An Investigation into the Origins of a Copious Vaginal Discharge during Intercourse: "Enough

to Wet the Bed": That "Is Not Urine"

Author(s): Desmond Heath
Source: The Journal of Sex Research, Vol. 20, No. 2 (May, 1984), pp. 194-210
Published by: Taylor & Francis, Ltd.
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The Journal of Ses Research Vol. 20, No. 2, pp. 194-215 May, 1984

ADVERSARIA
Commentaries,Remarks,and Notes
Pertainingto Sex Research

AN INVESTIGATION INTO THE ORIGINS OF A COPIOUS

VAGINAL DISCHARGE DURING INTERCOURSE:"ENOUGH TO
WET THE BED"-THAT "IS NOT URINE"

Desmond Heath
A case study of large-volumevaginal discharge during intercourse origi-
nally preparedin 1979, is described, as is the course of investigation into
its origin. It is argued that this 'swetting of the bed" is not a pathological
sigiificance but is within the normal range and variation of the physio-
logical function of the paraurethralglands of Skene. A 1982 addendum
discusses developments in this field of sexual research, including the
rediscovery of female ejaculation; 2 decades dominated by the
'4paradigmof cliterocentricity"; and a recent shift back to the vagina,
specifically the urethro-vaginalbody, in female sexual function. A 1983
addendum reports on an immunohistochemical demonstration of the
homology between the female urethral glands and the male prostate.
Evidence for the secretion of prostatic acid phosphatase by the female
glands suggests an ejaculatory function equivalent to that of the male
though without the gonadal, "seminal" component. Further investiga-
tions of female ejaculation are discussed.

Desmond Heath, MD, is a Psychiatrist in private practice and Attending Physician

in Psychiatry at the Mount Sinai Hospital Medical Center, New York City. Portions of
this paper were first read in 1980 at the Winter Meeting of the Wilderness Psychiatric
Conference.Thanks are extended to Edward Grefik for his assistance and support.
Requests for reprints should be sent to Desmond Heath, MD, 1230 Park Avenue}
New York, NY 10128.

Editor'sNote
In 1978 and 1981 I accepted and published articles concerning the phenomenonthat
has been labeled femaleejaculation.At the time (1981) I indicated that "the ideas and
preliminarydata . . . suggest lthat] further consideration . . . and investigation . . . are
warranted.!'These articles have provoked additional consideration and heated debate
which, for the most part, has been valuable to the process of scientific inquiry. Heathss
paper, which is exceptionally long for the Adversariasection, is really a series of three
separate papers that have been written over a period of 5 years. They are being pub-
lished together here, in sequence, to reflect the progression of his ideas and research
that were, in part, stimulated and influencedby the earlierJSR publications. Maintain-
ing the integrity of the separate pieces over time, I think, reveals the nature of that
odyssey in an interesting and insightful way.

194

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 ADVERSARIA 195
This paper concerns the vicisitudes of an observation that has interested the
scientific community from time to time since H;ppocrates and Galen. The
scientific community's acknowledgement of female "seminal" emission or
female ejaculation has waxed and waned over the centuries. In 1979 I reported
a case of bilateral urethral ejaculation which was rejected for publication. It is
now included, in its original form, within the present narrative. The climate of
science has changed since 1979 when female ejaculation was deemed at best a
projection of male Victorian pornographers{My SecretLife, 188811966;Mar-
cus, 1964X,and at worst an idea that would cast suspicion on the scientific in-
tegrity of the holder.
Times have changed. A new climate of opinion appears to have allowed a
dormant idea to arise spontaneously, as if new, in more than one place at a
time. In 1978 Sevely and Bennett reported the historical existence of female
ejaculation. Belzer took up their suggestion and set out to determineif female
ejaculation, that apparently existed in the past, still existed. He, with others
(Addiego et al., 1980; Addiego et al., 1981; Belzer, 1981; Perry & Whipple,
1981a, 1981b),forced the idea on a skeptical scientific community by reporting
their research. They started with the historical reports of female ejaculation
and came to link this function with the gland of origin of the ejaculate, the
female prostate. The erogenous nature of the urethra, reported by Dickinson
(1949) and the erogenous area of the anterior wall of the vagina, reported by
Grafenberg(1950)was recognized. Ladas, Whipple, and Perry (1982)added to
the momentum. They reported not only on female ejaculation and the
erogenous zone in the anteriorvaginal wall but recognized Kegel's (1953)work
on the relation between the pelvic floor musculature and female orgasmic
response. Without these workers and their unnamed associates, this paper
would, I think, have been once more rejected. These matters are far from set-
tled. My work, reported and also anticipated in the paper, will, I hope, help to
settle the current controversy.

