7.29.2015

Vaginal Orgasm in Woman With Unique Pelvic Anatomy? - A Journal Article I Read



Sexual function in a woman with congenital bladder exstrophy and multiple pelvic reconstructive surgeries: a case report. Vaccaro CM1, Herfel C, Karram MM, Pauls RN. J Sex Med. 2011 Feb;8(2):617-21.

Today, on A Journal Article I Read, we'll be talking about a case study of a woman who was born with a condition that affected her outer genitals and bladder. She has had her bladder and urethra removed, had necessary plastic surgery on her vulva and vagina, and endured many other pelvic surgeries including the removal of her cervix. She claims to have vaginal orgasms 100% of the time she has sex. The authors wonder whether she orgasms this way so easily because of the particularly unique organ configuration down there. So, to investigate this, they had her note the sexually sensitive areas on her genitals and then used MRI to see if clitoral tissue is related to those areas. The authors felt that her inner clitoral tissue corresponded to her sexually erotic areas.

So, that's basically the whole paper,  All in all, I thought the investigation into this women's experience was pretty cool. I have one big problem with it though. The researchers did not investigate into what exactly the subject meant when she said she orgasmed, and frankly when it comes to claims of orgasming through vaginal stimulation alone, researchers should not simply be taking a subject's word on the matter. This type of orgasm has a lot of baggage, and it has never been documented before. It requires special treatment. This is the same gripe I have with so many female orgasm studies, but it really is an important one. There is a physically verifiable rhythmic release of arousal-induced muscle tension that is an orgasm, and scientific investigation should verify and not simply assume, this is what is happening when a woman claims to orgasm vaginally. If a study does not take time for this verification, as is the case for this study, it deeply weakens any conclusions that are made from it.

So on to the study description. (All quoted material is from this study btw.)

A Disclaimer
I am no medical expert, and honestly, this article was pretty confusing for me the first couple times I read it. However, I do these article overviews so that I can get a deeper understanding of them and also so that I can offer other people a more accessible yet still extensive version of what these studies have to say.  So, I looked up a lot of shit on WebMD and Wikipedia, and things did start making more sense, so I tried to write about the procedures and stuff without so many big incomprehensible words. I hope that I didn't completely misunderstand anything and that what I did write is somewhat more comprehensible.

Some Background
  • She was born with bladder exstrophy which occurs in only 1 in 50,000 births (males and female equally). It is a failure of development of the lower abdominal wall, genital tubercules (the embryonic beginnings of what will become either the penis or clitoral glans), and pubic rami (a piece of the pubic bone).
  • Pelvic Organ Prolapse (a situation in which pelvic organs begin to kinda drop and end up pressing against things they shouldn't like the vagina) is a fairly common female disorder (about 1 in 11 women develop this), but it's way more common among women with bladder exstrophy. This condition could require surgery or multiple surgeries for some women.
  • In a previous study of 12 women with bladder exstrophy: 8 reported regular sexual activity, 6 reported regular orgasm, and 4 reported vaginal pain (other that the pain involved with having a shorter vagina as seems to often end up being the case for these women).

The Details On This Lady
  • She's 42, physically fit, well-groomed (I'm not sure why that was added to this report), 1 pregnancy delivered cesarean
  • At 2, she had her bladder removed. She also had an operation (that looks like it is no longer used for people with her condition) where the ureters that carry urine from the kidney were diverted to the lower colon (uretero-sigmoidostomy).
  • At 15 she had pain and found that her upper vagina was filling with menstrual blood. She then had a distal vaginoplasty  to "open and reconstruct the lower 1/3 of the vagina."
  • During her pregnancy, she began experiencing pelvic organ prolapse in the form of cervical prolapse and 2 years later her cervix was removed as part of the treatment (Manchester procedure), which helped for a while.
  • In 2000 she had a hysterectomy with an anterior repair, and "an anterior repair involves a midline dissection of the anterior vaginal mucosa and removal of redundant mucosa." (Vaginal mucosa is basically the lubrication making layer of the vaginal tissue)
  • In 2003 she was back with a Stage 4 vaginal prolapse, in which it seems her upper vagina was sagging down into her lower vagina, basically turning it sorta inside-out, and a ligament vaginal vault suspension was performed to correct it.
  • 2 years later the vaginal vault suspension failed and she had Stage 2 anterior vaginal wall prolapse. Sacrocolpoexy, another procedure to repair organ prolapse, was used.
  • Over the following 2 years she had 3 more surgeries for these types of problems.
  • She completed several questionnaires: the PISQ-12 and got 10/48 indicating a small impact of her pelvic orgasm prolapse on her sexual function, the FSFI with a 29.4/36 indicating good sexual function, the SF-12 with scores of 36.6 and 57.9, indicating she was above average in mental health and below average in physical health (which makes sense given her condition).
  • At the time of this study, a pelvic exam confirmed Stage 2 anterior vaginal wall prolapse and a shortened vagina length of 6 cm (okay - so that's about 2.3 inches and I've read stuff that says average is 3 to 4. I know the vagina expands during arousal, so that's not as tiny as it seems, but I just wanted to know how short 6cm really was in the grand scheme of things)

Her Sexual History
  • "Via recorded face-to-face interview with the subject and her husband, a full sexual history was outlined. She reported that typical sexual encounters result in one vaginal orgasm with manual stimulation, followed by one orgasm with vaginal penetration, thus being multi-orgasmic with each coital episode. Although she prefers the female dominant position, she reported the ability to orgasm from any position without additional manual stimulation of the clitoris." (I really don't know what exactly is meant by vaginal orgasm by manual stimulation)
  • "She described her pelvis as 'naturally tilted forward'...and she feels this leads to better stimulation of her clitoral tissue while in the female dominant position." 
  • She has some lack of lubrication and uses lubricants about 50% of the time. Due to her shortened vagina she has pain during deep thrusting, but it doesn't prevent orgasm. She desires sex about once a week now, but it was daily at her sexual peak.
  • She reports daily use of fluoxetine for depression, and alprazolam and acetaminaphen/hydrocodone as needed for anxiety and musculoskeletal pain.

The Investigation
  • "Together with her husband, her erotic tissues were marked and photographed. The markings include her sites of sexual stimulation and engorgement. This mapping identified the 12 and 1 o'clock positions of the vagina just inside the introitus to be sites of sexual sensation leading to orgasm. Additionally, her mons pubis was marked as another area of sensitivity." (introitus is the hole btw)
  • The pelvic MRI images were taken, and the researchers "identified the marked erotic locations as being consistent with clitoral tissue. therefore, in this subject the clitoris lies superficially on the distal anterior vaginal wall just beneath the mons pubis, with the most superficial sites being on her left." Superficially here means just beneath the surface and distal anterior is the part of the vagina that is close to the hole and towards the front of your body.
  • I was seriously confused about the picture below from this study. It doesn't give a lot of detail in the writing, and let's be honest, sometimes looking at the vulva area close up with nothing to orient yourself is hard to figure out. But, I'm pretty sure that is the vaginal hole with no urethra or visible clitoral glans above it.   



Conclusion
So, this woman does not have a bladder or a urethra, and the authors tell us it's unlikely a G-spot could exist on this women. (The G-spot being the female prostate that surrounds the urethra and can be felt through the distal anterior vaginal wall. Some say it could be the cause of vaginal orgasms but although it has been shown to stimulate ejaculation, it has never been shown to cause orgasm - this is true for both men and women). The researchers point this out to eliminate the g-spot as a possible cause for the "vaginal" orgasms this woman claims to have. Instead, they point to the inner clitoris.

"...we believe that this patient's vaginal eroticism is the clitoral complex that 'drapes' the anterior distal vagina. Given the findings reported here it is clear that further research is needed to investigate how position and location of the clitoris relates to female orgasm and sexual function."

