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1982 Edition
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FEMALE EJACULATION, by Cabello, Santamaría (Doctor, Psychologist and Sexologist). Address: Instituto Andaluz de Sexología. Alameda Principal, 21. 29001 Malaga. Spain. Tel. and Fax: (95) 2603640 E-mail: fcabello@ingenia.es WORDS Female ejaculation, PSA, Skene's ducts, female prostate. In our sexual therapy practice, out of a sample of 220 women, we have found three (1.36%) whose demand was related to the emission of liquid, trough the genitals, during orgasm. This took us to question ourselves about one of the main controversies surrounding the orgasmic response of women, that is, the existence or not of "female ejaculation". Investigations about this issue have been polarized around two clearly differentiated lines. On one hand, we have all those who state that any fluid emitted during orgasm is nothing else than a certain degree of urinary incontinence (Kinsey, 1953; Masters & Johnson, 1988; Bohlen, 1982; Kaplan, 1983; Golberg et al. 1983, Alzate, 1985, etc.). On the other, we have all those authors that try to prove that women emit certain fluid, that differs from vaginal lubrication, during their sexual response (Grafenberg, 1950; Sevely & Bennet, 1978; Belzer et al., 1981; Perry & Whipple, 1981; Addiego et al., 1981; Sensabaugh & Kahane, 1982; Belzer et al., 1984; Zaviavic et al., 1984; Stifter, 1987; etc.). Thanks to this last group, the presence, in the suposed female ejaculation, of specific prostate acid phosphatase and fructose, elements normally present in male ejaculation, seems proven. Anyhow, the investigators that support the existence of female ejaculation, seem to agree that it is a possibility that actually occurs in very few women: 10% for Whipple and Perry (1981), 14 % for Bullough et al. (1984), 40% for Darling, Davidson and Conway Welch (1990) and a 6% for Kratochvil (1994). We believe that most women ejaculate, although they are variations in the quantity of the emitted liquid and/or the direction of the emission. We think it is quite possible that the fact that many women do not perceive an ejaculation, during the orgasm, is caused by the product of their "female prostate" being very scarce or because the ejection takes the retrograde direction towards the bladder, as occurs in the retrograde ejaculation of some men. To try and test this hyphotesis, we have analyzed, in the pre and postorgasmic urine, the presence of prostate specific antigen (PSA) in order to find any difference due to the substances elaborated in the urethral and paraurethral glands and in Skene's ducts. All this is what is known as the "female prostate". After doing a Microparticle Enzyme Immunoassay (MEIA) to detect PSA, we observed that 75% of our sample presents PSA levels in postorgasmic urine that is not detectable in preorgasmic urine. The difference in PSA concentration between pre and post urine was tested for the whole set of data by two-tailed Wilcoxon's pairs signet-ranks test. The differences found were significant (p= 0.0002). With the obtained data, we confirm our hypothesis and intend to confirm the previous works about female ejaculation, calm those women that fear that they have urinated while experiencing orgasm and, finally, break the growing myth of the "ejaculating superfemale" because we state that all, or at least most, women ejaculate. Female ejaculation is not a novel issue. Hypocrates had already talked about "female semen". Later it was Galeno, going against the theories of Aristotle, who defended the existence of a female seminal liquid. De Graaf (1672), claimed the existence of a female "prostate" or "corpus glandulosum" that, according to him, secreted a fluid that made women more libidinous (pp. 103- 104). However, in recent times, the strongest bet was placed by Grafenberg (1950) claiming the existence of an area, the G point, in the anterior wall of vagina, that when stimulated provoked the emission of a fluid simultaneously with orgasm. Finally, it was the work of Ladas, Whipple & Perry about the G point, in 1982, the one that most contributed to the social diffusion of this issue, generating a period of new investigations about female sexual response. The possible anatomic structure of the supposed ejaculation would be the following: as sustained by Testud & Latarjet (1975), around the urethra we find a lot of urethral and paraurethral glands that, together, receive the name of "female prostate". This name has been assumed by other authors as Johnson (1922), Huffman (1948), Sevely & Bennett (1978), Duckett