The OFiginal1979 Paper

Over the years it has come to my attention that some women occasionally
experience a vaginal discharge during intercourse that is of sufficient quantity
to "wet the bed." These women tend to be embarrassedby a patch of wetness
some 2 feet in diameter in the bed. They and their partners frequently com-
ment in a puzzled way that "it is not urine!J'
One woman in analysis became, during the course of treatment, a better
observer of herself and also was able to discuss with her husband, a physician,
the nature of this phenomenon. She reported that during cunnilingus he had
felt and had plainly seen two "jets of clear watery liquid squirt," one from
either side of her urethral meatus. Apparently, when they had first experi-
enced this wetness during intercourse, he had thought that it might be urine
but concluded that it was not. She had been somewhat embarrassed, and the
whole experience was subject to a general confusion she then had about the
nature and workings of that part of her body. Subsequently, she reported that
her husband had confirmed, without any doubt, the "double-barreled"nature
of these powerful but fine jets of liquid;that they emanated from either side of

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 196 ADVERSARIA

the urethal meatus; that he says its taste is curiously reminiscent of those bit-
ter tastes generally preferredby men-such as beer, black coffee, black olives,
quinine, etc.1 Further, the patient and her husband agree that this, for them, is
a natural occurrence connected with sexual excitement. She knows it to be-
independent of orgasm, clearly connected to mounting and particular sensa-
tions of excitement, and that the pulses of the jets are from contractions over
which she has some measure of control. It is the large volume, some 50 ccsl im-
pressive to the point of embarrassment, that raised the thought that this
might be urine. Both now know for certain that it is not.2
I turned to an obstetrics book (Eastman, 1950) and confirmed a memory
from medical school days that there indeed are glands that would account for
the production of so copious a flow-the paraurethral glands of Skene (pp.
2 I-22).
It was not until I read a report similar to what I had heard over the years in
the April 1979 issue of MedicalAspects of HumanSexualitythat my interest
in this abstruse, if not recondite, matter was renewed. In the Questions-and-
Answers section one question was:
A female patient states that occasionally during intercourse she will have liquid
pour from the vagina in a small caliber stream that lasts from 5 to 20 seconds.
The stream is not urine. This has happened4 to 10 times in 10 years. What could
the source of this be, and could it be dangerous?(MedicalAspects of Human Sex-
uality, 1979, p. 35)
The consultant's response indicated that the patient must be suffering from a
pathological condition, and he advised extensive-even intrusive-investiga-
tion.
I was concerned that this patient not be subjected to unnecessary worry.
Because of this concern, I thought I ought to check the references. I found
Skene's work was very much alive in the "extra cerebral memory" of Sagan
(1977). How could such information be lost to medical science? The anatomy
was clear: 100 dissected cases with bilateralducts and branches followed after
ducts had been injected with mercury (Skene, 1880). When Skene said that the
function of the ducts was not known and that $hat would have to be left up to
later investigators, I felt sure that within 10 years of 1880 a description of a
copious flow of crystal clear liquid from these glands would have been des-
cribed in connection with genital lubrication in the literature. But seeing no
referenceto lead me on, and not having the time to dig, I called The Masters &
Johnson Institute and asked for someone who could help me with an esoteric,
out-of-the-waypiece of information concernlng human reproductive biology.
Five minutes on the phone with Masters convinced me that the knowledge had
never been lost for it had never been known.
lIt is possible that the chemical structure of the sex pheromones or their active
radicals is similar to the active radicals of those chemicals responsible for these pre-
ferred tastes. This somewhat unscientific speculation seems now not so fanciful since
the work of Huggins and Preti (1981) on vaginal odors and secretions.
2Urineand this fluid have distinctive olfactory and gustatory characteristics that are
impossible to confuse after the initial surprise and on thoughtful examination. In addi-
tion, my patient asserted that the fluid on the bedsheet left no odor of ammonia as
wouldurine in its characteristic decomposition.

