8-13 Hz fluctuations in rectal pressure are an objective marker of clitorally-induced orgasm in women

Orgasm is a subjective experience accompanied by involuntary muscle contractions. We hypothesized that orgasm in women would be distinguishable by frequency analysis of a perineal muscle-derived signal. Rectal pressure, an index of perineal muscle activity, was measured continuously in 23 healthy women during different sexual tasks: receiving clitoral stimulation, imitation of orgasm, and attempt to reach orgasm, in which case the women were asked to report whether orgasm had been reached ("orgasm") or not ("failed orgasm attempt"). We performed spectral analysis on the rectal pressure data and calculated the spectral power in the frequency bands delta (0.5-4 Hz), theta (4-8 Hz), alpha (8-13 Hz), and beta (13-25 Hz). The most significant and most important difference in spectral power between orgasm and both control motor tasks (imitation of orgasm and failed orgasm attempt) was found in the alpha band. An objective rule based on spectral power in the alpha band recognized 94% (29/31) of orgasms and correctly labeled 69% (44/64) of all orgasm attempts as either successful or failed. Because outbursts of alpha fluctuations in rectal pressure only occurred during orgasm and not during voluntary imitation of orgasm or failed attempts, we propose that they represent involuntary contractions of muscles in the rectal vicinity. This is the first objective and quantitative measure that has a strong correspondence with the subjective experience of orgasm.

Effects of vibratory stimulation on sexual response in women with spinal cord injury

Women with spinal cord injuries (SCIs) have predictable alterations in sexual responses. They commonly have a decreased ability to achieve genital sexual arousal. This study determined whether the use of vibratory stimulation would result in increased genital arousal as measured by vaginal pulse amplitude in women with SCIs. Subjects included 46 women with SCIs and 11 nondisabled control subjects. Results revealed vibratory clitoral stimulation resulted in increased vaginal pulse amplitude as compared with manual clitoral stimulation in both SCI and nondisabled subjects; however, these differences were not statistically significant. Subjective levels of arousal were also compared between SCI and nondisabled control subjects. Both vibratory and manual clitoral stimulation resulted in significantly increased arousal levels in both groups of subjects; however, statistically significant differences between the two conditions were only noted in nondisabled subjects. Further studies of the effects of repetitive vibratory stimulation are underway.

The Female Prostate Revisited: Perineal Ultrasound and Biochemical Studies of Female Ejaculate

INTRODUCTION

Many speculations have been made on the possible existence of a "female prostate gland" and "female ejaculation." Despite several reports on the subject, controversy still exists around the "female prostate" and whether such a gland might be the source of fluid emitted during orgasm (ejaculation).

AIM

To investigate the ultrasonographic, biochemical, and endoscopic features in two women who reported actual ejaculations during orgasm.

MAIN OUTCOME MEASURES

Perineal ultrasound studies, as well as biochemical characteristics of ejaculate and urethroscopy, have been performed in two women.

METHODS

Two premenopausal women--44 and 45 years of age--who actually reported fluid expulsion (ejaculation) during orgasm have been investigated. Ultrasound imaging, biochemical studies of the ejaculated fluid, and endoscopy of the urethra have been used to identify a prostate in the female. Ejaculated fluid parameters have been compared to voided urine samples.

RESULTS

On high-definition perineal ultrasound images, a structure was identified consistent with the gland tissue surrounding the entire length of the female urethra. On urethroscopy, one midline opening (duct) was seen just inside the external meatus in the six-o'clock position. Biochemically, the fluid emitted during orgasm showed all the parameters found in prostate plasma in contrast to the values measured in voided urine.

CONCLUSIONS

Data of the two women presented further underline the concept of the female prostate both as an organ itself and as the source of female ejaculation.

Do women with female ejaculation have detrusor overactivity?

INTRODUCTION

Questionnaire surveys suggest that 40-54% of women have experienced an expulsion of fluid at orgasm. Some of these women have coital incontinence, whereas others identify the fluid passed as female ejaculate.

AIM

To assess whether women who have experienced female ejaculation have detrusor overactivity or the bothersome lower urinary tract symptoms associated with coital incontinence.