y Snow (1988), Zaviacic & Whipple (1990), Zaviacic et al. (1933), Gittes & Namakura, (1996) etc. The identification of clear cells adenocarcinoma in paraurethral glands showing positive staining with antibodies to PSA and phosphatase acid prostatic antibodies (Ebisuno et al., 1995) have reaffirmed this idea. What is more, in some cases the presence of these tumors has been accompanied by high levels of blood PSA that have disappeared after ablation (Dodson et al. (1994)). The urethral glands drain in the urethra, differentiating them from the paraurethral glands that drain in the vestibule, around the urethral meatus. Histologically they are similar to the male prostatic glands (Testud y Latarjet, 1975; Tepper et al., 1984), although the ductal tissue predominates over the glandular tissue. The same authors also claim that, apart from the previously mentioned glands, there exists the yuxtaurethral glands or Skene's glands, which drain below the urethral meatus, in the position 4 and 8 (taking as reference the position of the numbers on the face of a clock). With the bibliographical relaunching of the female ejaculation, investigations have been oriented in two clearly different directions. On one hand we have those that claim that any ejected fluid is a product of certain degree of urinary incontinence (Kinsey, 1953; Masters & Johnson, 1988; Bohlen, 1982; Kaplan, 1983; Golberg et al. 1983, Alzate, 1985, etc.). On the other, we have all those authors that try to prove that women emit certain fluid, different from vaginal lubrication, during their sexual response (Grafenberg, 1950; Sevely & Bennet, 1978; Belzer et al., 1981; Perry & Whipple, 1981; Addiego et al., 1981; Sensabaugh & Kahane, 1982; Belzer et al., 1984; Zaviavic et al., 1984; Stifter, 1987; etc.). Thanks to this last group, the presence of prostate acid phosphate and fructose in the supposed female ejaculation, elements normally present in male ejaculation, seems proven. The quantity of fluid mentioned varies a lot according to different authors. Belzer (1983) estimates 10 ml; Goldberg (1983), from 3 to 15 ml.; Bullough (1984) 12 ml; Zaviavic (1987), 16 ml. and Heat (1984) from 30 to 50 ml. Nevertheless, the investigators that support the existence of female ejaculation, seem to agree that it is a possibility that actually occurs in very few women: 10% for Whipple and Perry (1981), 14 % for Bullough et al. (1984), 40% for Darling, Davidson and Conway Welch (1990) and a 6% for Kratochvil (1994). In our clinical experience, we have found some women that do not believe in the existence of female ejaculation (understood as expulsion of fluid during the orgasm or a sensation of greater humidity that increases during climax), others that believe that they lose urine during orgasm and even some that believe that female ejaculation is a common happening, to the extent of a woman coming to inquire about a possible anorgasmia because she "failed to ejaculate". Works that have appeared about female ejaculation have partially tranquilized those women who believed that they emitted urine during orgasm but they have created, in certain groups, a "quest of female ejaculation", as in its day happened with multiorgasmia. We do not think we are wrong when we claim that, in a way, all these publications, and the ones referred to the G point, have actually lengthened the list of the sexual myths instead of optimizing the sexual life of women. The existence of urethral and paraurethral tissue that is functional and not an atrophied gland seems clearly proven. We are also completely sure that some women, during orgasm, expel a certain amount of fluid (we have collected up to 16 ml.). Nevertheless, the authors that have investigated this issue, called the "female ejaculation", seem to agree that only a certain and limited number of women do actually "ejaculate". If all women have a "female prostate", our hypothesis is that most women ejaculate, although there are variations in the quantity of the emitted liquid and/or the direction of the emission. We think it is quite possible that women that do not perceive ejaculation during orgasm do actually ejaculate, but either the product of their "female prostate" is very scarce or it takes the retrograde direction towards the bladder, as occurs in the retrograde ejaculation of certain men. Our experimental hypothesis presupposes that if prostate specific antigen (a specific component of masculine prostate, present in seminal liquid) appears in postorgasmic urine the following suppositions would be confirmed: -The urine emitted after the orgasm carries the product of