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 ADVERSARIA 197

My next recourse was to the Anatomy Department of Mount Sinai Medical

School. My proposition was that if Skene's glands could be dissected out and
comparedto the salivary glands /of known productive capacity) for weight and
volume, one would have a fair idea whether or not it were possible for Skene's
glands to produce in the volume and rate observed. The anatomist at Mount
Sinai knew the glands to be the homologue of the prostate but probably not
that extensive. "However,"he added with lightened tone of voice, "no wonder
they produce that much fluid having been unknown for so long!" The prospect
of pursuing this Skene's/salivary comparison was slim, partly because it was
thought not to be scientifically rigorous enough for this day and age.
Back to the books! All sources described the urethral mucous glands and/or
the paraurethralducts (Bloom & Donger, 1972; Huffman, 1948, 1962; Skene,
1880, 1885). Many noted variations in the number and form of their openings
into the urethra including, in most instances, bilateral openings on either side
of the urethral meatus (the ducts of Skene). None described function, just as
Masters had said. Most emphasized, as Skene did 90 years ago, that their
significance was to be found in their pathology; principally their acute and
chronic infection. One source Huffman, 1962) supported my contention, now
developed, that the paraurethralglands of Skene are capable of producingand
ejecting in pulses, associated with sexual stimulation, a clear watery fluid
from two openings either side of the urethralmeatus at a rate of 30 to 50 ccs in
30 to 50 seconds.3 Huffman's description and a reproductionof his figure are
presented as Figure 1.
This, I believe, shows sufficient volume in the duct system to account for
secretion, engorgement, and contractile expulsion of fluid in the quantities and
manner described. The range seems to be broad. This case (Figure 1) does not
demonstrate bilateral Skene's ducts. This particular position in the range of
variation might show, on appropriatestimulation, a copious flow rather than
bilateral squirts. The opening of the urethral meatus and the exposing of the
openings of the Skene's ducts, when they exist, may be within the range of
normalanatomical variation. However, this could be the result of changes pro-
duced by childbirth, or a temporary eversion of the terminal urethra as a part
of the sexual response. Such unobstructed clearing of the duct openings must
be the situation in the case I have reported.

Addendum December 1982

When the preceding was written in May of 1979, it was submitted to
MedicalAspectsof HumanSexualityand also to this Journal.It was not then
accepted for publication. Rejection by Leonard Gross, then the Editor of
MedicalAspectsof HumanSexuality,was on the grounds that his consultants
knew of no such function of these glands and did not believe what was des-
cribed to be possible. Gross declined to publish the brief communication but
3Support in Huffman's work for my contention was gathered, principally, from his
cases showing extensive development of the glands around the urethra in some women.
Referring to volume of production, Huffman's most recent (1962) statement is that:
"They secrete a small amount of mucoid substance with sexual stimulation" (p. 299).

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 198 ADVERSARIA

r $

b fAfe
j tV l,F'{ sw l
N
wrw Z

K $ -
-

s - -

Wi;t '0 0s FS
\ta-**T. N i.

Figure 1. Drawing of wax model of adult human female urethra with its paraurethral
ducts and glands as seen in right lateral view. This reconstruction is in reality a cast of
the urethral canal with its outpouching ducts and glandular pockets. The base of the
model, labelled "Vaginal canal," represents a cast of that portion of the vagina which is
beneath and parallel to the urethra. The smaller diagrams demonstrate transverse sec-
tions through the urethra, the paraurethralducts and glands, and the vaginal canal
beneath the urethra at different levels above the meatus. Tissues.fromwhich this model
was reconstructed was obtained at necropsy of a 20-year-old virgin. This model
represents the distal 2.4 cm. of a urethra which had a total length of 2.8 cm. It will be
noted that no paraurethralducts open at or immediately within the urethral meatus.
Thirty-oneducts empty into this urethra. Although most of these ducts empty into the
distal third of the urethra, several empty into the middle and proximal thirds. After
leaving the urethra the ducts turn cephalad and extend parallelwith the urethralcanal.
Onelarge duct on the right develops into a cyst of considerablesize. At the midpoint in
the urethra many ducts and glands extend laterally far from the canal; at a more prox-
imallevel the urethra is surroundedby many small tubules, and on the right it is encom-
passed by a thin, compact semicircular sheet of ducts and glands. (From Huffman,
1948) Reprinted by permission of C. V. Mosby Company.

said he would pass on my opinion to the physician who asked the question.
Others also rejected my idea of urethral gland function. In one instance the
rejection was partly on the ground that one cannot rely on the observations of
a patient. My impression was that the idea was rejected because it was outside
the experience of that authority.

