The great G spot debate
Her husband inserted two fingers into her vagina while Dr Beverly Whipple and three colleagues observed closely. Despite the woman’s clitoris not being stimulated, it was later documented she appeared to orgasm “on several occasions”. This was a revelation. The “G spot” had been found.
The finding wasn’t without controversy and a new debate has recently been sparked by some scientists claiming the G spot does not exist. “There is no ‘spot’ in the vaginal wall that you can stimulate and reliably cause an orgasm,” says Helen O’Connell, a urological surgeon at the University of Melbourne. “That’s just wrong. We’ve got to move away from that.”
It seems astounding that in the 21st century anatomical structures are still being debated. Indeed, the G spot may be the last territorial dispute. Writing in the prestigious journal Nature Reviews Urology in August, Emmanuele Jannini at the University of Rome Tor Vergata and colleagues described the G spot as “a unique case of remaining major uncertainty regarding human gross anatomy”.
It’s unclear if this ignorance speaks to a historical malaise of viewing female sexual organs as invalid research material, or whether women’s bodies are so complicated that modern science cannot untangle the web of nerves, hormones and psychological factors that contribute to a female’s orgasm. In his paper, Jannini wrote that the relatively few anatomical studies of women have “added to this controversy rather than providing clarity”.
The debate has implications not just for healthy women and couples seeking to explore sexual desires, but for those undergoing cervical or vaginal surgery. If doctors do not properly understand the genital structures, they cannot understand the consequences of surgical procedures.
Throughout the 1950s and ’60s it was believed that “the vagina was a tube for menstruation and babies”, says Jannini. In 1953, the famous sexologist Alfred Kinsey wrote that “the walls of the vagina are ordinarily insensitive”. Perhaps this helped dull the pain of labour.
This understanding changed in the 1980s when Beverly Whipple, now at Rutgers University, and a colleague found a sensitive area halfway between the back of the pubic bone and the cervix, which could be felt through the front vaginal wall. When stimulated, the tissue would swell and females experienced intense pleasure. “We asked women, tell me how this feels and how that feels,” says Whipple, describing the physical examination of 400 women by physicians and nurses that verified the region. “We found a sensitive area in all of the research subjects.”
Whipple presented their results at a conference and was told they should name the finding. One suggestion was the “Whipple Tickle”. Instead, they named the area after a gynaecologist who in 1950 had described some similarly sensitive areas. The research of Dr Ernst Gräfenberg had been largely forgotten, in contrast to the more publicised work of Kinsey, and William Masters and Virginia Johnson (as seen in the recent Masters of Sex TV drama). But now his initial work was to become more famous than any of them, as Whipple unveiled the “G spot”. The media loved it.
Magazine articles and books followed. Whipple was invited to speak on television. Soon, she and others began investigating the anatomy of the vagina, hoping to find a scientific basis for what women were describing. Anecdotal reports flooded in. Women wrote to Whipple, thanking her. But scientific evidence was harder to find.
Some studies found more nerves in the wall of the vagina where the so-called G spot might be, but others did not. Now the weight of evidence is moving away from the G spot entirely. According to Amichai Kilchevsky at the Yale School of Medicine, dissections failed to find an “anatomic landmark” in that area, and studies cannot consistently find a region that when stimulated will produce an orgasm. “There is not one unified or universal spot that can be replicated in every woman,” says Kilchevsky.
O’Connell, one of the first scientists to study the nerves of the clitoris and vagina in detail, agrees. “There is a risk that the average woman keeps trying to find some magical spot, and it will lead to anxiety, sexual distress and a whole lot of unhelpful social behaviours,” she says.
Sheryl Kingsberg, a professor of gynaecology at Case Western Reserve University in Cleveland, is also damning of the G spot. In 2010, she wrote in “Controversies in Sexual Medicine” that it should “be more correctly labelled the P spot where the P stands for placebo”, suggesting that merely believing in the G spot is getting women off.
Some have taken this debate even further. In October, a paper published in Clinical Anatomy reported that “vaginal orgasm has no scientific basis”. This work has largely been lambasted, however because, while there may not be a G spot, the consensus among scientists is that some women can have orgasms through vaginal stimulation alone. This will, of course, not be news to the women who can report having experienced it. But without an “anatomical landmark”, how can science explain their sensations?
A new theory would explain anecdotal reports but do away with the G spot. In 2008, after extensive studies into the nerves and blood vessels supplying female genitalia, O’Connell argued that the lower vagina and clitoris are so interrelated they may be the same structure. She called it the “clitoral complex”; later Jannini dubbed a similar region the “clitourethrovaginal complex”. Perhaps we ought to call it the “O zone”, after Helen O’Connell. Whatever we call it, in his Nature paper Jannini said that such a complex “more accurately and scientifically describes the true nature of the G spot”.
“There are a number of components to the clitoris which are located at or near the entrance to the vagina,” says O’Connell. They also have the same tissue. Small studies using an ultrasound system while a woman is masturbating, or a couple has sex, find that when pressure is applied to the O zone, more blood flows through the arteries supplying the clitoris, increasing its size and possibly putting pressure on the vagina. The swelling may also stimulate nerves near the clitoris. Penetration or finger stimulation can also make the pelvic muscles contract, pushing the vagina closer to the clitoris.
One interpretation of these studies is that the clitoris is queen – the only structure producing orgasms. But a revealing study by Whipple and Barry Komisaruk, now at Rutgers University, found that women with a severed spinal cord, cutting off the nerve supply to the clitoris, could still have vaginal orgasms. This was verified by fMRI scans which found that regions of the brain often associated with orgasm light up as the women were vaginally stimulated. The team say that the orgasm was being produced through a different nerve pathway.
This suggests that women may experience more than one type of orgasm depending on the nerves being stimulated. Indeed, according to Jannini’s paper, women tend to describe vaginal and clitoral orgasms differently – clitoral being “sharp, bursting, short-lasting, superficial and more localised” and vaginal orgasms characterised as more diffuse and “whole body”. This idea, however, is also controversial.
Another area of contention is the anatomical differences between women, which may explain why some orgasm vaginally while others find it difficult to orgasm at all. A study published this year in The Journal of Sexual Medicine found that women who could not orgasm had a smaller clitoris, which was further from the outside wall of the vagina than women who orgasm. And a paper by Jannini reported that those experiencing vaginal orgasms had a thinner space between their urethra and vagina than those who do not. These studies only examined about 30 women, however, and must be taken with caution.
So it appears that this anatomical bewilderment is not merely a case of machismo medicine. When it comes to orgasms, women are trickier to understand than men. Adding to this complexity is the fact that vaginal tissue is under cyclical hormonal control. “This makes the story complicated, because we are not always looking at the same tissue, even in the same patient,” says Jannini. “Men are always the same – they’re quite boring.”
Still, O’Connell and Whipple say the relatively new scientific interest in the female orgasm means it is catching up with our knowledge of male sexual function and dysfunction. For example, uncertainties about how some urological or gynaecologic surgeries affect a woman’s ability to orgasm represent a “glaring omission” in the literature, says Whipple.
Meanwhile, she does not seem concerned about whether vaginal orgasms arrive through a “spot” or a “zone”. Whipple is more interested in supporting positive sexual experiences for women. “Know what feels good to you, feel good about it and communicate it to your partner,” she says. Spot on.
This article was first published in the print edition of The Saturday Paper on Nov 15, 2014 as "Exploring the O zone".
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