the "female prostate" on its way through the urethra. -The postorgasmic urine has diluted PSA (Prostate Specific Antigen) produced in the "female prostate" that could have fallen into the bladder because of incompetence of the sphincter in the moment of the orgasm (theoretically, it should be closed) or because the bladder sphincter relaxes with the orgasmic contractions and the gravity force pushes the fluid in women in supine position (this occurred to us as, after observing that those women that ejaculate outwards, that is, that emit fluid in the moment of the orgasm, comment that they expel more quantity when they are not lying, favoring the effect of gravity). Summarizing our position, we believe that all women ejaculate, that is, produce more or less quantity of secretion of the urethral and paraurethral glands and Skene's ducts and expel it outwards or inwards, towards the bladder, with the orgasmic contractions. With the confirmation of our hypothesis, we intend to confirm the previous works about female ejaculation, calm those women that fear that they are urinating while experiencing orgasm and, finally, put an end to the growing myth of the "ejaculating superfemale". Due to the type of fluids we needed for our investigation (pre and post- orgasmic urine and female "ejaculated" liquid of those women that did so outwards) we decided that our sample had to be composed of women that participated in the study voluntarily, without reward or pressure, because if we used any of the mentioned, the subjects of our study could easily give us urine samples that did not fulfill the requirements. We gave information about the objectives of our investigation to female students of different Masters in Sexology, women associations and other entities. After that, we asked all these women for samples of urine and "ejaculated" fluid. We established an anonymous system by which the samples could reach us without us knowing from were they proceeded. If the women chose otherwise, they could also identify their samples. Once in the laboratory, the samples were filtered and numbered for analysis. The complete sample consisted of 24 women, ages between 24 and 48. Six contributed with "ejaculation" samples; the rest only with urine samples.) Procedure: We did a Microparticle Enzyme Immunoassay (MEIA) of the pre and postorgasmic urine to detect PSA, using the Abbot AxSYM SYSTEM (1994, 1996), system and apparatus, and AxSYM PSA reactives. We also analyzed the liquid emitted in the moment of orgasm of our six samples to establish similarities and differences with the postorgasmic urine. Previously, we informed the women that they had to attain orgasm by manual self- stimulation, without having any contact with men's genitals, having previously washed their own genitals and at least two days after their last sexual relationship. The six women that emitted fluid during orgasm had to obtain the sample pressing slightly the perinea during self-stimulation until any fluid fell into a container. The rest of women had to collect, in the same type of containers, the urine previous to a self-stimulation session and later, in other container, the first portion of urine after orgasm. The biochemical parameter analyzed, considered by us the most specific and important to confirm our hypothesis, was the PSA. The importance of this parameter lies in the fact that it has only been found in prostatic tissue and in no other normal or pathological tissue. It has been isolated in seminal liquid (Wang et al., 1979, 1982; Papsidero et al., 1981; Nadji et al., 1981). It is a glycoprotein with a molecular weight of 33.000 to 34.000 daltons, with 7% of carbohydrates in its molecule, that is found in the epithelial cells of prostatic ducts. It is observed in the prostatic secretion. On the other hand, women do not present PSA in urine or serum. In 75% of the postorgasmic urine samples, we detected PSA. Applying a two- tailed Wilcoxon's pairs signet-ranks test, we found significant differences between pre and postorgasmic urine (p=0.0002). The mean PSA value in postorgasmic urine was 0.09 ng/ml when, theoretically, women do not have PSA. Out of the six women that gave us "ejaculation" samples, we found PSA in 100% of them the average value being 6.06 ng/ml. This extremely high figure was because one of the samples gave a value of 32 ng/ml of PSA (the analysis was repeated five times to confirm it) this could have been caused by some kind of oncological pathology or contamination of the sample by male semen. If we ignore this figure, the mean value of PSA in ejaculation samples was of 0.82 