the article is based on only 24 of the more than 250 peer-reviewed research publications concerning the Grafenberg spot and female ejaculation. It also ignores the research concerned with the adaptive significance of this sensitive area. Our purpose in conducting the original research published in peer-reviewed journals in the early 1980s3 was to validate and find a scientific explanation for the reported experiences of many women, not to create new goals. These were women who did not fit into the monolithic clitoral-centric model of sexual response, that is, they reported vaginal sensitivity and orgasm from vaginal stimulation and in some cases an expulsion of fluid that was not urine from the urethra. By saying that the Grafenberg spot is a myth, Hines has now contributed to denying women's sexual response and pleasurable experiences. In our research, we first established that the Grafenberg spot was a "sexologicreality, that is, a concept that many women found useful to describe their personal experiences. The second research question concerned the underlying anatomic reality for this experience. Skene's glands, the paraurethral glands, which have often been called the "female prostate throughout history, emerged as the anatomic basis for the experiences of these women (see Zaviacic,4 1999, more than 250 references). Hines may want to review Whipple and Komisaruk5
(1991) (52 references), and other studies published since that time. It is our
hope that Hines and your readers will not do a disservice to the multitude of
women who do enjoy stimulation of the area called the Grafenberg spot or who
expel a fluid from the urethra that is different from urine. We hope that
physicians will listen to the reports of their patients, review the literature,
and base their judgments on scientific data, not on a biased interpretation of
less than 10% of the published literature.
2. Addiego J, Belzer EG, Comolli J, Moger W, Perry JD, Whipple B. Female ejaculation: a case study. J Sex Res 1981;17:13-21. 3. Perry JD, Whipple B. Pelvic muscle strength of female ejaculators: evidence in support of a new theory of orgasm. J Sex Res 1981;17:22-39. 4. Zaviacic M. The human female prostate: from vestigial Skene's paraurethral glands and ducts to woman's functional prostate. Bratislava: Slovak Academic Press; 1999. 5. Whipple B, Komisaruk BR. The G spot, orgasm, and female ejaculation: are they related? In: Kothari P, editor. Proceedings of the First International Conference on Orgasm. Bombay (India): VRP Publishers; 1991. p. 227-37. Milan Zaviacic's Letter:To the Editors:The Clinical Opinion paper "The G-spot: A modern gynecologic mythby Terence M. Hines1 suggested that the following brief comments on the female prostate and ejaculation would be relevant and of interest to the readers. Research from our laboratory (which has included investigation of autopsy and biopsy samples of urethrae and prostates from 150 women) and others, as recently reviewed,2 presents the female prostate as a urogenital organ of women that has morphologic features (anatomy, histology), ultrastructure, functions (exocrine production of female prostatic fluid and neuroendocrine function), enzymatic properties (eg, prostatic specific antigen [PSA]) and histopathologic features similar to those of the male prostate. The majority of prostatic tissue (the posterior type of prostate) is localized in the place of the G-spot in only 10% of women.2 The main part of the female prostatic tissue (so called anterior, meatal type of the female prostate, found in 66% of women2) is in the distal part of the urethra2 and does not correspond to the topologic placement of the G-spot. According to Eichel et al,3 the meatal type of the female prostate is a newly identified female erogenous zone important to coital female orgasm.3 On the basis of research of the functioning female urogenital organ (ie, the female prostate), the Federative International Committee on Anatomical Terminology concurred at their recent 2001 meeting (Orlando, Fla) to the use of the term "female prostate(prostata feminina) in the new forthcoming edition of Histology Terminology. The female prostate presents, although substantially less frequently, with the same diseases as the male prostate. These include prostatic carcinoma, benign prostate hyperplasia, and the prostatitis窶吐emale urethral syndrome.2 The evaluation of the incidence of prostatic diseases in women and the modern nonvestigial concept of the female prostate as a functional urogenital organ opens new approaches in clinical investigation and therapy of diseases of this female organ. On the basis of evidence of prostatic components, especially PSA in the fluid of the female ejaculate, the female prostate is the principal source of fluid of female urethral expulsion and clearly participates in the female ejaculation phenomenon.4 In summary, we express our concern with the persisting skepticism and
omission of relevant literature, especially in relation to the female prostate
and female ejaculation phenomenon and implications of the exocrine function of
the female prostate.
2. Zaviacic M. The human female prostate. In: Vestigial Skene's paraurethral glands and ducts to woman's functional prostate. Bratislava (Slovakia): Slovak Academic Press; 1999. p. 1-171. 3. Eichel EW, Ablin RJ, Zaviacic M. A natural anatomic design (c.a.t.) for coital orgasm: implications for health and pathology [abstract]. Proceedings of the 15th World Congress on Sexology; 24-28 June 2001; Paris, France. Paris: The Congress; 2001. p. 2. 4. Cabello F. Female ejaculation: myths and reality. In: Borras-Valls JJ, Peres-Conchillo M, editors. Sexuality and human rights. Proceedings of the 13th World Congress of Sexology; 25-29 June 1997; Valencia, Spain. Valencia: Nau Llibres; 1997. p. 1-8.