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 ADVERSARIA 199

Another person, though he rejected the idea completely, referredme to the

Sevely and Bennett (1978) article. Chronologically, my 1979 contribution
follows Sevely and Bennett's landmarkpaper, but was written, as is evident in
the reading of it, without knowledge of their findings. Sevely visited me in
July of 1979. She assured me that scientific research was underway. Relieved
that the matter was in good hands and satisfied that a physiological func-
tion-ejaculation from a female prostatic homologue-would no longer be in-
terpreted as a pathological event, I returned to listening to my patients with
an ear for theirexperience.
It was not until April 1982, when Beverly Whipplewrote to me about my un-
published paper, that I revived my interest and caught up with the published
literature containing documentation of the widespread reporting of this ex-
perience and the chemical analysis of the female ejaculate.
EarlyReferencesin the Literature
At this time I would like to recognize some earlierreferences to the bilateral
ejaculation from the paraurethralducts and glands. I will then focus on those
contributions that show the urethra and the anterior vaginal wall to be an
erotic zone that rivals or even surpasses the clitoris in some women. Finally, I
will posit a concept of this area which does not see it as three separate en-
tities-the urethra, its glands, and the rugal portion of the anterior vaginal
wall-but as one organ. My evidence, I believe, warrants such a designation on
embryological, anatomical, and physiological grounds.
Concerningbilaterality of anatomic representation and physiologic function
of ejaculation, de Graaf (1972), writing in 1672, referred to large ducts and
lacunae, stating:
In the lowerpart, near the outlet of the urinarypassage,this membrane[the
urethrallining]is piercedby large ducts, or lacunae,throughwhichpituito-
serousmatteroccasionallydischargesin considerablequantities.(p. 103)
In his Plate V (shown here as Figure 2), de Graaf showed two ducts placed
laterally but did not specify their number in the text, though he stated, "This
liquid was clearly not designed by Nature to moisten the urethra (as some peo-
ple think). The ducts are so placed at the outlet of the urethra that the liquid
does not touch it as it rushes out" (p. 104).
When following up a reference under prostate in The OxfordEnglishDic-
tionary (1933), I found an unequivocal reference to bilaterality. William
Smellie in his Treatise on the theory and practice of midwifery (1776) said:
On each side of the Meatusurinarius,are two smallLacunaeor opetiings,the
tubesof which,endingin a kindof Sacculus,comefromthe prostratelsic]gland:
from these a thin fluid is ejectedin time for copulation,and that fromsome
womenwith considerableforce;andsometimes,thoughseldom,to the quantity
of severaldrachms.(p. 94)
A drachm equals 14.2 ccs. "Several" I take to mean from 3 to 5; so "several
drachms" would measure between 40 and 70 ccs. In one trial, 50 ccs. of water
poured onto a sheet covering a regular bedpad and mattress spread to a patch
measuring 11 x 16 inches in 10 minutes.
Astruc (1737), having described the accessory sex glands of the male, said:

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 1 :

200 ADVERSARIA

%:/ s zZs v 4
if s

k) 3st:: - /

e g ,;; '

X-sss

Figure2. Urethra or urinary passage opened lengthwise in the front part, from de Graff
(1672). Reprinted with permission of the New York Academy of Medicine. A. The
urinarybladder;B. The neck of the bladder;C. The urethra opened lengthwise; D. The
orificeof the urethra and exits of the lacunae in it; E. The lacunae traversing the "pros-
tatae";F. The lacunae taken from the "prostatae" and distended by air;G. The internal
substance of the "prostatae," or glandulous body; H. The parts of the bladder drawn
apartafter division; I. The ureters cut; K. The labia of the pudendum;L. The orifice of
thevagina; M. The fleshy fibres of the sphincter cut. Legend reprintedby permission of
theJournal of Reproduction and Fertility.
There are the same number of seminary receptacles in Women, from whence the
seminal fluids may be pouredinto the vagina, but these are situated in a different
manner than those in Men .... The ... prostate, ... in females surrounds the
urethraand opens with two small mouths into the vagina, just under the clitoris,
and with several lacunae along the sides of the urethra."(p. 250) [Vagina in this
context clearly refers to the vulva rather than the vaginal introitus or the vaginal
barrel.]
Skeneand Subsequent Literature
Neither Skene (1885) nor Dickinson (1949X,who mentioned that he was "a

