By Michael Goodman, MD
Copyright 2019. All rights reserved.
The vagina and the clitoris are crucial elements in the wonderful stew that is a woman’s sexual pleasure.
Of course a myriad of other factors season the dish! But whether you’re tangoing solo or with a partner, it’s even better if you know the “ins and outs” of the dance… Sooo… here is the most up-to-date information, direct from the evidence-based medical literature!
Despite a debate lasting over 100 years, the existence of different orgasms (mental, from nipple/breast stimulation, clitoral, vaginal, cervical, anal, etc.) is still controversial. The only agreement is that the clitoris is intimately involved. The debate is over the question: Are there anatomic bases for two different orgasms? Is the vagina and cervix able on its own to trigger an orgasm?
The answer appears to be a definite “yes.”
First, to make sure that we’re on the same page, let’s define the terms: Clitoral orgasm is one derived exclusively from direct stimulation of the external clitoris (the “head” or glans, and the body, lying under the hood. (Sounds like a line from a blues song…) Vaginal orgasm (or “vaginally activated orgasm,” -VAO-, a term penned by Italian physician and renown sex researcher Emmanuelle A Giannini, MD,) is the climax obtained during vaginal penetration of penis, toy, or finger(s), without direct stimulation of the external clitoris.
Several researchers over the years have discovered the existence in most women of a zone, or zones, on either the upper or lower walls of the vagina (especially the upper wall) where tactile stimulation can lead to orgasm, without any direct stimulation of the external clitoris. The vagina possesses enough nerves to participate mightily in sexual response.
Medical evidence well justifies the existence of the VAO. A direct correlation between the size of the space underneath the anterior vaginal wall in the area of the so-called “G-Spot” and the intensity of VAO has been found. Pressure stimulation in this area, without any direct external clitoral stimulation increases blood velocity and flow into the clitoris. Odile Buisson MD, a sexuality researcher from Paris, has noted contraction of the pelvic muscles with only internal stimulation. This “reflex” was noted to increase with the volume of vaginal inflation (either via increased penile size, or tightening of the vagina via exercises or surgery) which increases the contact between the “inserted object” and the anterior vaginal wall (AVW), including that part of the clitoral complex, the “bulb” and the “crus,” which implant in the anterior vaginal wall near the “G-area.”
These findings, of course, indicate a relationship between the clitoris and vagina. During vaginal penetration the root of the clitoris is stretched by the penis against the AVW and the pubic bones; the clitoris and vagina therefore can be seen as an anatomical and functional unit during intercourse.
So, then, is VAO secondary to stretching of the root of the clitoris, or pressure against specific nerve receptors imbedded in the anterior vaginal wall? And what about contributions form other areas within the vaginal canal? What about the posterior vaginal wall? What about direct cervical stimulation? In other words, can vaginal be separate from clitoral orgasm?
Several experienced investigators have presented evidence to suggest that the orgasm triggered by stimulation of the vagina and cervix differs physiologically from that induced by clitoral stimulation. Professor Stuart Brody PhD, from Scotland, and others have noted a dramatic increase in the release of the neurochemical prolactin, associated in women both with milk letdown during nursing, and with sexual satisfaction, during stimulation of the anterior vaginal wall. Interesting also is the apparent favorable effect of the drug oxytocin (which is also released during nursing) on empathy, sexual sensitivity, and orgasmic response in women (and perhaps men as well…)
Most important however may be the work of Beverly Whipple PhD from New York City, Barry Komisaruk PhD from Rutgers, and John Perry PhD, who performed sexuality research on a group of women with complete spinal cord separation. Since the innervation of the clitoris comes directly from the lower spinal cord via the pudendal nerve, paraplegics have no innervation to the clitoris, and thus no pathway for a stimulation/pleasure experience from their clitoris. Yet, women with complete spinal cord separation do indeed experience orgasm, proving that vaginal and cervical stimulations generate their own unique sensory input to the brain separate and distinct from clitoral input and adequate to activate orgasm.
They hypothesized that the vagus nerves (10th cranial nerve), operating independently of the spinal cord, convey the vaginal and cervical sensation directly to the brain, bypassing the spinal cord. These women could still experience powerful orgasms via stimulation of the anterior vaginal wall, posterior vaginal wall and/or cervix in the absence of any clitoral connection to the brain! The fact that this sensitive area of the anterior vaginal wall ~ 1 inch inside from the urethra swells when it is stimulated, and in some women leads to orgasm and “female ejaculation” secondary to the muscular contractions expressing fluid from glands in the area lends additional credibility to the theory of VAO, the “G-spot,” and female ejaculation. This is clear evidence that VAO is not dependant upon the clitoris.
Interesting also is the fact that women who were educated in their youth that the vagina is a source of female orgasm (as opposed to women who received no sex education, or were taught that the clitoris is the sole source of orgasm), have greater VAO constancy. Some European studies have tended to show that women having VAOs tended to report better satisfaction with their sex life.
While understanding that orgasm is not just a reflex but a total body experience, researchers have documented the existence of autonomic nervous system response from the sensitive areas within the vagina discussed above. The “autonomic nervous system” is the “automatic” part of the nervous system, not governed by the spinal cord, and brain/spinal cord responses. Autonomic, or “automatic” nerves operate on their own, “dancing to their own drummer…” if you will. It is these nerves that help us digest food, tell us when our bladder is full, regulate many internal organ responses (anything in the body that “works on its own”) and- yes!- responds in an automatic and excitatory way when areas within the vaginal wall and cervix are stimulated.
