The Clitoral Truth: The Secret World at Your Fingertips (12 page)

THE MEDICALIZATION OF THE FEMALE PROSTATE

Leonore Tiefer, who is leading the movement against the medicalization of sexuality, is concerned that given “the insatiability

of the media for the commercial potential of sexual topics,” the possibility of female ejaculation would result in yet another performance standard for women to meet. Tiefer is also concerned that women who cannot find a G spot or do not have visible ejaculation will feel compelled to consult a sex therapist, and “that’s not the most empowering message” we should be giving to women.
54
Like most doctors, urologists, whose work focuses on the male prostate gland and erectile dysfunction, have ignored the female prostate and its role in sexual response. Yet, some critics have proposed that urological neglect may not be all that bad. In a

contemporary critique of Huffman’s paper, a colleague wrote:

I rather wish that Dr. Huffman had not found it so convenient to apply the term female prostate to the group of glands under consideration. This is not a new concept, and this anatomical concept in the past has led, upon the part of certain eminent urologists, to an overly enthusiastic adoption of the clinical concept of female prostatism. This idea has resulted in the too frequent use of the cautery punch [destruction of tissue by burning as with a tiny hot poker or electric probe], or resectoscope [surgical removal using telescope-like instrument for visualization] on the female vesicle orifice...

Furthermore, I am convinced that the use of the cautery punch or resectoscope on the vesicle neck [part of the urethra

attached to the bladder] of the female carries with it certain dangers of intractable sphincter incompetence [inability to hold urine) or even vesicovaginal fistula [formation of a pocket in the urethral wall in which urine becomes trapped].
55

This is no idle fantasy. The above-mentioned treatments, along with others such as urethral dilation, are routinely employed by urologists today as a treatment for chronic urinary urgency and frequency, referred to as lower urinary tract sensitivity (LUTS).These treatments are often performed when there are no specific causes for the symptoms, although no well-designed studies document their usefulness.

Nonetheless, Ruben Glues and Robert Nakamura, urologists at the Scripps Clinic and Research Foundation in California, note the increasing acceptance of the concept of a female prostate among urologists: “In the past decade, the availability of the specific histochemical staining for prostate-specific antigen (PSA) has rehabilitated the status of the paraurethral glands and spotlighted them as the homologue of the prostate.” Like Huffman, Gittes and Nakamura are only concerned with female prostate diseases, not the sexual function. In fact, Gittes says he believes that there is no ejaculatory potential in women.
56

These are serious issues that must be addressed in a thoughtful and responsible manner. Research should focus on understanding and explaining female ejaculation. Doctors should make genuine efforts to acquaint themselves with the sexual function of the female prostate to avoid treating a perfectly normal sexual function. We can hope (I know that I am dreaming) that the media will avoid the temptation to sensationalize female ejaculation, and instead concentrate on educating the public about it in c0onjunction with a genuine exploration of women’s sexuality.

THE LOST HISTORY OF FEMALE EJACULATION

The earliest mention of female ejaculation appears in one of the first Chinese sex advice books,
Secret Methods of the Plain Girl,
a compendium of sexual practices from the time of the Yellow Emperor, the first emperor of China: “Her Jade Gate (vagina), becomes moist and slippery; then the man should plunge into her very deeply. Finally, copious emissions from her Inner Heart begin to exude outword.”
57
In this context, “plain” may actually mean “pure” rather then unattractive or boring, while “inner heart” is clearly not the heart that pumps blood, but a colorful metaphor for the female prostrate.

The Kama Sutra
of Vatsyayana, the famous ancient Indian sexuality advice book, observes that “the semen of women continues to fall from the beginning of the sexual union to its end, in the same

way as that of the male,” indicating the copiousness of female ejaculate, and suggesting that women’s ejaculate squirts or “falls” as a man’s does.
58

Although the Greeks didn’t understand precisely how conception occurred, they were intensely curious about it, and believed that fertilization was somehow due to sexual secretions. A reference to what is clearly female ejaculation appears in the works of a disciple of the Greek physician Hippocrates. During the time of conception, he writes, “if the ejaculate of the man runs together directly with that from the woman, she will conceive.”
59
Here, the word “ejaculate” seems to mean exactly that, and not the less concentrated effluent which we know as “vaginal sweating,” or the few drops of viscous mucous secretion from the vulvovaginal glands.