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 ADVERSARIA 201

pupilof and illustratorfor Skene when he was discoveringthe urethral

glands"(p. 63), referredto physiologicfunctionor productionof fluid other
thanpurulentdischargeassociatedwith infection.Both SkeneandDickinson
showedbilaterality,as did Huffman(1951).Anatomicvariationwas stressed
byHuffman:"It canbe assumedthat whileparaurethral ductsandglandsnor-
mallyoccurin the humanfemale, two largetubulesare not alwayspresent"(p.
617).Concerning function, Huffman wrote: "Since only a portion of the
epitheliumlining the paraurethralducts and glands shows evidence of
secretoryactivity, it is doubtfulif these vestigal remnantshave any ap-
function"(p.618).However,he did add:"It has also beensuggested
preciable
thatsexualstimulationcauses the paraurethral glandsto elaboratea mucoid
secretioncomparableto that produced by the glands of the male urethra"
p.618).
Variationin Glands
In Huffman'smoredetailedreport(1948)he showedgreatvariationin the
numberandpositionof glandopeningsinto the urethra(pp.91, 93,98).This
anatomicvariationwas also clearlyobservedby Deter,Caldwell,and Folsom
(1946)who stated: "Glandswere foundin 92Noof the urethrasstudied"(p.
654).Theyclassified100 femaleurethraeinto fourgrades:GroupI, "minimal
amountof glandulartissue," 18(Mo;GroupII, 29(Mo; GroupIII, 28No; andGroup
IV, in whichthe "glandular structuressurround the whole urethra," 17No; in
the remaining 8Nothey found no glands(p.654). I mention this because it sup-
pliesan anatomicandhistologicexplanationforthe greatrangeof physiologic
functionexperiencedamongwomen.Someexperienceno erogenouszoneand
have never"wetthe bed,"whereasothershaveno doubtaboutthe existence
of both.
Deteret al. (1946)considered"thepossibleeffects of hormones"on the ex-
tent and functionof these glands,but shift right past an erotic,sexualfunc-
tion to the pathological.
Onemightvisualize[theyspeculate]a humancasein whichthe normalbalanceof
male and femalehormones,both of whichare normallypresentin the human
female,forsomereasonis altered,suchas at menopause,at puberty,orfollowing
marriage,andthe posteriorurethralglands,whichareotherwiseinactive,would
undergohypertrophy.As a result of this physiologicalhypertrophy[notenow
onecaneasilysee whythesehypertrophied
the shift to the pathological], glands
wouldbe moresusceptibleto infection.(p. 660)
Erotic Zone
I agreein honoringGrafenberg,as Ladaset al. (1982)have,forhis is, in my
literaturesearch also, the first referenceto an erotic zone in the anterior
vaginalwallandalso to its protrusionoutwardsinto the vaginalintroitus.He
clearlyrecognizedthis as partof the femalesexualresponseanda component
of genitaltumescence.Grafenberg(1950)said:
An eroticzonealwayscouldbe demonstratedon the anteriorwallof the vagina
along the courseof the urethra.... Duringorgasmthis areais presseddown
againstthe fingerlikea smallcystoceleprotrudingintothe vaginalcanal.(p.146)
Concerningvolumeof ejaculate,Grafenberg's(1950)observationssupport

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 202 ADVERSARIA
my 30 to 50 ccs figure.He wrote:
Occasionally the production of fluid is so profuse that a large towel has to be
spread under the woman to prevent the bedsheets from getting soiled. This con-
vulsory expulsion of fluids occurs always at the acme of orgasm and
simultaneously with it. If there is an opportunity to observe the orgasm of such
women, one can see that large quantities of a clear transparent fluid are expelled
not from the vulva, but out of the urethra in gushes. (p. 147)
Moresignificantto me than the femaleejaculatoryvolumeis Grafenberg's
referenceto an associationof the urethralglands with the anteriorvaginal
glands
wall.He wrotethat the fluidexpelledis "secretionsof the intraurethral
correlatedwith the erotogeniczonealongthe urethrain the anteriorvaginal
wall"(p. 147).This is the first referenceI foundto supporta physiologicalin-
tegrationof these threeentitiesinto a single structure.
In the samepaperGrafenbergrecognizedthe individualinnervationof this
areawhenhe wrote:
Some investigators of female sex behavior believe that most women cannot ex-
perience vaginal orgasm, because there are no nerves in the vaginal wall, proxi-
mate to the base of the clitoris. (p. 146)
It is not clearin my readingof the text whetherthe assertionaboutvaginalin-
nervationis Hardenberg's(1949)or Kinsey's.The passage in Hardenberg
reads:
Kinsey questions how significant the stimulation of the interior of the vagina
may be. He also points out that there is a great deal of anatomic and clinical evi-
dence to indicate that most of the interior of the vagina is without nerves. A con-
siderableamount of surgery can be performedinside the vagina without need for
anesthetics. Nerves have been demonstrated inside the vagina only in the area of
the anterior wall, proximate to the base of the clitoris. He [Kinsey]cites the need
for further research in this field because of the widespread but certainly un-
founded opiIlion among psychiatrists that there is such a thing as vaginal
orgasm which is something different from an orgasm achieved through clitoral
stimulation. (p. 225) [In a footnote here Hardenbergcites Kinsey, Pomeroy, and
Martin (1948)].
Such writingas this marksthe beginningof 2 decadesof sexual research
Kinseyet al. (1948};Kinsey,
underthe dominantparadigmof cliterocentricity.
Pomeroy,Martin,and Gebhard(1953);MastersandJohnson(1966);andHite
(1976) all contributedto the dominanceof the clitoris in the scientific
understandingof femaleorgasmicexperience.

