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European Journal of Obstetrics & Gynecology and Reproductive Biology 154 (2011) 38

Contents lists available at ScienceDirect

European Journal of Obstetrics & Gynecology and


Reproductive Biology
journal homepage: www.elsevier.com/locate/ejogrb

Review

Embryology and anatomy of the vulva: the female orgasm and womens
sexual health
Vincenzo Puppo *
Centro Italiano di Sessuologia (CIS), Via Regnoli 74, 40138 Bologna, Italy

A R T I C L E I N F O

A B S T R A C T

Article history:
Received 16 December 2009
Received in revised form 3 August 2010
Accepted 13 August 2010

Sexual health is vital to overall well-being. Orgasm is a normal psycho-physiological function of human
beings and every woman has the right to feel sexual pleasure. The anatomy of the vulva and of the female
erectile organs (trigger of orgasm) is described in human anatomy textbooks. Female sexual physiology
was rst described in Dickinsons textbook in 1949 and subsequently by Masters and Johnson in 1966.
During womens sexual response, changes occur in the congestive structures that are essential to the
understanding of womens sexual response and specically of their orgasm. Female and male external
genital organs arise from the same embryologic structures, i.e. phallus, urogenital folds, urogenital sinus
and labioscrotal swellings. The vulva is formed by the labia majora and vestibule, with its erectile
apparatus: clitoris (glans, body, crura), labia minora, vestibular bulbs and corpus spongiosum.
Grafenberg, in 1950, discovered no G-spot and did not report an orgasm of the intraurethral glands.
The hypothetical area named G-spot should not be dened with Grafenbergs name. The female orgasm
should be a normal phase of the sexual response cycle, which is possible to achieve by all healthy women
with effective sexual stimulation. Knowledge of the embryology, anatomy and physiology of the female
erectile organs are important in the eld of womens sexual health.
2010 Elsevier Ireland Ltd. All rights reserved.

Keywords:
Sexual health
Vulva
Clitoris
Female orgasm
G-spot

Contents
1.
2.
3.

4.
5.

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The embryological development of the vulva . . . . . . . . . . . . . . .
The vulva . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.1.
The vestibule. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.2.
The labia minora . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.3.
The clitoris . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.4.
The vestibular bulbs and the female corpus spongiosum .
3.5.
The corpus spongiosum of the female urethra . . . . . . . . .
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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1. Introduction
Orgasm is a normal psycho-physiological function of human
beings [1]. Women have the right to feel sexual pleasure: sexual
health is a global issue that is vital to overall well-being [2]. The
anatomy of the vulva and of the female erectile organs (trigger of

* Correspondence address: Via Pistoiese 301/6, 50145 Florence, Italy.


Tel.: +39 055300425.
E-mail address: dottvincenzopuppo@yahoo.it.
0301-2115/$ see front matter 2010 Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.ejogrb.2010.08.009

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3
4
4
4
4
5
5
6
6
7
7

orgasm) is described in human anatomy textbooks with the clitoris


considered as homologous to the male penis [1,35]. Female sexual
physiology was rst described in Dickinsons textbook in 1949 and
subsequently by Masters and Johnson in 1966 [1,5].
For women, clitoral stimulation is important for achieving
orgasm. Distinguishing between clitoral and vaginal orgasm is not
correct from a physiological point of view [1,57]. The vagina is
mainly a reproductive organ with little sensitivity [1,36], the
vaginal orgasm is not corroborated by anatomical evidence and the
term was invented by Freud in 1905. For Laqueur the theory of
Freud is an instrument for making women accept their social role