Terence Hine's Reply:To the Editors:The basic point of my original article seems to have been missed by Whipple and Perry and by Chalker. Whipple and Perry note that there are numerous papers on the G-spot in the literature. How nice. There are also numerous papers in the literature on, say, psychoanalysis, ESP, cold fusion, and similar topics. The number of papers is not the issue. Their relevance to the specific topic of my original paper is. The original paper was aimed directly at the point that there is no histologic verification of the type of neural innervation on the anterior vaginal wall that would be necessary if the G-spot is an anatomically real area. I have no doubt that were there among the papers that Whipple and Perry make reference to even one that conclusively showed such innervation, either in the anterior wall or in the paraurethral area, they would have cited it specifically. That they did not do so suggests that none of the aforementioned papers address the anatomic point. The same can be said for Chalker's comment. Nowhere in that comment do we
find the slightest indication of any evidence of the sort of neural innervation
that would support the claims of G-spot proponents. Perhaps such innervation
does exist and simply hasn't yet been found. I doubt it, but that is a
possibility. But the way to settle the issue is to conduct the studies, not to
discuss irrelevant matters.
ホイップルおよびペリーの手紙:エディターに:敏感なエリアを指定した2人の研究者が尿道のコースに沿って恥骨の後部と頚部の中間の前部の膣壁によって感じたとともに、「Grafenbergスポット、we、感じられた、私たちはテレンスM.ハインズに応答するべきである、貧弱に、研究した、記事「Gスポット:現代の婦人科医学の神話。sup>1 不運にも、記事は、Grafenbergスポットおよび女性の射出に関する250を超えるピア・レビューされた研究出版物のうちの24だけに基づきます。さらに、それは、この敏感なエリアの適応的意義に関係のある研究を無視します。 初期の1980年代3の中のピア・レビューされたジャーナル中で公表されたオリジナルの研究を行なう私たちの目的は、新しいゴールを作るのではなく多くの女性の報告された経験のための科学的説明を有効にし見つけることでした。。これらは、性反応の単一体の陰核の中心のモデルに入らなかった女性でした、すなわち、彼らは、膣の刺激からの、およびいくつかの場合での膣の感度およびオルガスムを報告しました、尿道からの尿でなかった流体の追放。Grafenbergスポットが神話であると言うことによって、ハインズは女性の性反応および楽しい経験の否定に今寄与しました。 私たちの研究では、私たちは、Grafenbergスポットがそうであると最初に確証しました、1つの「sexologicreality(すなわち多くの女性がそれらの個人の経験について記述するのに有用であると感じた概念)。第2の研究質問は、この経験用の根本的な解剖の現実に関係がありました。スケネの腺(副尿導管腺)、それはしばしば呼ばれた「歴史を通じての女性prostateこれらの女性(250の参照以上に、Zaviacicおよび41999年を参照)の経験の解剖の根拠として出現しました。。 ハインズはホイップルおよびKomisaruk5(1991)(52の参照)、およびその時以来公表された他の研究を調査したいと思うかもしれません。。Grafenbergスポットと呼ばれるエリアの刺激を楽しむか、彼らは尿とは異なる尿道から流体を出す多くの女性にハインズとあなたの読者が迷惑を行わないであろうのは私たちの希望です。私たちは、内科医が患者の報告書を聞き文学を調査するだろう、また、彼らの判断が公表された文学の10%未満の偏見的である解釈ではなく科学的資料に基づくだろうことを望みます。 2. Addiego J、Belzer EG、コモリのJ、Moger W、ペリーJD、ホイップルB.