ng/ml. In the postorgasmic urine of the subgroup of women that ejaculated, the levels of PSA were higher (mean value = 0.31 ng/ml, once the extreme value sample previously mentioned is ignored) than in the rest of the samples of postorgasmic urine. Levels of PSA (in ng/ml) Pre orgasmic: * Ejaculation: Postorgasmic 1) 0.00: 0.00 The obtained data seems to confirm our hypothesis that at least most women (75% of our sample), produce a certain amount of PSA during orgasm, that can only come from the urethral and paraurethral glands (female prostate). We think this proves, therefore, that during orgasm, the so called female prostate is active, emitting more or less quantity of fluid to the urethra. The fact that some women detect this fluid and others do not depends on the quantity of it and the direction of ejection, being, in any case, detectable in the postorgasmic urine. This idea is reinforced by the fact that, women that perceive this "ejaculation", have higher levels of PSA in the postorgasmic urine than women that do not, being unidentifiable in both cases in preorgasmic urine. On the basis of this data, we conclude that all, or nearly all, women ejaculate, with variations in the quantity and subjective perception of this ejaculation. Therefore, our investigation also expects to create a tranquilizing effect in women in two ways: in those that do perceive their ejaculation, assuring them that it is a perfectly normal and, probably, common phenomenon. In those that do not perceive it, avoiding them an "endless quest" for their ejaculation, because they probably do ejaculate but in scarce quantities. These results, however, leave some questions unanswered. First of all, we can not state without a doubt if the female ejaculation is related to the sexual response or if it is a parallel phenomenon induced by orgasmic contractions. We do not know either if the emission of a greater quantity of fluid is related to a bigger glandular structure. It would be interesting to study the glandular morphology of women that expel fluid because it is possible that, on occasions, the emission of a big quantity of liquid is supported by a Skene's ducts cyst (Lee & Kim, 1992, find 7 cases among 14.500 births) or a urethral diverticulum. In fact, some women have told us that when they reach an orgasm after a long period of sexual abstinence, the ejaculated quantity is enormous and it goes on diminishing with each orgasm until nearly disappearing. Another doubt relates to whether the increase of PSA occurs only as a result of sexual excitement or whether it is necessary to have an orgasm too. Zaviacic and Whipple (1990), observe that out of ten women that have an orgasm that can be detected, one third emit a liquid after a fast stimulation, while another third emits the fluid without reaching orgasm, and the remaining third at the moment of orgasm, after about 15 minutes of stimulation. The question is if the liquid emitted by the first group has the same biochemical composition than the liquid emitted during orgasm. In our clinical experience, among the few women that claim to ejaculate, urinary infections are common. This contradicts the idea, defended by Whipple and Perry (1982), that women that ejaculate suffer less from cystitis. It seems logical that those that emit more quantity of fluid have a bigger paraurethral structure, that could probably favor infections and other pathologies such as the adenocarcinoma of the paraurethral gland that, according to Dodson et al. (1994), which make up 0.003% of all female genital cancers. Last but not least, we should also start thinking about a new name for what we have referred to as "female ejaculation". Some feminists argue that investigations tend to refer to this phenomenon in women as an analogy of processes occurring in men. As we have tried to prove, "female ejaculation" is probably much more common than we previously thought, being a normal response in women and not an exceptional happening in only some of them. Investigations should try to, first of all, argue back the results of this investigation with a wider sample and using an immunoradiometric assay (that is more precise than MEIA) and then answer the various questions elicited by the present investigation.
Ormaza, Bilbao, C., Corbella C., Fora F., García Serrán M.E., González de la Rosa, Lozoya J.A., Mansukhani A., Morán A., Peña O.M., Sibbick, J., Tirado de la Flor, Vicioso L,. ANALYSTS : Rico C., Casero C., Recio I., Valverde E., Herrero J. INSTITUTIONS: Clínica El Sur (Sevilla), Instituto Espill, Sociedad Malagueña de Sexología. DATA ANALYSIS: Sánchez León A.