Aristotle had a somewhat muddled view of reproduction. He believed that conception was caused by elements contained in the male ejaculate, and that female fluids only contributed to nurturing the fetus. Yet, when he discussed women’s genital anatomy, he produced a marvelously intuitive description of the anatomical mechanism by which women ejaculate:

The path along which the semen passes in women is of the following nature: they possess a tube—like the penis of the male, but inside the body—and they breathe through this by a small duct which is placed above the place through which

women urinate. This is why, when they are eager to make love, this place is not in the same state as it was before they were excited.
60

It would seem that Aristotle is distinguishing between the female urethra, which is just inside the body, and the male urethra, much of which is located externally. The “small duct” could only be one of the paraurethral ducts, located beside or, as he notes, “above” the urethral opening. The claim that women also breathe through these ducts is ambiguous, but probably derives from Greek notions about how body fluids are produced. In the last sentence Aristotle notes the changes in “this place,” the area surrounding the urethra during sexual excitement. He may be implying that the urethral sponge becomes larger and erect when women are sexually aroused. In the second century C. E., Galen asserted that women had testicles (ovaries) and of course, elaculated.
61

There seems to have been no question about the existence of female ejaculation in the seventeenth century. The English physician Laevinius Lemnius observed that a woman “draws forth the man’s seed, and casts her own with it” and “takes more delight, and is more recreated by it.”
62
The French obstetrician Francois Mauriceau found that “the glands near [the urethra’s] outer end are relevant to sexual pleasure because they pour out great quantifies of saline liquor during coition, which increases the heat and enjoyment of women.”
63

Danish gynecologist Kaspar Bartholin’s description of the vagina directly echoes that of Aristotle and Galen when he renders a portrait of what can only be the urethral sponge. It “becomes longer or shorter, broader or narrower, and swells sundry ways according to the lust of the woman,” Bartholin explained. This structure is “of a hard and nervous flesh, and somewhat spongy, like the Yard.” (“Yard” is a measurement term used in Renaissance England to describe the penis.)

Bartholin’s observation is remarkably easy to verify. If you (or your partner) insert a finger into the vagina before sexual response and press toward the pubic mound, you will feel the moist, ridged walls of the vagina—nothing more. Do the same thing during sexual response and press upward, you will feel a dramatic change. The sponge may feel different in different women, as Bartholin noted, “longer or shorter, broader or narrower,” and may swell in various ways, depending perhaps on how excited a woman is. During the seventeenth century “nervous” meant “strong” or “vigorous,” rather than “highly excitable,” “unnaturally uneasy,” or “apprehensive,” as it does today. Thus, Bartholin’s characterization of the clitoral sponge as “of a hard and nervous flesh” vividly renders it similar to the penile sponge: firm and vigorous. If we fast-forward to the present, the videos on female ejaculation show the tip of the sponge protruding underneath the skin around the urethra, and sometimes it can be seen actually protruding through the vaginal opening.

In 1672, the renowned Dutch embryologist Regnier de Graaf published the results of an intensive investigation of women’s “generative organs,” including meticulous dissection and illustration of the tissue surrounding the female urethra. Citing Galen and Herophilus, another well-known Greek physician, as authorities on the subject, de Graaf describes “a whitish, membranous substance about one finger breadth thick which completely surrounds the urethral canal... [that] could be called quite aptly the female prostate.” De Graaf goes on to say that “the function of the ‘prostate’ is to generate a pituito-serous juice [mucus mixed with a clear watery fluid] which makes women more libidinous with its pungency and saltiness and lubricates their sexual parts in agreeable fashion during coitus.”
64