My Thoughts
Connecting Clitoral Placement to Her Vaginal Orgasm Ability
Relating the inner clitoris to vaginal eroticism is nothing new. In fact I'd say, within research, it's currently the most hip way of reasoning how vaginally stimulated orgasms might happen.  The hypothesis goes vaguely like this; the penis jostles the vaginal wall, which jostles the tissue outside the vaginal wall, which jostles the clitoral legs, and that's how the orgasm is caused. So, I imagine for these researchers it seems sensible to connect clitoral legs to this woman's capacity to vaginally orgasm, but it's much more of a stretch than one might think. There is indication that a penis moving in a vagina does jostle and press down on stuff in there, including the clitoral legs, but like all other hypotheses for how a vaginal orgasm happens, there is absolutely no proof an orgasm can or has ever been caused this way.

Still, the woman in this study has a unique anatomy which could provide insight into how women might orgasm vaginally if vaginal orgasms are, in fact, a thing that can happen. I'm honestly a little confused about how exactly the clitoris exists in this woman and how it is different from what is normally expected. My best assumption from the reading is that the glans is hidden beneath the skin and the clitoral legs are closer to the surface of the skin than is normally expected. The paper does not specifically describe these things in detail, so I could be wrong.

How The Glans Fits In
Without a visible, external glans, the researchers tell us that this woman's genital anatomy "has been altered in such a way not unlike those who have had female circumcision." However, they rightly point out that many women who have gone through female circumcision do still report the ability to orgasm due to undamaged clitoral tissue beneath the skin - which she seems to have. So stimulation of the glans through her skin seems to be a possibility for how she reaches orgasm - but she specifically claims to reach orgasm during any intercourse position without additional stimulation of the glans.

The glans is an important factor here because stimulation of the glans area is an observed, recorded and verified way that seemingly all intact, healthy women can orgasm. Stimulation to that external clitoral glans area is, actually, the only way that scientist have observed woman orgasming.

How The Clitoral Legs Fit In
The clitoral legs are the inner clitoral structures. They are 2 spongy erectile legs that straddle the vagina. The researchers kept using the term "superficial placement" of the clitoris when discussing it's uniqueness, which I kinda just took to mean not the 'real' place it's supposed to be, but I slowly realized that they are probably meaning that it is very close to the surface of the skin (see I can learn vocabulary!). So, I imagine her clitoral legs are a little closer to the surface of the skin and maybe closer to the vagina...but I'm not positive about that. I do know that there's no bladder in there, so they are probably placed at least somewhat differently than most women's clitoral legs. I am also not completely sure whether the researchers felt the "superficial nature" of the vagina was important because it could be stimulated more easily through her pelvic skin around her vulva, or whether they felt it was closer to her vaginal opening and could be stimulated to orgasm through the movement of things going in and out of the vagina. Either way, the researchers seem to be focusing on orgasm through stimulation of the clitoral legs, and that is is not something that has ever been observed.

The Researchers Are Looking For The Cause Of Something That Hasn't Been Proven to Exist
So the idea that women can orgasm by stimulating the clitoral legs during intercourse is merely an untested hypothesis for how vaginally stimulated orgasms might work. Furthermore, vaginally stimulated orgasms themselves are also merely an untested hypothesis. Yes, this woman and a minority of other women clearly say they do have them, but this is a scientific investigation after all, and investigators really should be quite hesitant to take women at their word about experiencing something that the researchers have never seen proof for. Here's a few reasons why:
  • Even quite educated people may not know what an orgasm is physically (the rhythmic release of muscle tension that has built up during arousal), or that an ejaculation is different from an orgasm in both men and woman. We don't usually learn those things in school, and people may use the word incorrectly.
  • Even though a 'vaginal' orgasm has never been documented ever in science, and even though it is undisputedly not something the majority of women say they experience, it is the #1 way we see women orgasming in books, TV, movies, and porn. It's not unreasonable to assume women may be influenced in the way they describe and experience their sexual functioning by this discrepancy between their actual experiences vs. media depictions of female orgasm. It's not crazy to wonder whether women's words might not match the physical things happening in their bodies.
  • The inability to orgasm 'vaginally' was professionally deemed a mental illness in our country up into the 1970's. My mother and her generation, the people who raised me and the other 20-40 somethings walking around today, were already functioning, sexually active people by that time. Do researchers think that this kind of deeply personal stigma around the ability to orgasm vaginally just fell off the earth? Do they not think that this stigma might influence answers to questions about whether she can or cannot? Do they not think they should take special care when investigating this?

This all to point out that, well, the subject in this study says she orgasms twice every single time she has sex, but...maybe she doesn't. It might be that she's not really lying about it. It might be that she's authentically describing her experience, but maybe that experience is more of a climactic feeling rather than the rhythmic muscle release that is physically an orgasm. Maybe she is physically orgasming 100% of the time she has intercourse. But, the truth is, we just don't know, and the researchers simply didn't think it was important enough to verify or even discuss the lack of verification as a possible limitation to this study.

Can I just say too, that ESPECIALLY because she was giving her sexual history face-to-face with her husband sitting right next to her, the researchers should have considered the possibility that the situation may have put undue pressure on the subject and could have skewed her answers. I mean, researchers know some women lie to their partners about their ability to orgasm, so they must know that there is pressure out there in the world that encourages women to misrepresent their sexual functions to their partners. It seems to me that having a woman describe her sexual function while her husband sits next to her puts a possible barrier to honest answers. The researchers should have at least commented and acknowledged that the husband situation complicated the study a bit.

My Conclusion
This truly was an interesting paper. With the subject's unique physiology, this paper could be a starting point for further investigation into orgasm ability in women with more common pelvic anatomy (and these researchers clearly understood that - in fact they actually followed up with THIS study that I wrote about here last week. It looked at clitoral size and distance in relation to a woman's ability to orgasm).

However, even as just a starting point, there are problems. The lack of verification for the subject's ability to orgasm during intercourse without additional clitoral stimulation is an important limitation for this study. Looking at this rationally, the subject has claimed to orgasm in a way that has never been observed. As far as scientific knowledge goes, it may not even be possible. I mean, if she is actually physically orgasming this way, she, with her unique genital anatomy, might be the only person who can orgasm like that. Verifying her ability to orgasm this way would actually be pretty huge. Yet, the researchers didn't even seem to consider verification. They simply go forward assuming that this type of orgasm is possible. Furthermore, they take the subject at her word that this type of yet-undocumented orgasm happens to her. There is a lot of assuming going on here. Granted, researchers almost never verify claims of vaginal orgasm, so this study is not out of the norm. However, just because this lack of verification is common doesn't mean it's quality science. Maybe, just maybe, some researcher somewhere should verify that there are women who can attain an orgasm from stimulation inside the vagina (checking for the rhythmic muscular activity is quite possible). If researchers are able to do that, then it would make sense for researchers to start concerning themselves with the mechanisms for how these types of orgasms happens and what kinds of things make it easier or harder for women. Until that happens though, any study that assumes without verification that its subject(s) can orgasm vaginally will contain conclusions that simply cannot be taken too seriously.


7.27.2015

American Idiot - The SSL Review (Theater Edition)



A few weeks back, Barnaby, another of the directors of this here movie the blog is about, got some tickets to American Idiot playing at the Phoenix Theater, which is actually a pretty cool long-running Indianapolis contemporary theater company. They only produce things that haven't been produced in this city yet, and often, they're producing world premiere shows. American Idiot, if you don't know, is a rock opera (at least that's what I would call it) by the band Green Day. They created a concept album of the same name before the the musical was created.



I'm telling you about this because, to my surprise, I found that the musical is eligible for SSL Review, and it's not because there was discussion of female orgasm or masturbation. It's because there was an actual depiction - which I truly didn't expect in a play, but was happy to see because, by golly, you know I love doing an SSL Review.

Here's what happened to the best of my memory - cause I didn't expect to need my note-taking supplies, so no notes were taken. Johnny, the main character, finds a love that is billed Whatsername, and the two of them have sex in a bed in the middle of the stage. It's not the only thing happening onstage - which is common in this play. It follows 3 young guys from the suburbs. One stays in the hometown to be with his pregnant girlfriend. Johnny and the other guy head off to the city, but the other guy eventually goes off to the army. Often we are seeing their stories simultaneously. So, there is a song happening during the sex. It goes how sex tends to go in the media. They "make-out" lay down in bed and do the intercourse till they both orgasm and go to sleep. Obviously, genitals are down under the blankets, so I'm just going by the body movements to assess if the stimulation that's being mimicked warrants her orgasm.