V. Puppo / European Journal of Obstetrics & Gynecology and Reproductive Biology 154 (2011) 38

[7]. During womens sexual response, changes occur in the


congestive structures that are essential to the understanding of
their sexual response and specically of their orgasm.
2. The embryological development of the vulva
In anatomy textbooks there is a separation between the
embryological development of the internal and external genital
organs in the male and in the female. It is important to know this
because it is related to the function of these organs, i.e. the internal
genitals have a reproductive function, while the external ones have
the function of giving pleasure [35].
There is an important difference between the two genders: in
the male, ejaculation and the release of sperm happen at the same
time as orgasm. In the female, however, orgasm is not connected to
reproductive function, and ovulation is not accompanied by
orgasm. The ovum is fertilized when it is in the uterine tubes,
which are internal organs, but the clitoris and the other female
erectile structures are located externally [35].
In male and female embryos the external and the internal
genital organs are indifferent for the rst few weeks. At 8 weeks
of gestation the external genitalia of males and females begin to
develop from the urogenital sinus (which is divided into pelvic and
phallic parts), from the genital tubercle or phallus, from the
urogenital folds and from the labioscrotal swellings [3,4]. The
corpora cavernosa of the clitoris and the glans with the prepuce are
formed from the phallus (which bends forward or caudally) [3,4].
In the female these structures are not so large as in the male,
although in the early phases the clitoris exceeds the length of the
homologous male counterpart [3].
The vestibule of the vagina, the labia minora, the vestibular
bulbs and the female corpus spongiosum are formed by the pelvic
and phallic part of the urogenital sinus and from the urogenital
folds, which do not fuse together. The labioscrotal swellings do not
meld and they form the labia majora [3,4,8].
In the female, the pelvic part of the urogenital sinus moves
down, is incorporated by the phallic part and opens externally as
the vaginal and urethral orices. In the male, the pelvic part of the
urogenital sinus corresponds to the internal portion of urethra
located under the seminal collicle (veru montanum), a prominence
in the dorsal surface of the prostatic urethra where the ejaculatory
ducts open. Between the two ejaculatory ducts is the prostatic
utricle (i.e. the male vagina: it is the homologous to the female
vagina) [3,4]. Sometimes the ejaculatory ducts open into the
prostatic utricle instead of the prostatic urethra. The small segment
of the prostatic urethra which reaches the seminal collicle from the
bladder corresponds to the whole female urethra [3,4].
The main difference between male and female genitalia is the
lack of the development in the female of the external urethra, as
consequence of the non-fusion of the urogenital folds. However,
the structures responsible for forming the external urethra in the
male are also present in the female and correspond to the vestibule
of the vagina and to the internal surface of the labia minora [3,4].
The vulva, in fetal life and after birth, appears with the labia
majora closed: to visualize the vaginal opening it is necessary to
open the labia, and therefore the labia minora are in contact with
each other. The picture of the normal vulva should be shown with
the labia majora and the labia minora closed.
3. The vulva
The vulva is formed by the labia majora and vestibule, with its
erectile apparatus: labia minora, clitoris (glans, body, crura), and
vestibular bulbs with the corpus spongiosum. These structures are
localized under the urogenital diaphragm, behind the pubic
symphysis in the anterior perineal region [35].

3.1. The vestibule


The vaginal vestibule is triangular in shape. It corresponds to
the dorsal wall of the male cavernosa urethra. Here the external
orice of the urethra with the paraurethral (Skenes) ducts opening
on both sides are localized [35]. Their length is 0.53 cm and they
are found, in women, with the intraurethral (Skenes) gland which
has been named the female prostate [4,5,9]. This structure can be
affected by the same diseases as the male counterpart, including
carcinoma and prostatitis; the secretion of these glands, expelled
during the female orgasm (female ejaculation) into the vaginal
vestibule through the urethral meatus or through the orices of the
paraurethral ducts, contains prostate-specic antigen [9].
From a physiological point of view the term female emission
is more accurate than female ejaculation (in a few women there is a
powerful expulsion of this uid); in the male it corresponds to the
phase of emission of seminal liquid which is ejected out in the
prostatic urethra [10]. The lack of the ejaculation phase in the
female could explain why women do not have a refractory period
and are able to have multiple orgasms.
In the mid-line of the vestibule is located a longitudinal
formation 45 mm wide, with dened margins and more pale than
the nearby tissue, thin and well wedged in the dermis of the
vestibule, which goes up from the urethral orice to the sulcus of
the inferior surface of the corpora cavernosa of the clitoris up to the
glans, described rst by Pozzi in 1884 and named masculine
bride (habenulae uretrales). It corresponds to the dorsal part of
the male corpus spongiosum of urethra: it is the female corpus
spongiosum [35,8].
The vagina is an internal genital organ and the vaginal opening
(introitus) is usually a median ssure, under the urethral meatus.
The anterior vaginal wall is separated from the posterior urethral
wall by the urethrovaginal septum and there are no secretory
glands in the vagina [35].
The Bartholins glands end up on the sides of the vaginal
opening, and are homologous to the male bulbourethral glands or
Cowpers gland [35]. According to some studies, pre-ejaculatory
uid secreted by Cowpers gland in the distal urethra, during
sexual stimulation, lacks in sperm so that it cannot cause a
pregnancy after coitus interruptus [11]. Bartholins glands secrete
a sticky liquid similar to the mucus preceding orgasm and, as in the
male, this pre-orgasmic secretion is light and more frequent after
prolonged sexual stimulation [1]. Endocrine cells producing
serotonin, calcitonin, bombesin, katacalcin and alpha-hCG have
been found in Bartholins glands [12]. Furthermore in the vestibule
many mucous glands open, called minor vestibular glands [3,4].
3.2. The labia minora
The labia minora, or nymphs, are two small cutaneous folds, 3
4 cm long. They are normally approximated together. They
correspond to the ventral wall of both the cavernosa urethra
and the corpus spongiosum of the urethra in the male [35]. They
vary in size. They may be almost unrecognisable or may protrude
from the labia majora (hypertrophic labia minora should not be
considered a malformation). In addition they can be asymmetrical
or double on one or both sides [35,13,14]. In some races the labia
minora can be very large because of the practice of stretching
them: in some African populations they can be as large as 20 cm
and are known as Hottentot apron [4,5]; today this is classied in
the type IV female genital mutilations [15].
The upper points converge to form the prepuce and frenulum of
the clitoris; posteriorly they form the frenulum of the labia minora
but they can be also separated [35]. The labia minora contain
erectile tissue constituted by a thick connective tissue rich in small
blood vessels. With sexual arousal the labia minora, because of

