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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,”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—and 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 tissue” except 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—a substance that does not appear in either male or female urine—in 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 “Gräfenberg spot,” we felt we should respond to Terence M. Hines' poorly researched article “The G-spot: A modern gynecologic myth.”1 Unfortunately the article is based on only 24 of the more than 250 peer-reviewed research publications concerning the Gräfenberg 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 1980s2,3 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 Gräfenberg 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 Gräfenberg spot was a “sexologic” reality, 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 Gräfenberg 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 myth” by 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.2,3 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–female 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.2,4 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: Borrás-Valls JJ, Péres-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. |
Appendix A
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