Mapping the way to G-spot utopia

Special to The Times

When in 1950 Dr. Ernst Grafenberg described finding a surprisingly sensitive spot inside the vagina near the urethra, he made the process seem so foolproof. A medical article detailed his effortless demonstrations of the existence of this "distinct erotogenic zone" -- and the not-unexpected consequences of stimulating such a zone -- in his own patients. Anyone with a vagina could surely do the same for herself.

Well, perhaps it was that easy for him. But outside his examining room, nothing about Gräfenberg’s spot:zzFw77tO16wJ:info.med.yale.edu/therarad/summers/Grafenberg.doc has proven so simple.

In the 1980s, after nabbing a catchy new name and a starring role in a bestselling book, the G spot achieved notoriety in American sex culture. For some women, its discovery and stimulation led to mind-blowing orgasms. But for others, exploring the promised land around the urethra led only to a sense of bewilderment -- sometimes enlivened by an irritating urge to urinate.

Some researchers doubted there was anything to stimulate in the first place. A scientific article in 2001 denounced the G spot as a "modern gynecologic myth."

This might seem a bit baffling. How can 21st century researchers argue about whether a palpable part of the body in fact exists?

For one thing, there's no standard definition of the G spot. Experts advise women to explore the region about one to two inches along the front vaginal wall (the side closest to the belly, not the spine). Yet scientists disagree about what they're searching for -- a separate gland, the deep-down part of the clitoris, or something else entirely?

Meanwhile, recent research points to another stumble on the road to G-spot utopia: Whatever a G spot is, not every woman may have one.

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Tissue at issue

In 2002, a team of Italian researchers making a detailed study of the pelvic regions of 14 women found surprising differences in anatomy. Only 12 of the women possessed erectile tissue -- the nerve-infused sensitive stuff that makes up clitorises and penises -- along the front inner wall of the vagina, where the G spot is said to exist.

And only nine women had Skene glands, made of tissue that would have become the prostate gland had the female embryo turned out to be a male. (Think of male nipples. It's the same idea.)

What's more, these glands and erectile tissue were awash in the same active enzymes in the penis that respond to drugs such as Viagra. The structures were likely candidates for the mechanism of the G spot, and the evidence, published in the journal Urology, hinted that only some women had them. (How many women, however, is still unclear; the study was too small to make estimates.)

But there was a big problem, says Emmanuele Jannini, professor of experimental medicine at University of L'Aquila in Italy, who led the investigation. The study had to rely on autopsy results from women whose bodies had been donated to science. There was no way to know whether the special tissue and glands made any difference sexually.

So Jannini decided to examine the pelvises of living women using ultrasound imaging. His study, published in March in the Journal of Sexual Medicine, looked at 20 women, about half of whom said they experienced "vaginal orgasms" through the stimulation of the front wall of the vagina alone.

This vaginal-orgasm group tended to have slightly thicker tissue than did the clitoral-orgasm group, the team found -- about a 2-millimeter difference along the upper wall between the vagina and the urethra. Although ultrasound images can't show exactly what's in there, it's the same place that Skene glands and erectile tissue from the inner bulb of the clitoris are likely to be.

Plenty of nerves suffuse this area, says Barry Komisaruk, psychology professor at Rutgers University, who was not involved in the study. The vagina and clitoris each have different kinds of nerves, and because the male prostate is richly innervated, it's possible that the Skene glands have their own kind as well.

But without further study, it's impossible to understand how the nerve networks in women with thicker tissues might be different, Komisaruk says. Nor does science know whether stimulating this spot leads to the bigger, deeper orgasms of G-spot legend. But, he says, the area's different nerves lead to different parts of the brain, each producing their own sensations. "So stimulating a combination of nerves might be synergistic, leading to a unique sensation and to more complex orgasms." His preliminary work shows that different regions of the brain perk up when women stimulate their front vaginal wall, say, as opposed to their clitoris or cervix.

To Jannini, it's clear: Some women have extra-thick, sensitive, different tissue in the front wall of the vagina, whose stimulation can lead to vaginal orgasms. Other women don't. (Call it a G spot if you like, he says; until there's a formal definition, the label is more about marketing than science.) Figuring out once and for all which group a woman is in might someday be done with a detailed biochemical analysis and ultrasound imaging.

Thick or thin, though, it's all part of natural variability, Jannini believes. "A woman without the so-called G spot is perfectly normal," he says. Exactly why tissue in this region would be thicker in some women isn't clear, though their natural testosterone levels may be involved. His team is now investigating how too much or too little of the hormone might change this tissue size.

But there are probably no shortcuts to this kind of plumped-up G spot. Some cosmetic surgeons offer "G-Shots" -- injections of collagen into vaginal wall tissue -- though there's no published evidence showing they create a more sensitive vagina. Nor is there any reason to suspect they would, Jannini says. A thicker G spot is more sensitive because of the chemically active tissue naturally there. Inserting a blob of foreign material won't change that, he says.

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Variability as the rule

Although intriguing, the G-spot ultrasound study is far from definitive, researchers say. It's hard to draw conclusions from the small number of participants, for one thing. And the study didn't explore whether the women's vaginal orgasms were in fact due solely to stimulation of the front vaginal wall or if other parts of the vagina or cervix were involved. Plus, the thickness of women's tissue probably lies along a continuum, reflecting to some degree the amount of sensitivity within.

In fact, sexual variability seems to be the rule among women, says Kim Wallen, a psychology professor at Emory University. He has explored the methods women use to experience orgasm, and how the configuration of a woman's external clitoris and vagina relate to her orgasms during intercourse. In recent work, published in February in the journal Evolution and Development, he and a colleague found that the women's clitorises vary in length about three times more than men's penises do. This might relate to why the G spot differs so wildly among women, he says -- and also hint as to why its absence need not matter so much in practice.

"Our work has shown that the variability in women's orgasms is quite remarkable," Wallen says.

"Women's potential to have different kinds of sexual experiences is probably greater than it is in men. And the variability in women's genitalia may also reflect that there are more paths to orgasm in women than in men."

Or, as Ernst Grafenberg wrote, "There is no spot in the female body, from which sexual desire could not be aroused."

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