Interview Emmanuele Jannini
How would you define the G-spot? (an organ, a fonction?)
We published solid evidences (it is difficult to disagree with a picture, as those we published in our paper of ten yrs ago on Urology) using the old method of classic science: autopsies, showing that in the region, named G spot, glands nerves, muscles and vessels from the inner clitoris (in different relative proportions from woman to woman) built an area which, if directly stimulated, can potentially trigger female pleasure. We, in fact, first demonstrated in the anterior vaginal wall the same biochemical machinery (Nitric Oxide, PDE5 – the target of Viagra) which is used by the male to obtain excitation, is present in this part of the human vagina and not in other parts.
I am afraid I am not able to understand the difference between organ and function. It is difficult to imagine that a (biologic) function can exist without the correspondent organ. Love is a function? Probably yes, but I am afraid that Ronsard needs neurons and neurotransmitters to try to seduce Helène. Only a fantôme sans os can have functions without organs. Hence, what we called “vaginally-stimulated orgasm” (VSO, vulgo: “vaginal orgasm”) must have something physical to trigger it. For sure the main spot to have this (and other) orgasm is between ears. But I believe (I am not a woman) that something ‘physical’ in the vagina would help. I understood that this ‘something’ has been named from the last name of the first ob/gyn writing on that (Grafemberg). I also understood that, a part of the first pioneering (but excellent) studies of Zaviacic in Czechoslovakia and that of O’Connell in Australia, no one went inside the vagina looking at microanatomy, molecular biology and biochemistry of this region. My group did ten yrs ago.
For sure we have to clarify one aspect: if the Gspot is described as a magic button that can be pressed to obtain (automatic) pleasure, it does not exist. In our autopsies, we did not find, inside the anterior vaginal wall, any concrete, isolated, spot. On the contrary, in the region called Gspot, we found a lot of possible ingredients of the cake of pleasure. Interestingly, the final recipe of these ingredients may change from woman to woman.
If the Gspot is a functional area which needs to be stimulated to elicit the VSO, it simply impossible to say that it does not exist. One of two: Gspot (or the gynecological UFO, as in a poorly researched article it has been written some yrs ago by Hines, a psychologist unknown to the scientific environment) exists or it is matter of fantasy. I am afraid that in the latter case we must consider the women with VSO as hysterical. And I disagree with this hypothesis.
To Andrea Burri, a study based on 20 subjects is not representative and so inconclusive.
In that case, would the controversy stop if someone had the means to do the same experiments (yours, or Odiles Buisson and Pierre Foldes sonographies) on hundreds of people?
Andrea Burri is a smart researcher. She performed and excellent survey (probably the largest) demonstrating how frequent is the idea to have the Gspot. Unfortunately her discussion was not in keeping with her results, but nobody is perfect. In fact, I agree with this comment: our paper published in the JSM was not conclusive nor representative. It has been published because the aim of our article was not to describe or represent the Gspot. Our task was to demonstrate that somatic and/or functional differences exist between women with different orgasmic experiences. For this reason, the number of our very, very, very selected population has been considered more than sufficient. If I need to demonstrate that you and me are different, I need to study just… two subjects. If I need to demonstrate that it is possible to have 6 fingers instead of 5, how many subjects I need to study? One, with 6 fingers! Personally, I do prefer a small, but very well controlled study with respect to a study enrolling tons of subjects but with a weak method. Of course, it would be interesting to answer to the question: how many have the Gspot (or 6 fingers)? I do not know the answer and, so far, my methods (qualitative and not quantitative) have been overtly inadequate. It would be nice to collaborate with the colleagues of the Kings’College to answer to this question (regarding the Polydactyly - the 6 fingers - I think it occurs in1 in every 500 live births. But this is another story).
The real question is: is our small study replicable? The answer seems positive. Very interestingly, another Italian group (completely independent from mine) published two recent articles using exactly the same experimental tools: echoscan in women with or without VSO. Magically, the differences we found in our 9+11 women were perfectly replicated in a much bigger number of subjects. Thus, I think that now my findings are a little bit less “inconclusive”…
Regarding Odile and Pierre; they are both great colleagues and excellent scientists. I felt glad to have the opportunity to collaborate and to publish with those friends. They have a very large expertise, respectively, in echography and in gemital anatomy of female. For this reason I am sure that I will continue to collaborate with my French great colleagues.