A Reconstruction
Lower one-fifth vaginal wall embryologically endoderm. Kinsey and his
associatesapparentlyhadbeenunmovedby Koff's(1933)data and opinions.
In his definitiveDevelopment of the Vagina in the Human Fetus, Koff
recognizedthe glandsin the 60 and 106 mm foetuses (pp.70, 77),but more
significantly,establisheda differencein originbetweenthe upperand lower
parts of the vagina.He stated that: "the upperpart of the vaginadevelops
fromthe Mullerianducts, whilethe lowerportion,aboutone-fifth,is formed
fromthe sinovaginalbulbswhicharisefromthe epitheliumof the urogential
sinus"(p.90).Thushe providedan anatomic,embryologicbasis fora possible
later physiologicdistinctionbetweenthe lowerone-fifthand the upperfour-

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 ADVERSARIA 203
fifths of the vagina.4It is a functionaldifferencethat I am attemptingto for-
wardhere;this anatomicaldifferenceis nowgenerallyaccepted.Forexample,
Karam,Salt, and Hajj (1977)stated:"Patientswithcongetiitalabsenceof the
uterususuallyalso haveabsenceof the vagina.Theabsentpartof the vagina
wouldbe the upperpart whichhas Mullerianorigin,while the lowervagina
whichoriginatesfromthe urogenitalsinusmaybe essentiallynormal"(p.543).
The "essentiallynormal"partwhichthey state variedin lengthfrom"1 to 4.5
cm"would,of course includethe urethrovaginal areaof the anteriorwall.
Kinseyused suchembryologicevidencein his argumentagainstvaginalsen-
sitivity and vaginal orgasm. However,Kinsey was incorrectin his unat-
tributedstatement:"Unlikeits vestibule,the vaginais derivedembryologi-
cally fromthe primitiveegg ducts [Mullerianducts]which,like [herehe was
correct]nearlyall otherinternalbody structureslmesoderm], are poorlysup-
pliedwith endorgansof touch"(p.579).He wouldhavebeencorrectonlyif he
hadreferredto the upperfour-fifthsof the vagina.Thelowerone-fifthis of en-
dodermalorigin,as opposedto mesodermalImuscles,bone,etc.)orectodermal
(skin,the outsideof the labiamajora,brain,spinalcord,etc.).
Anterzorvaginalwallsensitivein Kinseydata.Kinseyet al. (1948),although
they concludedthere is no vaginal sensitivity and thereforeno "vaginal
orgasm,"repeatedlyqualifiedtheirstatementswith referencesto sensitivity
at the anteriorvaginalwall withinthe lowerone-fifth.The followingare two
examples:(Italicsmineforemphasis)
In most females the walls of the vagina are devoid of end organs of touch and are
quite insensitive when they are gently stroked or lightly pressed. For most indi-
viduals the insensitivity extends to every part of the vagina .... Less than 14No
were at all conscious that they had been touched .... Most of those ... had the
sensitivity confined to certain points, in most cases on the upper(anterior}walls
of the vagina just inside the vaginal entrance. Although some 20Nohad mastur-
bated on occasion by inserting fingers . . . the majority . . . did so primarily for
the sake of providing additional pressure on the introital ring of muscles, or to
stimulate the anterior wall of the vagina at the base of the clitor7s.(p. 580)
Becauseof data obtainedin my analyticworkand based on embryologic,
anatomic,andhistochemicalevidencepresentedhere,I musttakeexceptionto
the followingopinionof Kinsey.Concerning"psychoanalystsand someother
clinicians'" views on "vaginalorgasms,"Kinseyet al. (1948)said:
It is difficult, however, in light of our present understanding of the anatomy and
physiology of sexual response, to understand what can be meant by "vaginal
orgasm." The literature usually implies that the vagina itself should be the
center of stimulation, and this as we have seen is a physical and physiologic im-
possibility for nearly all females. (p. 582)

4The embryology of vaginal epithelialisation by sinus epithelium and variations in

the origins of the vaginal barrel are described by Ulfelder and Robboy (1976). In the
discussion of that paper Krantz (1950) said: "the function of tissues and organ
systems-physiology-is totally predicated upon the ontogeny of the specific organ or
system. The vagina is no different in this regard." He added: "A further observation of
the intricacies of development of the vagina with the urogenital sinus is the intimate
relationshipof the lower two-thirds of the urethra with the vagina. The urethraactually
penetrates and is surroundedby the smooth muscle of the vagina" (p. 775).