METHODS

We recruited six women who self-identified as having experienced female ejaculation and six controls who had not. Each woman completed a 3-day bladder diary and two validated bladder questionnaires: the Urgency Perception Scale (UPS) and the Incontinence Impact Questionnaire (IIQ). Each woman underwent short provocative ambulatory urodynamics, a modified form of urodynamics, with a high sensitivity for detrusor overactivity.

MAIN OUTCOME MEASURES

Prevalence of detrusor overactivity, 24-hour urinary frequency, IIQ and UPS scores.

RESULTS

No woman in either group had detrusor overactivity. The bladder diaries and questionnaire results were within the normal range for all women.

CONCLUSION

Women who experience female ejaculation may have normal voiding patterns, no bothersome incontinence symptoms, and no demonstrable detrusor overactivity. Women who report female ejaculation, in the absence of other lower urinary tract symptoms, do not require further investigation, and may be reassured that it is an uncommon, but physiological, phenomenon.

Sleep and sex: what can go wrong? A review of the literature on sleep related disorders and abnormal sexual behaviors and experiences

STUDY OBJECTIVES

To formulate the first classification of sleep related disorders and abnormal sexual behaviors and experiences.

DESIGN

A computerized literature search was conducted, and other sources, such as textbooks, were searched.

RESULTS

Many categories of sleep related disorders were represented in the classification: parasomnias (confusional arousals/sleepwalking, with or without obstructive sleep apnea; REM sleep behavior disorder); sleep related seizures; Kleine-Levin syndrome (KLS); severe chronic insomnia; restless legs syndrome; narcolepsy; sleep exacerbation of persistent sexual arousal syndrome; sleep related painful erections; sleep related dissociative disorders; nocturnal psychotic disorders; miscellaneous states. Kleine-Levin syndrome (78 cases) and parasomnias (31 cases) were most frequently reported. Parasomnias and sleep related seizures had overlapping and divergent clinical features. Thirty-one cases of parasomnias (25 males; mean age, 32 years) and 7 cases of sleep related seizures (4 males; mean age, 38 years) were identified. A full range of sleep related sexual behaviors with self and/or bed partners or others were reported, including masturbation, sexual vocalizations, fondling, sexual intercourse with climax, sexual assault/rape, ictal sexual hyperarousal, ictal orgasm, and ictal automatism. Adverse physical and/or psychosocial effects from the sleepsex were present in all parasomnia and sleep related seizure cases, but pleasurable effects were reported by 5 bed partners and by 3 patients with sleep related seizures. Forensic consequences were common, occurring in 35.5% (11/31) of parasomnia cases, with most (9/11) involving minors. All parasomnias cases reported amnesia for the sleep-sex, in contrast to 28.6% (2/7) of sleep related seizure cases. Polysomnography (without penile tumescence monitoring), performed in 26 of 31 parasomnia cases, documented sexual moaning from slow wave sleep in 3 cases and sexual intercourse during stage 1 sleep/wakefulness in one case (with sex provoked by the bed partner). Confusional arousals (CAs) were diagnosed as the cause of "sleepsex" ("sexsomnia") in 26 cases (with obstructive sleep apnea [OSA] comorbidity in 4 cases), and sleepwalking in 2 cases, totaling 90.3% (28/31) of cases being NREM sleep parasomnias. REM behavior disorder was the presumed cause in the other 3 cases. Bedtime clonazepam therapy was effective in 90% (9/10) of treated parasomnia cases; nasal continuous positive airway pressure therapy was effective in controlling comorbid OSA and CAs in both treated cases. All five treated patients with sleep related sexual seizures responded to anticonvulsant therapy. The hypersexuality in KLS, which was twice as common in males compared to females, had no reported effective therapy.

CONCLUSIONS

A broad range of sleep related disorders associated with abnormal sexual behaviors and experiences exists, with major clinical and forensic consequences.