At the beginning Johnny's on top, and he's clearly banging her, and then Whatsername gets on top towards the end, and that's when she has her orgasm. It's a sexy and pretty rough sex scene. The banging is truly banging - there's clearly an aggressive, in and out situation that's happening. This is true in both positions. When he's on top, he's banging her, and when she's on top she's banging him. There's definitely no hands down in her clit vulva area at all the whole time, and no vibrators were whipped out, so the only possible means for clitoral stimulation during this sex is if she is able to stimulate her clit against his body while they're doing it. However, that very clearly was not the case. When she came, she was basically sitting upright, cowgirl style on him, bouncing, nay slamming, straight up and down. She was not pitched forward so that her vulva might touch him. The only stimulation happening was his penis stimulating the inside of her vagina - ain't nothin' was touchin' that clit.

Now, since there has never, ever been a recorded instance of a woman orgasming from stimulation to the inside of her vagina, I have to say that this was a highly unrealistic depiction of how a woman might orgasm. That said though, it is also the most common way that women are depicted to orgasm...ya know, from some ol' bangin'. So, it makes perfect sense that this would be how it was staged. I guess I mean to say that this depiction is only unrealistic when considering what is actually known about female orgasm. However, put in the context of a sexual culture that is riddled with a deep misunderstanding of the lady-gasm, it's just normal. I also should point out that there was a Green Day song happening while these two were getting it on, and they were actually working in  rhythm with it most of the time, so the pretty heavy slamming onto that dick she was doing in the end was also kinda to create that synchronicity with the music.

This, unfortunately, is not going to get a good SSL Review because, frankly, there was a depiction of a terribly unrealistic orgasm. It really didn't do any more harm to our cultural conversation about how women orgasm, but it definitely reinforced the status quo, and if you're not part of the solution, you're part of the problem.

However, as you know, an SSL Review doesn't have anything to do with the actual quality of the show. One could be good, the other bad and vice versa, so I'd like to point out that The Phoenix put together a great show, and the actress who played Whatsername was, for me, actually the highlight. Her voice, her body movement and dancing, her acting - she was the whole package and she stood out. I mean, even with the lack of realism, the sex scene was good, and it was interesting to see a sex depiction live. It actually got me thinking a little more about depictions of female orgasm in the media. It's just a woman up there. I know this, of course, but it puts it in a different perspective when you see it in a play where that woman is just feet from you.

The things women need to do to actually orgasm are just a little dirtier and weirder. We see men and women banging against each other all the time in R-rated movies and TV, but when they grind pelvis to pelvis in a way that would get that clit some action, it seems a little nastier. A woman reaching down to her vulva and getting herself off is, well actually pretty unheard of in movies, but if it did happen, it would be some dirty, shocking, weird shit. It becomes more than a simple sex scene - it makes a statement. We're just not used to seeing that kind of thing. It's exotic, and it's really putting yourself out there to perform a sex act in that way. An actress, and the people around her (including the people in charge) would all have to be open and on the same page about that, and I think that's probably rare. My point is, I guess I just had a moment of realizing that changing the way lady-gasms are depicted in our media will take a lot more courage and outspokenness from actresses and directors than I usually think about.

So, American Idiot only gets a 1 vulva rating, but the depicting lady gave a fantastic performance even with the unrealistic orgasm. My hope is that maybe some future actress will read this, and someday when she plays the part, she gets all revolutionary and aggressively reaches down and rubs out her clit hardcore style in rhythm to some Green Day - all while riding ol' Johnny cowgirl style....and hopefully her director will let her do it.
(!)

7.24.2015

A New Study about Clit Size and Orgasms!!!



This time on An Article I Read, I'll be looking at an article that aims to "evaluate clitoral size and location with regard to female sexual function." The conclusion, from the authors was, "Women with anorgasmia possessed a smaller clitoral glans and clitoral components farther from the vaginal lumen than women with normal orgasmic function." (The vaginal lumen is basically the vaginal hole BTW)

Clitoral size and location in relation to sexual function using pelvic MRI. Oakley SH1, Vaccaro CM, Crisp CC, Estanol MV, Fellner AN, Kleeman SD, Pauls RN.J Sex Med. 2014 Apr;11(4):1013-22. doi: 10.1111/jsm.12450. Epub 2014 Feb 13.

The Quick and Dirty
Here's the basics. This study is comparing measurement of clitoral size and also distance from different areas of the clitoris to the vagina among 10 women grouped as "anorgasmic" and 20 grouped as "normally orgasmic." The measurements for each woman are gained through pictures from pelvic MRI. The women were grouped based on their answers to 4 specific questions on commonly used sexual functioning assessments. Those same assessments were used in their entirely to assess the women's overall sexual function, and assessments were also used to evaluate their overall health and level of body self-consciousness during sex. Personal data was taken, and also their blood was also taken at the same time in each of their menstrual cycles in order to test for 5 different hormone levels measurements. All the information received from the women were assessed to see if there was a statistically significant difference between the 2 groups and to see if any of the assessments showed significant correlations to another assessment.

This is a pretty new article - 2014, and I think it's the newest one on this topic. I reviewed an article from a few years back that re-evaluated very old data on this topic HERE. This new study is important because, well, it's a modern study with modern techniques, and this is a topic that people wonder about. Although the paper concludes that there is a connection between women with anorgasmia and having a larger clit, farther from the vagina, I don't think that statement is reasonably supported in this study. There were a lot of measurements of the clit size and distance that didn't show any statistically significant differences between the two groups of women. They took around 23 different measurements of size and distance, and only 5 actually show significance. In fact, the clitoral glans area that the authors put forth as a significant difference between the two groups of women is only significant when they measured it from the coronal, but not the sagittal view.  Unfortunately, this study also failed at asking the participants the proper questions so that they could be grouped in a way that would creating meaning when compared to the clitoral measurements. Statistics are only as good as the understanding that exists of the population it is describing, and I don't think the understanding was good at all. So, this might be harsh,  but I think there is some picking and choosing and bad assumptions going on with this study that make it basically meaningless....but oh do let me go into more detail...

The Study's Introduction
The authors point out that orgasm difficulty is found to be common among women, and that it's possible that the size and position of the clitoral complex has something to do with that. (Clitoral complex is a phrase that is used with some variety of meaning. Here I believe they are including it to mean all the inner parts of the clitoris, the vestibular bulbs, and the area around the urethra and anterior part of the vagina - or what is now being called the CUC or clitoral urethral complex). It points to other related studies: one that compares ability to vaginally orgasm with the thickness of the urethro-vaginal space (I wrote about that one HERE), one that I previously wrote about HERE that reassesses historical data, one on reconstructive surgery after female genital mutilation ([16] below) and another MRI study that concluded smaller clits were actually related to better sexual function ([15] below - I'll get to reviewing this one soon). The authors end the intro with the following.
"However, very little has focused on the clitoral-vaginal distance or size of the organ relative to female response. The available data were biased by small sample size [15], retrospective evaluation [15], or nongeneralizable populations undergoing surgery [16] and bear conflicting results. As such, a clear understanding of these facets of clitoral anatomy impact orgasm is lacking."
The Studies Aims
"Thus, the purpose of this cross-sectional study was to determine if the size of the clitoris and its location relative to the vagina impact sexual stimulation and subsequent orgasmic function. We hypothesized that women with normal orgasmic function may possess a larger clitoral area or a CUC which is closer to the vaginal wall compared to women with anorgasmia."

The Population, Experimental Design, and My Rant

Dividing the women into groups
The researchers divided the women into either the "anorgasmic" or "normally orgasmic" groups based on their answers to 4 questions from 2 different questionnaires. Both these questionnaires are used to rate a woman's sexual function, and one is specifically related to pelvic organ prolapse or incontinence.

A response of "rarely able" or "never able" to achieve orgasm on question #2 of the the Prolapse/Incontinence Sexual Questionnaire-12 (PISQ-12)  and/or a total unadjusted score of < 6 on the orgasm domain of the Female Sexual Function Index (FSFI) put women in the "Anorgasmic" group. Likewise, in the PISQ-12 a response of "most" or "all" on question #2  and/or a total unadjusted score of  > 12 on the orgasm domain of the FSFI put women in the "normally orgasmic" group. The authors say the following about these questionnaires: "Both of these validated questionnaires inquire about sexual function during sexual activity, which could include caressing, foreplay, masturbation, and vaginal intercourse."

