Beverly Whipple

G SPOT AND FEMALE PLEASURE

Reproduced here by permission of the author.

The Grafenberg spot, or G spot, is a sensitive area felt through the anterior vaginal wall. It is usually located about halfway between the back of the pubic bone and the cervix, along the course of the urethra and near the neck of the bladder. It swells when it is stimulated, although it is difficult to palpate when in an unstimulated state. It was named by John Perry and Beverly Whipple in 1981 to commemorate the research of Ernst Graefenberg, a German-born obstetrician and gynecologist, who in 1944, along with Robert L. Dickinson, described a zone of erogenous feeling located along the suburethral surface of the anterior vaginal wall. In 1950, Graefenberg wrote that:

"an erotic zone could always be demonstrated on the anterior wall of the vagina along the course of the urethra, [which] seems to be surrounded by erectile tissue like the corpora cavernosa [of the penis].... In the course of sexual stimulation the female urethra begins to enlarge and can be easily felt. It swells out greatly at the end of orgasm. The most stimulating part is located at the posterior urethra, where it arises from the neck of the bladder."

Though Graefenberg and others had written about this phenomenon, it was more or less ignored until Perry and Whipple focused renewed attention on it. In teaching women to do Kegel exercises with biofeedback for treatment of stress urinary incontinence, some of the women had very strong pelvic muscles, whereas women with stress urinary incontinence have very weak pelvic muscles. The women with strong pelvic muscles reported that they only lost fluid from the urethra during sexual stimulation and in some cases during orgasm. The women reported that the fluid was about a teaspoon (3-5cc's) and did not smell or taste like urine and looked like watered down fat free milk. The two researchers were encouraged to investigate the subject through conversations with women who described what was sexually pleasurable to them. They also had the fluid analyzed and found it was significantly different from urine from the same woman, and in another study found that the women who experienced, what they called female ejaculation, has significantly stronger voluntary pelvic and uterine muscle contractions.  Since the original report the spelling of Grafenberg has been anglicized.

Perry and Whipple reported that they had a physician or nurse examine more than 400 women who had volunteered to be research subjects, and a sensitive area felt through the anterior vaginal wall was found in each of these women. They cautioned, however, that they could not state with certainty that every woman had such a sensitive area. They called this sensitive area the Grafenberg spot, which was later shortened to the G spot.

Women have reported that it is difficult for them to locate and stimulate the Grafenberg spot in their own bodies (except with a dildo or similar device). A number of women who reported that they were able to locate the Grafenberg spot by themselves say they have done so while seated on a toilet. After emptying the bladder, they explore along the anterior (upper front) wall of the vagina with firm pressure, pushing up toward the navel. Some women have also found it helpful to apply downward pressure on the abdomen with the other hand, just above the pubic bone or top of the pubic hairline. As the Grafenberg spot is stimulated and begins to swell, it can often be felt between the two sets of fingers.

It is easier for women to identify the erotic sensation when the area is stimulated by a partner. The partner inserts one or two fingers (palm up) into the woman's vagina while the woman lies on her back, then applies firm pressure through the upper vaginal wall with a "come here" motion. At the same time, the woman can also apply firm downward pressure on her abdomen just above the pubic hairline. This way the woman and her partner can both feel the swelling: the partner through the vaginal wall and the woman through her abdomen. If a penis is used to stimulate the G spot, the positions most likely to provide effective stimulation are the female sitting on top of the male's penis or the vaginal rear-entry position.

The G spot feels like a small lump or a spongy bean. Stimulation causes it to swell and to increase in diameter from the size of a dime to, in some women, the size of a half-dollar. When the Grafenberg spot is first touched, many women state that it feels as though they have to urinate, even if they have just emptied the bladder. However, within 2-10 seconds of massage, the initial reaction is replaced in some women by a strong and distinctive feeling of sexual pleasure. More recently, Jannini and colleagues have conducted ultrasounds of this area and have called this area the clito-urethro-vaginal complex.