Painful ejaculation

We reviewed previous publications on post-orgasmic pain with reference to prevalence, epidemiology and treatment options, using the Ovid and PubMed (updated May 2006) databases to comprehensively search MEDLINE for reports on post-orgasmic pain that included peer-reviewed English-language articles. Official proceedings of internationally known scientific societies were also assessed. Because of the heterogeneity of the studies we did not apply meta- analytic techniques to the data. The incidence of post-orgasmic pain is 1-9.7%. The ejaculatory pain is associated with prostatitis, chronic pelvic pain syndrome, benign prostatic hyperplasia, and ejaculatory duct obstruction; it is also described in patients after procedures like radical prostatectomy. Aetiopathogenic theories include those referring to bladder neck closure and pudendal neuropathy. The treatment options vary from self-care, a 'perineal hyperprotection programme' to medication with the alpha-blocker, topiramate, and even surgical procedures like removing a section of the sacrotuberous ligament, neurolysis of the pudendal nerve or removing a section of the sacrospinous ligament. This is the first update of the subject, with reference to prevalence, epidemiology and treatment options. There is a need for adequately powered, prospective randomized trials on aetiology and treatment options.

Correlation between insula activation and self-reported quality of orgasm in women

Current multidimensional models of women's sexual function acknowledge the implicit impact of psychosocial factors on women's sexual function. Interaction between human sexual function and intensity of love has been also assumed, even if love is not an absolute condition. Yet, whereas great insights have been made in understanding the central mechanisms of the peripheral manifestations of women's sexual response, including orgasm, the cerebral correlates sustaining the interaction between women's sexual satisfaction and the unconscious role of the partner in this interpersonal experience remain unknown. Using functional imaging, we assessed brain activity elicited when 29 healthy female volunteers were unconsciously exposed to the subliminal presentation of their significant partner's name (a task known to elicit a partner-related neural network) and correlated it with individual scores obtained from different sexual dimensions: self-reported partnered orgasm quality (ease, satisfaction, frequency), love intensity and emotional closeness with that partner. Behavioral results identified a correlation between love and self-reported partnered orgasm quality. The more women were in love/emotionally close to their partner, the more they tended to report being satisfied with the quality of their partnered orgasm. However, no relationship was found between intensity of love and partnered orgasm frequency. Neuroimaging data expanded these behavioral results by demonstrating the involvement of a specific left-lateralized insula focus of neural activity correlating with orgasm scores, irrespective of dimension (frequency, ease, satisfaction). In contrast, intensity of being in love was correlated with a network involving the angular gyrus. These findings strongly suggest that intimate and sexual relationships are sustained by partly different mechanisms, even if they share some emotional-related mechanisms. The critical correlation between self-reports of orgasm quality and activation of the left anterior insula, a part of the partner-related neural network known to play a pivotal role in somatic processes, suggests the importance of somatic information in the integration of sexual experience. On the other hand, the correlation between activation of the angular gyrus and love intensity reinforces the assumption that the representation of love calls for higher order cognitive levels, such as those related to the generation of abstract concepts. By highlighting the specific role of the anterior insula in the way women integrate components of physical satisfaction in the context of an intimate relationship with a partner, the current findings take a step in the understanding of a woman's sexual pleasure.

[A predictive model for the quality of sexual life in hysterectomized women]

BACKGROUND

The effects of hysterectomy on sexuality has been extensively studied.

AIM

To establish a model to predict the quality of sexual life in hysterectomized women, six months after surgery.

MATERIAL AND METHODS

Analytical, longitudinal and prospective study of 90 hysterectomized women aged 45+/-7 years. Two structured interviews at the time of surgery and six months later were carried out to determine the characteristics of sexuality and communication within the couple.

RESULTS

In the two interviews, communication and the quality of sexual life were described as "good" in 72 and 77% of women, respectively (NS). The variables that had a 40% influence on the quality of sexual life sixth months after surgery, were oophorectomy status, the presence of orgasm, the characteristics of communication and the basal sexuality with the couple.

CONCLUSIONS

The sexuality of the hysterectomized women will depend, on a great extent, of pre-surgical variables. Therefore, it is important to consider these variables for the education of hysterectomized women.

Brain activation during human male ejaculation revisited

In a prior [O]-H2O positron emission tomographic study we reported brain regions involved in human male ejaculation. Here, we used another, more recently acquired data set to evaluate the methodological approach of this previous study, and discovered that part of the reported activation pattern was not related to ejaculation. With a new analysis of these ejaculation data, we now demonstrate ejaculation-related activations in the deep cerebellar nuclei (dentate nucleus), anterior vermis, pons, and ventrolateral thalamus, and, most importantly, ejaculation-related deactivations throughout the prefrontal cortex. This revision offers a new and more accurate insight into the brain regions involved in human male ejaculation.