V. Puppo / European Journal of Obstetrics & Gynecology and Reproductive Biology 154 (2011) 38

engorgement with blood, become turgid, doubling or tripling in


thickness. They have a great sensitivity, due to the considerable
number of nerve endings and sensory receptors. Among these, as in
the male, the most important for erogenous sensitivity are the
genital corpuscles (typical receptors of the external genitals); the
KrauseFinger corpuscles (corpuscles of voluptuousness) are
predominant. Pacini and Meissner corpuscles (cutaneous mechanoreceptors distributed on various areas of the skin, but concentrated in areas especially sensitive to light touch) are also present
[1,35,16,17].
3.3. The clitoris
The clitoris is usually considered the homologue of the male
penis. It is formed by two corpora cavernosa and the glans, covered
by the prepuce [1,35,7,17]. The corpora cavernosa are two
cylindrical organs, made of cavernous erectile tissue that becomes
turgid and erect with sexual arousal; the crura represent the
hidden part of the clitoris located in contact with the ischiopubic
ramus, covered by the ischiocavernosus muscle, a supercial
perineal muscle [1,35,17].
The perineal muscles are innervated by branches of the
pudendal nerve coming Onufs nucleus; pudendal nerve integrity
may play a role in female sexual dysfunction [18]. Onufs nucleus
is located at the sacral level of the spinal cord and is formed by
motoneurons innervating the perineal muscles; the number and
the size of these neurons are sexually dimorphic: this dimorphism
is mediated by androgens (in absence of these hormones the
motoneurons die by apoptosis) with ciliary neurotrophic factor
(CNTF) and other trophic factors [19]. Because of this, in females
the ischiocavernosus muscles are much thinner than the male
counterparts. Their contraction during female arousal determines
a surge of blood in the crura towards the corpora cavernosa of the
clitoris and a compression of the deep dorsal vein, contributing
therefore to erection of the clitoris [1,35].
The ischiocavernosus muscles, like the bulbocavernosus, are
type mixed muscles (even if histologically they are striated).
During erection, they are implicated in producing a continuous
involuntary reex hypertonic contraction, important not only for
the rigidity of the penis but also for the maintenance of the erection
[3,4,20].
The crura are joined beyond and in front of the pubic symphysis,
forming the body of the clitoris (which in the accid state is 13 cm
long), which goes back and up to the glans. The suspensory
ligament links the clitoral body to the mons pubis and pubic
symphysis [35,17]. The erectile tissue of the clitoris is made up of
caverns covered by the tunica albuginea: the two corpora
cavernosa have the same structure as the male penis; in some
studies a subalbugineal layer in the corpora cavernosa is not
present and the subalbugineal venous plexus is not located
internally [35,21]. The glans is 47 mm long and covers the distal
part of the corpora cavernosa, from which it is independent [35].
The prepuce covers all or part of the glans, its size varies
considerably, and it is just like the foreskin of the male penis; it is a
specialized, specic erogenous tissue in both males and females.
The fetal development of the prepuce and the glans in the male and
female is similar: they are fused together during the rst year after
the birth. If they are not divided it can cause adhesions and
phimosis, as in the male. An accumulation of smegma in infants
and preadolescent girls under the prepuce is responsible for
adhesions between the glans and prepuce and for phimosis of the
clitoris [35,22].
The glans contains cavernous tissue, as in the male, in direct
contact with the skin due to the absence of the albuginea. It is rich
in nerve endings and in genital and KrauseFinger corpuscles, and
corpuscles of Pacini and Meissner [35,17]. These receptors,

