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Tunçkol E, Heim C, Brunk I, Vida I, Brecht M. Innervation pattern and fiber counts of the human dorsal nerve of clitoris. Sci Rep 2024; 14:23060. [PMID: 39367034 DOI: 10.1038/s41598-024-72898-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 09/11/2024] [Indexed: 10/06/2024] Open
Abstract
Even tough clitoris plays a critical role in female sexuality, we lack a precise understanding of qualitative and quantitative aspects of the innervation of the human clitoris. To address this issue, we dissected human clitorides from body donors and imaged them after staining with iodine with microCT for a macroscopic analysis. To resolve innervation patterns at the microscopic level we prepared thin sections of clitorides and stained them with trichrome azan to reveal the tissue structure combined with immunocytochemistry against Neurofilament H antibodies to reveal all axons and luxol blue labeling to reveal myelinated axons. We find the clitoral branch of pudendal nerve that innervates the clitoris not as single nerve, but as number of loose bundles. In the crus of the clitoris, about 12 such bundles can be recognized while about 32 bundles are present in the clitoral hemi-body. We counted on avarage 2917 axons in the crus of the clitoris (76% of which are myelinated) and 3137 axons in the hemibody of the clitoris (71% of which are myelinated). While the human clitoris receives only one third of the number of axons that innervate the human penis, an estimate of innervation density (per surface area) revealed that clitoris has approximately 6 times denser innervation compared to the penis. Thus, our study combines histology with microCT analysis provides detailed information on the number, myelination and innervation density of dorsal nerve of clitoris.
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Affiliation(s)
- Elçin Tunçkol
- Bernstein Center for Computational Neuroscience Berlin, Humboldt-Universität zu Berlin, Philippstrasse 13, Haus 6, Berlin, Germany
| | - Christine Heim
- Institute of Medical Psychology, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117, Berlin, Germany
| | - Irene Brunk
- Institute for Integrative Neuroanatomy, Charité - Universitätsmedizin Berlin, CCM, Philippstrasse 12, 10115, Berlin, Germany
| | - Imre Vida
- Institute for Integrative Neuroanatomy, Charité - Universitätsmedizin Berlin, CCM, Philippstrasse 12, 10115, Berlin, Germany
| | - Michael Brecht
- Bernstein Center for Computational Neuroscience Berlin, Humboldt-Universität zu Berlin, Philippstrasse 13, Haus 6, Berlin, Germany.
- NeuroCure Cluster of Excellence, Humboldt-Universität zu Berlin, Berlin, Germany.
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Cutillas-Blasco S, Ruiz-Gonzalez C, Rueda-Ruzafa L, Ropero-Padilla C, Roman P, Rodriguez-Arrastia M. Experiences of young women in the practice of squirting: a descriptive qualitative study. J Sex Med 2024; 21:691-699. [PMID: 38899734 DOI: 10.1093/jsxmed/qdae065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 05/09/2024] [Accepted: 05/14/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND While female ejaculation is viewed as a potential enhancer of women's sexual experiences and their relationships with their sexual partners, existing studies to date emphasize the need for further exploration of the squirting phenomenon. AIM The study sought to explore experiences and perceptions about the phenomenon of squirting in young adult women. METHODS A descriptive qualitative study was conducted. Semi-structured, in-depth interviews were conducted between December 2022 and March 2023. Seventeen young adult women who experienced squirting were recruited using a convenience and snowball sampling. ATLAS.ti v.9 software was used for a thematic analysis of the interview data. The study adhered to the recommendations for reporting qualitative research (Standards for Reporting Qualitative Research). OUTCOMES The outcomes included (1) exploring factors influencing initial squirting experiences, (2) insights gained through squirting experiences, (3) communication as the cornerstone in sexual relationships, and (4) resources and sources for knowledge on the squirting phenomenon. RESULTS After the analysis of the results, the following subthemes emerged: (1) first perceptions on squirting, (2) facilitating factors, (3) physical sensations and psychological aspects in squirting experience, (4) sources of information about squirting and (5) addressing squirting in comprehensive sex education. CLINICAL IMPLICATIONS Frontline healthcare providers should undergo specific training to address anxiety related to squirting among certain individuals and enhance societal awareness while offering emotional support for diverse sexual response variations. STRENGTHS AND LIMITATIONS Acknowledging limitations in our study of young women's experiences with squirting, a more diverse sample could provide alternative insights. Despite this, our findings contribute valuable knowledge, suggesting avenues for professional training to promote sexual and reproductive health in a more realistic and sensitive manner. CONCLUSION This study explored the emotional and psychological effects of squirting on women's sexual experiences, ranging from heightened arousal to feelings of humiliation and embarrassment. It emphasized the importance of a partner's reaction in interpreting the event and the limited understanding of squirting, often influenced by pornography.