Associations between testosterone secretion and sexual activity in women

Some studies show an increase in testosterone (T) after sexual activity; this literature has inconsistent findings, focuses mostly on men, and does not employ control activities. The present study examined within-subject effects of intercourse versus control activities (cuddling; exercise) on salivary T. The initial sample included 49 women (mostly heterosexual), though not all participants returned all samples or engaged in all activities, leaving a smaller sample for endocrine analyses (n=16). Participants attended an initial session in the laboratory where they completed questionnaires, and then engaged in the activities on their own. On three separate nights, they provided pre-activity, post-activity, and next-morning saliva samples and completed brief questionnaires at the last two timepoints. Women's T was higher pre-intercourse than pre-control activity. Women's T was also higher post-intercourse than post-control activity, though the percent change in T from pre- to post-activity was highest for cuddling, then intercourse, then exercise. Next-morning T did not differ by activity. Data pointed to an association between T and orgasming, sexual desire, and relationship commitment. Analyses on post-activity appraisals suggest that the close intimate physicality of a sexual and non-sexual nature can affect T and be beneficial in short-term and perhaps longer-lasting ways for women's sexuality and relationships.

A 60-year-old woman with sexual difficulties

A growing body of evidence is available to guide care for women with sexual concerns. This article considers the case of a 60-year-old woman who with menopause developed decreased libido, rapidity of sexual arousal, and intensity of orgasm. She requests information about strategies to optimize sexual function. Effects of aging and menopause on female sexual response are reviewed and an evaluation approach presented to help clinicians respond productively to women who request intervention. The effectiveness and safety of different treatment options are discussed, including education, lifestyle changes, counseling, medications, mechanical devices, and pelvic floor exercises; recommendations are made to help postmenopausal women maximize sexual pleasure and satisfaction.

Sexual sequelae of general medical disorders

That sexual symptoms can signal serious underlying disease confirms the importance of sexual enquiry as an integral component of medical assessment. Data on sexual function are sparse in some medical specialties. However, increased scientific understanding of the central and peripheral physiology of sexual response could help to identify the pathophysiology of sexual dysfunction from disease and medical interventions, and also to ameliorate or prevent some dysfunctions. Many common general medical disorders have negative effects on desire, arousal, orgasm, ejaculation, and freedom from pain during sex. Chronic disease also interferes indirectly with sexual function, by altering relationships and self-image and causing fatigue, pain, disfigurement, and dependency. Current approaches to assessment of sexual dysfunction are based on models that combine psychological and biological aspects.

Genetic influences on variation in female orgasmic function: a twin study

Orgasmic dysfunction in females is commonly reported in the general population with little consensus on its aetiology. We performed a classical twin study to explore whether there were observable genetic influences on female orgasmic dysfunction. Adult females from the TwinsUK register were sent a confidential survey including questions on sexual problems. Complete responses to the questions on orgasmic dysfunction were obtained from 4037 women consisting of 683 monozygotic and 714 dizygotic pairs of female twins aged between 19 and 83 years. One in three women (32%) reported never or infrequently achieving orgasm during intercourse, with a corresponding figure of 21% during masturbation. A significant genetic influence was seen with an estimated heritability for difficulty reaching orgasm during intercourse of 34% (95% confidence interval 27-40%) and 45% (95% confidence interval 38-52%) for orgasm during masturbation. These results show that the wide variation in orgasmic dysfunction in females has a genetic basis and cannot be attributed solely to cultural influences. These results should stimulate further research into the biological and perhaps evolutionary processes governing female sexual function.

Triptans in orgasmic headache

Orgasmic headache (headache associated with sexual activity type 2 according to the International Headache Society classification) is a sudden severe headache which occurs at orgasm. Experiences with triptan therapy are described. Two out of four patients with severe headache continuing for >2 h had a positive response to acute triptan therapy. Two out of three patients using triptans as short-term prophylaxis reported a reliable response on several occasions. Triptans might be a treatment option to shorten orgasmic headache attacks after the diagnosis is clear and, particularly, subarachnoid haemorrhage has been excluded. In patients who chose to predict their sexual activity, short-term prophylaxis with oral triptans 30 min before sexual activity might be a therapeutic option in those not responsive to or not tolerating indomethacin.

