This article appears on the Internet at http://www.doctorg.com/FemaleEjaculation.htm and is being sent to you because a request to do so was made to our autoresponder. THE G-"CREST" AND FEMALE EJACULATION (c)1997 by Gary Schubach, Ed.D. The question of the sexual phenomenon known as female ejaculation and whether there exists a female erogenous zone popularly known as the "G spot" have been major areas of continued controversy and debate among sex researchers, gynecologists and sex therapists. Perhaps no two sexual issues, including the question of clitoral vs. vaginal orgasms, have created so much public interest. These subjects are continuing to attract the attention of the public, particularly of women, as well as the so-called experts in human sexuality, because they are biological issues that have significant social ramifications. What would be the potential impact on our collective sexual belief systems (and actual behaviors/activities) if female ejaculation and the existence of the G spot achieved widespread legitimacy? Since the 1920's the conventional medical establishment has dismissed "female ejaculation" as actually being a condition known as urinary stress incontinence. This condition is considered to be an undesirable bodily dysfunction in which urine is involuntarily expelled from the urethras of women due to physical straining such as might also occur with coughing or sneezing as well as sexual arousal or orgasm. Women have generally considered such expulsions to be a source of personal shame or embarrassment that also frequently elicited disapproval from their sexual partners. Physicians usually attempt to correct the condition, either by the use of Kegel exercises or by surgery. Furthermore, noted experts in the field of human sexuality such as Alfred Kinsey and Masters and Johnson dismissed female ejaculation as being an "erroneous but widespread concept." (I) Masters and Johnson also argued against the existence of the erogenous zone known as the "G-spot" and stood steadfastly for the premise that the clitoris alone was responsible for triggering female orgasm. However, if it should turn out that these experts had underestimated the sexual capabilities of women's bodies by portraying pleasurable sexual activities like female ejaculation as abnormal and/or imagined, it could have a significant effect on women's views of their sexuality. If the new evidence about these expulsions demonstrated that they are natural sexual bodily functions then many women could be free of guilt and shame about expelling fluid during sex. Other benefits of a public recognition of female ejaculation as a natural event (and the so-called G spot as an erogenous zone, capable of producing orgasm in a woman) could be the creation of additional sexual activities that might not just be a prelude to intercourse but an end unto themselves. It could lead to a broadening of peoples' sensual experiences and their sexual repertoire. New pleasurable behaviors, with no goal other than pleasure from those activities, could be learned with the added benefits that they have very low risk in terms of AIDS, STDs and unwanted pregnancy. All of these social issues become a backdrop for new evidence I discovered during my doctoral research project that, as a result of advanced and heightened states of sensual/sexual arousal, some women do expel fluid. In the past, the assumption has been that the expulsions originated either in the bladder or from the urethral glands and ducts. My study indicated that both may be the case in that a small amount of fluid may be released from the urethral glands and ducts in some instances and mixed in the urethra with a clear fluid that originates in the bladder. The Nature of Female Orgasm For the last 50 years, modern science has generally accepted first Kinsey's and then Masters and Johnson's premise that the clitoris alone was responsible for triggering female orgasm. They saw the creation of an "orgasmic platform" that underwent a build-up of muscle tension and sexual energy that was then released during orgasm. (II) However, in 1981, Perry and Whipple, two of the co-authors of the book, The G Spot and Other Recent Discoveries About Human Sexuality, presented a theory of a second form of orgasm. This "uterine" orgasm "included the Gräfenberg Spot (presumed to be the female prostate) as its major source of stimulation . . ." (III) Singer and Singer then went on, in 1978, to describe a blended orgasm which "combines elements of the previous two kinds . . . characterized by contractions of the orgasmic platform, but the orgasm is subjectively regarded as deeper than a vulval orgasm." (IV) Now there is new evidence from urology textbooks that heightened stimulation during sensual arousal can indeed create an involuntary opening of the bladder sphincter. This involuntary opening can occur from stimulation of either the clitoris, or from stimulation of the pelvic nerve through