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 ADVERSARIA
204
As I have noted, it is
important to recognize variation
anatomy. Kinsey's data contain both in function and
variation, but his conclusions
Urethra, lower vaginal wall and appear not to.
istence of a single structure, the glands-one structure. Regarding the ex-
lower vaginal wall and the urethrovaginal body, composed of
glands, there is further urethra,
embryologists and anatomists. supporting evidence from
Evatt (1910-1911)stated: "I
find, with Wood-Jones, that
between the urethra and the no septum exists
the structure of the glands vagina" (p. 129). Deter et al. (1946}
and their wide demonstrated
photomicrographs(p. 658, Fig. 5). They distribution around the urethra in
Berkowshaja(1939) stating that: summarized Petrowa, Karaewa, and
These [para]urethralglands are
not surroundedby muscle or
and, therefore, the female
prostate is not separated from the connective tissue
They [Petrowa et al.] further neighboringtissue.
state
glandular system is concerned in that there is complete analogy so far as the
In other words, the the development of the
glandular system of the anterior urethra in both sexes.
urethra, together with the part of the final female
tate. (p. 653) paraurethralglands constitute a
rudimentary pros-
Petrowa noted markedvariation in
and,along with Evatt and Deter, distribution and development of the glands
ofthe paraurethral glands also attempted to delineate
the exact origins
as distinct from the
paraurethral glands are thought to be of periurethral glands. The
periurethral urogenital sinus origin, whereas the
glands, further up the urethra,
budding from the primitive urethra. are thought to be derived
This from
sinusglands to be of endodermal makes the paraurethralurogenital
origin and the periurethral
mesodermal origin-true homologues of the glands to be of
Variation in response to hormonesmay median lobe of the male prostate.
these be because of the difference
two parts of the female in
prostate. Similar differences have origin of
gestedbetween the different lobes of the been sug-
/1925) male prostate. For example,
wrote: "In man . . . benign Huggins
apartof the prostate, the prostatic hypertrophy always
involves only
periurethral
Johnson81922)stated that in the region" (p. 291).
glands
are found just outside the female embryo, 275 mm stage,
[urethral]orifice belonging, "several
urogenitalsinus. Two of these, larger than therefore, to the
ofthe the others, are placed on
orifice" (p. 22). He added that either side
"these glands conform in
paraurethral ducts of Skene and their origin position to the
the
urogenital sinus cannot be doubted" as prostatic ducts
belonging to
Ricci,Lisa, and Thom (1950) p. 22).
which presented photomicrographs of
"Skene's ducts extend well up Case #17 in
into
the urethrovaginal wall" (p. into the urethra and
penetrate deeply
503). Another, Case #7,
penetrationof Skene's ducts with shows "the deep
cystic dilatation buried well
urethrovaginalwall" (p. 503). These into the
cle
fibersinterlacing the glands, histological studies show extensive
circling the urethra, and forming mus-
rugal
part of the vaginal wall. the interior,
Further, Gardiner,Gray, and
stated:
"The urethra is fused with the O'Rahilly (1975),
Krantz lower one-thirdof the vagina"
(1950),in his most detailed (p.
lower study, is more specific. He wrote: 484).
two-thirdsof its course, the urethra "In the
the is an inseparableand
anteriorvaginal wall" (p. 48). He integral part of
called this area the
urethrovaginal sep-

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 ADVERSARIA 205
tum andspecificallystated that in this regionthe urethraandvaginareceive
the same bloodsupplyin distinctionto the upperthird of the urethra,and
bladder.
Gillan and Brindley (1979) reported '4greateramplitude"of "vaginal
vascularresponses to vibratorystimulationof the clitoris. . . in its lower
anteriorwall than elsewhere"(p. 471).This also suggests, in agreementwith
Krantz,a distinct vascularityfor this area,based though on a measurable
functionaldifference.
Aboutthe arrangementof musclefibresKrantzwrote:
Theurethra,in the lowertwo-thirdsof its course,is inseparable
fromthe anterior
vaginalwall.The circularmusclefibresof the vaginacoursesuperiorlyand in-
feriorlyaroundthe urethra.In this areathereappearsto be no definitecleavage
planepresentbetweenthe urethraand the anteriorvaginalwall. In the upper
thirdof the urethraa definitecleavageplanebecomesapparent,andat this point
the vaginalmusculatureno longersurroundsthe urethra.(p. 53)
Aboutthe glands,Krantzsaid:
The glands aroundthe urethraform no specificpattern.They are dispersed
amongthe longitudinalmusclefibresof the urethra,beingmostprominentin the
lowerthird,and in manyinstancesthey extendalongthe entirecourseof the
urethrato the vesicalneck.(p. 51)
He did not mentionbilateralducts but did state:
Theductsaresimpleandenterdirectlyintotheurethraexceptin the lowerthird
wherethey may courseparallelto the urethrafor severalmillimetersto open
directlyto the outside.Thenumberof suchducts is not constant.(pp.51-52).
In his sectionon embryologyKrantzsidesteppedthe issue of exactoriginof
differentpartsof the glandsby writing:"Theglands(para-peri) of the urethra
(femaleprostate)arecloacalderivativesoriginatingas outpocketingsfromthe
urethralcanal"(p. 46\.
The urethralcarina CurtisandHuffman(1950)describedthe urethralcarina
where "the urethraindents the anteriorvaginal wall" (p. 36). Anson and
McVay(1971)gave a fullerdescription:
In the lowerportionthe cavity [of the vagina]is invadedby prominentmedian
elevationsor columns(columnae rugarum).... Thelowerportionof the anterior
columnis especiallypronounced, owingto the bulgingproducedby the adjacent
urethra;herethe columnis raisedto formthe urethralcarina-a crestlikeeleva-
tion situatedjust dorsalto the externalurethralorifice.(p. 804)
These descriptions,in gynecologyand surgicalanatomytextbooks,are the
closest I have foundto the Ladaset al. (1982\"G Spot."
Tumescence, urethro-vaginalbody and varzation.TheGrafenberg spot is an
areathat shouldbe understoodas a functionalentity or organ.It is not a spot
to be touchedorindicatedby the tip of onefinger,but an areato be coveredby
the full breadthof the middletwo fingersandat least two thirdstheirlength.
Thisorgan,beneatha 3 x 5 cm areaof the anteriorvaginalwall,swellsin some
women,undersome circumstancesof sexual arousal,to a volumeof up to
50 ccs /aboutthe size of a hen'segg-the "smallcystocele"describedby Graf-
enberg).
It is my opinion that the tumescent response of this organ, the
urethrovaginalbody, varies fromone humanfemaleto another.It has been
demonstratedthat the organis more fully developedin some womenthan