A general look at female orgasm and anorgasmia

Male and female genital anatomy evolves from the same embryonic tissue. Is it therefore possible that males and females have the same potential for orgasmic response? Have forces external to a woman's biology influenced her potential enjoyment of this bodily function, or is female orgasm a by-product of that early sameness and variable because it has no or very little functional or evolutionary benefit? In modern times, we continue to study the anatomy and physiology of female sexual responses. The journey now is to understand the similarities and differences between the male and female sexual responses and be respectful of both. Female sexual response models and the classification of female sexual dysfunctions direct the thoughts and treatments of sexual and relationship therapists. The ultimate aim is to allow each woman to have the best possible sex life and orgasm, namely the one she wants. The psychophysiological treatments for female orgasmic dysfunction are on the whole successful. However, in anorgasmia proven to be biological in aetiology, following menopause for example, physiological changes occur that cannot be resolved by these strategies alone. We need to be supportive of the pharmaceutical industry finding medication that we can appropriately and responsibly use for the good of women with sexual difficulties, because good sexuality is a very important quality of life issue for very many women.

Toward an understanding of the cerebral substrates of woman's orgasm

The way women experience orgasm is of interest to scientists, clinicians, and laypeople. Whereas the origin and the function of a woman's orgasm remains controversial, the current models of sexual function acknowledge a combined role of central (spinal and cerebral) and peripheral processes during orgasm experience. At the central level, although it is accepted that the spinal cord drives orgasm, the cerebral involvement and cognitive representation of a woman's orgasm has not been extensively investigated. Important gaps in our knowledge remain. Recently, the astonishing advances of neuroimaging techniques applied in parallel with a neuropsychological approach allowed the unravelling of specific functional neuroanatomy of a woman's orgasm. Here, clinical and experimental findings on the cortico-subcortical pathway of a woman's orgasm are reviewed and compared with the neural basis of a man's orgasm. By defining the specific brain areas that sustain the assumed higher-order representation of a woman's orgasm, this review provides a foundation for future studies. The next challenge of functional imaging and neuropsychological studies is to understand the hierarchical interactions between these multiple cortical areas, not only with a correlation analysis but also with high spatio-temporal resolution techniques demonstrating the causal necessity, the temporal time course and the direction of the causality. Further studies using a multi-disciplinary approach are needed to identify the spatio-temporal dynamic of a woman's orgasm, its dysfunctions and possible new treatments.

Intercourse orgasm consistency, concordance of women's genital and subjective sexual arousal, and erotic stimulus presentation sequence

Many studies report discordance between women's genital (vaginal pulse amplitude) and subjective sexual arousal responses to erotica. Consistent with our previous research, I hypothesized that the association between physiological and subjective domains would be greater for women with greater orgasmic consistency (OC) during penile-vaginal intercourse but not for OC during masturbation or noncoital partnered sexual activities. I confirmed this specific hypothesis in a sample of young Dutch women (N = 27, mean age 20, all with current partners), replicating our earlier psychophysiological findings with postmenopausal women. Also replicated were the findings that intercourse OC (40% of the women had an orgasm from 90-100% of intercourse events, 44% from 9-89% of intercourse events) was not less than for other sexual activity and that OC during intercourse was uncorrelated with OC during masturbation. We observed the association of intercourse consistency with genital-subjective concordance when visual erotica was presented in a sequence of increasing intensity (analogous to typical real sexual encounters) but not when presented in decreasing, random, or fixed-intensity sequence. I discuss the results in terms of the unique nature of penile-vaginal intercourse and the study's implications for sex therapy and sex research.

Clitoris et point G: liaison fatale

Ultrasonography is a good means for studying the clitoris and its relationship with the G spot. We used it to demonstrate that clitoral bodies have a descending movement and come close to the distal anterior vaginal wall during a voluntary or reflex contraction of levator ani muscles. This fact could explain the particular sensitivity of the G spot and its role in the orgasm.

