©2002 By Gary Schubach, Ed. D., A.C.S.
An interesting controversy has arisen over an article in the American Journal of Obstetrics and Gynecology by Dr. Terence Hines entitled, “The G-Spot: A Modern Gynecologic Myth.”Hines concludes: “the evidence is far too weak to support the reality of the G-spot.” I couldn’t disagree more.
Gräfenberg does not refer to the G-spot as “a small but allegedly highly sensitive area on the anterior wall of the human vagina about a third of the way up from the vaginal opening,” but to the “area” or “zone” on the upper wall of the vaginathrough which the prostate (aka Skene’s glands and ducts) can be accessed. In women, the prostate gland, while generally smaller than the male prostate, also surrounds the urethra, close to the urethral opening. The great sensitivity comes not from what is on the upper wall of the vagina, but from glands and ducts behind the vaginal wall.
It should be clear from an unbiased reading of Gräfenberg‘s paper that he is talking about the prostate (aka Skene’s glands) when he writes, “Analogous to the male urethra, the female urethra also seems to be surrounded by erectile tissues like the corpora cavernosa. In the course of sexual stimulation, the female urethra begins to enlarge and can be felt easily. It swells out greatly at the end of orgasm. The most stimulating part is located at the posterior urethra, where it arises from the neck of the bladder.”
The biggest problem I have with the Hines article, however, is that he cites relevant articles that support the existence of a female prostate gland as the so-called G- Spot, but ends up concluding that it does not exist. Though he finds the G-spot so hard to locate himself, he promises to discuss Drs. Davidson, Darling and Conway-Welch ‘s acknowledgement that the female prostate gland is indeed the G-Spot and, then, never really does. Instead, he ends up making the statement, “If the G-Spot does exist, it will certainly be more than a system of glands and ducts. If an area of tissue is highly sensitive, that sensitivity must be mediated by nerve endings, not ducts.” Hines is correct but, as already noted, the female prostate is not located on the wall of the vagina, and the nerves that give the prostate its sensation may be in the muscle coat around the glands rather than in the glands themselves. Recent studies have also suggested that the anterior wall of the vagina could be more densely innervated than the posterior wall.
Further, in his evidence against the so called G-Spot, Hines states that the “issue of female ejaculation is relevant to the G-spot for two reasons. First, the two are often considered together in the popular literature with the strong implication that the reality of ejaculation supports the reality of the G-spot. Second, some authors mistake the presence of glands that may produce a female ejaculate with the G-spot, (a topic discussed in detail later).” However, he never discusses it in detail in his article. Contrary to Hines’ assumptions, both my own and other studies have shown conclusively that a woman can reach orgasm by stimulation of the prostate though the upper wall of the vagina which may or may not include ejaculation. Similar to men, it is also possible for women to have an ejaculation without prostate (G-Spot) stimulation.
I have no argument with Hines’ point, “that manual stimulation of the putative G-spot, resulted in real sexual arousal, in no way demonstrates that the stimulated area is anatomically different from other areas in the vagina.” However, while citing various pathological studies, including a 1948 study in the American Journal of Obstetrics and Gynecology, Hines omits at least seven authoritative pathological studies that support the existence of a female prostate gland. From the research of deGraff in 1672 to the recent work of Zaviacic, there have been numerous studies that in some way support the conclusion that, what has been called Skene’s and/or paraurethral ducts and glands, are a homologue of the male prostate.
Hines opined that there is lack of evidence in support of female ejaculation. Yet, he overlooked Santamaría who showed the presence of PSA in female urethral expulsions, as well as my own doctoral research that showed differences in the chemical composition of fluid obtained by catheterization from the same woman’s baseline urine specimen and a specimen that was drained from her bladder prior to ejaculation. His complaint about the insufficiencies of pre-1985 research concerning the presence of acid phosphatase (PAP) also shows a lack of awareness that forensic pathologists, due to PAP occurring naturally in the vagina, long ago discredited PAP detection as a certain prostatic marker.
Hines proposes that if women ejaculate a fluid that is not urine or has non-urine constituents, it must be coming from someplace other than the bladder. However, my study showed, for the first time, what had been suggested by Goldberg thirteen years earlier; namely, that ejaculatory fluid possibly originates not from either the bladder or the urethral glands, but from both.
I’m afraid that I also cannot agree with Dr. Hines’ observation that most popular books, and even textbooks, recognize the existence of the G-Spot as the prevailing medical or social paradigm. Such noted experts in the field of human sexuality as Alfred Kinsey and Masters and Johnson, dismissed female ejaculation as being an “erroneous but widespread concept.” Masters and Johnson also argued against the existence of the erogenous zone known as the “G-spot” and steadfastly stood for the premise that the clitoris alone was responsible for triggering female orgasm.
Dr. Hines and I, however, completely agree that the existence of the G-Spot is not just an issue of minor anatomical interest. It is an area of enormous importance in terms of how millions of women view their sexuality, and the amount of pleasure and intimacy they can experience with their sexual partners. If the evidence demonstrates the G-spot and female ejaculation as components of natural sexual functioning, women can be freed from guilt and shame about prostate (G-Spot) stimulation and the expulsion of fluid during sex. In addition, Hines’ article exposes the need for health professionals to have more education and training in Human Sexuality. Such knowledge will help them better serve their patients. The current debate demonstrates why Dr. Milan Zaviacic’s medical school textbook, The Human Female Prostate: From Vestigial Skene’s Glands and Ducts to Woman’s Functional Prostate, should be required medical school reading.
In conclusion, this article has demonstrated that the term “spot” is not a useful metaphor to describe the anatomical basis of the female erogenous experience of stimulation of the upper vaginal wall. The term only contributes to the confusion. A more accurate and descriptive term, such as the female prostate or prostata feminina, should make it easier for everyone to understand the issues involved and to better serve women’s health needs. In fact, the Federative International Committee on Anatomical Terminology has recently agreed to adopt the term female prostate (or prostata feminina), implying function as well as form in its definitive Histology Terminology.
It is clear that more research is needed to answer the questions past studies have raised, but it is my hope that the foregoing discussion has illuminated some important issues for further exploration. For example, a noteworthy outcome to this discussion might be the search for scientific consensus concerning whether the female prostate is indeed the illusive G-Spot. Specifically, it would be valuable to analyze urethral expulsions during sexual arousal for the presence of PSA in comparison with baseline and other urine specimens from the same female subject. Additionally, all urethral expulsions could be examined for possible evidence of hormonal alterations as a result of sexual arousal. The physiological process by which the bladder sphincter may involuntarily open as a result of stimulation of the female prostate (G-Spot) also warrants further study.