because of the smaller dimensions of the clitoris, are more


concentrated in the female than in the male glans and they
probably do not require to surface to be excited by mechanical
stimuli. Some studies have suggested that penile mechanoreceptors are more responsive when the penis is erect or near body
temperature [23]. In fact the glans has a protopathic sensitivity and
it can be maintained, much more easily than in the male, in a state
of arousal without an evident increase in its dimensions, with an
easier receptiveness of the KrauseFinger corpuscles [1,5,24].
Verkauf et al. with prospective measurement of clitoral
dimensions in 200 normal women at routine gynecologic
examination in an ofce setting, suggested that the clitoris is
not inuenced by age, height, weight, or current use of oral
contraceptives, but in pregnant women it was signicantly larger
[25]; the clitoral sexual response is not affected by aging [1].
As in males, in females it is possible to have priapism of the
clitoris, a rare condition associated with prolonged erection of the
corpora cavernosa, an erection lasting for more than six hours and
unassociated with sexual arousal, causing engorgement, swelling,
and pain of the clitoris and immediate adjacent area. The cause of
priapism, in male and female, is impaired outow of blood from the
corpora cavernosa because of venous obstruction or because of
failure of the alpha-adrenergic relaxation system [26,27]. Most
reported cases of female priapism describe the association with the
use of antidepressant and other psychotropic drugs, all with alphaadrenergic blocking potential, such as trazodone, buproprion
citalopram and nefazodone. . . . Treatment consisted of discontinuing the offending medication or providing symptomatic pain relief.
Serious permanent damage where treatment has been delayed has
been reported in men but not in women. Furthermore, the
association between congenital clitoromegaly and priapism has
also not been reported previously. With this concern in mind, we
felt justied to resort to management options described for male
priapism but hitherto not for female priapism, i.e. the direct
injection with epinephrine and heparin, followed by aspiration to
provide immediate decompression [27].
3.4. The vestibular bulbs and the female corpus spongiosum
The vestibular bulbs are two erectile organs and correspond to
the urethral bulb in the male. The bulbs are situated in the anterior
region of the perineum, the bulboclitoral region, which is
homologous to penile region in the male. Their dimensions in
the accid state are 34 cm in length and they become engorged or
erected during arousal, when in the lower third of the vagina the
orgasmic platform of Masters and Johnson is reached [1,3
5,8,17].
The two bulbs are joined together, under the vestibule of the
vagina, by the commissure of the bulbs and, through the corpus
spongiosum or pars intermedia, they extend to the base of the
glans. The corpus spongiosum is constituted by cavernous tissue
which thins towards the glans and is situated underneath the
vestibular epithelium [35,8].
In the angle of the clitoris, in the space between the corpora
cavernosa and the female corpus spongiosum, there is the venous
plexus of Kobelt, responsible for communication between the
venous circulation of the bulbs and of the corpora cavernosa of the
clitoris; it corresponds to the inferior veins of the male corpora
cavernosa, which open in the inferior median sulcus between
corpora cavernosa and the male urethra, and receives the veins
coming from the upper part of the male corpus spongiosum [35].
The bulbs are covered by the bulbocavernosus muscles, which
are implicated in inferior vaginismus, while the pubovaginal
muscle is responsible for superior vaginismus. Some studies have
suggested that the components of the levator ani muscle are the
puborectal, iliococcygeal, pubovisceral muscles, further subdi-

[(Fig._1)TD$IG]