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Affiliation(s)
- Selene Cutillas-Blasco
- Department of Nursing Science, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, Carr. Sacramento, s/n, 04120, La Cañada, Almería, Spain
| | - Cristofer Ruiz-Gonzalez
- Torrecardenas University Hospital, 04120 Almería, Spain
- Research Group CTS-1114 Advances and Innovation in Health, University of Almería, 04120 Almería, Spain
| | - Lola Rueda-Ruzafa
- Department of Nursing Science, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, Carr. Sacramento, s/n, 04120, La Cañada, Almería, Spain
- Research Group CTS-1114 Advances and Innovation in Health, University of Almería, 04120 Almería, Spain
| | - Carmen Ropero-Padilla
- Department of Nursing Science, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, Carr. Sacramento, s/n, 04120, La Cañada, Almería, Spain
- Research Group CTS-1114 Advances and Innovation in Health, University of Almería, 04120 Almería, Spain
- Research Group Science Flows, Universitat de València, Av. de Blasco Ibáñez, 13, El Pla del Real, 46010 Valencia, Spain
| | - Pablo Roman
- Department of Nursing Science, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, Carr. Sacramento, s/n, 04120, La Cañada, Almería, Spain
- Research Group CTS-1114 Advances and Innovation in Health, University of Almería, 04120 Almería, Spain
- Health Research Center CEINSA, University of Almería, 04120 Almería, Spain
| | - Miguel Rodriguez-Arrastia
- Department of Nursing Science, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, Carr. Sacramento, s/n, 04120, La Cañada, Almería, Spain
- Research Group CTS-1114 Advances and Innovation in Health, University of Almería, 04120 Almería, Spain
- Research Group Science Flows, Universitat de València, Av. de Blasco Ibáñez, 13, El Pla del Real, 46010 Valencia, Spain
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Hensel DJ, von Hippel CD, Lapage CC, Perkins RH. Vaginal Squirting: Experiences, Discoveries, and Strategies in a U.S. Probability Sample of Women Ages 18-93. JOURNAL OF SEX RESEARCH 2024; 61:529-539. [PMID: 37606312 DOI: 10.1080/00224499.2023.2243939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
Vaginal squirting is a phenomenon in which women expel fluid during the sexual response process, but it remains poorly understood in the extant literature. The study purpose was to use nationally representative data to investigate adult women's experiences with vaginal squirting. We assessed the prevalence of women who have ever squirted in their lifetime, the level of pleasure and concurrency of orgasm women reported during squirting, the ways in which women discovered squirting, and the challenges and/or concerns women experience with squirting. Forty percent of U.S. adult women (M = 47.6 years, SD = 16.8; Md = 24 years) had ever squirted in their lifetime (Md frequency = three to five times). Two thirds of women reported unintentional discovery of squirting, and most (75%) used specific techniques to promote build up and release of squirting versus squirting spontaneously. About 60% of participants reported squirting to be very or somewhat pleasurable, but only 20% "always" experienced squirting and orgasm together. Women reported different challenges with squirting, such as the time required to reach squirting or the experience being too emotionally intense. Our findings contribute to the growth of much needed, detailed literature on the ways in which women discover and enjoy squirting as part of their sexual lives. Knowledge of these techniques can enable women to better identify their own preferences, communicate about them with their partners, and advocate for their sexual pleasure.
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Affiliation(s)
- Devon J Hensel
- Department of Pediatrics, Division of Adolescent Medicine, Indiana University School of Medicine
- Department of Sociology, Indiana University Purdue University-Indianapolis
- OMGYES Research Group, For Goodness Sake LLC
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Beserman Navon L. 'And she shall be called woman, because she was taken out of man': androcentrism and the creation of knowledge-driven ignorance. CULTURE, HEALTH & SEXUALITY 2024; 26:377-390. [PMID: 37255224 DOI: 10.1080/13691058.2023.2212291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 05/06/2023] [Indexed: 06/01/2023]
Abstract
In this paper, I critically analyse biomedical clinical studies and literature reviews regarding the physiological phenomenon known as female ejaculation to demonstrate a process by which androcentric bias, which positions the male body as the scientific 'standard human', produces what I term as knowledge-driven ignorance. I show how even though knowledge about female ejaculation has expanded, its biomedical ontological status remains vague and controversial. The production of ignorance in this case does not result from active erasure or concealment, but rather from unintentional disregard, and is a by-product of knowledge-creation itself. As such, it is not only the narration of the scientific story that has the power to abject and exclude certain bodies from culture, but also what is untold and unknown.
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Affiliation(s)
- Lior Beserman Navon
- Department of Sociology and Anthropology, The Hebrew University of Jerusalem, Jerusalem, Israel
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Arias-Castillo L, García L, García-Perdomo HA. The complexity of female orgasm and ejaculation. Arch Gynecol Obstet 2023; 308:427-434. [PMID: 36208324 DOI: 10.1007/s00404-022-06810-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 09/28/2022] [Indexed: 11/02/2022]
Abstract
The anatomy and physiology of the female orgasm are often neglected. The female orgasm is a normal psychophysiological function to all women, and some even can achieve ejaculation as part of the normal physiological response at the height of sexual arousal. The complexity of female sexuality requires a deep understanding of genital anatomy. The clitoris is the principal organ for female pleasure. The vaginal stimulation of the anterior vaginal wall led women to orgasm due to the stimulation of the clitourethrovaginal complex and not due to stimulation of a particular organ called the G spot in the anterior distal vaginal wall. Female ejaculation follows orgasm. It consists of the orgasmic expulsion of a smaller quantity of whitish fluid produced by the female prostate. Squirting can be differentiated from female ejaculation because it is the orgasmic transurethral expulsion of a substantial amount of diluted urine during sexual activity, and it is not considered pathological. The female orgasm is influenced by many aspects such as communication, emotional intimacy, long-standing relationship, adequate body image and self-esteem, proper touching and knowledge of the female body, regular masturbation, male sexual performance, male and female fertility, chronic pain, and capacity to engage in new sexual acts. Stronger orgasms could be achieved when clitoral stimulation, anterior vaginal wall stimulation, and oral sex is involved in the same sexual act.
