Sexual and Relationship Therapy, Vol 18, No.

1, 2003

PHYSIOLOGY UPDATE

The G-spotreality or illusion?

ROY J. LEVIN
Department of Biomedical Science, University of Shefeld, Shefeld, Yorkshire, United Kingdom

Introduction In 1950 Ernst Grafenberg, a gynaecologist who had left Nazi Germany to live in New York, published a paper in a somewhat obscure sexological journal describing a highly erogenous zone on the anterior wall of the vagina along the course of the urethra about a third of the way in from the introitus and below the base of the bladder (Grafenberg, 1950). Strong digital stimulation of this zone activated a rapid and high level of sexual arousal which, if maintained, induced orgasm. The stimulated area was claimed to swell up like a small cystocoele and protrude into the lumen. The nding and its implication for female sexual arousal was ignored until Ladas et al. (1982) redescribed, renamed and repopularized it in a popular book entitled The G-spot and the other discoveries about human sexuality in 1982. Since then the concept of the G-spot has never been far from controversy. This is especially so as the area became linked with another controversial topic, that of female ejaculation. Anecdotal reports described women spurting a uid at orgasm from their urethras (so-called urethral expulsions). The uid was claimed not to be urine or vaginal uid. Later studies showed that even sexual arousal could activate uid expulsion in some women (Zaviacic & Whipple, 1993). The suggestion was that the uid came from the female prostate usually anatomically located as the paraurethral or Skenes glands. While no direct connection between the G-spot and the paraurethral glands has ever been shown there is an implication that the paraurethral glands and the G-spot are probably linked, if not the same. Lenke et al. (1992), for example, localised the G-spot in dissections of cadavers and in conscious women (as an hypoechogenic zone) at the urethral sphincter. However, according to the studies on the Prostatic Specic Antigen (PAS) component of the uid, while they locate the principal source of the expulsions as the female prostate Zaviacic & Ablin (2002) claim that the majority of the prostatic tissue (the posterior
Correspondence to: R.J. Levin, Department of Biomedical Science, University of Sheffield, Western Bank, Sheffield S10 2TN, Yorkshire, United Kingdom. E-mail: r.j.levin@sheffield.ac.uk ISSN 14681994 print/ISSN 1468-1479 online/03/010117-03 # British Association for Sexual and Relationship Therapy DOI: 10.1080/1468199031000064487

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prostate) is localized in the place of the G spot in only 10% of women, the main part of the tissue (anterior or meatal type) being in the distal part of the urethra in about 66% of women. The uid expulsions are usually of relatively small amounts but in a remarkable report published in an electronic journal, Schubach (2001) catheterized and drained the bladders of six women who claimed to expel signicant volumes of uid at orgasm. His conclusion was that the uid they expelled undoubtedly came from their bladders and that it amounted from 90 to 900 ml! He proposed that the only reasonable conclusion would be that the uid came from a combination of residual moisture in the walls of the bladder and from post draining kidney output. As the expelled uid appeared to be an altered (diluted) form of urine he speculated that a possible chemical process goes on during sexual excitement that changes the composition of urine. He suggested that the effects of aldosterone be examined but this hormone is an unlikely candidate as its major function is to save uid by concentrating urine through an increased sodium reabsorption. Many publications of varying levels of critical scientic reliability have now been published about the G-spot and female ejaculation and both have slowly achieved some degree of acceptance. Hines (2001), however, has re-reviewed the published material and came to the conclusion that it was far too weak to support the reality of the G-spot. In a tongue in cheek comment he likened it to a sort of gynecologic UFO: much sought for, much discussed, but unveried by objective means. His major criticism rests on the fact that if a sensitive G-spot existed on the anterior vaginal wall that could induce arousal and orgasm then it would be expected that that sensitivity would be mediated by nerve endings there should thus be a plexus of nerve bres in the area. In his review of the literature he could not nd any study that showed such a plexus existing although he concedes that the studies that have examined the innervation of the anterior vaginal wall did not specically set out to search for such a plexus and they thus might have missed it. The controversial article stimulated three letters to the Editor in a later issue of the journal, two criticising the article and defending the G-spot (Chalker, 2002; Whipple & Perry, 2002) and a third describing in more detail the female prostate (Zaviacic & Ablin, 2002). Hines (2002) in his reply, however, was adamant and pressed his point that none of the authors could quote a reference or study where the neural supply that would be expected to innervate the G-spot could be located histologically. The most recent immunochemical study of Skenes glands has reported that type 5 phosphodiesterase (PDE5) is present within the cells of the acini of the glands but no immunostaining of the nerves was observed (DAmati et al., 2002). Because the anterior vaginal wall has at least three putative erogenous sites namely Halbans fascia, the urethra and clitoral tissue while the so-called G-spot/paraurethral glandular area is more a zone rather than a punctate spot (Hoch, 1986 and see Levin, 2000 for references) it is difcult to see how claimed strong digital/penile stimulation of the G-spot would not also stimulate the other structures all leading to enhanced arousal. Thus, rather than focus on a G-spot per se it would be more sensible to regard the whole area (urethra-clitoral-G area-Halbans fascia) as the anterior wall erogenous complex.

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Contributor ROY J. LEVIN, MSc, PhD, Reader in Physiology (Retired)