V. Puppo / European Journal of Obstetrics & Gynecology and Reproductive Biology 154 (2011) 38

Fig. 1. I, The male penis. II III, The female erectile organs (without vestibular bulb). Modied from: Puppo V. La sessualita` umana e leducazione a fare lamore. Firenze: Loggia
de Lanzi, 2005. I - 1, Glans. 2, Correspondent part to the labia minora. 3, Scrotum. 4, Anus. II - 1, Glans. 2, Labia minora. 3, Labia majora. 4, Anus. 5, Frenulum. 6, Sulcus
nympholabialis. III - 1, Corpora cavernosa. 2, Septum. 3, Corpus spongiosum. 4, Kobelts venous plexus.

vided into pubovaginal, puboperineal and puboanal. This terminology was accepted in 1998 by the Federative Committee on
Anatomical Terminology [35,28]. The rhythmic contractions of
lower third of the vagina during orgasm are mainly due to the
contractions of the bulbocavernosus muscle [1,35].
3.5. The corpus spongiosum of the female urethra
The corpus spongiosum of the urethra is present in all
women, as in the male. It is a cavernous tissue rich in veins,
situated at submucosal level and among the muscular bundles of
the smooth muscular tunica of the urethral wall. It becomes
engorged, or erect, with sexual arousal and Grafenberg in
1950 wrote In the course of sexual stimulation the female
urethra begins to enlarge [4,17,29]. Female urethral sensibility
has been little investigated until now, though Dickinson wrote
in 1949 Indeed, the meatus is largely endowed with special
sensibility [5], and Grafenberg in 1950 described some cases of
female and male urethral masturbation [29].
Therefore the erectile structures are the same in female and in
male. The clitoris is the homologue of the two corpora cavernosa,

[(Fig._2)TD$IG]

Fig. 2. The female erectile organs (The female penis without labia minora)
Modied from: Puppo V. La sessualita` umana e leducazione a fare lamore. Firenze:
Loggia de Lanzi, 2005. 1, Body. 2, Glans. 3, Suspensory ligament. 4, Angle of clitoris.
5, Vestibular bulb. 6, Crus. 7, Corpus spongiosum.

glans and prepuce of the male penis, and the male erection is
equivalent to the erection of all female erectile organs (vaginal
lubrication is a consequence of congestion) [35,17]. The female
external genitals are joined together even though separated by the
presence of the vaginal opening, and they represent the penis and
the scrotum of the male (Figs. 1 and 2) [35,8]. This has been
recognized for many years. In 1949 Dickinson wrote: Vulvo-vaginal
changes in excitement. Protrusion of erectile bulbs of vestibule.
Clitoris erection. Labial erection. [5]. Laqueur wrote that Realdus
Columbus, in 1559, named the love or sweetness of Venus
(amoris dulcedo) what he found in the nature, a female penis
[7,30].
4. Discussion
Addiego et al. in 1981 wrote: At the April, 1979, testing
session, the subject identied an erotically sensitive spot, palpable
through the anterior wall of her vagina. We subsequently named
this area the Grafenberg spot, in recognition of the person who
wrote of its existence and relationship to female ejaculation
(Grafenberg, 1950) [31]. Subsequently the Grafenberg spot (i.e.
intraurethral glands or female prostate) was seized on by the
popular media, which called it the G-spot. The G-spot is currently
an hypothesis: Grafenberg, in 1950, discovered no G-spot [29,32].
In his article he did not describe a vaginal spot, but the role of the
urethra in female orgasm (not the role of the vagina): the urethra,
on the anterior wall of the vagina, is a distinct erotogenic zone in
women [29].
Grafenberg described some cases of female urethral masturbation and the corpus spongiosum of the female urethra, stating that,
analogous to the male urethra, the female urethra also seems to
be surrounded by erectile tissues like the corpora cavernosa. He
did not report an orgasm of intraurethral glands, but wrote:
Involuntary expulsion of urine is reported in sex literature. In the
cases observed by us, the uid 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 [29].
In 1950 Grafenberg wrote about the corpus spongiosum of
the female urethra: In the course of sexual stimulation 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 [29]. The so-called G-spot of the anterior vaginal
wall is located in Pawlicks triangle (which corresponds to
Lieutauds triangle in bladder) that has a smooth vaginal mucosa
and it is only a space with minor resistance [4].