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Affiliation(s)
- Liliana Arias-Castillo
- Department of Family Medicine, School of Medicine, Academic Vice President Universidad del Valle, Cali, Colombia
| | - Lina García
- UROGIV Research Group, School of Medicine, Universidad del Valle, Cll 4b # 36-00, Cali, Colombia
| | - Herney Andrés García-Perdomo
- UROGIV Research Group, School of Medicine, Universidad del Valle, Cll 4b # 36-00, Cali, Colombia.
- Division of Urology/Urooncology, Department of Surgery, School of Medicine, Universidad del Valle, Cali, Colombia.
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O'Dwyer C, Kumar S, Wassersug R, Khorrami A, Mukherjee S, Mankowski P, Genoway K, Kavanagh AG. Vaginal self-lubrication following peritoneal, penile inversion, and colonic gender-affirming vaginoplasty: a physiologic, anatomic, and histologic review. Sex Med Rev 2023:7146050. [PMID: 37105933 DOI: 10.1093/sxmrev/qead015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/20/2023] [Accepted: 03/23/2023] [Indexed: 04/29/2023]
Abstract
INTRODUCTION Vaginal self-lubrication is central to the sexual satisfaction and healthy genitourinary function of patients who have undergone gender-affirming vaginoplasty (GAV). Secretory capacities of different neovaginal lining tissues have been variably described in the literature, with little evidence-based consensus on their success in providing a functionally self-lubricating neovagina. We review the existing neovaginal lubrication data and the anatomy, histology, and physiology of penile and scrotal skin, colon, and peritoneum to better characterize their capacity to be functionally self-lubricating when used as neovaginal lining. OBJECTIVES The study sought to review and compare the merits of penile and scrotal skin grafts, spatulated urethra, colon, and peritoneal flaps to produce functional lubrication analogous to that of the natal vagina in the setting of GAV. METHODS We conducted a systematic review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Medline, EMBASE, ClinicalTrials.gov, and the Cochrane Library databases were searched for peer-reviewed studies published prior to December 12, 2022, that (1) included data specific to transfeminine individuals; (2) were full-text randomized controlled studies, case reports, case series, retrospective cohort studies, prospective cohort studies, qualitative studies, and cross-sectional studies; and (3) included specific discussion of vaginal lubrication or fluid secretion following GAV utilizing penile skin, colonic tissue, or peritoneum. RESULTS We identified 580 studies, of which 28 met our inclusion criteria. Data on neovaginal lubrication were limited to qualitative clinician observations, patient-reported outcomes, and satisfaction measures. No studies quantifying neovaginal secretions were identified for any GAV graft or flap technique. Anatomically, penile and scrotal skin have no self-lubricating potential, though penile inversion vaginoplasty may produce some sexually responsive secretory fluid when urethral tissue is incorporated and lubricating genitourinary accessory glands are retained. Colonic and peritoneal tissues both have secretory capacity, but fluid production by these tissues is continuous, nonresponsive to sexual arousal, and likely inappropriate in volume, and so may not meet the needs or expectations of some patients. The impact of surgical tissue translocation on their innate secretory function has not been documented. CONCLUSIONS None of penile/scrotal skin, colon, or peritoneum provides functional neovaginal lubrication comparable to that of the adult natal vagina. Each tissue has limitations, particularly with respect to inappropriate volume and/or chronicity of secretions. The existing evidence does not support recommending one GAV technique over others based on lubrication outcomes. Finally, difficulty distinguishing between physiologic and pathologic neovaginal fluid secretion may confound the assessment of neovaginal self-lubrication, as many pathologies of the neovagina present with symptomatic discharge.