the upper wall of the vagina, or from both simultaneously. (V) Stimulation of the urethral glands can be accomplished either by manual stimulation or intercourse, utilizing a correct angle of penetration. Stimulation of the G Crest of some women can also be produced by pressing downward from the outside of the body, slightly above the pubic bone. Other studies indicated that "stimulation of the anterior vaginal wall is clearly not a prerequisite to ejaculation, although the data suggest it may be facilitated by this type of stimulation." (VI) All of this highlights how subjective and personal a woman's experience of orgasm can be. There is much yet to learn about the intricacies of female orgasm, including the emotional and intellectual components. The experience of orgasm for many women is a continuum of experience, not one way or another, correct or incorrect. There can be a blending of different types of orgasmic experiences that are unique to the individual. (VII) This point was made over and over in the comments of the female subjects in my study. One woman participant indicated that she had categorized and kept notes on 126 different types of orgasm to date and she is constantly finding new and more subtle variations. Historical References To Female Ejaculation Throughout time there have been reports of the expulsion of fluid from the vagina by women during sexual arousal and/or orgasm. There were references to this by historic scientific figures such as Aristotle and Galen, discussing and identifying vaginal expulsions which did not seem to have the appearance or smell of urine and did not stain bed sheets. There were also many references to vaginal expulsions in classical literature. However, it is impossible to determine whether these passages are simple reporting of what the writer actually saw or a dramatization of popular male sexual fantasies of the times. (VIII) The first modern description both of female genitalia and the question of vaginal expulsions came from the 17th century Dutch physician, Regnier De Graaf. He stated: "The urethra is lined internally by a thin membrane. In the lower part, near the outlet of the urinary passage, this membrane is pierced by large ducts, or lacunae, through which pituito-serous matter occasionally discharges in considerable quantities. Between this very thin membrane and the fleshy fibres we have just described there is, along the whole duct of the urethra, a whitish, membranous substance about one finger-breadth thick which completely surrounds the urethral canal . . . the substance could be called quite aptly the female prostatae or corpus glandulosum, 'glandulous body.'" (IX) De Graaf's description of the "prostate" in women in reference to the glands surrounding the female urethra represented conventional medical thought for almost 200 years. In 1880, Dr. Alexander Skene, professor of gynecology in the Long Island College Hospital in Brooklyn, New York, wrote a paper describing and diagramming various glands and ducts surrounding the female urethra. Modern science then began to refer to them as Skene's glands, a term that is still in use today. In 1953, Dr. Samuel Berkow, a urologist, came to the conclusion that the tissue of Skene's glands was erectile when stimulated. However, Berkow's primary interest was in urination and he believed that the function of the "erectile tissue" was to pinch off the urethra in order to control urination. He never explored the question of whether it could become erect during sexual activity. (X) In 1950, the German obstetrician, Ernst Gräfenberg, wrote of observing the expulsion of fluid from the urethra during sexual arousal. "If there is the opportunity to observe the orgasm of such women, one can see that large quantities of a clear, transparent fluid (that) are expelled not from the vulva, but out of the urethra in gushes. At first, I thought that the bladder sphincter has become defective by the intensity of the orgasm. Involuntary expulsion of urine is reported in sex literature. In the cases observed by us, the fluid was examined and it had no urinary character. I am inclined to believe that 'urine' reported to be expelled during female orgasm is not urine, but only secretions of the intraurethral glands correlated with the erotogenic zone along the urethra in the anterior vaginal wall. Moreover, the profuse secretions coming out with the orgasm have no lubricating significance, otherwise they would be produced at the beginning of intercourse and not at the peak of orgasm." (XI) At the same time, the medical and scientific establishment was highly resistant to considering evidence of a cause for female ejaculation other than urinary stress incontinence. Again, they (and presumably their female patients) tended to consider ejaculation as an undesirable bodily dysfunction, generally resulting in the women experiencing guilt and shame. There have also been frequent reports of disapproval and