The aim of this collaboration, at least for me, will be not to stop the controversy (there are still guys who believe that Darwin is wrong and the Genesis is a Treatise of Biology), but to increase our knowledge in hic sunt leones. I am personally more than attracted to collaborate with any scientist around the world really interested in finding evidences (not opinions!) in the mystery of female pleasure.
In your study, you link the existence of the G-spot directly to the ability to have vaginal orgasms, why?
Can you read without eyes?
A part from this joke, it seems impossible (or, at least, quite difficult) to have an orgasm without an organ triggering this function. The real question is infact another: is it possible to have a vaginal orgasm? If the answer is yes, for sure something (so far journalistically called Gspot) exists.
One more proof of the presence of Gspot is the interesting phenomenon of female ejaculation. We do not know exactly and scientifically this phenomenon. Some evidences suggest that the fluid ejaculated is urine. In this case, we do not need to admit the existence of the Gspot. On the contrary, if the large number of experiments so far published, demonstrating that the female ejaculate contains the same marker of male prostatatic activity (PSA), are correct (an I am sure they are), it is evident that the skene gland (a critical part of the Gspot, or CUV complex) play a role in the orgasm of some women. Thus, Gspot exists!
How much of the G-spot sensitivity is psychological, how much is physical? Is one side stronger than the other?
Despite the fact that I am the creator and the coordinator of the first, and unique, public school of sexology, which is a 2-yrs full time course of 180 university credits giving the title of Clinical Psychologist with special competence in Sexology… I am not psychologist. I am just MD, specialist in endocrinology and andrology, with a background in molecular biology obtained working on the role of thyroid hormone receptor role on male development both in very old marine species and in humans. I am afraid I have not so many instruments to answer to your question. However, I had the privilege to be the first professor teaching sexual medicine in the Italian medical school. Thus, I tried to deal with psychological issues. My understanding is that… the question is a bit old. I have no difficulty to admit that the brain (i.e. intrapsychic and relational life) is our first sexual organ. But sex needs also vessels, glands, hormones, nerves and muscles to work. We are studying these aspects, which are not in antagonism or separate from, or even excluding the psychological environment/involvement. I recently published a polemic article on the JSM against the Manichaeism of question like this one: the separation of the mind from the body is a western, stupid idea, not rooted on scientific evidences. Thus, for several reasons I confess that I do not know the correct answer to your question.
However, one thing I know: female sexuality is not evident as the male sexuality. It is matter of discovery. If you ask now, suddenly, to 100 random female students of your faculty to draw a simple, schematic representation of female genitalia, possibly with clitoris, urethra, vaginal opening, and labia in the right relative position, how many are able to give you a correct framework? I am afraid not as many as you may believe. This simple experiment can provide the answer to the ultimate question: Are Women Born or Made? Sexually speaking, I think the latter is the correct answer. Hence, if female sexuality needs to be discovered, a hidden area/function such as that we are talking about can be or cannot be discovered. This is matter of behaviour. As you can see, psychology, education, environment, experiences play a dramatic role in the answer to the question; do you have a Gspot? Obviously the answer to this question is not related with anatomy. This is the reason why several women change their ability to obtain orgasm in function of the knowledge and the use ot the anterior vaginal wall.
Do you feel research on the G-spot is censored, or on the contrary highly publicitised? (in other words, is it easier to be published with “G-spot” in the title? )
No, it is not easy to have this term in a scientific paper. This is probably correct: Gspot is definitively not a scientific term, but a journalist one. I have been the first asking for an involvement of the International Society of Sexual Medicine in the effort to better define this area and function. Actually, the most evidence-based definition seems “ CUV complex” (see later).
Italy has a reputation to be a quite conservative, even machist country. Is it more difficult to research on female sexuality there than somewhere else?
Italy is catholic country. Thus,… very sexually libertine. However, after the joke, is a matter of evidences that Italians are in very powerful position in all international Scientific Societies dealing with human sexuality. I think, more than any other country. If you look at the number of scientific publications in sexual medicine you may probably find Italians at very fist places. Fur sure Italy is the best country in Europe regarding the scientific production in sexual medicine, as well andrology and endocrinology. Yes, despite the stereotypes and some pathological behaviours (…), we are very interested in the science of sex and to know female sexuality.
What difficulties (if any) do you have to face when researching? (financial, legislative, technical...)