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Affiliation(s)
- Cormac O'Dwyer
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
- Gender Surgery Program of British Columbia, Vancouver Coastal Health, Vancouver, British Columbia V5Z 1M9, Canada
| | - Sahil Kumar
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
- Gender Surgery Program of British Columbia, Vancouver Coastal Health, Vancouver, British Columbia V5Z 1M9, Canada
| | - Richard Wassersug
- Gender Surgery Program of British Columbia, Vancouver Coastal Health, Vancouver, British Columbia V5Z 1M9, Canada
| | - Amir Khorrami
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
- Gender Surgery Program of British Columbia, Vancouver Coastal Health, Vancouver, British Columbia V5Z 1M9, Canada
| | - Smita Mukherjee
- Gender Surgery Program of British Columbia, Vancouver Coastal Health, Vancouver, British Columbia V5Z 1M9, Canada
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia V5Z 1M9, Canada
| | - Peter Mankowski
- Gender Surgery Program of British Columbia, Vancouver Coastal Health, Vancouver, British Columbia V5Z 1M9, Canada
- Division of Plastic and Reconstructive Surgery, University of British Columbia, Vancouver, British Columbia V5Z 1M9, Canada
| | - Krista Genoway
- Gender Surgery Program of British Columbia, Vancouver Coastal Health, Vancouver, British Columbia V5Z 1M9, Canada
- Division of Plastic and Reconstructive Surgery, University of British Columbia, Vancouver, British Columbia V5Z 1M9, Canada
| | - Alexander G Kavanagh
- Gender Surgery Program of British Columbia, Vancouver Coastal Health, Vancouver, British Columbia V5Z 1M9, Canada
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia V5Z 1M9, Canada
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Tzelepis K, Zacharouli K, Samara AA, Koutras A, Kontomanolis EN, Perivoliotis K, Pavlidou E, Sotiriou S. Large Cyst of Skene Gland: A Rare Perineum Mass. Surg J (N Y) 2023; 9:e71-e74. [PMID: 37192958 PMCID: PMC10183249 DOI: 10.1055/s-0043-1768944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/12/2023] [Indexed: 05/18/2023] Open
Abstract
Objective In this report we present a rare case of a large cyst of Skene gland in a female patient with a palpable vaginal mass persisting for at least 2 years. Case Report A 67-year-old female admitted to the department of urology due to the presence of "a vaginal mass" for the past 2 years. A cyst of Skene's duct was suspected based on clinical manifestation and findings of magnetic resonance imaging showing an extensive cyst formation in the upper vaginal area and anterior to the urethra. Based on these findings, a decision for surgical removement of the cyst was made. The cyst was incised, drained, and marsupialized. The postoperative recovery was uneventful, and the patient was discharged on the second postoperative day. Conclusion High clinical suspicion is important to reach this rare diagnosis. Partial excision and marsupialization of the cyst is a simple procedure with low morbidity, without recurrence, and excellent results.
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Affiliation(s)
| | - Konstantina Zacharouli
- Department of Pathology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Athina A. Samara
- Laboratory of Histology and Embryology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
- Address for correspondence Athina A. Samara, MD, MSc Department of Embryology, University of ThessalyMezourlo Hill, 41100, LarissaGreece
| | - Antonios Koutras
- Department of Obstetrics and Gynecology, Alexandra Hospital, Kapodistrian University of Athens, Athens, Greece
| | - Emmanuel N. Kontomanolis
- Department of Obstetrics and Gynecology, Faculty of Medicine, School of Health Sciences, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Efterpi Pavlidou
- Department of Speech and Language Therapy, University of Ioannina, Ioannina, Greece
| | - Sotirios Sotiriou
- Laboratory of Histology and Embryology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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Affiliation(s)
- Zlatko Pastor
- Obstetrics and Gynecology Department, 2nd Medical Faculty, University Hospital Motol, Charles University, Prague 5, Czech Republic
| | - Roman Chmel
- Obstetrics and Gynecology Department, 2nd Medical Faculty, University Hospital Motol, Charles University, Prague 5, Czech Republic
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Inoue M. Response to Re: Enhanced visualization of female squirting. Int J Urol 2023; 30:244. [PMID: 36415125 DOI: 10.1111/iju.15107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 11/24/2022]
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Inoue M, Sekiguchi Y, Ninomiya N, Kobayashi T, Araki M. Enhanced visualization of female squirting. Int J Urol 2022; 29:1368-1370. [PMID: 36000809 DOI: 10.1111/iju.15004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/13/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Squirting is the involuntary expulsion of fluid from the female urethra following stimulation of the anterior vaginal wall before or during orgasm. The mechanism underlying squirting has not been established. PURPOSE To elucidate the mechanism of squirting. METHODS The subjects in the current study were women who were able to squirt. They were not sex workers. A urethral catheter was inserted before sexual stimulation and the bladder was emptied. Then, a mixture of indigo carmine (10 ml) and saline (40 ml) was injected into the bladder. Sexual stimulation was provided to facilitate squirting, which was videotaped and verified. The secretions were collected in sterile cups, and prostate specific antigen (PSA) and glucose levels were measured. RESULTS Five women (2 in the 30s, 2 in the 40s, and 1 in the 50s) participated in this study. All women were able to squirt; three squirted only with manual sexual stimulation and two with penetrative sexual stimulation. The discharged fluid was blue in all cases, confirming the bladder as the source. The fluid was PSA-positive in four patients. CONCLUSIONS The main component of squirt fluid is urine, but may also contain fluid from Skene's glands (female prostate). This is the first report in which visualization of squirting was enhanced.