Some women report an orgasm from stimulation of this area, and some also report an expulsion of fluid from the urethra when they experience this type of orgasm. Others report the expulsion of fluid following stimulation of the G spot without orgasm, and there have been a few reports of fluid expulsion with stimulation of other genital areas. Chemical analysis of the fluid and comparison of it to urine have been conducted, and the results have been published in many separate research reports. In some of these studies, the fluid expelled from the urethra was observed by the researchers and subjected to chemical analysis. The chemical analysis reported on concentrations of prostatic acid phosphatase, urea, creatinine, glucose, fructose, and pH.  More recent studies have also identified prostatic-specific antigen (PSA) in the ejaculate and none in the urine samples from the same women. Cabello hypothesized that all women experience female ejaculation but since the amount is so small and most women are lying on their backs during sexual stimulation, the fluid may remain in the urethra. He tested his hypothesis by collecting urine samples before and after self-stimulation and found a significant  difference in PSA. There was none in the urine before sexual self-stimulation but was found in the urine after self-stimulation without female ejaculation, supporting his hypothesis. In 2011, a study from Mexico demonstrated that there is a significant difference between "squirting or gushing" ejaculations and "real" female ejaculation.  The first has the features of diluted urine such as urea, creatinine and uric acid, while real female ejaculation is biochemically different from urine and from "gushing" in that it contains prostatic-specific antigen.

The question of female ejaculate is still being examined and opinions vary, with a few  arguing that the ejaculate is simply due to the relaxation of muscles, allowing for some urinary incontinence. However, analysis of the fluids expelled do not support this in the women studied.

Perry and Whipple estimated that perhaps 10 percent of women ejaculate. Subsequent questionnaire responses have yielded higher estimates, from 40 percent to 68 percent. The questionnaire data, however, may be biased because those women who believed that they experienced this phenomenon might have been more likely to complete the questionnaires.

Some women have reported that they had surgery to stop the expulsion of fluid, while other women reported deliberately avoiding orgasm because they thought there was something wrong with them for enjoying vaginal stimulation, sometimes with a small amount of fluid expelled from the urethra. Disseminating information about current research findings, even though the issue remains controversial, is important in lessening anxiety and in allowing women both to feel better about sexuality and to find pleasure in their sexual responses.

In a physical examination for vaginal sensitivity, Perry and Whipple found that among 47 subjects, 90 percent reported being highly sensitive in their vaginas at the 12 o'clock position (upper or anterior wall of the vaginal vault), 57 percent at the 11 o'clock position, 47 percent at the 1 o'clock position, 30 percent at the 4 o'clock position, and 37 percent at the 8 o'clock position. The G spot is not normally felt during a gynecological examination, because the area must be sexually stimulated in order for it to swell and be palpable and it is covered by a bi-valve speculum. Physicians do not sexually stimulate their patients and therefore do not find the G spot.

Other researchers have also reported findings of vaginal sensitivity, among them Hoch, Alzate and London, and Alzate and Hoch, but the latter concluded that although there is a zone of tactile erotic sensitivity, evidence remains inconclusive. The Federation of Feminist Women's Health Centers describes this area as the "urethral sponge," a sheath of erectile tissue around the urethra that becomes engorged during sexual excitement and protects the urethra during sexual activity. Zaviacic and colleagues in Slovakia reported a specifically sensitive site with a manually detectable tumescence in 27 women who were palpated. Masters, Johnson, and Kolodny observed that only 10 percent of 100 women had an area of heightened sensitivity in the anterior wall or possessed tissue mass that resembled this sensitive area. Hartman and Fithian reported finding sensitivity in large numbers of women at the 12 o'clock, 4 o'clock, and 8 o'clock positions.

In an anonymous questionnaire distributed to professional women in the United States and Canada, Davidson and colleagues found that 786 (66 percent) of their 1, 245 respondents perceived an especially sensitive area in their vagina that, if stimulated, produced pleasurable feelings. Whipple found that of the 800 women who completed a sexual-health questionnaire, 69 percent of the subjects reported 12 o'clock as the most sensitive area.