フィメイルの射出:事例研究。Jセックス事実1981;17:13-21。 3. ペリーJD(女性の絶叫者のホイップルB.骨盤筋の強度):オルガスムに関する新説を支持する証拠。Jセックス事実1981;17:22-39。 4. ZaviacicなM。人間の女性前立腺:退化したスケネの副尿導管腺および管から女性の機能的な前立腺まで。ブラティスラヴァ:スロバキア人のアカデミックプレス;1999. 5. ホイップルB(Komisaruk BR)。Gスポット、オルガスムおよび女性の射出:それらが関連づけられますか。次のものの中で:Kothari P(エディター)。オルガスムに関する国際労働者協会会議の議事録。ボンベイ(インド):VRPパブリシャ;1991.p。227-37. ミラノZaviacicの手紙:エディターに:臨床のオピニオン・ペーパー「Gスポット:現代の婦人科医学のmythbyテレンスM.ハインズ1は、女性前立腺と射出に関する次の短評が適切でリーダに興味深いだろうということを示唆しました。。 私たちの研究所他(それは検死の調査、および150人の女性からのurethraeおよび前立腺の生検標本を含んでいる)からの研究、最近調査されたこととして、2は、男性の前立腺のものに似ている形態学的状態(解剖、組織学)、超微細構造、機能(女性の前立腺液および神経内分泌機能の外分泌腺の生産)、酵素の特性(eg(前立腺特異抗原[PSA]))および組織病理学の特徴がある、女性の泌尿生殖器として女性前立腺を示します。。 大多数の前立腺組織(後部のタイプの前立腺)は女性の10%だけでGスポットの場所に局地化されます。女性の前立腺組織(女性2の66%で見つかった、そう呼ばれた前部のmeatalなタイプの女性前立腺)の主要部分が、ある2、尿道2の遠位の部分、またGスポットの位相的な配置に一致しません。。。。Eichelらによれば、meatalなものが女性前立腺にタイプする3は、性交の女性のオルガスムにとって重要な新しく識別された女性エロジナスゾーンです。333 機能する女性の泌尿生殖器(つまり女性前立腺)の研究に基づいて、解剖の用語の連合のインターナショナル委員会は用語の使用に彼らの最近の2001年の会合(オーランドー(Fla))で同調しました「組織学用語の新しい次回の版の中の女性prostate(prostata feminina)。 女性前立腺プレゼント、であるが、男性の前立腺と同じ疾病と共に、本質的にそれほど頻繁に。これらは前立腺癌、良性の前立腺肥大およびprostatitis窶吐emale尿道症候群を含んでいます。2、機能的な泌尿生殖器としての女性前立腺の女性および現代の退化していない概念の中の前立腺疾患の発生率の評価は、この雌性器官の疾病の臨床試験および治療での新しいアプローチを開きます。。 前立腺のコンポーネントの証拠の基礎(特に女性の射精液の流体中のPSA)においては、女性前立腺は女性の尿道の追放の流体の主要な源で、女性の射出現象に明白に参加します。44 要約すると、私たちは、特に女性前立腺および女性の射出現象、および女性前立腺の外分泌機能の含意に関して、関連文献の固執する懐疑および省略に対する関係を示します。 2. ZaviacicなM。人間の女性前立腺。次のものの中で:退化したスケネの女性の機能的な前立腺への副尿導管腺および管。ブラティスラヴァ(スロヴァキア):スロバキア人のアカデミックプレス;1999.p。1-171. 3. Eichel EW、Ablin RJ、ZaviacicなM。性交のオルガスムの自然な解剖の設計(c.a.t。):健康および病理学[アブストラクト]のための含意。性科学上の15番目の世界大会の議事録;2001年6月24-28日;パリ(フランス)。パリ:コングレス;2001.p。2. 4. Cabello F.フィメイルの射出:神話と現実。次のものの中で:Borras-バレスJJ、ペレス=Conchillo M、エディター。セクシュアリティと人権。性科学の13番目の世界大会の議事録;1997年6月25-29日;バレンシア(スペイン)。バレンシア:Nau Llibres;1997.p。1-8.
テレンス・ハインの返答:エディターに:私の元の記事の基点は、ホイップルとペリー、およびChalkerによって抜かされたように見えます。ホイップルとペリーは、多数の書類が文献の中にGスポットの上にあると述べます。どれくらいよいか。文献にさらに多数の書類が例えばオンです、精神分析、ESP、低温核融合および同様のトピック。紙の数は問題ではありません。私の原本書類の特定のトピックとのそれらの関連はそうです。原本書類は、あるポイントに直接向けられました、Gスポットが解剖学的に土地ならば必要な前部の膣壁上の神経の神経支配のタイプの組織学の立証はない。私は疑問を抱きません、それはホイップルとペリーが決定的にそのような神経支配を示した一つさえへの、前壁、あるいはparaurethralなエリア中の言及にする書類中にそこにあった、それらはそれを特に引用していたでしょう。それらがそうしなかったことは、前述の書類のどれも解剖のポイントをアドレスしないことを示唆します。 同じことがChalkerのコメントのために言えます。そのコメントでは、どこにもない、私たちは、Gスポット提案者のクレームを支援する種類の神経の神経支配の証拠の中で最も少しの表示を見つけます。恐らく、そのような神経支配は存在し、単にまだ見つかっていません。私は、それだがそれが可能性かどうか疑います。しかし、問題を解決する方法は、無関係の問題について議論するのではなく研究を行なうことです。
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