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Affiliation(s)
| | | | | | - Tomoko Kobayashi
- Okayama Central Hospital, Okayama, Japan.,Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Motoo Araki
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Vaginal Lubrication and Pressure Increase Induced by Pudendal Nerve Stimulation in Cats. J Sex Med 2022; 19:1517-1523. [PMID: 36057523 DOI: 10.1016/j.jsxm.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/25/2022] [Accepted: 07/31/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Vaginal lubrication and contractions are among the top difficulties affecting sexual intercourse in women after spinal cord injury. AIM This study aimed at determining if pudendal nerve stimulation (PNS) can improve vaginal lubrication and induce increases in vaginal pressure. METHODS In anesthetized cats, a small piece of cotton was inserted into the vagina for 10 minutes with or without PNS to measure vaginal wetness by the weight increase of the vaginal cotton. Then, a small balloon catheter was inserted into the vagina to measure the pressure increase induced by PNS. Intensity response of the vagina to PNS (30 Hz, 0.2 ms, 5 seconds) was determined at 1-4 times of intensity threshold (T) for PNS to induce an observable vaginal pressure increase. Frequency response was determined at 2T intensity in a range of PNS frequencies (5-50 Hz). Finally, fatigue in vaginal pressure was determined by applying PNS (30 Hz, 2T) either continuously or intermittently (5 seconds on and 5 seconds off) for 4 minutes. OUTCOMES The effectiveness of PNS in increasing vaginal wetness and pressure is evaluated. RESULTS PNS significantly (P = .0327) increased the measurement of vaginal wetness from 15.8 ± 3.8 mg during control without stimulation to 32.4 ± 4.7 mg after stimulation. Vaginal pressure increased as PNS intensity or frequency increased. PNS (30 Hz, 2T) induced vaginal pressure increase ≥80% of the maximal response. Intermittent PNS induced significantly (P = .0354) smaller fatigue (45.6 ± 3.7%) in vaginal pressure than continuous PNS (69.1 ± 3.0%) during the 4-minute stimulation. CLINICAL TRANSLATION This study raises the possibility of developing a novel pudendal neuromodulation device to improve female sexual function after spinal cord injury. STRENGTHS & LIMITATIONS This study provides preclinical data supporting the development of a novel pudendal neuromodulation device. The limitation includes the lack of chemical analysis of the vaginal secretion. CONCLUSION PNS can improve vaginal lubrication and induce increases in vaginal pressure.
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Szell N, Flashenburg J. Midurethral Slings and Female Sexual Dysfunction. J Sex Med 2022; 19:1317-1320. [DOI: 10.1016/j.jsxm.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/19/2022] [Accepted: 06/24/2022] [Indexed: 10/16/2022]
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Pitak-Arnnop P, Messer-Peti R, Tangmanee C, Neff A, Meningaud JP. Prostate cancer awareness among transgender women after gender-affirming surgery. Prostate 2022; 82:1060-1067. [PMID: 35416318 DOI: 10.1002/pros.24355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/02/2022] [Accepted: 04/04/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND The prostate gland remains unresected during gender-affirming surgery (GAS) for transgender women (TGW), and may develop malignancies in later life. We sought to evaluate prostate cancer awareness (PCA) among post-GAS TGW. METHODS The investigators implemented a cross-sectional study and enrolled a sample of Thai post-GAS TGW without medical background. Predictor variables were categorized as demographic, clinical, operative, or postoperative. The outcome variable was PCA (yes/no). Appropriate statistics were computed, and a p-value ≤ 0.05 was considered statistically significant. RESULTS The sample consisted of 100 Thai post-GAS TGW (4% bisexual, 12% bachelor [or higher] graduates, 51% service workers, 64% had monthly net income <40,000 TB [or ca. 1050 Euro], 92% operated by plastic surgeons) with a mean age of 26.2 ± 5.4 years (range: 18-45). On bivariate analysis, PCA was significantly associated with educational level (p = 0.007; adjusted odd ratio [ORadj. ]: 5.85; 95% confidence interval [95% CI]: 1.65-20.69), being operated ≥ 10 years (p = 0.01; ORadj. : 0.16; 95% CI: 0.04-0.76), self-recognition of the remaining prostate gland (p = 0.0001; ORadj. : 0.02; 95% CI: 0-0.12), and emphasis on PCA by the GAS operator (p = 0.01; ORadj. : 0.07; 95% CI: 0.01-0.63). Multiple linear regression analysis revealed a statistically significant, positive correlation (r = 0.78; p = 0.0001) among these four predictors, and continued to confirm the positive effect on PCA in TGW with high education and realization of the prostate gland (r = 0.56; p = 0.04) or information on PCA by the operator (r = 0.68; p = 0.003). CONCLUSION The GSA operator should intensively inform TGW about the remnant prostate and the risk of PC, especially those with low and middle levels of education attained.