The actual questions used 
However, I looked those questionnaires up (The FSFI is used all the time in these types of studies so I thought I should become familiar) and strangely that's just not true.

PSQI-12 Question #2 (to be answered considering sex life over the last 6 months):
Do you climax (have an orgasm) when having sexual intercourse with your partner? -Always -Usually -Sometime -Rarely -Never 

The underline is their emphasis not mine, and since this question is from the validation study for the PISQ-12 that was cited (I triple checked), I find it incredibly odd the authors would say what they said above...cause it is clearly about intercourse. Also, the authors quoted the terms "most" "all" "rarely able" and "never able" when speaking about the question, but those terms aren't used in the actual question, so I find all that curious. Now, the FSFI questions were more open.

Orgasm Domain Questions (11-13) from FSFI - with the scoring included. (Here's the Scoring Key for the FSFI too):

11. Over the past 4 weeks, when you had sexual stimulation or intercourse, how often did you reach orgasm (climax)?
0 = No sexual activity
5 = Almost always or always
4 = Most times (more than half the time)
3 = Sometimes (about half the time)
2 = A few times (less than half the time)
1 = Almost never or never 
12. Over the past 4 weeks, when you had sexual stimulation or intercourse, how difficult was it for you to reach orgasm (climax)?
0 = No sexual activity
1 = Extremely difficult or impossible
2 = Very difficult
3 = Difficult
4 = Slightly difficult
5 = Not difficult 
13. Over the past 4 weeks, how satisfied were you with your ability to reach orgasm (climax) during sexual activity or intercourse?
0 = No sexual activity
5 = Very satisfied
4 = Moderately satisfied
3 = About equally satisfied and dissatisfied
2 = Moderately dissatisfied
1 = Very dissatisfied
Why I think they are terrible questions for this study
So this is my absolute biggest gripe with this study: The questions that the researchers used to categorize these women are not useful to an investigation about clitoral size/location and orgasm ability.  First off, it's not necessarily women who have never/rarely orgasmsed vs. women who orgasm all the time. Both groups could include women who orgasm sometimes. For instance, in the FSFI, a woman could say she orgasmed sometimes (3pts), that it's slightly difficult (4pts) and that she's very satisfied with that (5 points), and she's got a score of 12 and is in the "normally orgasmic" group. But another women could say she orgasms sometimes (3pts), that it's very difficult (2pts) and that she's very unsatisfied with it (1pt), and she's got a score of 6 and in the "anorgasmic group." Maybe the only difference between these two women is that one feels worse about what she has to do to get off and her partner is less into it. Granted, that's probably not commonly the case, but even if that happened once among these 30 women, then it's enough to worry about.

But folks, that's just a surface gripe. The problems with this study go way deeper. The authors believe this study can discern if size or location of the clit impacts sexual stimulation and subsequent orgasmic function. I disagree.

It's an irrelevant thing to investigate
Women can orgasm through stimulation of the clitoral glans. There's no indication that there are women with anatomy that makes this impossible, so with sufficient stimulation, any healthy, intact women could orgasm through stimulation of her external clitoral glans area. It doesn't matter where it is or how big it is. It just needs to be found and touched. It's the same way for a man and his penis. Even considering the female orgasm during intercourse, size and location do not necessarily have anything to do with a woman's ability. If a woman wants to orgasm while having intercourse but her clitoral glans is a millimeter further from her vagina than another woman, well, who cares? She can just tilt her hips a millimeter more or less than the other woman would or maybe have her partner adjust their body slightly and then just continue grinding the clit up against his body. Or simply make sure her or her partner's hand or the vibrator is in the right place. It's that easy. The only reason this question about whether size and location makes a difference to orgasm ability even exists is because women's sexual experiences too often don't specifically cater to her organ of sexual pleasure (the clitoral glans) the way that men's sexual experiences regularly cater to the male organ of sexual pleasure (the penis). Thus the clitoral glans is often ignored, yet there is little realization that the lack of orgasm may simply be due to lack of proper clitoral stimulation. So, when a woman says on a survey that she has not orgasmsed much during her latest sexual encounters, it doesn't mean she cannot or that she is innately less capable of orgasm than another woman. It just means that she didn't get proper stimulation and arousal. So discerning between women the way this study does says more about these women's sexual technique, relationships, and past experiences than it does about anything innate. Honestly, thinking that the clitoral size and distance from the vagina has any meaningful relationship to the differences between these women is unrealistic if you really think about it, and frankly it's not very thoughtful about our sexual culture and the actual experiences of women and their orgasms.

Unless it's investigated this way....but, it's not
Okay, so there are a minority of women who say that they can orgasm through inner vaginal stimulation alone - with no additional touching of the outer clitoral glans area. The most high-profile theory (although not necessarily the only or the most well-backed one) right now for how that might occur is that the penis stimulates the inner clitoral legs through the vaginal wall and through the tissue between the clitoral legs and the vaginal wall. So, I can see how an investigation into the distance between the vagina and the inner clitoris might be useful if researchers were studying the anatomical differences between women who say they can regularly orgasm through vaginal penetration alone and women who say they cannot and have never orgasmed this way.

*I would like to point out that unlike our scientific knowledge of clitoral stimulation leading to orgasm, there is simply not any information that tells us exactly what specific kind of inner vaginal stimulation leads a woman to have an orgasm. In fact, an orgasm caused by inner vaginal stimulation has never ever been recorded or verified in any way, and so there is always that wild-card possibility that must be considered in which this type of orgasm doesn't actually exist as a physically verifiable thing in the first place. So, even if women were split up this way, it might actually just be two groups of women that both don't orgasm through vaginal stimulation, yet one group happens to describe the physically non-orgasmic experience as orgasmic and the other doesn't.* However, let's give it the benefit of the doubt and assume there are some women who can orgasm this way. It still leaves the question of whether this study coul have anything useful to say about how clit size/location affects this possible type of orgasm. And, it doesn't. It doesn't because the two groups of women who would need to be tested against each other (women who specifically claim to regularly orgasm vaginally with no extra clitoral stimulation vs. women who never/rarely orgasm this way) are not the groups used for this study. Questions that would have discerned these women from each other were not asked, and so this study simply has nothing to say on this aspect of female orgasm either.

Or this way....which the authors also don't do
There is one more theory about female orgasm that might benefit from information on size and location of the clitoris. Master's and Johnson found that some women could get a Rube-Goldberg thing going during intercourse where the skin around the vaginal opening was stretched, which pulled on the inner labia, which pulled on the clitoral hood, which gave the ol' clit just enough stimulation to orgasm. Never mind that M&J only observed this using a mechanical dildo  machine that the woman controlled and that could go in and out at speeds faster than any man, and also never mind that these orgasms, given their very indirect stimulation route to the clit, were the weakest ones the women had (in the amount of muscle contraction and her subjective rating). Just know that if a woman did get off this way, I could see how the size and location of the clit could affect that. Women who could orgasm this way and woman who could not orgasm that way would be good groups to use in an investigation for this type of orgasm. However, they were not. As I said above, questions that would have discerned these women from each other were not asked, so there is nothing that can be learned about this aspect of female orgasm from this study either.

Which means...
So, my point is that this study is not set up well to investigate the affect clitoral size and location has on female's ability to orgasm. The truth is, simply asking the broad question of whether clit size and location affects women's ability to orgasm seems the same as asking whether dick size and location has an affect on a man's ability to orgasm. It's not a useful question to ask because it seems obvious that people just find a way to stimulate dicks no matter the size or location. It's not hard, actually. I assure you no researchers out there are worrying about whether a dick that is a few millimeters closer to a dude's asshole makes it easier for him to come. It's just absurd when looked at realistically. However, there are specific questions about a woman't ability to orgasm during intercourse (with no additional clitoral stimulation) that warrant investigation into clitoral size and location, but those questions were not specifically asked and a suitable experimental population was not created for those questions. In the end we are left with a study that simply doesn't tell us anything useful about the relationship between a woman's ability to orgasm and her clit size/location...even though it claims that it does.

