I live!  I apologize greatly for such a prolonged absence, but it was important for me to focus these months on school.  It has paid off because as of today I hold a Master of Arts degree in Bioethics and Medical Humanities.  Hurrah!  Now, I hope to devote the proper amount of time to this blog.  I began writing an article about the vulva before my hiatus and decided to finish it for my return.

So, what is the vulva? What’s the difference between the vulva and the vagina? Isn’t it all just one, connected thing down there? Why are there different names if it’s just a vagina, after all?  What does the vulva do?  All good questions. All questions I hope to answer.

The word vulva comes from Latin and was used to mean “womb” or, more generally, “female genitals.”  In modern usage, the word vulva refers specifically to the the external genitals of the female.  The word vagina is often used as a catchall term to refer to both the internal and external reproductive organs of a female; however, to be completely correct, the vagina is an internal structure only and the vulva is the external structure only.  These external components that make up what we call the vulva include the clitoris, the labia majora and minora (outer and inner lips), the pubic mound (mons pubis), the vestibule of the vagina (the area inside the labia minora that includes the openings for the urethra and vagina), and the vaginal orifice (the actual opening of the vagina).

Here is a diagram:

Its development occurs during phases, particularly the fetal and pubertal stages.  As the entrance to the reproductive tract, it protects its opening by a “double door”:  the labia majora (large lips) and the labia minora (small lips).  The vagina is a self-cleaning organ with an environment that promotes healthy microorganisms that balance each other out and guard against invading, unhealthy elements.  Cleaning your vulva is important to gynecological health.  Simply use warm water and mild soap on a daily basis.  (Remember, this is for external use!)  It is unwise to use heavily perfumed soaps as they can irritate your vulva.  It is also unnecessary to douche unless a doctor specifically recommends it.  Douches can cause irritation and flush out those healthy microorganisms allowing for infection to set in.  The vulva is more vulnerable to infections than the external genitalia of males.  So, take good care of it.

The vulva is key to sexual functioning.  The external structures of female genitalia are very full of nerve endings allowing for pleasure when properly stimulated.  When aroused, the vulva undergoes several physical changes it making it one of the external signs that a woman is aroused.  First, moisture from the vagina reaches the vaginal orifice, moistening the vulva.  The labia majora become enlarged and spread apart somewhat and can change color somewhat (darkened from increased blood flow).  The labia minora and the clitoris also increase in size.  During orgasm, the various muscles contract, though most of these contracting muscles are not located in the vulva.  Following orgasm, stimulation of the vulva may be uncomfortable or even painful.  The increased blood flow slowly dissipates until the vulva returns to normal.

The vulva performs different functions than the vagina, thus it is important to know the difference between the vulva and the vagina.  Especially if you are talking to a medical professional, be sure to clarify whether you mean the internal structures (vagina) or the external structures (vulva).  Have anything to say about vulvas?  Have you say and leave a comment!


The “G Spot”

We mentioned the “g spot” a few entries back and it clearly begged more attention. So, what IS the g spot? Why is it called the g spot? What can the g spot do? What can’t it do? Does everyone have a g spot? Let’s try to get some answers to these questions.

The “g spot” is named after a German-born, American-practicing gynecologist named Ernst Gräfenberg who hypothesized between 1944 and 1950 that such a spot existed. He described it as “an erotic zone [in the vagina] that would swell during sexual stimulation.” The g spot is supposed to be a cluster of nerve endings that lend themselves to a heightened response to stimulation. The g spot is presumed to be located centrally on the front wall of the vagina (directly adjacent to the bladder). Stimulation of the g-spot is purported to intensify orgasms and promote instances of female ejaculation.

Of course, many gynecologists and researchers (and many average women!) argue against the existence of a “g spot.”  Among those who support the idea of a g spot, reasons vary as to its purpose and origin.  Proponents argue that the g spot is describable besides its ability to induce pleasure; it is a small patch (varying in size) that is rough, like a walnut, unlike the rest of the smooth vagina.  One prominent argument for the g spot purports that the tissue that makes up the g spot is the female homologue of the prostate.  This “female prostate,” also called Skene’s gland, is supposedly responsible for female ejaculation.  Another argument maintains that the g spot is simply an extension of the network of nerves extending from the clitoris, being part of the “anterior wall erogenous complex.”  Thus, stimulation of the g spot is just stimulation of the clitoris.  Finally, a third argument suggests that the g spot is actually an evolutionary tool that helps women cope with the pain of childbirth.  Research has shown that stimulation of the g spot increases pain tolerance by 47%.  This amount goes up when aroused and more than doubles during orgasm–though the chances of being sexually aroused or orgasm during childbirth are slim to none, I daresay.