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Affiliation(s)
- Poramate Pitak-Arnnop
- Department of Oral and Craniomaxillofacial Plastic Surgery, University Hospital of Giessen and Marburg, UKGM GmbH, Campus Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
| | - Robert Messer-Peti
- Department of Urology, Caritas Hospital Bad Mergentheim and Tauberfranken Prostate Centre - Academic Teaching Hospital of Julius-Maximilians-University of Würzburg, Bad Mergentheim, Germany
| | - Chatpong Tangmanee
- Department of Statistics, Chulalongkorn Business School, Bangkok, Thailand
| | - Andreas Neff
- Department of Oral and Craniomaxillofacial Plastic Surgery, University Hospital of Giessen and Marburg, UKGM GmbH, Campus Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
| | - Jean-Paul Meningaud
- Department of Plastic, Reconstructive, Aesthetic and Maxillofacial Surgery, Henri Mondor University Hospital, AP-HP, Faculty of Medicine, University Paris-Est Créteil Val de Marne (Paris XII), Créteil, France
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Pastor Z, Chmel R. Female Ejaculation and Squirting as Similar but Completely Different Phenomena: A Narrative Review of Current Research. Clin Anat 2022; 35:616-625. [PMID: 35388532 DOI: 10.1002/ca.23879] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/03/2022] [Accepted: 04/04/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Women expel fluids of various quantities and compositions from the urethra during sexual arousal and orgasm. These are classified as either female ejaculation (FE) or squirting (SQ). The aim of our analysis was to present evidence that FE and SQ are similar but etiologically different phenomena. MATERIALS AND METHODS A review of studies was performed on fluids expelled from the urogenital tract during female sexual activities using the Web of Knowledge TM (Web of Science Core Collection) and MEDLINE (Ovid) databases from 1946 to 2021. RESULTS Until 2011, all female orgasmic expulsions of fluids were referred to as FE. The fluid was known to be either from the paraurethral glands or as a result of coital incontinence. At present, SQ is considered as a transurethral expulsion of approximately ten milliliters or more of transparent fluid, while FE is considered as a secretion of a few milliliters of thick fluid. The fluid in SQ is similar to urine and is expelled by the urinary bladder. The secretion in FE originates from the paraurethral glands and contains a high concentration of prostate-specific antigen. Both phenomena can occur simultaneously. CONCLUSIONS The mechanisms underlying SQ and FE are entirely different. SQ is a massive transurethral orgasmic expulsion from the urinary bladder, while FE is the secretion of a very small amount of fluid from the paraurethral glands.
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Affiliation(s)
- Zlatko Pastor
- Obstetrics and Gynecology Department, University Hospital Motol and 2nd Medical Faculty of Charles University, Prague, Czech Republic
| | - Roman Chmel
- Obstetrics and Gynecology Department, University Hospital Motol and 2nd Medical Faculty of Charles University, Prague, Czech Republic
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Tomalty D, Giovannetti O, Hannan J, Komisaruk B, Goldstein S, Goldstein I, Adams M. Should We Call It a Prostate? A Review of the Female Periurethral Glandular Tissue Morphology, Histochemistry, Nomenclature, and Role in Iatrogenic Sexual Dysfunction. Sex Med Rev 2022; 10:183-194. [PMID: 35074318 DOI: 10.1016/j.sxmr.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/13/2021] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION There is evidence of glandular tissue within the region of the anterior vaginal wall-female periurethral tissue (AVW-FPT) having similar morphology and immunohistochemistry to the prostate in men and having physiological roles in the female sexual response (FSR). Whether this tissue should be called a prostate in women has been debated. Iatrogenic injury to structures of the AVW-FPT, including these glands and the associated neurovasculature, could be a cause of female sexual dysfunction (FSD). OBJECTIVES To consolidate the current knowledge concerning the glandular tissue surrounding the urethra in women, evidence was reviewed to address whether: (i) these glands comprise the prostate in women, (ii) they have specific functions in the FSR, and (iii) injury to the AVW-FPT and prostate has sexual dysfunction as a likely outcome. METHODS A literature review was conducted using keywords including female prostate, Skene's/paraurethral glands, periurethral tissue, Gräfenberg (G)-spot, female ejaculation, mid-urethral sling (MUS), and sexual dysfunction. RESULTS Histological and immunohistochemical studies of the glandular tissue surrounding the urethra support the existence of prostate in women. Evidence suggests this tissue may have physiologically and clinically relevant autonomic and sensory innervation, and during sexual arousal may contribute to secretions involved in ejaculation and orgasm. Gaps in knowledge relating to the functional anatomy, physiological roles, and embryological origins of this tissue have impeded the acceptance of a prostate in women. Injury to the innervation, vasculature, and/or glandular tissue within the surgical field of MUS implantation suggests iatrogenic sexual dysfunction is plausible. CONCLUSIONS Continuing to advance our understanding of the morphology, histochemistry, and physiologic capacity of this glandular tissue will clarify the characterization of this tissue as the "prostate" involved in the FSR, and its role in FSD following surgical injury. Tomalty D, Giovannetti O, Hannan J, et al. Should We Call It a Prostate? A Review of the Female Periurethral Glandular Tissue Morphology, Histochemistry, Nomenclature, and Role in Iatrogenic Sexual Dysfunction. Sex Med Rev 2021;XX:XXX-XXX.