In the 1880s, the American gynecologist Alexander J. C. Skene also conducted an investigation into the makeup of the female prostate.
65
In a report of over a hundred dissections and several cases of chronic urethral infection, Skene identified two tiny ducts on either side of the urethra leading to two glands embedded in the surrounding spongy tissue. He succeeded in getting these two glands named after himself, but his inquiry only scratched the surface. Had Skene and his successors been aware of the historical record, they might have discovered (or rediscovered, as it were) several dozen additional glands deeper inside of the urethral sponge that feed into

the two large paraurethral glands. A few of the glands, called periurethral glands, open directly into the urethra.
66

In one of the most widely read sex advice books (or “marriage manual” as such books were billed in the past),
Ideal Marriage: Its Physiology and Technique
, published in successive editions from 1928 through the 1950s, the Dutch sexologist Theodore H. van de Velde addressed the issue of female ejaculation:

So far as I can form an opinion on this subject, it appears that the majority of laymen believe that something is forcibly squirted (or propelled or extruded), or expelled from the woman’s body in orgasm, and should so happen normally, as in the man’s case. Finally it is at least just as certain that such an ‘ejaculation’ does not take place in many women of sexually normal functions, as that it does take place in others.
67

Van de Velde’s report appears to be based on the personal ejaculation accounts of his patients since he notes that “laymen” believe that it occurs. His speculation that ejaculation does not occur in many women may be incorrect, although it was probably a reasonable assessment, since many women either may not have recognized it or produced enough fluid to be noticed.

The classic modern study of the female prostate was performed by John W. Huffman, a gynecologist at Chicago’s Northwestern University Medical School. In his 1948 article, Huffman provides a summary of medical citations on the subject, starting with Galen, through the 1930s. The article also contains intricate drawings of the tissue surrounding the urethra made from laboriously constructed wax models of urethras obtained from eleven different cadavers. Huffman exposes Skene’s error in identifying only two ducts and glands near the urethral opening. One of his models shows up to thirty-one glands embedded in the labyrinthine erectile tissue surrounding the urethra. Cross sections of these models and several accompanying photos taken through a microscope show the distribution of the glands throughout the urethra, with the densest concentration in the middle section. The largest ones (those that Skene identified) are situated closer to the urethral opening. Describing the female prostate, Huffman commented, “The urethra might well be compared to a tree about which and growing outward from its base are numerous stunted branches, the paraurethral ducts and glands.”
68

Although the sole and only function of any gland is to manufacture and secrete a particular type of substance, Huffman, Skene, and other modern researchers were only interested in the disease potential of the paraurethral glands.

Dr. Ernest Grafenberg, a German gynecologist who immigrated to New York City before World War II, was the first modern sex researcher to take an interest in the secretions of the female prostate, and their role in women’s sexuality. Having observed women masturbating to orgasm in a clinical setting, Grafenberg asserted that “one can see that large quantities of a clear, transparent fluid are expelled not from the vulva, but out of the urethra in gushes.” He also makes the astute observation that “the profuse secretions coming out with the orgasm have no lubricating significance, otherwise they would be produced at the beginning of intercourse and not at the peak of orgasm.”
69

In spite of the recognition of a female prostate and its specific role in women’s sexual response throughout history, Huffman’s work on its structure and Grafenberg’s attempt to explain its sexual function had little impact. The urethral sponge and the glands that it contains remained anatomical curiosities until the early 1980s, when several sexuality researchers, such as Beverly Whipple and John Perry, focused attention on them and named the part of the urethral sponge that can be felt through the vaginal wall the “G spot.”

RECLAIMING THE FEMALE PROSTATE

In the mid-1970s, Josephine Lowndes Sevely, a Harvard graduate student in psychology, undertook a study of female ejaculation. In the introduction to her book
Eve’s Secrets: A New Theory of Female Sexuality
, Sevely says that she had come across numerous references to “female fluids” and was aware of “the open acceptance of the phenomenon in other cultures in earlier times when awareness of ‘female semen; ...was a part of scientific and popular belief.”
70
Sevely conducted an intensive search of historical, medical, and anthropological literature and found a wealth of references.
Eve’s Secrets
documents the widespread acceptance of the phenomenon through the ages and includes a revealing survey of non-Western cultures as well, ranging from ancient Greek and Judaic texts to modern anthropological accounts of Native American and Pacific Islands cultures.