So, how many women actually have g spots?  No on really seems to know.  Virtually every study that has been done on the subject has been disputed for some reason or another.  Most studies have been limited to very small numbers of women, thus not giving an accurate cross-section of the general population.  Also, many researchers base their findings on the study of an individual woman, not women.  Thus, g spot studies are usually criticized for relying too heavily on anecdotal evidence.  So while it is unclear what percentage of women have a g spot, it is very clear that not all women have one–even by the “walnut” definition.  Even among women who report having a g spot, not all women report the same benefits.  Indeed, numerous women who say they do have an area of increased sensation on the anterior vaginal wall note that it is unpleasant and that too much stimulation is painful.

The debate over the g spot, or perhaps lack thereof, is not likely to be settled any time soon.  Much more research needs to be done to say anything conclusively about this phenomenon.  So, do you have anything to add or a question to ask?  Go for it.

The Clitoris

So, since I’ve mentioned the clitoris in the several past entries, let’s talk about it a little more. The clitoris is oftentimes the most misunderstood part of women’s genitalia. Men seem to know little about it, and many women don’t know much more about it than men. What is it? What does it do?

The etymology of the word clitoris is uncertain, but may have derived from the Greek kleitoris, meaning “little hill.” The clitoris, sometimes abbreviated as “clit,” is the homologous structure of the penis found in males. (Though, to be more biologically accurate, the penis is the homologous structure to the clitoris in females.) Normally, all female mammals have a clitoris, the spotted hyena possibly have the most interesting clitoris. Not only does the spotted hyena urinate through its clitoris, unlike all other mammals, but it also gives birth through its clitoris.

In humans, the clitoris is usually a small, “button-like” projection in the genitalia that is nestled in the anterior of the labia. Only the tip of the clitoris is visible and the interior shaft can reach up to five inches in depth. Like a penis, a clitoris becomes stiff and swollen when aroused. However, because the urethra is separate from the clitoris and sexual intercourse and childbirth occur through the vagina, the clitoris seems to only function for sexual pleasure. The clitoris has thousands of nerve endings, much more densely clustered than those in the penis.

Masters and Johnson argued in 1966 that clitoral orgasm is the only type of orgasm [169].   After examining vaginas closely, they found that the tissue of the vagina itself was incapable of producing an orgasm. While on the surface, this argument is very easily rebuked, Masters and Johnson had a more complex argument. They argued that clitoral tissues extends throughout the vulva and vagina, thus what is felt to be vaginal stimulation is simply an extended form of clitoral stimulation.  Of course, many people have criticized this argument as it clearly does not address how orgasms can be achieved through stimulation of distant body parts such as the breast.

The clitoris has often been a target of misogynistic fear, as evidenced by some of the motives in female genital modification and mutilation.  Amnesty International estimates there are 6,000 incidences of female genital mutilation every day.  Of course, misogyny is not the only reason for this practice but it is a driving force.  The clitoris is a symbol of evil to various cultures whose beliefs range from babies dying if they come in contact with a clitoris during childbirth to a woman’s sexuality being untamable if she has an intact clitoris.  As it is important in these cultures to ensure the children a man’s wife bears are indeed his children, a clitoridectomy (and other forms of mutilation) is seen as a way of ensuring a woman will remain faithful to her husband.

Of course, there is much more that could be said about the clitoris in general and clitorises in particular, but this is just meant to be a beginning basis of discussion of the clitoris.  So, any question or comments?  I’d love to hear from you!

Female Orgasm and Resolution

By popular demand (or at least one demand), today’s entry will make a complete circle of Masters and Johnson’s human sexual response cycle.  So, what happens after arousal?  For women (and sometimes men), arousal does not always result in the obvious:  orgasm.  Many women have trouble reaching orgasm, while many others reach multiple orgasms.  These are variants of the M & J sexual response cycle, but we’ll get to that.

So what happens during a woman’s orgasm?  Following the changes that occur during the excitement and plateau phases (arousal), several other physiological changes occur.  For instance, when a woman nears orgasm the glans in the clitoris moves inward under the clitoral hood and the labia minora darken.   The vagina tightens, then lengthens and dilates while becoming more engorged.  The muscles of the uterus then begin to rhythmically contract.  Dutch researchers found earlier this year that it is possible to objectively determine orgasms in women by measuring the frequencies of contractions in the uterus, vagina, anus, and pelvic muscles.  It is not uncommon, however, for other muscles to contract and spasm.  The well-known toes poking out from the sheets is probably the most commonly cited “non-sexual” muscle contraction during orgasm.