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Affiliation(s)
- Diane Tomalty
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada.
| | - Olivia Giovannetti
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Johanna Hannan
- Department of Physiology, East Carolina University, Greenville, NC, USA
| | - Barry Komisaruk
- Department of Psychology, Rutgers University, Newark, NJ, USA
| | | | - Irwin Goldstein
- San Diego Sexual Medicine, San Diego, CA, USA; Alvarado Hospital, San Diego, CA, USA
| | - Michael Adams
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
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Zhang J, Zhang J, Cong S, Feng J, Pan L, Zhu Y, Zhang A, Ma J. Transcriptome profiling of lncRNA and co-expression network in the vaginal epithelial tissue of women with lubrication disorders. PeerJ 2021; 9:e12485. [PMID: 34824921 PMCID: PMC8590395 DOI: 10.7717/peerj.12485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 10/22/2021] [Indexed: 12/14/2022] Open
Abstract
Background Vaginal lubrication is a crucial physiological response that occurs at the beginning of sexual arousal. However, research on lubrication disorders (LD) is still in its infancy, and the role of long non-coding RNAs (lncRNAs) in LD remains unclear. This study aimed to explore the function of lncRNAs in the pathogenesis of vaginal LD. Methods The expression profiles of LD and normal control (NC) lncRNAs were examined using next-generation sequencing (NGS), and eight selected differentially expressed lncRNAs were verified by quantitative real-time PCR. We conducted GO annotation and KEGG pathway enrichment analyses to determine the principal functions of significantly deregulated genes. LncRNA-mRNA co-expression and protein-protein interaction (PPI) networks were constructed and the lncRNA transcription factors (TFs) were predicted. Results From the results, we identified 181,631 lncRNAs and 145,224 mRNAs in vaginal epithelial tissue. Subsequently, our preliminary judgment revealed a total of 499 up-regulated and 337 down-regulated lncRNAs in LD. The top three enriched GO items of the dysregulated lncRNAs included the following significant terms: “contractile fiber part,” “actin filament-based process,” and “contractile fiber”. The most enriched pathways were “cell-extracellular matrix interactions,” “muscle contraction,” “cell-cell communication,” and “cGMP-PKG signaling pathway”. Our results also showed that the lncRNA-mRNA co-expression network was a powerful platform for predicting lncRNA functions. We determined the three hub genes, ADCY5, CXCL12, and NMU, using PPI network construction and analysis. A total of 231 TFs were predicted with RHOXF1, SNAI2, ZNF354C and TBX15 were suspected to be involved in the mechanism of LD. Conclusion In this study, we constructed the lncRNA-mRNA co-expression network, predicted the lncRNA TFs, and comprehensively analyzed lncRNA expression profiles in LD, providing a basis for future studies on LD clinical biomarkers and therapeutic targets. Further research is also needed to fully determine lncRNA’s role in LD development.
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Affiliation(s)
- Jingjing Zhang
- Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, China
| | - Jing Zhang
- Jiangsu Health Vocational College, Nanjing, China
| | - Shengnan Cong
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Jingyi Feng
- High School Affiliated to Nanjing Normal University International Department, Nanjing, China
| | - Lianjun Pan
- Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, China
| | - Yuan Zhu
- Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, China
| | - Aixia Zhang
- Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, China
| | - Jiehua Ma
- Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing, China
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17
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Abstract
The vagina is an excellent site for topical passive immunization, as access is relatively easy, and it is an enclosed space that has been shown to retain bioactive antibodies for several hours. A number of sexually transmitted infections could potentially be prevented by delivery of specific monoclonal antibodies to the vagina. Furthermore, our group is developing antisperm antibodies for vaginally delivered on-demand topical contraception. In this article, we describe physical features of the vagina that could play a role in antibody deployment, and antibody modifications that could affect mAb retention and function in the female reproductive tract. We also review results of recent Phase 1 clinical trials of vaginal passive immunization with antibodies against sexually transmitted pathogens, and describe our current studies on the use of anti-sperm mAbs for contraception.
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Affiliation(s)
- Deborah J Anderson
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
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Mollaioli D, Sansone A, Colonnello E, Limoncin E, Ciocca G, Vignozzi L, Jannini EA. Do We Still Believe There Is a G-spot? CURRENT SEXUAL HEALTH REPORTS 2021. [DOI: 10.1007/s11930-021-00311-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Abstract
In the field of female sexuality, the existence of the so-called “G-spot” represents a topic still anchored to anecdotes and opinions and explained using non-scientific points, as well as being overused for commercial and mediatic purposes.
Purpose of Review
The scope of this review is to give an update on the current state of information regarding the G-spot and suggesting potential future directions in the research field of this interesting, albeit controversial, aspect of human sexual physiology.
Recent Findings
From evolutionary, anatomical, and functional points of view, new evidence has rebutted the original conceptualization of the G-spot, abandoning the idea of a specific anatomical point able to produce exceptional orgasmic experiences through the stimulation of the anterior vaginal wall, the site where the G-spot is assumed to be. From a psychological perspective, only few findings to date are able to describe the psychological, behavioral, and social correlates of the pleasure experience by G-spot-induced or, better, vaginally induced orgasm (VAO).
Summary
Recent literature suggests the existence of a G-spot but specifies that, since it is not a spot, neither anatomically nor functionally, it cannot be called G, nor spot, anymore. It is indeed a functional, dynamic, and hormone-dependent area (called clitorourethrovaginal, CUV, complex), extremely individual in its development and action due to the combined influence of biological and psychological aspects, which may trigger VAO and in some particular cases also female ejaculation (FE).