The Rest of the Study Stuff
So, I've said my main piece. In a lot of ways everything else about this study is irrelevant because the population and the questions they are asking aren't meaningful to the conclusions they made. However, I'll still give you more details, but in bullet form.

  • 10 women were  categorized as "anorgasmic" and 20 were categorized and "normally orgasmic." The women were matched via age and BMI
  • All were over 18, sexually active with at least 1 sexual encounter within the last 4 weeks, and pre-menopausal. Also, they had no pelvic bulge or urinary incontinence, no history of sexual abuse, no sexual dysfunction in the domain of pain, no pregnancy, no use of serotonin uptake inhibitors or testosterone supplements
  • They were questioned about how many times they had sex in the past 4 weeks and the percentage of time to orgasm, and their favorite positions for ease of achieving orgasm were ranked (missionary, female dominant, woman on all fours, manual, and oral) See table below.




  • The women were given a questionnaire to assess their mental and physical health and one to asses their level of body exposure self-consciousness during sexual activity. There was no significant score difference between the two groups of women on those questionnaires.
  • There was a statistically significant difference between the total scores on both the FSFI and PSQI-12 between the 2 groups of women, with the "anorgasmic" group scoring toward higher sexual dysfunction and the "normally orgasmic" group scoring toward lack of sexual dysfunction. It has to be noted (and the authors do briefly note this at the end) that there are problems with using the total scores on the FSFI and the PSQI-12 as indications of different sexual function between the two groups of women given that some questions on each of those surveys were used as criteria for putting the women into those groups in the first place.
  • Their blood was taken at the follicular phase of their menstrual cycle. Estradiol, Free testosterone, Total testosterone, Free androgen index, and Sex hormone binding globulin was measured. There was no statistical difference between levels for the two groups of women except in the Sex hormone binding globulin. The "normally orgasming" group had higher.
  • All kinds of distances were measured from pictures taken through MRI from the Sagittal, Coronal, and Axial view. The table is below, with some, but not all, of the the measurements. The majority of the measurements were not significantly different between groups. The only measurements that were significantly different between the groups were as follows - the coronal view of the glans area (the sagittal view of the glans area was not), sagittal distance between the inferior aspect of the glans to the anterior vaginal wall, sagittal distance between the body and the anterior vaginal wall, lateral axial crura distance, and total vaginal length.



  • All the different variables (the hormone levels, every single measurement taken, every test score, and all the personal information) were all compared to each other to see if any had correlations. Most didn't, but here's a couple that did. A larger distance between the clitoral body and the vagina in sagittal view correlated with poorer scores on the PISQ-12, FSFI, and the BESAQ. Also clitoral glans area from the sagittal view correlated positively to testosterone measurements. A larger clitoral body was also noted to correlate with a higher estradiol level.

Conclusion

The study concluded with the following:
"In conclusion, a smaller clitoral glans and greater distance of the clitoral body from the vaginal lumen were noted in women with anorgasmia. Although adequate sexual function is complex, we document that clitoral size and location may be paramount in impacting sexual function, specifically orgasm. Although these physical characteristics cannot be changed, understanding the physiology of the female sexual response advances knowledge. In addition, such awareness may highlight strategies for treatment of women distressed by sexual dysfunction."

This study makes a lot of attempts to find some correlation between the size and location of the clitoris and the ability for women to orgasm, but it only found statistically significant differences between the 2 groups of women in just a couple of the clitoral measurements attained - one of which ceased being significant when measured from a different view. However, the bigger issue is that the information taken from the women in this study was not enough to group them in an appropriate way for gaining any useful meaning from the clitoral measurements. The clitoral measurements are maybe a useful things to have, but they certainly do not, contrary to what the study purports, show that women with a larger clit closer to the vagina are better able to orgasm...and it's unfortunate that pop-science studies like THIS and THIS claim it does too.

7.22.2015

Honest Liars Podcast!



Guess how I spent my 4th of July this year? Skyping into a podcast with an American and an English dude living in South Korea, that's how. It's The Honest Liars podcast, and it was, uh, super fun. I am a bit of a nervous wreck about talking. I prefer to write so that the thoughts have time to slowly move from my head down to my feet and then around to some other places and then out of my body before someone gets bored and asks another question. It just takes a while, ya know? However, I think it went well. The guys, Colin and Adam were really thoughtful and fun.

Plus their Honest Liars site is something I think is pretty cool. It's all about creating radically honest relationships in your life - and not like, "oh you should, like, always be honest with each other!" No, this is some deep honesty shit. It's about being honest about yourself and with yourself and then putting that honest version of yourself out there - often into relationships that were not founded on that kind of honesty. It's about accepting the honesty from others - and deciding how the relationship should begin, continue or end based on that honesty. I listened to some of their other podcasts, and I'm definitely for the shit these dudes are spitting. I also think that kind of deep, radical honesty is right in line with Science, Sex and the Ladies. Things gonna have to get preeettttty real about the female orgasm in a lot of people's minds and a lot of bedrooms if we want to see see much change in the sexual culture.



Anyway, we talked about all kinds of fun stuff; masturbating to Lady Marmalade, the female porn area of PornHub, Betty Dodson's advise about vibrators under pillows, sexual scripts, pee holes, you name it, we discussed it. There was tons more we could have talked about, but we talked so much it had to be split into 3 parts, so it's good for now. Plus, I think we got into some really good discussions. Have a listen.

Thanks again to Colin and Adam!

Science, Sex and The Ladies - Honest Liars interview with Trisha Borowicz PART 1

Science, Sex and The Ladies - Honest Liars interview with Trisha Borowicz PART 2

Science, Sex and The Ladies - Honest Liars interview with Trisha Borowicz PART 3

7.18.2015

Random Male Hite Report - #12



Hello, friends. It's time for more Random Hite Report! In 1976, Shere Hite dropped The Hite Report where she compiled detailed survey answers from over 3,000 women about sex, masturbation, orgasms, and relationships. It's insane to me how revolutionary this book still is. Read it, seriously. We really haven't changed that much in 40 years, and it's an incredibly insightful read.

Then in 1981, she dropped The Hite Report on Male Sexuality where over 7,000 men give detailed answers about sex, relationships, and women. It too is revolutionary, and the honesty, vulnerability, and detail in this book is so important and moving. I think everyone should read this too. So, I give you a taste every now and then to entice you to get these books. Seriously, they are both like 1 cent online.



Anyway, what I do is flip to one random page and copy the contents of that page, no more-no less, directly onto this blog. Enjoy.

 The Hite Report on Male Sexuality
Knopf, 1981 pg 450

This is from the chapter INTERCOURSE. Under the question "When should a man ejaculate? Should the woman be consulted?"

...to terminate. Someone could always go on longer."
    "Personally I think the best time to ejaculate is at the end of a long series of thrusts. I usually like to thrust my way through a series of peaks, always backing of at the 'point of no return.' Finally, when I've decided I want to orgasm, I thrust away to a building, burning peak and quickly wash over it to my release. There is no need to consult the woman, because the final pattern and urgency of the thrusting communicates the ides."
    "A man should ejaculate when he's ready. Consultation is not needed."
    "Things should happen without a great deal of studied manipulation."
    "A strange question this, but a man should ejaculate when he has an orgasm and both he and his partner should set their sexual paces towards his orgasm, or orgasm for both. The woman should be consulted in a way, but orgasm will happen after so much stimulation, not on command." 
    Many said ejaculation was involuntary, and therefore consultation impossible:   
    "A man ejaculates when he can't hold it back any longer. It's not the type of thing you have a consultation over."
    "Frankly, I don't have too much control. I do let them know when I'm about to come."
    "I don't decide. It's when I finish climaxing."
    "I think sex ends in the majority of cases precisely when the male is 'finished.' My wife, for instance, can go on and on, whether she has had her orgasm or not-a man cannot do this. This is the reason, I think, that the male decides when to end sex."
    "After I'm done, it's over. I can't help it." 
    Some men resented the idea of consultation: 
    "Consult the woman? How? I wouldn't want to ask for her permission."
    "A man should ejaculate when he's damn good and ready, that's when. But, damn good and ready depends on my partner, and if she ain't damn good and ready, then I ain't either. 'Consulted?' Sounds like we're calling in medical advise as to whether or not to operate. A man and a woman should get to know each other, then they would know, or could at least lay a pretty good guesss, as to when his or his partner was going to come; one night stands excepted. Sex should end like it started, naturally, and together."
    "When he can't stand it another minute or second longer. Since women don't get any real pleasure out of when I come or thrusting, why should they be consulted? It's my orgasm."
    "When it comes, it shouldn't be forced or held back. I don't consult the woman, and I certainly don't expect her to consult me as to when she can orgasm. When it comes, it comes."

