It is hard to overestimate the damage done by Sigmund Freud in popularizing the myth of the vaginal orgasm. Only one third of women are capable of achieving orgasm with penile penetration alone (meaning hands off, penile thrusting only), so the idea that everyone should be having orgasms this way results in two thirds of women believing there is something wrong with their sexual wiring when really they are perfect.
Not orgasming with unassisted penile penetration is not a flaw, it’s a feature.
Further supporting this vaginal orgasm myth is the idea of the G-spot, supposedly identified by Dr. Ernst Gräfenberg in 1950. In modern lore, this is a magical spot on the vaginal wall (beneath the bladder) that when touched will drive a woman “wild.” Again, many women feel frustrated when they don’t have a G-spot.
Digging through the data, we find that Dr. Gräfenberg’s original paper did not describe a special spot. His paper is actually called “The Role of the Urethra in Female Orgasm,” and he described an “erotic zone” in the front of the vagina that was intimate with the urethra and lower portion of the bladder. Yes, he was likely describing the body, root, and bulbs of the clitoris as they envelop the urethra. As expected, multiple studies have found no macroscopic structure other than the urethra, the clitoris, and vaginal wall in the location of the so-called G-spot. The lower part of the vagina, close to the urethra, will feel great for many women because stimulation here is accessing the clitoris, but it takes the right stimulation—it is not an “on/off switch.”
It is not surprising to me when I hear of women who fake orgasms with male partners. After all, they have been led to believe that a female orgasm should be reached with a penis by way of an imaginary spot.
MRI studies looking at anatomy during heterosexual sex reveal that the clitoris can be compressed by the penis, which is why some women can orgasm with penile penetration. Ultrasound studies looking at clitoral swelling during external masturbation and during vaginal penetration indicate that both cause clitoral engorgement. This means that touching externally on your vulva or vestibule or internally with a penis, fingers, tongue, or toys are all producing the same end result—clitoral stimulation. Even nipple stimulation, which many women find erotic, triggers an area in the brain that overlaps with—yes, you guessed it—the area that interprets sensations from the clitoris. The clitoris is the pleasure aggregator and amplifier.
Basically, all pleasure roads lead to the clitoris.
It is best to do away with terms like vaginal orgasm and G-spot, as they are incorrect. The goal is female orgasm, and it can be achieved in so many ways.
Do women ejaculate or “squirt”?
The answer is yes, but not in the way the internet thinks.
If you spend any time looking at online videos of so-called female ejaculation you would come to the false conclusion that some women have a secret vaginal gland that can release a gush of fluid with the right touch. Many of these videos are labeled as “squirting.”
For a woman to ejaculate, the fluid must come from the vagina, the urethra, or a specialized gland. For reference, the male prostate releases about 5 ml of fluid with ejaculation, and there is no gland the size of a prostate in the vulva or vagina. So the idea that women can ejaculate a gush of fluid larger than 5 ml is, even without doing the research, rather doubtful.
But I’m me, so I researched it.
There is a pair of glands on either side of the urethra (the tube that drains the bladder) called Skene’s glands. These are about the size of a pea or smaller, and they are sometimes referred to as the female prostate because their secretions contain traces of prostate-specific antigen (PSA), a protein found in the male prostate. Skene’s glands can secrete a small amount of fluid, perhaps 1–2 ml at most, during sexual activity. It would be medically correct to call this ejaculate, but it will not squirt any distance or have a large volume.
In one study, 38 women masturbated to orgasm (confirmed by monitors that measured pelvic floor muscle contractions), and no ejaculate was seen coming from the vagina or the urethra. However, if the incidence of squirting or ejaculation was 1 in 50, say 2 percent of women, this study might not be large enough to identify them.
Another study looked specifically at a small group of women who reported squirting, meaning they said that they release a large amount of fluid during orgasm. They were screened to make sure they did not have incontinence. The women emptied their bladders and stimulated to orgasm. The amount of urine in their bladder at baseline, while aroused, and after orgasm was measured by ultrasound. Their urine was collected and analyzed before stimulation and after orgasm, and the “squirted” fluid was analyzed as well.
The results? The women’s bladders filled remarkably fast during sexual stimulation. There was urine before orgasm and their bladders were empty after squirting. The squirted fluid was identified in the lab as urine.
Why does this happen? It is possible when women report squirting that they are simply having an orgasm strong enough for the pelvic floor muscles to empty their bladder, which is why it is associated with heightened pleasure. It is also possible that a more intense sexual response could result in a faster filling of the bladder.
It is also possible that some women have a lot of transudate—meaning they get very wet—during sex. When they orgasm, that fluid could come out all at once.
I looked at enough squirting videos to categorize most as either women who had inserted water (or another fluid) vaginally and were now releasing it for the video—meaning they were acting—or fluid clearly coming from the urethra and, hence, urine. There were some that showed secretions from Skene’s glands, and as expected there were just a few drops of white liquid.
The reason we need to be medically accurate about the source of female ejaculation and squirting is that some women feel they are inadequate if they can’t squirt, and there are already enough sex myths that reduce a woman’s pleasure to a male metric. If you have urine leakage during sex and it is bothersome to you, then see a bladder specialist (a urogynecologist is a good place to start). If you are having fun and are not bothered, then it doesn’t really matter what is coming from where.
A good sexual encounter is not about optics that make a man (it’s usually a man in this scenario) feel as if he has achieved something. A good sexual encounter is about pleasure. As long as you are having an orgasm or two, who cares about anything else?
If arousal is partly due to increased blood flow, can special vibrators or medications that increase blood flow help?
Sexual arousal causes increased blood flow to the clitoris. There are several devices on the market that specifically provide suction to the clitoris to draw in blood—think a small suction cup placed over the glans—based on the idea that more blood flow may help physical arousal. There are inexpensive hand pumps, vibrators that fit over the clitoral glans, as well as more expensive devices, like the Fiera Arouser and the Eros Clitoral Therapy Device. Studies on the Eros device are very small, of low quality, and made up of self-selected patients. Having more options for clitoral stimulation and sexploration can be fun and a device that delivers a more suction-like sensation to the clitoral glans—the part of the clitoris with the most nerve endings—may also be an option to try for women who have difficulty achieving orgasm or who have never had an orgasm. However, we don’t know if expensive devices like the Fiera and Eros are better for sexual arousal than receiving oral sex, masturbating, or a more traditional vibrator. Everyone is different, and whether these devices appeal could be very personal.
Studies have looked at medications that increase blood flow to see if they improve female sexual response—after all, the class of drugs that includes sildenafil (VIAGRA) works for men by increasing blood flow to the penis. One study indicated that these medications do increase clitoral blood flow for women who report difficulties feeling aroused, but that did not translate into a feeling of sexual arousal. One possibility is the feeling of arousal is not just dependent on blood-flow-induced changes, but the brain needs to perceive that sensation as sexually pleasurable.
What about anal sex?
Anal sex has been increasing