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Emulsion-Based Multicompartment Vaginal Drug Carriers: From Nanoemulsions to Nanoemulgels. Int J Mol Sci 2021; 22:ijms22126455. [PMID: 34208652 PMCID: PMC8233730 DOI: 10.3390/ijms22126455] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 01/05/2023] Open
Abstract
In order to overcome the limitations associated with vaginal administration of drugs, e.g., the short contact time of the drug form with the mucosa or continuous carrier wash-out, the development of new carriers for gynecological use is necessary. Furthermore, high individual anatomical and physiological variability resulting in unsatisfactory therapeutic efficacy of lipophilic active substances requires application of multicompartment drug delivery systems. This manuscript provides an up-to-date comprehensive review of the literature on emulsion-based vaginal dosage forms (EVDF) including macroemulsions, microemulsions, nanoemulsions, multiple emulsions and self-emulsifying drug delivery systems. The first part of the paper discusses (i) the influence of anatomical-physiological conditions on therapeutic efficacy of drug forms after local and systemic administration, (ii) characterization of EVDF components and the manufacturing techniques of these dosage forms and (iii) methods used to evaluate the physicochemical and pharmaceutical properties of emulsion-based vaginal dosage forms. The second part of the paper presents (iv) the results of biological and in vivo studies as well as (v) clinical evaluation of EVDF safety and therapeutic efficacy across different indications.
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Rodriguez FD, Camacho A, Bordes SJ, Gardner B, Levin RJ, Tubbs RS. Female ejaculation: An update on anatomy, history, and controversies. Clin Anat 2020; 34:103-107. [PMID: 32681804 DOI: 10.1002/ca.23654] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/12/2020] [Accepted: 07/13/2020] [Indexed: 11/09/2022]
Abstract
Female ejaculation is a contentious topic. From a review of the literature, history indicates that it is not a modern concept; some females were aware of it in times past without understanding the role of the fluid or composition of the ejaculate. Over time, scholars experimented, mainly with anatomical studies, in an attempt to identify the source of the ejaculate and explore its physiological and anatomical benefits for the female sexual experience. Despite these studies, views about female ejaculation remain controversial and inconsistent, with no clear conclusion as to its function. This review discusses the history of studies of female ejaculation and presents various hypotheses from an anatomical and physiological perspective. After reviewing 44 publications from 1889 to 2019, it became apparent that clinical and anatomical studies conducted during recent decades provide substantial evidence in support of the female ejaculatory phenomenon. Anatomical studies have shown that the ejaculate originates in the paraurethral (Skene's) glands, but its composition has been debated. Female ejaculate differs from urine in its creatinine and urea concentrations. The fluid also contains prostate specific antigen (PSA) and could have antibacterial properties that serve to protect the urethra. While the specific function of female ejaculation remains a topic of debate, there is sufficient evidence to support the existence of the phenomenon.
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Affiliation(s)
| | - Amarilis Camacho
- University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Stephen J Bordes
- Department of Anatomical Sciences, St. George's University School of Medicine, St. George's, Grenada
| | - Brady Gardner
- Department of Anatomical Sciences, St. George's University School of Medicine, St. George's, Grenada
| | | | - R Shane Tubbs
- Department of Anatomical Sciences, St. George's University School of Medicine, St. George's, Grenada.,Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Neurology, Tulane University School of Medicine, New Orleans, Louisiana, USA
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Vaginal Mesh for Urinary Incontinence and Prolapse: Impact on Sexual Function. CURRENT SEXUAL HEALTH REPORTS 2019. [DOI: 10.1007/s11930-019-00194-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Hara R, Nagai A, Nakatsuka T, Ohira S, Fujii T, Miyaji Y. Male squirting: Analysis of one case using color Doppler ultrasonography. IJU Case Rep 2018; 1:19-21. [PMID: 32743357 PMCID: PMC7292083 DOI: 10.1002/iju5.12021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/19/2018] [Indexed: 11/11/2022] Open
Abstract
Introduction There is no scientific evidence for the mechanism of male squirting, although the term is common in mass media. Here, we describe the first recording of male squirting using color Doppler ultrasonography. Case presentation We recruited a 25-year-old male volunteer who was able to have male squirting. A transrectal ultrasound probe was inserted into the rectum and male squirting was observed following normal ejaculation. With penis stimulation for a further 20 s after ejaculation, translucent misty fluids with a creatine level similar to that of urine came from the extraurethral orifice for about 60 s. Color Doppler ultrasonography recorded strong contraction of the prostate and pelvic striated muscles just before male squirting, and then the stream went from the urinary bladder through the prostatic urethra. Conclusion In male squirting, urine in the bladder gushes out from the external urethral orifice due to strong contraction of the prostate and pelvic striated muscles.
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Affiliation(s)
- Ryoei Hara
- Department of Urology Kawasaki Medical School Kurashiki Okayama Japan
| | - Atsushi Nagai
- Department of Urology Kawasaki Medical School Kurashiki Okayama Japan
| | - Tohta Nakatsuka
- Department of Urology Kawasaki Medical School Kurashiki Okayama Japan
| | - Shin Ohira
- Department of Urology Kawasaki Medical School Kurashiki Okayama Japan
| | - Tomohiro Fujii
- Department of Urology Kawasaki Medical School Kurashiki Okayama Japan
| | - Yoshiyuki Miyaji
- Department of Urology Kawasaki Medical School Kurashiki Okayama Japan
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