Alzate, H., y Hoch, Z. (1986). The G spot and female ejaculation: A current appraisal. Journal of Sex and Marital Therapy. 12, 211-220. Addiego, F., Belzer, E.G., Comolli, J., Moger, W., Perry, J.D., y Whipple, B. (1981). Female ejaculation: A case study. Journal of Sex Research. 17, 13-21. Belzer, E. (1981). Orgasmic expulsions of women: A review and Heuristic Inquiry. Journal of Sex Research. 17, 1-15 Belzer, E. (1984). A review of female ejaculation and the Grafenberg spot. Women Health. 9, 5-16. Bohlen, J.G. (1982). Female ejaculation and urinary stress incontinence. Journal of Sex Research. 18, 130-145. Bullough, B., David, M., Whipple, B., Dixon, J., Allgeier, E.R., y Drury, K.C. (1984). Subjective reports of female orgasmic expulsion of fluid. Nurse Pract. 9: 55-59. Darling, C.A., Davidson, J.K., y Conway-Welch, C. (1990). Female ejaculation: perceived origins, the Grafenberg spot/area, an sexual responsiveness. Archives of Sexual Behavior. 19, (1), 29-47. Dodson, MK., Cliby, W.A., Keeney, G. L., Peterson, M.F., Podratz, K.C. (1994). Skene's gland adenocarcinoma with increased serum level of PSA. Gynecol. Oncol. 55 (2), 304-307 Duckett, J.W., Snow, B.W. (1988). Trastornos de la uretra. In: Campbell Urología, vol 2. Buenos Aires: Panamerica. Ebisuno, S., Miyai, M., y Nagareda, T. (1995). Clear cell adenocarcinoma of the female urethra showing positive staining whit antibodies to prostate specific antigen and prostatic acid phosphatase. Urology. 45 (4), 682-685. Golberg, D.C. et al. (1983). The Grafenberg Spot and Female Ejaculation: a review or initial hypotheses. Journal of Sex and Marital Therapy. 9, 27-37. Gittes, R.F., Nakamura, R.M. (1996). Female Urthral syndrome. A female prostatitis. West. J. Med. 164 (5), 435-438. Graaf de, R. (1672). New treatise concerning the generative organs of women. En H. B. Jocelyn y B.P. Setchell (1972), trad. Journal of Reproduction and Fertility 17, 77-222. Heath, D. (1984). An investigation into the origins of a copious vaginal discharge during intercourse: "Enough to wet the bed - that is not urine". Journal of Sex Research. 20, 194-210. Kinsey, A.C., Pomeroy, W.B., Martin, C.E., y Gebhard, P.H. (1953). Sexual Behavior in the Human Female. Filadelfia: W.B. Saunders Company. Kratochvil, S. (1994). Orgasmic Expulsion in women. Cesk Psychiatr. 90 (2), 71-77. Ladas, A.K., Whipple, B., y Perry, J.D. (1982). The G Spot and other recent discoveries about human sexuality. New York: Dell. Lee, N-H., y Kim, S.Y. (1992). Skene's duct cysts in female newborns. J. Pediatr Surg. 27 (1), 15-17. Nadji, M., Taber, S.Z., Castro, A., Chu, T.M., Murphy, G.P., Wang, M.C., , y Morales, A.R. (1981). Prostatic Specific antigen: An inmunohistologic marker for prostatic neoplasms. Cancer. 48, 1.229. Papsidero, L.D., Kuriyama, M., Wang, M.C., Horoszewicz, J., Leon, S.S., Valenzuela, L.A., Murphy, G.P., y Chu, T.M. (1981). Prostate antigen: a marker for human prostate ephitelial cells. J.N.C.I. 66, 37. Perry, J.D., y Whipple, B. (1981). Pelvic Muscle Strength of Female Ejaculators: Evidence in support of a new theory of orgasm. Journal of Sex Research. 17 (1), 22-39. Pollen, J., Dreilinger, A. (1984). Inmunohistochemical identification of prostatic acid phosphatase and prostate specific antigen in female periurethral glands. Urology, 23., 303. Sensabaugh, G.R. y Kahane, D. (1982, Mayo). Biochemical studies on female ejaculates. Comunicación al Congreso de la Asociación de Criminalistas de California, Newport Beach, CA. Sevely, J., y Bennett, J. (1978). Concerning female ejaculation and the female prostate. Journal of Sex Research. 14, 1-20.Stifter, K.F. (1987, June). Female Ejaculation: New Aspects and Results. VIII World Congress for Sexology. Heidelberg. Schubach, G. (1997). Urethral expulsions during sensual arousal and bladder. Comunicación Personal. Tepper, S.L., Jagirdar, J., Heath, D., y Geller, S.A. (1984). Homology between the female paraurethral (Skene's) glands and the prostate. Arch. Pathol. Lab. Med. 108, 423-425. Testud, L., Latarjet, A. (1975). Tratado de Anatomía Humana. Vol 4. Barcelona: Salvat Wang, M.C., Valenzuela, L.A., Murphy, G.P., y Chu, T.M. (1979). Purification of a human prostate specific antigen. Invest Urol. 17, 159. Zaviacic, M., Jakubovsky, J., Polak, S., Zaviacicova, A., Holoman, I.K., y Gregor, P. (1984). The fluid of female urethral expulsions analyzed by histochemical electronmicroscopic an other methods. Histochemical Journal. 16, 445-447. Zaviacic, M., y Whipple, B. (1990). Update on the female prostate and the Phenomenon of female ejaculation. The Journal of Sex Research. 33 (3). 221-230. |
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