7.15.2015

The Overnight - The SSL Review




I will warn you up front. This SSL Review will have spoilers. Since I don't review whole movies - just the depictions/discussions of female orgasm and masturbation in movie - I don't usually have to give away any true spoilers to say what I want to say. However, this movie is an incredibly unique one as SSL Reviews go, and there was some shit in it that I just can't not mention. My point is, if you want to go into this movie completely surprised, then maybe wait to read this after you watch. Otherwise, read on.




General Non-SSL Overview
I actually enjoyed watching this movie. It was fun and kept me interested, and even though I have sort of a distaste for the main character in Orange is the New Black, her character in this movie did not annoy the shit out of me like I had worried it might. Also, ever since I watched the 70's swinger TV show Swingtown a few years ago, I have loved the idea of a 'swing trap.' You see, these 70's swingers didn't have the Internet to find other swingers, so they had to just find them in real life - which is a lot trickier, and might just involve a swing couple turning out some other couple they meet. There's a lot of finesse and confidence that goes into that - that's high level swinging, and I respect that shit.

from The Overnight Tumblr - and yes, I am.

The Weird Part I Want to Talk About
I'm telling you this because the first part of this movie was particularly awesome because I was always anticipating the full-on swinger trap coming up. I was ready to pull the trigger on a "Swing-trap bitches!" (and me and Charlie were the only one's in the theater, so I would definitely have said that out loud). However the movie never went fully swing, which was a little disappointing to me, and it also went in this really weird, slightly troubling directions. So, basically the movie was about a couple that is new to LA, and they are invited to dinner with a family that has a son their son's age. It's their first social encounter in the city. From that point it just turns into a night that, once the LA couple convinces the other couple to let the boys go up and sleep instead of heading home, grows ever wilder and weirder. There's drugs, and booze, hot tubs, skinny dipping, and well, other things. Like I said, the whole things seems like a big ol' swing trap, but in the end, it's not really. The dude in the LA couple still loves and likes his wife, but basically wants guys sexually - so much so that he's lost interest in his wife. They sleep in separate rooms and just plain don't have sex (which by the end we see that they really aren't okay with). This night was their first attempt to try to fulfill this need for him. So, yes, in a way I realize this was kind of a swing trap, but it was kind of a dark one and not really a swing-style one. I mean, if this were a true swing trap, the LA couple would have been fine, sexually speaking, but ya know, just adding in some extras. Sure the LA guy might want a piece of a dude, but it doesn't mean he has lost interest in his wife - or women. He's just bi, baby. It'd all be in good fun. But in this movie, this swing-trap arose from these people's problems, and serious ones at that. I mean, this LA dude, well, he's gay, like really gay - like he maybe shouldn't have married a woman gay.

So, there feels like there's something kinda irresponsible there, especially when at the end of the movie the LA couple sees the other couple again and tells them they're in therapy and going to try to make the marriage work (and I'd say this part of the film is pretty un-ironic and jokey). If you read between the lines it's kinda like this gay, heterosexually-married guy is going to therapy to not be gay anymore so he can be with his wife sexually again. It's not only sad to me because it took all the fun-loving wildness out of a classic swing-trap, but it also strangely insinuates that you can therapy out a gay guy in a straight marriage.

Okay, so I just had to get that out, cause it was so wierd to me. The SSL review part might be even weirder though. This movie, to my utter surprise, started as a 5 vulva rated movie. Let me set the scene - it was the very first scene in fact.

The First Scene :)
Alex and Emily are having intercourse, missionary style, in bed. It seems like day time. She tells him, "Circles, honey, circles," or something like that, and he starts moving his hips in circles. Then she says something like, "bigger circles," and his hips start moving in bigger circles. They seem kinda rushed and desperate - like it's getting toward the end, and they need to catch that orgasm before it leaves. Then they sorta say something like, 'Let's just...." and he rolls off her, and they both just start masturbating quickly under the sheets. He's clearly stroking a dick under there, and she's clearly rubbing the outer vulva/clitoral area in a small, quick circular motion. Now, if you know me and this blog, you know this made my jaw drop. I'm pretty sure I fist pumped in the theater (we were the only ones there, remember). I mean, this is a couple who is having intercourse that decided to get their orgasms in a completely realistic way. A woman using her hand on her clit at any time in a sexual situation with a man is almost unheard of in Hollywood.

Actually, no orgasms happened because their son runs in and jumps on the bed before either finish, but they clearly would have. Seriously, I cannot fully express the joy in my heart when I saw a depiction of a normal heterosexual couple approaching female orgasm in such a realistic way. Outer clitoral stimulation causes orgasms, and vaginal stimulation does not (unless of course there is outer clitoral stimulation happening at the same time...I'm still waiting to see a movie with a woman getting fucked and rubbing her clit to orgasm at the same time). It was just so refreshing to see a wider portrayal of what heterosexual sex could involve. Plus, I just plain love mutual masturbation. Let's start seeing more of that, could we?

The Take-Back :(
And then....well, and then they ruined it. This is the first movie I've ever reviewed that went from a 5 vulva rating to a zero rating so fast. And, it wasn't that there was another scene later that was had a less realistic depiction. It was that it had a later scene that obliterated the good scene - turned it's meaning completely.

So Alex, we find, has a deep insecurity about his penis size. We learn this because LA guy (played by Jason Schwartzman - actually really well I might add) gets naked to jump in the pool, and he has this nicely sized prosthetic limpish dick with a huge bush. Alex tells Emily that he can't take off his clothes because, as she knows, he's just too self conscious. They end up going down to only their underwear. However, later in the night as Alex gets more drunk and high, and they're all in a hot tub together, he confesses this deep secret, an that he felt terribly self-conscious when he saw LA dude's 'horsecock.' Everyone is being kind and accepting to him, and Emily keeps trying to reassure him that it's no big deal to her.

from The Overnight Tumblr - and he would if he wasn't so insecure

Cool. Fair enough so far, just a little story about a common male insecurity. But then, he gets kinda angry and says something like, "Oh really? Is that why we always have to do 'circles'?" He goes on, and in his rant describes the situation as him having to move his little dick around in circles so that it would make it feel to her like a big dick. This blew my mind again, but in a much worse way. Basically, the insinuation we, the audience, get is that Alex's dick is too small for Emily to feel in her vaginal walls. He has to move that small dick in circles around the perimeter of her vaginal walls quickly enough so it feels like one big dick is touching all the walls at the same time (and he really does describe it this way).

First Off...what?
I had never heard of this idea of moving a dick around the vagina in circles to make it feel bigger. So, maybe that means it's a good, surprising joke? Although it's only funny if it were true that women need their vaginal walls stimulated in order to orgasm. Since that's not true...and in fact there is no scientific evidence that vaginal wall stimulation has ever made a woman orgasm, then it just becomes another terribly misleading insinuation about how female orgasm works wrapped in a joke and put into people's brain like a contagious and harmful virus.

From The Overnight Tumblr - those damn stupid circles....

Secondly...my 1st scene joy was all a hoax
Emily doesn't disagree with him about his circle in the vagina talk. She just sits back kinda defeated. If I look back to the first scene, it makes sense too. Like I said, she seemed kinda desperate to come, but I kinda took it as a doing-it-real-quick-and-trying-to-finish thing that can happen when you get to the orgasm part, so you just make it happen however you can at that moment.