Perry and Whipple hypothesized that the G spot is probably composed of a complex network of blood vessels, the paraurethral glands and ducts, nerve endings, and the tissue surrounding the bladder neck, but they did not conduct any anatomical studies in this area. Zaviacic and his colleagues have conducted the most extensive immunohistochemical analysis of the paraurethral, or Skene's, glands in women; they found that there was a cross-antigenicity between the male prostate gland and the Skene's gland and that the enzymatic reactions of the male and female prostatic tissues are similar—so similar that Zaviacic held that the term "female prostate" was appropriate. In 2001 the Federative International Committee on Anatomical Terminology (FICAT) agreed on the term female prostate in the new Histology Terminology. Alzate.   Hoch disagreed with such a term, claiming that it is confusing to call the Skene's gland the female prostate.

In a review article in 2012, Kilchevsky et al., concluded that the area of the G spot is not a distinct anatomical entity. This was supported by Perry and Whipple when they named this sensitive area the Grafenberg spot or G spot. Thabet, from Egypt conducted a study to clarify the reality of the G spot histologically, anatomically and sexually to determine the possible effect of female circumcision and anterior vaginal wall surgery on the integrity and function of this area. Based on his study of 175 women, he concluded that the G spot is a functional reality in 82.3%, an anatomical reality in 54.3% and a histological reality in 47.4% of his subjects. He also stated that anterior vaginal wall surgery usually affects the G spot and female sexuality, but female circumcisions rarely affects them. Ostrenski in 2012 claimed to have documented the anatomical existence of the G spot. His claim is based upon his dissection of the vaginal wall of an 83-year-olc multiparous cadaver. In a commentary on the paper by Komisaruk, Whipple and Jannini  and in a letter to the Editor, Levin and Wylie pointed out limitations of this study, including no history of the subject, no histological evidence, and no report of innervations of the tissue dissected.  They also stated that they had all published that the G spot area is not one anatomical entity but a rich complexity of variable anatomical and functional zone of erotogenic complexity, with differently innervated structures.

A\ word of caution. There is a procedure called the G shot, where collagen is injected into the anterior wall of the vagina. There are no published double blind placebo-controlled studies about the effectiveness of this procedure, however it has been franchised all over the United States and in many other countries. It is reported that women come back every few months for injections to enhance their G spot.

Despite the evidence that specific anatomical structures correspond to the area defined as the Grafenberg spot, its exact anatomical identity remains inconclusive. All we can say with certainty is that some women report pleasurable vaginal sensitivity and that the anterior wall appears to be the most sensitive area of the vagina. A distinct area identified through the anterior vaginal wall that swells when stimulated has not been found universally by all researchers who have conducted sexological examinations. This seems to imply either that not all women have this distinct area or that perhaps different criteria have been used to identify it. Those women who report having a G spot say the orgasm resulting from stimulation of this sensitive area is different from that resulting from clitoral stimulation, the main difference being that it is "deeper" inside. Some also report a bearing-down feeling during orgasm from G spot stimulation. Komisaruk et al, using fMRI of the brain, have demonstrated that clitoral, vaginal and cervical stimulation activate the sensory cortex in the medial paracentral loblule, and that the sites are regionally differentiated and separable and distinct.

Obviously, women do not have to fit one  model of sexual response, and there are many reported sexual responses in women, as discussed by Jannini et al.  Women also have been socialized to believe and accept traditional views about their sexual responses and  pleasure, and often what they have been taught is different from what they experience. For women, the whole body can be sensual and sexual, and women have the potential to experience sensual and sexual pleasure from their thoughts, feelings, beliefs, fantasies, and dreams. Each woman has to be aware of what is pleasurable to her, acknowledge it to herself, and then communicate what is pleasurable to her partner. Women need to be   encouraged to feel good about the variety of ways they experience sensual and sexual pleasure, without setting up specific goals (such as find the G spot or experiencing female ejaculation). By setting such  goals they miss a lot of pleasure along the way. Healthy sexuality begins with acceptance of the self, in addition to an emphasis on the process, rather than the goals, of sensual and sexual interactions.

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Beverly Whipple July 2012