Female Ejaculation Myth Coital Incontinence Skene Duct Secretion

Female Ejaculation: Myth? Coital Incontinence? Skene Duct Secretion? Pooling of Vaginal fluid? Bernie Brenner Gynaecologist Pelvic Floor Clinic Auckland

Overview • Anatomy • Non Urinary Origin – Female Ejaculate • G Spot • Ejaculate Fluid – Pooled Vaginal Fluid • Urinary Origin – Stress Urinary Incontinence – Detrussor Contraction

The Female Ejaculate Anatomical Considerations – Skene’s Gland or ducts analagous to the male prostate

Non Urinary Origin - History Grafenberg in ‘ 50 postulates the existence of an ejaculate of non urine fluid during orgasm. Addiego ’ 81 finds a higher level of prostatic acid phospahtase and also coins the Term “G Spot” Grafenberg E. The role of the urethra in female orgasm. Int J Sexology 1950; 3: 145 -8 Addiego F, et al Female ejaculation: a case study. J Sex Res 1981; 17: 1 -13

The G Spot - ? Connection with Female ejaculation • G spot refers to a small highly sensitive area on the anterior vaginal wall near opening • G spot and ejaculation considered together because stimulation of spot leads to a more intense orgasm with resultant ejaculation Goldberg DC et al. The G spot and female ejaculation: a review of initial hypotheses. J Sex Marital Ther 1983; 9: 27 -37

G Spot Review Hines writes on the G spot Reviews literature from several perspectives and concludes “ the G spot will remain a sort of gynae UFO: much searched for, much discussed, but unverified by objective means” [2001 Am J O&G] Nevertheless with a ruler, a calculator and a colposcope:

Female Ejaculate Biochemical considerations Prostate–specific antigen present Prostate-specific acid phosphatase Zaviacic M, Ablin RJ. The female prostate and prostate-specific antigen. Immunohistochemical localization, implications for this prostate marker in women, and reasons for using the term “prostate” in the human female. Histol Histopathol 2000; 15: 131 -42

Pooling of vaginal fluid

Coital Incontinence Urinary Origin • Mechanisms of urine loss during sexual activity – Multi-factorial but common 23 to 34% – Leakage with deep penetration and abdominal pressure 77% – Leakage with orgasm 74% – Leakage with clitoral stimulation 50% Vierhout ME Mechanisms of urine loss during sexual activity Eur J Obstet Gynecol Reprod Biol. 1993 Nov; 52(1): 45 -7 Korda and Hilton studies

Detrussor Contraction

Conclusion • Skene Glands ejaculate • Pooling of fluid and levator contraction with orgasm • Coital / Stress urinary incontinence / Detrussor Contraction And the G spot? Probably most easily found at the end of the word “shoppin. G”