Actually, it was really a your-dick-never-seems-to-be-able-to-make-me-come situation. So at first he's just fucking her normal. Then she wants circles (cause she needs a bigger dick, of course), but that is still not working, so she wants bigger circles (cause that feels like a bigger dick, I guess), and then she knows it's not going to work, so they just stop fucking and start masturbating. I honestly had thought that she wanted the circles because it was more of a "grindy" motion. Thus, his body/pelvis area could sorta dig in close (ya know, with constant pressure against her instead of the possibility of intermittent clit touch during the in-out stuff), and grind in circular motions down onto her clitoral/vulva area more. To me that's what I imagine when circle-y pelvis sex movements are discussed. It's a fairly sensible way a woman might get off during intercourse, so of course she would want that, I thought, and of course I would love to see that in a movie. I feel so betrayed, so betrayed!

Thirdly...why, god, why?!?!
That once joyously progressive first scene suddenly becomes super backwards, and what really nails the point home is a scene later in the movie. Alex and Emily start to be pretty certain that they're in a swinger-trap situation, and they are conversing privately. It comes out that she is a little interested in the horsecock. She has never had sex with anyone but Alex, and she is curious sometimes. And then she says (not an exact quote - it's from memory), "I think it's wierd that we have to masturbate together to get off." It's like she drove a stake right through my heart. Not only is she putting the stigma straight back into a couple masturbating together that I thought the first scene was dispelling, but she is also further insinuating that the size of his dick (and how it can't stimulate her vaginal wall correctly) is the reason it's hard for her to orgasm with him. So, as if we haven't heard this enough in movies, TV, and book already in our lives, here's what this movie tells the audience and adds into the cultural conversation:

  • Normal means a guy being able to fuck a lady into orgasm
  • Touching yourself during sex is wierd, and clearly a lesser way for a couple to orgasm 
  • Bigger is better for dicks when it comes to lady-gasms
  • And, my favorite: Women orgasm from inner vaginal stimulation

Although, I will have you note that even though the movie tells us that Emily needs more vag-wall rubbing to get off, she completely ignores her vag-wall when she is getting herself off. She, like almost all women, stimulates the outer clitoral vulva area. I guess if it were true, as is widely believed (but actually has no real evidence to back that belief up), that women have 2 distinct stimulation pathways to orgasm, one in the outer clitoral/vulva area and one inside the vagina, then her stimulation switch makes sense. If, as I propose is true (and I believe the science clearly backs up), women only have the outer pathway, then it's just a downright back-assward scene.

The Verdict
Like I said, I actually enjoyed watching this movie, but it will be getting a super shitty SSL Review. It didn't just hold to the common, quite incorrect and misleading cultural 'knowledge' about female orgasm as most movies do. It actively poo-pooed more progressive depictions of sex, like women needing outer clitoral/vaginal stimulation to orgasm and couples mutually masturbating to get off. I actually don't usually do this, but this movie is getting rated with ZERO VULVAS. :(


7.13.2015

Cervical Stimulation and Orgasm in Women with Spinal Cord injuries - A journal Article I read



Here is another installment of A Journal Article I read. This one is about an article I've been meaning to do for a long time. It's one that's used A LOT in articles (everything from crappy web articles to the background parts of other journal articles), TV segments, and in even debates with me as proof that there is stuff up in the vagina that can actually make women orgasm. Also, this is an article with Beverly Whipple and Barry Komisaruk as authors. Both are very active in the media and often pop up as the the expert in articles about female orgasm.  Whipple was one of the 3 authors of the G-Spot and Other Recent Discoveries About Female Sexuality - the book that introduced the G-spot and female ejaculation to pop culture. Komisaruk is a scientist in the psychology department at Rudgers and has been researching about females and orgasm for a long while - working closely with Whipple actually since at least the early 90's. This seems to me to be their most famous work.

Brain activation during vaginocervical self-stimulation and orgasm in women with complete spinal cord injury: fMRI evidence of mediation by the vagus nerves.
Komisaruk BR1, Whipple B, Crawford A, Liu WC, Kalnin A, Mosier K. Brain Res.
2004 Oct 22;1024(1-2):77-88.

The Quick Version
I'm going to give a quick overview for those of you who don't like the details. I actually think this research into women with Spinal Cord Injury (SCI) is pretty cool stuff - and probably promising for many women with SCI (There's also another good study about women with SCI and orgasm HERE. I'll review it eventually, but check it out if you're interested)

 In this study, 5 women with Spinal Cord Injury (SCI)  were given cervical stimulation. And...it’s a particular kind of cervical stimulation that involves a pessary, which is kinda like a hard cervical ring that had to be professionally fitted to each woman individually. The pessary has Velcro on it, and a device that ends with a modified tampon with Velcro on the end is inserted in and attached to the Velcro on the pessary. It is controlled by the patient and sort of puts suction-y pressure on the cervix (without really touching the cervix - cause that hurts like a bitch, right?). It’s not your average vaginal stimulation, ya know? Three of the five women verbally reported orgasm which was accompanied by an increase in brain activity in places the researchers felt, given some past studies, were consistent with what would be expected during orgasm. Heart rate, respiration, and blood pressure were not measured and neither was pelvic muscular activity. They suggest the Vagus nerve bypasses the spine and makes this possible even with the spinal injuries.

So, the study supports a very particular type of cervical stimulation having some amount of direct pathway to the brain. However, 3 of the 5 women claimed that this cervical stimulation caused an orgasm also. Increased brain activity was found at the time these 3 women claimed to orgasm, and that was seen as proof that the orgasm happened. However, as of yet there is no clear understanding of whether that brain activity is a reliable marker to indicate any particular kind of climactic sexual experience, much less the muscle contractions identified by M&J’s work (which were not tested for directly either). There is also no understanding of what that brain activity correlates to physically, or if it correlates to anything physical at all. Although a kind of cool study, it does not show proof for vaginal or cervical stimulated orgasms as is often suggested.

The Details

Background
The background discussion mostly focuses of whether or not there is direct connection between the brain and female genitals. It points out evidence in rat studies that basically say there seems to be a direct connection through the Vagus nerve between the cervix / uterus and the brain - meaning that it doesn't first go through the spine. They say this because there were some stimuli that could still be detected in these rat's brains even when the spine was severed in a place that should not allow stimulus detection that far down their bodies. It goes on to say that until this article there was no evidence that this was true in humans also.

The Experiment
The 5 women ranged in age from 23 to 54 and there time with SCI ranged from 1 to 21 years. They were all found to be healthy both physically and mentally. They were also examined to ascertain the level and completeness of the SCI using standard methods.
"Individuals were imaged in the coronal and sagittal planes using standard functional MR imaging BOLD techniques....Individuals' heads were immobilized with foam and taped to the head holder to limit motion."
Each woman first went through a series of tests in the MRI as a sort of control to demarcate the Nucleus Tractus Solitarii (NTS) region of the medulla oblongata. This was done because that is where the Vagus nerve is known to project, and the hypothesis is that the cervical stimulation will project there too since it is believed that the Vagus nerve is carrying the stimuli directly to the brain. This was done by having the women perform activities that are known to project on or near the NTS. These included things like tapping a finger and tasting sweet, sour, salty and bitter.

The women later self stimulated their cervix, using the contraption described above (I also added a quote with the specifics of this device at the end of this article), and MRI images were taken during the process. There is no information given about how long the women were allowed to stimulate their cervix or if there were particular instructions for the process.

Results
Basically, theses authors found that there was, as expected, activation in the projection zone of the Vagus nerves during the time the women were applying Cervical Self Stimulation (CSS). It was found to be in the lower part of the NTS which means it was lateral to the area activated by taste sensations (which is expected to be in the anterior part of the NTS) and it was adjacent to the part activated during finger tapping (which was expected to be in the nucleus cuneatus which is next to the NTS).

Komisaruk et al. Brain Res. 2004 Oct 22;1024(1-2):77-88.

For the 3 women who claimed to orgasm, there was gradual increase in brain activity, from onset of CSS to orgasm. It doesn't really give data about if there was or was not an increase in brain activity during CSS for the 2 women who did not orgasm, and it did not compare the brain activity of the women who did and did not orgasm. There was also no discussion of how long each of these women engaged in CSS - except that EL went from CSS onset to orgasm in about 8 minutes.