V. Puppo / European Journal of Obstetrics & Gynecology and Reproductive Biology 154 (2011) 38

Hines in 2001 wrote: Grafenberg discusses no evidence for a Gspot. . . .[Some female patients], he says, derived sexual pleasure
from inserting objects, such as hat pins, into their urethras. Just how
later writers (i.e. 2) transformed these reports into evidence for a Gspot is unclear. . . . Women who fail to nd their G-spot, because they
fail to respond to stimulation as the G-spot myth suggests that they
should, may end up feeling inadequate or abnormal. [32].
Burri et al. in 2010 wrote: The existence of the G-spot seems to
be widely accepted among women, despite the failure of numerous
behavioral, anatomical, and biochemical studies to prove its
existence. . . .there is no physiological or physical basis for the Gspot. [33]. Besides, there are no ultrasonographic images or
anatomical pictures of the G-spot, and the female prostate has no
anatomical structure that can cause an orgasm [35]. The
hypothetical area named G-spot should not be dened with
Grafenbergs name.
G-spot amplication is a procedure that is not medically
indicated. The American College of Obstetricians and Gynecologists states: So-called vaginal rejuvenation, designer vaginoplasty, revirgination, and G-spot amplication are vaginal surgical
procedures being offered by some practitioners. Women should be
informed about the lack of data supporting the efcacy of these
procedures and their potential complications, including infection,
altered sensation, dyspareunia, adhesions, and scarring [34].
The importance of orgasm has been questioned: Orgasm and
resolution are not essential in Bassons model of the sexual
response cycle [35]. Basson et al. in 2005 wrote, Orgasm may or
may not be necessary for sexual satisfaction [36]. According to
Masters and Johnson, however: Physiologically sexual response
could be described as a cycle with four phases: excitement,
plateau, orgasm, and resolution (i.e. the period of return to the
unaroused state) . . . If there has been considerable excitement but
orgasm has not occurred, resolution takes a longer time . . . there is
sometimes a lingering sensation of pelvic heaviness or aching that
is due to continued vasocongestion, . . .this may create a condition
of some discomfort, particularly if high levels of arousal were
prolonged [1,37].
In 1949 Dickinson wrote about long-term sequelae of female
sexual excitement without orgasm: Vulvo-vaginal changes in
excitement. Chronic or persisting alterations due to strong, long
continued and close-set repetition of excitation are the following:
(1) Inammation at mouth of duct of vulvo-vaginal gland. (2)
Prominent veins in certain locations about vulva. (3) Varicosities of
bulb, and of pars intermedia toward clitoris. (4) Varicosities in base
of broad ligament. (5) Varicosities in upper part of broad ligament.
(6) Enlargement of clitoris. (7) Labial enlargement. (8) Levator
thickening and irritability, followed by relaxation. (9) Hymen
gaping, worn, ironed out or disappearing. (10) Chronic bladder base
congestion, (11) Hemorrhoids. [5]. The evidence for these statements is unclear but physiologically, female sexual satisfaction is
based on orgasm and resolution [1,37,38].
5. Conclusion
Dickinson wrote: Exalting vaginal orgasm while decrying
clitoris satisfaction is found to beget much frustration. Orgasm is
orgasm, however achieved [5]. Masters and Johnson agreed.
Physiologically all female orgasms follow the same reex response
patterns, no matter what the source of sexual stimulation. An
orgasm that comes from rubbing the clitoris cannot be distinguished
physiologically from one that comes from intercourse or breast
stimulation alone [1,37]. Clitoral/vaginal/uterine orgasm, G/A/C/U
spot orgasm, are terms that should not be used by sexologists,
women and mass-media [3,4,38].
The female orgasm (and resolution) should be a normal phase of
the sexual response cycle, which is possible to achieve by all healthy

women with effective sexual stimulation, and aging alone does not
diminish female sexual interest or the potential of the woman to be
sexually responsive if her general health is good [1,37].
Clitoral bulbs, clitoral or clitorisurethrovaginal complex, urethrovaginal space, periurethral glans, genitosensory component of
the vagus nerve, and G-spot, are terms used by some sexologists but
they are not accepted or shared by experts in human anatomy
[3,4,38]. Findings from the disciplines of embryology, anatomy, and
physiology about the congestive structures of womens urogenital
areas, which are homologous to mens erectile organs, should form
the basis of the discourse about the biological basis womens orgasm.
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