Using ultrasound during intercourse (an interesting concept by itself), researchers have discovered that the special sensitivity of the upper vaginal wall near the opening of the vagina can be explained by pressure and movement of this area. It also is known that this specific area has significantly richer innervation than other areas of the vagina. Indeed, the anterior vaginal wall seems to be so interrelated with the clitoris that it is a matter of debate whether the two are truly separate structures.
It is important not to put women into a model of only one or two ways to experience sexual pleasure, satisfaction, and orgasm; the goal is to feel good about the variety of ways sexual pleasure may be experienced. According to Dr. Whipple and confirmed by other researchers, women describe two different types of orgasm: clitoral orgasms obtained by direct external stimulation is described as “warm” or “electrical,” and relatively localized and the orgasm obtained by penetration is depicted as “throbbing,” “deep,” and generally stronger and more whole body-involving.
The anterior vaginal wall especially, and to a lesser degree the posterior vaginal wall and cervix have a strong autonomic component. Hence, the two components of the clitoris (the external and the internal) can activate two separate parts of the brain, with some overlaps, and probably generate the different perceptions of orgasm reported by women.
This (vaginal orgasms) may also be the reason that vaginal tightening operations (“Vaginoplasty” or “Vaginal Reconstruction”) designed to increase friction with intercourse appear to work so well: These surgeries change the angle of the vagina so as to produce better contact and friction against the anterior vaginal wall and the “root” of the clitoris, with the goal of vaginal tightening being production of better overall friction from penis (or toy) against the cervix and vaginal wall hot spots.
So, as Woody Allen’s character said in Manhattan, “…Sex is the most fun you can have without laughing.”
“…A little coitus never hoitus.” Now, you know the specifics…
The author is deeply indebted to Drs Emmanuelle A Jannini, MD, Alberto Rubio-Casillas, Biologist, Beverly Whipple, PhD, Odille Buisson, MD, Barry R Komisaruk, PhD, and Stuart Brody, PhD for their article, “Female Orgasm(s): One, Two, Several,” which appeared in the Journal of Sexual Medicine, Vol. 9(2012), pp.956-965. Other references include:
1. Alzate H. Vaginal eroticism: A replication study. Arch Sex Behav 1985;14:529-37.
2. Alzate H, Londono ML. Vaginal erotic sensitivity. J Sex Marital Ther 1984;10:49-56.
3. D’Amati G, di Gioia CR, Bologna M, Giordano D, Giorgi M, Dolci S, Jannini, EA. Type 5 phosphodiesterase expression in the human vagina. Urology 2002;60:191-95.
4. D’Amati G, di Gioia CR, Proietti Pannunzi L, Pistilli D, Carosa E, Lenzi A, Jannini EA. Functional anatomy of the human vagina. J Endocrinol Invest 2003;26:92-96.
5. Jannini EA, d’Amati G, Lenzi A. Histology and immumohistochemical studies of female genital tissue. In: Goldstein I, Meston C, Davis S, Traish A, eds. Women’s sexual function and dysfunction: Study, diagnosis and treatment. London: Taylor and Francis, 2006:125-33.
6. Buisson O, Foldes P, Jannini EA, Mimoun S. Coitus as revealed by ultrasound in one volunteer couple. J Sex Med 2010;7:2750-54.
7. Shafik A. Vaginocavernosis reflex. Clinical significance and role in sexual act. Gynecol Obstet Invest 1993;35:114-17.
8. Foldes P, Buisson O. The clitoral complex: A dynamic sonographic study. J Sex Med 2009;6:1223-31.
9. Gravina GL, Brandetti F, Martini P, Carose E, Di Stasi SM, Morano S, Lenzi A, Jannini EA. Measurement of the thickness of the urethrovaginal space in women with and without vaginal orgasm. J Sex Med 2008;5:610-18.
10. Rubio-Casillas A, Jannini EA. New insights from one case of female ejaculation. J Sex Med 2011;8:3500-04.
11. Brody S, Kruger TH. The post-orgasmic prolactin increase following intercourse is greater than following masturbation and suggests greater satiety. Biol Psychol 2006;71:312-15.
12. Ladas AK, Whipple B, Perry J. The G-spot and other recent discoveries about human sexuality. New York: Holt, Reinehart and Wiston; 1982.
13. Whipple B, Gerdes C, Komisaruk BR. Sexual response to self-stimulation in women with complete spinal cord injury. J Sex Res 1996;33:234-41.
14. O’Connell HE, Eizenberg N, Rahman M, Cleeve J. The anatomy of the distal vagina: Towards unity. J Sex Med 2008;5:1883-91.
15. Song YB, Hwang K, Kim DJ, Han SH. Innervation of the vagina: Microdissection and immunohistochemical study. J Sex Marital Ther 2009;35:144-53.
16. Komisaruk BR, Whipple B, Crawford A, Liu WC, Kalnin A, Mosier K. Brain activation during vaginocervical self-stimulation and orgasm in women with complete spinal cord injury: fMRI evidence of mediation by vagus nerves. Brain Res 2004;1024:77-88.
17. Komisaruk BR, Gerdes CA, Whipple B. “Complete” spinal cord injury does not block perceptual responses to genital self-stimulation in women. Arch Neurol 1997;54:1513-20.
18. Brody S, Weiss P. Vaginal orgasm is associated with vaginal (not clitoral) sex education, focusing mental attention on vaginal sensations, intercourse duration, and a preference for a longer penis. J Sex Med 2010;7:2774-81.
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