Komisaruk et al. Brain Res. 2004 Oct 22;1024(1-2):77-88.

All of the women reported a sensation when the stimulator was placed against the pessary on the cervix, although they each described it a little differently. AN described a feeling of changing pressure, VA described a "chill inside," AP and EL described a "touch inside," with EL also feeling vaginal muscle contraction at that time.

The women were also checked for pain threshold during the cervical stimulation compared with resting pain threshold. I know from reading their prior studies focused exclusively on this test that this was ascertained using a device to put increasing pressure on the fingertip, but strangely I couldn't find anything about the experimental method for this in the study even though the results were reported here. The authors tell us each woman had increased pain threshold during the cervical self stimulation. It seems weird to me that it's not in there, but I'm not too worried about it since I've seen one of their studies on it before - which I will review soon.

Discussion
The discussion first focuses on the spinal injuries each women has and whether it seems clear that the brain activation that occurred during cervical self-stimulation could be confidently said to have occurred through direct brain-cervix access by the Vagus nerve. The later part of the discussion mostly focused on what other studies showed about brain activation during orgasm and arousal.
"There appeared to be an overall increase in brain activation at orgasm in the present study in which activation of specific and multiple brain regions could be discerned...Differences between regional activation during, versus before or after, orgasm suggest that areas more directly related to orgasm include paraventricular area of the hypothalamus, medial amygdala, anterior cingulate region of the limbic cortex, and region of the nucleus accumbens. At present, we cannot distinguish whether these regions are activated uniquely at orgasm, or whether their activity increases gradually, only exceeding an arbitrary detection threshold at orgasm."

Komisaruk et al. Brain Res. 2004 Oct 22;1024(1-2):77-88.

The authors go on to tell us there is no known evidence of orgasm in rats, but compares the brain scans in this study to those of cervix stimulation in rats.

 Below is the only discussion about how previous studies about brain imaging during orgasm match up to this study.
"To our knowledge, this is the first evidence of activation of hypothalamus during orgasm in men or women. Earlier reports of orgasm in men found activation in prefrontal cortex, but not subcortical structures [74]. Recently, Holstege et al. using positron emission tomography reported that during orgasm, elicited in men by penile stimulation by a partner [21,24] and elicited in women by clitoral stimulation by a partner [25], the mesodiencephalic region, cerebellum, and several cortical areas, but not the hypothalamus, became activated."
The authors then discuss a prior study by Wallet et al. of men during sexual arousal - not orgasm- caused by visual stimulation. The fMRI in this study, "reported that activity was increased in the amygdala, hippocampus, hypothalamus in men relative to women, wheras the striatal regions (candate and nucleus accumbens) were activated in women."

I am no brain fMRI expert or neuroscience expert here, but from the past data they are comparing this to, it seems like the activation they are seeing might be as close to the studies capturing visually stimulated arousal as it is to the studies capturing orgasm.  I might be wrong here, but it just didn't seem like the activation observed in this study were clearly types of activation that indicates orgasm .

The the authors go on to discuss brain areas activated in this study that may indicate oxytocin release. However, as they themselves mention, oxytocin release, although part of orgasm, is also part of all kinds of other things, including vaginal or cervical stimulation (known as the Ferguson Reflex). They then make connections with the oxytocin release and the women's increased pain tolerance, and talk more about what might be involved in that increased pain tolerance observed in this study. The only other part of the discussion that involves itself with orgasm specifically is the following assertion.
"A salient and reliable feature of brain regions activated during orgasm was activation of the cerebellum. The cerebellum modulates muscle tension via the gamma efferent system, and it receives proprioceptive information [45]. Since muscle tension can reach peak levels during orgasm [44] and contribute to the sensory pleasure during orgasm [31,32], it is not unlikely that the cerebellum thereby plays a significant motoric and hedonic role in orgasm." 

So, it seems the authors are pointing to the activation in the cerebellum as the most important and reliable indication that an orgasm really did happen. They point to this because the cerebellum deals with muscles. It's funny to me because when they say this, they cite Masters and Johnson's Human Sexual Response (that's the [44]), which means to me that they are acknowledging that the rhythmic muscle activity that Masters and Johnson identified as a reliable marker of orgasm, is in fact quite important and reliable.  It's funny to me because these authors have a long track record of advocating for widening the scope of what the word 'orgasm' (particularly female orgasm) means beyond the very clear, observable, and widely accepted definition Masters and Johnson set out in the book cited above. They also have a long history of not checking for or even really discussing that reliably observable marker for orgasm in their studies about female orgasm.

So, maybe the brain activation in the cerebellum during the reported orgasms in this study is an indication of the muscular activity of an actual, Masters and Johnson defined orgasm, but maybe it's not. We don't really know much about what exactly the brain activation indicates or whether we could count on any parts of that brain activation to accurately and reliably mark orgasm. However, if these authors really wanted to prove that these women had orgasms and that the activation seen in their brains were truly related to orgasm, then they could have just checked. It is absolutely possible to do so, but they did not.

Conclusion
And that brings me to the conclusion. I'm on board with their statements like, "In women, the Vagus nerves provide a genital (vaginal-cervical) sensory pathway that bypasses the spinal cord." I think that's fair given the data they collected in this study.

I'm not cool, however, with their conclusion that, "in cases of compromise of vagina-cervical sensory activity via the genitospinal nerves, genital sensory activity conveyed via the Vagus nerves is evidently adequate to induce orgasm in women."

I think that indicating a particular physical stimulation causes orgasm when an orgasm has not been verified is a bit irresponsible (even though tons of researchers still do it). These authors' findings of extra brain activity when a woman says she has orgasmsed is not enough to make that conclusion. This is a scientific investigation, and the bottom line is that asking a person whether or not a particular physical event happened in their body is simply not good enough. It's a start - not a conclusion.

The data they collected is certainly worthwhile, and could be important for further research, but claiming that these women stimulated their cervix to orgasm is at best contentious. There is no evidence that what these women experienced involved the rhythmic muscle activity known to be a reliable, accurate marker for an orgasm. There is not even evidence that the brain activation identified  in this study is a reliable or accurate marker of anything at all - much less orgasm.

This study, to my dismay, does as most studies about inner-vaginal stimulated orgasms do. It does not actually confirm an orgasm takes place. It's easily detectable, but too often in studies about female orgasm, the researchers simply don't bother. There is a physical thing called an orgasm, and we acknowledge that this physical thing is an orgasm when we talk about males. However, for females it seems like any time a woman says she orgasms, then we must include whatever it is that she experienced at that time within the definition of the word orgasm. It's really, like, the worst way to go about scientific inquiry, like just the worst. One person could literally be using that word to describe something completely physically different than another person. Yet, scientists are investigating, speaking about, advising on, and making conclusion about all those different 'orgasms' as if they are the same things. I mean, how could there be any confusion or miscalculations involved in that?

This lack of verification might just seem like a small experimental choice, but it is much more. If the women in this study say they orgasm, but they are actually not exhibiting rhythmic muscle spasms, then those women are experiencing something different than women who do experience the rhythmic muscle spasms - and their experiences should not be called the same thing or discussed in the same way. Some things are the same, and some things are different. The scientific community should acknowledge when things are the same and different. It's not a hard concept.  Debate about the value of these two different experiences or what to call them is absolutely valid, but if the scientists doing research in this area are intentionally refusing (as I worry some are) to even gather information about what I know they know is important to a clear understanding of how female sexual release works, then I call bullshit. This area of study, and women, deserve better.

Appendix (in case you want to know more about that cervix stimulator)
"Vaginal-cervical self stimulator was applied with a passive stimulator consisting of a handle into which a modified tampon mounted on a lucite rod was inserted at right angles. A Velcro disc was attached at the tip of the tampon. To a ring pessary (Model PRSFS, Milex Products, Chicago, IL) previously fitted to each subject by her gynecologist, was attached by suture silk a matching Velcro disc. The pessary was inserted by a registered nurse and the Velcro disc attached to the tampon stimulator was pressed against the matching Velcro disc on the pessary. This device centered the stimulator tip against the cervix through the pessary and the pessary protected the cervix."