Regional cerebral blood flow changes associated with clitorally induced orgasm in healthy women

There is a severe lack of knowledge regarding the brain regions involved in human sexual performance in general, and female orgasm in particular. We used [15O]-H2O positron emission tomography to measure regional cerebral blood flow (rCBF) in 12 healthy women during a nonsexual resting state, clitorally induced orgasm, sexual clitoral stimulation (sexual arousal control) and imitation of orgasm (motor output control). Extracerebral markers of sexual performance and orgasm were rectal pressure variability (RPstd) and perceived level of sexual arousal (PSA). Sexual stimulation of the clitoris (compared to rest) significantly increased rCBF in the left secondary and right dorsal primary somatosensory cortex, providing the first account of neocortical processing of sexual clitoral information. In contrast, orgasm was mainly associated with profound rCBF decreases in the neocortex when compared with the control conditions (clitoral stimulation and imitation of orgasm), particularly in the left lateral orbitofrontal cortex, inferior temporal gyrus and anterior temporal pole. Significant positive correlations were found between RPstd and rCBF in the left deep cerebellar nuclei, and between PSA and rCBF in the ventral midbrain and right caudate nucleus. We propose that decreased blood flow in the left lateral orbitofrontal cortex signifies behavioural disinhibition during orgasm in women, and that deactivation of the temporal lobe is directly related to high sexual arousal. In addition, the deep cerebellar nuclei may be involved in orgasm-specific muscle contractions while the involvement of the ventral midbrain and right caudate nucleus suggests a role for dopamine in female sexual arousal and orgasm.

Sexual Dysfunctions and Blood Hormonal Profile in Men with Focal Epilepsy

PURPOSE

To evaluate the incidence of sexual dysfunction in men with focal epilepsy and to establish their hormonal profiles.

METHODS

We prospectively analyzed sexual functions and hormone blood levels in 40 male patients (age ranged from 18 to 44 years, with an average age of 27.6+/-5.6 years) with refractory focal epilepsy. We used the Czech version of the structured questionnaire entitled International Inventory of Erectile Function (IIEF) to assess the patients' sexual functions. The subscales of this questionnaire separately evaluate erectile function (IIEF I), orgasmic function (IIEF II), sexual desire (IIEF III), intercourse satisfaction (IIEF IV), and overall satisfaction with sex life (IIEF V). In all of the patients, the following blood tests were performed: quantitative assessment of blood levels of prolactin (PRL), total testosterone (total-T), free androgen index (FAI), sexual hormone-binding globulin (SHBG), estradiol (E2), dehydroepiandrosterone sulfate (DHEAS), progesterone (PRG), follicle-stimulating hormone (FSH), and luteinizing hormone (LH). All these quantitative laboratory data were correlated with other clinical variables and with the results of the IIEF. chi2 and Wilcoxon tests were used for the statistical analysis. A p-value<0.05 was considered to be statistically significant.

RESULTS

At least one of the types of sexual dysfunction, as defined by IIEF (IIEF I, II, and III), was found in 22 (55%) of the 40 patients (55%). Erectile dysfunction (IIEF I) was found in six (15%) of 40 patients, orgasmic dysfunction (IIEF II) in six (15%) of 40 patients, and loss of sexual desire (IIEF III) in 16 (40%) of 40 patients. According to other subscales of IIEF, 22 (55%) of 40 patients were not satisfied with sexual intercourse (IIEF IV), and 20 (50%) of 40 patients were not satisfied with their sex livee (IIEF V). None of the subscales of IIEF was significantly correlated with the age of the patients or with the duration of epilepsy. In patients with at least one of the sexual dysfunctions (IIEF I, II, and III), we found a statistically significant increase of FSH and SHBG, and a decrease of DHEAS and FAI in comparison with those in the patients with normal sexual functions. In patients with erectile dysfunction, we found the same changes and a significant increase of E2. In patients with orgasmic dysfunction, we found a statistically significant decrease of DHEAS. In patients with dysfunction of sexual desire, we noticed a significant increase of SHBG and a decrease of DHEAS and FAI. All patients with orgasmic dysfunction were being treated with carbamazepine (CBZ) in monotherapy or combination therapy. In patients with at least one type of sexual dysfunction (IIEF I, II, and III), we found a higher proportion of valproate treatment in monotherapy or combination therapy in comparison with CBZ.

CONCLUSIONS

Our study showed a relatively high incidence of sexual dysfunction and dissatisfaction with sexual intercourse and sex life, as defined by the IIEF I-V questionnaire, in men with refractory focal epilepsy. The most frequent dysfunction in these patients is the impairment of sexual desire. However, our study indicates some specific hormonal changes related to various types of sexual dysfunction that are not related to antiepileptic drug treatment.