recriminations from sexual partners of women who "ejaculate" that have often led to painful relationship issues and even dissolution of marriages. At this point, it should be noted that doctors, who may be very knowledgeable in the areas of urology and reproductive biology, have had little training or experience in human sexuality. If a woman patient were to have evidence of an expulsion of fluid during sensual/sexual activity, a doctor would be unlikely to check for sensitivity through the anterior wall of the vagina. Even if the physician were to suspect a possible expulsion from Skene's glands, ethics would prevent most doctors from engaging in an Ob/Gyn exam in which the patients was sexually aroused so as to duplicate the conditions of the expulsions. In the early 1980's, there were several studies that concluded that what had been called Skene's glands and/or paraurethral ducts and glands were, in fact, not a vestigial homologue of the male prostate but, instead, a "small, functional organ that produces female prostatic secretion and possesses cells with neuroendocrine function, comparable to the male prostate." (XII) The G "Crest" The so called G "Spot" is perhaps the most misunderstood area of three seemingly interconnected subjects: female ejaculation, the urethral glands and ducts, and the G "spot." This term was first introduced to the public at large in the book, The G Spot and Other Recent Discoveries About Human Sexuality. It referred to the previously mentioned 1950 article in the International Journal of Sexology in which Gräfenberg also wrote about erotic sensitivity along the anterior vaginal wall. Gräfenberg clearly stated that it was his opinion that what he felt through the anterior vaginal wall was erectile tissue. He stated that during sexual arousal "the female urethra begins to enlarge and can be felt easily. 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." (XIII) Others have noted that the size and development of these tissues will vary greatly from woman to woman and may change during arousal. The area on the upper wall of the vagina has been popularly but erroneously called the G spot and would be better labeled as the G Crest. It is the popular media that has promulgated the notion of a "spot" on the anterior wall of the vagina itself. The search for a "spot" on the anterior wall of the vagina, as opposed to searching for the urethral glands through the anterior wall may be contributing to the difficulty of finding the G "spot" and the controversy as to whether it exists at all. There is great potential value in renaming the G "spot" as the G "Crest." In that terminology, the "G" would be retained, as reference to and as credit to the important work of Gräfenberg. The word 'Crest' is also more useful as a description than "spot" because the swollen female urethral glands feel more like a protruding ridge than a spot (thus enabling her partner to locate the area more readily with less confusion) thus lessening some of the confusion there seems to be in finding it. Furthermore, the word 'Crest' also invokes an image of rising sensual/sexual pleasure. There have been studies that have indicated that the stimulation of the 'G Crest' by itself may induce an orgasm that feels very pleasurable, although different than a clitoral orgasm. As Gräfenberg previously observed, this may induce an expulsion of fluid through the urethra at orgasm. In 1988, Milan Zaviacic, M. D., Ph.D., head of the Institute of Pathology of the Comenius University in Bratislava, Slovakia, examined and stimulated the 'G Crests' of 27 women patients who volunteered for his study. Ten of the 27 women (37%) were induced to have urethral expulsions, with a wide variation in the amount of stimulation required before the expulsion. (XIV) The Experiment I became interested in the controversy about the source and cause of female ejaculation during the course of my doctoral studies. My doctoral research project was an exploratory experiment designed to provide information about some of the key issues in this controversy by collecting precise data during a medical procedure. The procedure I chose involved placing a Foley catheter through the urethra and into the bladder of seven women who reported that they regularly expelled fluid during sensual and/or sexual arousal. The purpose of the catheter was to effectively segregate the bladder from the urethra and collect vaginal expulsions in a controlled, medically supervised environment. It was an interesting experiment that had been conceived previously by researchers but never actually performed. I was moved to do this research mainly because I was intrigued by the fact that it had never been done before and fortunately I was acquainted with women ejaculators who were potential and willing subjects. Following a considerable amount of time screening and preparing the applicants, I assembled and managed the necessary research team, including