Honestly speaking, I did not experience any difficulty in my academic career dealing with female orgasm or speaking once a week in television as expert in medical sexology. This was for one simple reason: I published scientifically quite a lot. The impact factor of my publications, my citation index, my H index (all parameters of the scientific value of a researcher) prevented any difficult in fund raising. I have to admit that my lab is very rich. My research on female sexuality has been financed by the Italian ministry of University: it has been a good choice, since we published several papers on the topic. Now we have a more money on a project that use what we understood using the model of female pleasure to further understand the mechanism of cardiovascular diseases. My fellows are currently working in laboratories overseas and we have a lot of international collaborations around the world. It seems to me that we did not have so many difficulties financial, legislative, technical …
Andrea Burri: “I think we should just eliminate the word “G-spot”. Every piece of research is important; it’s all part of a big picture. But we should stop linking it to the G-spot. Like finding that the width of the vaginal wall is associated with vaginal orgasm, like did Jannini - Why is it not the association it is? Why does it have to be something else?” Any answer?
As in several other aspects, I agree with Dr. Burri. When I wrote scientifically on G spot, I proposed to name it from the anatomy: CUV area, i.e. Clitoro-Urethro-Vaginal area. A functional and complex region composed by the Skene glands (responsible of the ejaculation and ‘prostatic’ behaviour of this region), the muscles, the nerves (we demonstrated that these nerves use exactly the same biochemical tools the male is using to have the erection: nitric oxide synthases) and the vessels of the clitoris. If somebody is happy to delete the term Gspot from science, I am not going to make a religion war. However, being a clinician, I think I will use it when I am communicating the concepts physiology and anatomy of the VSO. In my mind, people may understand Gspot better than CUV, even if Gspot is not perfectly correct.
But I do not wont to elude the point of Dr. Burri: she says that we should stop linking the G-spot/vaginal orgasm with the width of the vaginal wall. Always, when a researcher try to link a behaviour or a psychological aspect with anatomy (despite the sentence of Freud: <>) a violent reaction raises from psychologists. It seems a Pavlovian reaction: it is a sin to correlate sex with anatomy, genes, body, diseases, etc. I know: correlations are always scientifically risky, but it is the unique way we have to try to understand the physiology. Regarding the width of the vagina, I think that our finding (again: confirmed by others!) suggests that the anterior vaginal wall (better: the CUV complex), as measured as distance between two points, correlates with the ability to obtain a VSO and, probably, with sexual activity itself. Was Lamarck right? Does the use increase the organ? Some recent evidences suggest this intriguing possibility. Hence, we are back to the first question: Gspot is both matter of both anatomy and physiology, it is an area which trigger a function.
In spite of being a widely accepted expression, the G-spot has caused scientific debate for 30 years... How is this debate going to evolve? When will it end?
Here we are in the environment of Communication. Thus, let me make a though using the categories of communication. If I call the journalist saying that, how many magazines would be interested? Very few: the existence of the Gspot is not a news. Tons of papers, books, stories, manuals, movies have been produced on this. On the contrary, if someone would like to go in media he must announce that the Gspot does not exist. But this is not science: it is just a smart strategy.
Gspot is definitively a journalist name. For me Yves or Mario, or Segolene, instead of “G” would be the same (however, I want to spend a tribute to my friend Beverly Whipple who authored this successful name). But people understand Gspot very well (as Andrea Burri elegantly demonstrated: 56% of her huge sample admitted to have it!). Thus I cannot see a reason to change a well recognized name. Probably, Lutetia is a more precise name for the Ville Lumière, but how many would understand it? I am much more interested on the scientific aspects than on a never ending debate which seems just on names rather than on the scientific evidences.
Finally, it is matter of facts that, while a lot of direct and indirect evidences confirm that the CUV complex play a pivotal role in the physiology of female orgasm, so far no one single convincing evidence has been provided against this role. Hence, it cannot be considered a real scientific debate. Evidences in one side and opinions in the other is not a controversy. Is nothing. In fact, we demonstrated, in a sharp letter published by the JSM, and peer reviewed as a full article, that the idea that an hidden anatomic part may exist or not using a self filled questionnaire, without an objective medical examination is at least prescientific. It is also nonscientific the aim to “demonstrate” the non-existence of the Gspot to relief the anxiety of the women looking for this mirage. The scientific task is just to find what is true. And I am sure that the freedom of women goes thru the knowledge. John, 8:32.