Women have a more difficult time reaching orgasm than men and can often go through only the first two stages of sexual response, but still feel they had a satisfactory sexual experience.  To make up for the greater difficulty of achieving orgasm, women do have a few checks in their column.  Women usually have longer orgasms than men.  Men’s are usually only a few seconds long.  Women are also able to achieve much hyped “multiple orgasms” (note that, oddly, about 5/6ths of the “multiple orgasms” section of this article is devoted to males).   This means that a woman can achieve the third stage of sexual response multiple times without necessarily having to go through the fourth and first stages again–the woman simply reverts to the second stage, then returning to the third stage again.

Following orgasm, the woman enters into the fourth and final stage of the human sexual response cycle:  the resolution (sometimes referred to as the refractory period).  During this phase, the body returns to its original, pre-arousal state.  Some of the changes required to return to normal take place right away, while others take longer.  Technically speaking, women do not have a refractory period and men do.  The refractory period is the time frame within the resolution after which the sexual response cycle can begin again.  The refractory period can be anywhere from a few minutes to a few days depending on the health and age of the man.  Women do not have a refractory period because their bodies, generally speaking, are always ready to reenter the sexual response cycle (thus the ability to achieve multiple orgasms).

Another difference between women’s and men’s orgasms is their source, so to speak.  While virtually all male orgasms are a result of stimulation of the penis, female orgasms can come from a variety of places.  Many orgasms can result from stimulation of the clitoris (homologous to the penis).  Other orgasms result from stimulation of the “G spot.”  Some women have no trouble achieving orgasm from vaginal stimulation (such as simple intercourse).  Orgasms can also originate in other erogenous zones, notably the breasts (especially the nipples) and anus.  I have heard women speak of orgasms resulting from stimulation of the neck, toes, and arms.  Really, it just depends on what your body responds to.

So, those are the basics of the female orgasm and resolution.  I know I did not cover it all.  Have a question or a comment?  Go for it.

Female Sexual Arousal

What IS female arousal? With men, it is pretty straightforward to determine whether a man is aroused or not. Is the penis erect or not? Of course, there are nuances to this but, overall, that’s the litmus test for men. What physiological signs are present when a woman is sexually aroused?

When sexually aroused (usually a combination of psychological and physical stimulation), women’s breasts usually become enlarged and the nipples become erect. Of course, there are various reasons for enlarged breasts and erect nipples, but they are usually present to some degree when a woman is aroused. The enlargement of the breasts is usually slight enough that it is rarely noticed. The veins in the breasts also become more visible as the breasts swell. Additionally, the skin may flush during arousal especially on the chest and neck. This is most visible in fair-skinned individuals. Approximately 50-75% of women experience flush during arousal, while only about 25% of men experience flush.

During sexual arousal, a woman’s vagina and reproductive organs undergo several changes. The vaginal lining moistens with lubricating fluid within 10 to 30 seconds of the beginning of arousal. This fluid is believed to be the “sweating” of the vaginal walls. The sweating resulted from the increased blood supply and the engorgement of vaginal tissues. Also the vaginal walls lengthen and distend, which pulls the cervix and the uterus slowly back and up into the false pelvis (the part of the pelvis above the hip joint). The engorgement of the vagina is a type of vasocongestion, a phenomenon also seen in menstruation, REM sleep, allergic reaction, and deeply emotional responses.

The glans in the head clitoris also become swollen and erect like a penis. (The clitoris, after all, is homologous to the penis–see this illustration for a better idea of how much like a penis a clitoris is, or really vice versa.) This reaction to arousal varies in degree between women. The labia majora swell as do the labia minora, though to a lesser degree.

Women’s blood pressure, breathing, and heart rate increase considerably during sexual arousal. This happens in order to accommodate the increased blood supply to various parts of the body with sufficient oxygen. Muscles throughout the body also become tense because of this. These and the above signs of arousal occur during the first two stages of the human sexual response as outlined by Masters and Johnson: excitement and plateau.

There are various other individual idiosyncratic responses that can occur during sexual arousal. For instance, some women report unprovoked sneezing, increased ticklishness, and swollen lips. So the next time you lay eyes on the one that makes your heart jump remember what’s going on with your body. Comments or questions? You know where to leave them. Thanks!