medical personnel, and we created a relaxed and comfortable environment that was conducive to the experiment. After urine specimens were collected from each of the female subjects, they were aroused for a period of at least an hour in whatever manner was preferable to them before the actual insertion of the catheter. The stimulation choices that were utilized were manual self-stimulation, manual stimulation by a partner and/or use of a non-mechanical acrylic device known as a Crystal or G spot wand. After the subjects indicated that they felt properly stimulated and ready for the ejaculatory demonstration part of the experiment, the catheter was inserted. Their bladders were drained and the collection bag was changed. The bag with the drained fluid was saved for later analysis (of levels of urea and creatinine, the two main ingredients of urine). Then, with the catheter in place, the subjects were asked to resume their stimulation of choice and achieved what they (and the medical team) considered to be an ejaculatory orgasm. Any method that the woman preferred was acceptable, although intercourse was not possible, due to the presence of the catheter tube. The primary conclusion from the experiment was that, at least for these seven women, all knowledgeable and experienced ejaculators, the vast majority of the fluid expelled unquestionably came from their bladders. Even though their bladders were drained by the catheter, they still expelled from 50 ml to 900 ml of fluid post-drained through the tube and into the catheter bag, the only reasonable conclusion for which seemed to be that the liquid came from a combination of fluid from the walls of the bladder and from new kidney output. We also noted a consistency of results between our study and the earlier studies that also showed a greatly reduced concentration of urea and creatinine (the primary components of urine). The clear inference was that the expelled fluid is an altered form of urine, meaning that there appears to be a process that goes on during sensual or sexual stimulation and excitement that effects the chemical composition of urine. Conclusions The evidence of this experiment is clear and groundbreaking that the vast majority of the fluid expelled by women during sexual arousal originates in the bladder. Furthermore, that fluid, which passes through the urethra, may be "deurinized" liquid from the bladder. Additionally, in some women and at some times, a small discharge may be added from the female equivalent of the prostate gland, medically known as Skene's glands and long thought to be dormant and no longer functional, and which may be neither. It has not yet been proven whether women can expel at least a small amount of fluid from their urethral (prostate) glands, during a very deep and intense orgasm, but I sense that it is very close to being proven. Past research has indicated that most women have urethral glands and ducts about a third the size of the prostate gland of the average man, so the amount of fluid that might be emitted would naturally be likely to be less. In my study, having segregated the urethra from the bladder, we observed, at least for our seven subjects, that more than 95% of the fluid expelled during sexual arousal originated in the bladder. However, that fluid contained an average of only 25% of the amounts of urea and creatinine found in the subjects' baseline urine samples. We theorized that it may lose the appearance and smell of urine due to the secretion of the hormone aldosterone during sensual/sexual arousal, causing the re-absorption of sodium and the excretion of potassium by the kidneys. (XV) Furthermore, I found research material indicating that an involuntary opening of the bladder sphincter can be triggered with stimulation of either the G Crest or the clitoris or both simultaneously. (XVI) Moreover, on five occasions we observed a small milky discharge from the urethra which may mix in the urethra with the fluid from the bladder. So, it is possible that the ejaculatory fluid originates not from either the bladder or the urethral glands, but from both. For the scientific community to keep saying that the fluid originating in the bladder is solely the result of urinary stress incontinence is a vast oversimplification. The same muscles, nerves, sphincters and reflexes may be involved in female ejaculation as in urinary stress incontinence but this is not urination and we do not want to leave women nor their partners with the impression that they are inappropriately urinating during sexual arousal. It should also be noted that, at least in American culture, there are strong negative associations with urination and defecation even though urine, of course, is sterile and not all cultures have the same biases regarding it. However, if female ejaculation is viewed as natural and pleasurable, then a woman can feel good about her body as well as all fluids that come out of it. She can then experience these expulsions during sexual arousal more positively than in a situation in which these expulsions are considered "dirty", or a malfunction of the bladder, urogenital system or any of its components. Desmond Heath, a New York psychiatrist, offered an interesting hypothesis on the question of whether all women can ejaculate and, if so, why don't they? Basically, it is his premise that little girls often become excited in their lives and this may result in their dribbling a few drops of urine. He theorizes that this is probably followed by some form of displeasure by their parents or other adults, along with an admonition that this is bad and wrong, possibly accompanied by feelings of shame on the part of the child. Often punishment follows. Subsequently, women learn to keep their pubococcygeal muscles contracted and don't allow the pelvic floor to relax. Later on, when they become sexually active, it is natural that most women find it difficult to feel emotionally safe enough to allow themselves to become aroused sufficiently to ejaculate.(XVII) For women, relaxation and emotional safety are crucial in order to become aroused and stimulated enough so that at orgasm they can ejaculate. At such moments a woman might expel voluminous amounts of fluid from a nearly empty bladder, the fluid having only a tinge of the odor, smell or appearance of normal urine. However, for this to happen to women naturally and normally, our society will have to abandon its puritanical ancestry and celebrate this event as a symbol of a woman fully enjoying bodily pleasure. A New Possiblity for Mutual Pleasure Despite the fact that scientists and sexologists have underestimated the capabilities of women's bodies to experience pleasure, female ejaculation is now beginning to be accepted as a natural and very pleasurable activity. With stimulation of the G Crest, there is another source of pleasure and orgasm available for women. In light of this potentiality, what current sexual activities may need to be reconsidered? Sensual activities such as oral or manual stimulation of the genitals and/or simple caressing (which are now regarded as pleasurable but are relegated to being just "foreplay" or a prelude to intercourse or "real" sex) may provide an orgasm that is easier to facilitate, more intense and more gratifying than is possible with intercourse itself. In many modern relationships both partners work at full time jobs. By the time they get home from work and take care of family needs, it is often unrealistic to expect that they will have the time or energy for mutually satisfying intercourse. However, their emotional and physical needs might be served by sensual and/or sexual contact that is not simply a precursor to intercourse but is rather a pleasurable end unto itself. It's a cliché in our society that men are primarily focused on sexual intimacy, while women principally seek emotional intimacy. My experience is that both men and women find sex and sensuality to be pleasurable physical, emotional and even spiritual expressions of their love and caring for each other. Because of male conditioning in our society and the hypersensitivity of the adolescent penis, it has been easier for men to give themselves permission to be sexually aroused. However, for a woman to feel safe enough to become fully aroused, she must feel that she is emotionally as well as physically safe. Once she feels that safety -- along with emotional closeness -- she is more willing to explore sexual expressions of intimacy. So where is the common ground? How can men and women be together in ways where men can enjoy physical contact and women can feel safe and comfortable? One new sexual activity that couples could experience might be referred to as a focalized pleasure ceremony. This ritual could be pleasurable and, at the same time, an expression of love and caring between loving partners. It would not necessarily have to be enormously time consuming, nor terribly strenuous, so it can be done even when one or both parties are somewhat tired. The activity would not necessarily be a prelude to intercourse, but it is possible that intercourse might follow if that were a mutual decision. This is how the ceremony might proceed . . . The male partner could learn to gently explore different areas of the vagina to see where the woman has a strong response. He could then make short excursions away from that area to give it a chance to rest, then return to it for further stimulation. The woman could give him positive feedback on what makes her feel the best as they proceed slowly from one degree of pressure to the next, from one area to another. In this way, the man would know where the woman is most sensitive and discover how best to pleasure her. Each time the partners engage in a pleasure ceremony, it's important to discover what is really appealing to the woman at that moment. Women are all different in wondrously unique and varied ways. The same woman may even have different sensitivities within the same lovemaking session. It is important to know how her sensitivities are changing and shifting in small and subtle ways during a period of time. Men, being achievement and results-oriented, tend to want to find a formula that works and then stay with it. They feel good when they achieve results. Thus, equipped with the knowledge about the G Crest, men will achieve far better results in lovemaking and sex play if they realize that there are times when women want direct hands-on stimulation more than they want intercourse, just as men themselves sometimes prefer to be orally or manually stimulated to orgasm. If the man is familiar with several methods of stimulation and several areas in the woman's body where she often feels pleasure then he can go to one of those areas, manually stimulate it and see if it's sensitive at the moment. If it is not, he can go to each of the other areas that were really pleasurable or orgasmic for her in the past until he finds the one that is pleasurable today, right now. Or he can ask her to let him know what area she wants touched and in what way. That way a man can always feel that he has several alternatives to stimulate a woman and to make her feel wonderful. The woman feels appreciated because the man is not focused on only one spot or method while ignoring the others, thinking that exactly the same thing is going to work all the time, based on the erroneous assumption that she always "feels" in the same way. A full understanding of the potential of female ejaculation and the nature of the G Crest can create a wide range of sensual opportunities, as long as there is no pressure on the woman to perform in any particular way. Not all women ejaculate and even women who are capable of it will not ejaculate every time. The best perspective for a man to hold is "it's all right if you do or don't . . . I just want to give you whatever pleasure you desire." Most of all, it is valuable for the male, as her lover, to look for the different approaches to pleasuring her and the different ways to excite her, so as to express love and caring. (c)1997 by Dr. Gary Schubach REFERENCES (I) Masters, W. and Johnson, V Human Sexual Response. Boston: Little, Brown, 1966. pg. 135. (II) Whipple, Beverly, Komisaruk, Barry. "The G spot, orgasm and female ejaculation: Are they related?" The First International Conference on Orgasm presentation, February 1991, pg. 230.. (III) Perry, John D., and Whipple, Beverly. "Pelvic muscle strength of female ejaculation", Journal of Sex Research, 17", 1981, pg. 32. (IV) Singer, Josephine and Singer, Irving. "Types of female orgasm," in LoPiccolo, J. & LoPiccolo, L. (Eds.) Handbook of Sex Therapy. New York: Plenum Press, 1978, pg. 179. (V) Tanagho, E. A., M.D. and McAninch, J. W., M.D. Smith's General Urology. Norwalk, Connecticut: Appleton & Lange, 1995, Table 30-5, pg. 539. (VI) Bullough, B., David, M., Whipple, B., Dixon, J., Algeier, E. R., and Drury, K.C. "Subjective reports of female orgasmic expulsion of fluid," Nurse Practitioner, March, 1984, pg. 59. (VII) Ladas, Alice K., Whipple, Beverly and Perry, John D. The G Spot and Other Recent Discoveries About Human Sexuality. New York: Dell Publishing, 1982, pg. 152 (VIII) Sevely, J. Lowndes, and Bennett, J. W. "Concerning female ejaculation and the female prostate," Journal of Sex Research, 14: 424-427, 1978, pg. 5 (IX) De Graaf, Regnier. (1672) "New treatise concerning the generative organs of women." In Journal of Reproduction and Fertility, Supplement No. 17, 77-222. H. B. Jocelyn and B. P. Setchell, eds. Oxford, England: Blackwell Scientific Publications, 1972, pgs. 103-104. (X) Berkow, Samuel G. "The corpus spongeosum of the urethra: its possible role in urinary control and stress incontinence in women," American Journal of Obstetrics and Gynecology, 65: 1953, pg. 350. (XI) Gräfenberg, Ernst. "The role of urethra in female orgasm," International Journal of Sexology, 3:, 1950, pg. 147. (XII) Zaviacic, M., Whipple, B. "Update on the female prostate and the phenomenon of female ejaculation," The Journal of Sex Research, 1993, pg. 149. (XIII) Gräfenberg, pg. 146 (XIV) Zaviacic, M., Zaviacicova,A., Holoman,I. K. and Molcan,J.. "Female urethral expulsions evoked by local digital stimulation of the G-spot: Differences in the response patterns," The Journal of Sex Research, 24: 311-318, 1988, pg. 311 (XV) Normal Renal Function, pg. 88, in Smith's General Urology. Norwalk, Connecticut: Appleton & Lange, 1995 (XVI) Tanagho, E. A., M.D. and McAninch, J. W., M.D. Smith's General Urology. Norwalk, Connecticut: Appleton & Lange, 1995, Table 30-5, pg. 539. (XVII) Heath, D. "Female ejaculation: its relationship to disturbances of erotic function," Medical Hypotheses, 24 (1):103-106. Gary Schubach, Ed.D., A.C.S. 65 Flicker Drive Novato, CA 94949 415 459-2801-office 415 883-2989-fax http://www.DoctorG.com doctorg@slip.net