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206 ADVERSARIA

others(Deteret al., 1946,p. 654;Huffman,1948,pp. 91, 93, 98).In the resting,

unstimulatedstate it is to be palpatedby the middletwo fingers-lof the left
hand when the partnerlies on the left side of the female supine)-the two
fingersenteringthe vaginawith the thenareminenceoverthe monsvenerius.
In this positionthe rugalanteriorwallof the vagina,glands,andurethracan
be firmlymassaged.If this is agreeable,generaltumescenceof the vulvamay
follow.The vulva blossomsfroma swellingor plushingof the labia,engorge-
ment of the corporacavernosa,and the appearanceof the swollenanterior
vaginalwall(rugaenoweffaced)in the vaginalintroitus.Cunnilingus,without
excessive, awkwardprotrusionof the tongue, is easy in this fully flowered
state of the tumescent female genitals and may lead to the ejaculatory
response.I wouldreiteratethat not all womenhavethe responseandaddthat
many,who perhapsdo, may not find it agreeable.

Addendum-June1983
HistochemicalEvidenceof Prostate Homology
In collaborationwith Tepper,Jagirdar,and Gellerof the Departmentof
Pathologyat MountSinaiSchoolof Medicineand the LaboratoryServiceof
the Bronx Veterans AdministrationMedical Center, a study of female
urethraewas conductedusing immunohistochemical methods,to show the
presenceof prostatespecificcell-wallantigen(PSA)andprostatespecificacid
phosphatase(PSAcPh\within the secretorycells of the female para-and
periurethralglands.
Completefemaleurethraefrom autopsy of 17 femalesand a portionof a
urethra from one surgical specimen were examined. "Immunochemical
localizationof prostate specificacid phosphataseand prostatespecificcell-
wall antigenwas achieved,in routineparafinsections,by the unlabeledanti-
body enzymemethodwith peroxidase-antiperoxidase complexes."
All 18 cases showedurethralglandsunderhaematoxylinand eosin(H & E)
stain.Theglandswerepresentat everyage,newbornto 86 years(seeTable1)
withvariationin quantityanddistributionunrelatedto age. Eighty-threeper-
cent (15/18)of the specimenshadglandsthat stainedpositivein the secretory
columnarcells for prostate specific cell-wallantigen. Sixty-sevenpercent
(12/18)werepositiveforprostatespecificacidphosphatase.In threecases (16,
17, 18),althoughglandswerepresentin the H & E stainedsections,no reac-
tion was foundby the prostatespecificmethods.In threecases (13,14, 15)the
cell-wallantigenwas shownbut the acidphosphatasewas not demonstrated.
All cases that showedthe phosphatasealso showedthe specificcell-wallan-
tigen. Secretionsremainingwithin the lumenof the glands in the sections
showedpositiveforbothantigenandenzymein the casesthat showedpositive
in the secretorycells.
Immunohistochemical evidenceof homologybetweenthe male and female
prostatewas shown.However,concerningthe secretionsof theseglandsanda
possibleejaculatoryfunction,we concludedthat "ourfindingscouldbe inter-
pretedas supportfor these hypotheses,but proofof this cannotbe basedon
the methodswe haveused."

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 ADVERSARIA 207
Table1
UrethralGlandReactionto Staining
Hours
Case Age MajorDiagnosis PostmortemH&E PSAcPHaPSAb
1 25 years Systemiclupuserythematosus 24 + ++ ++
2 86 Glioma 20 + ++ ++
3 57 Lungcarcinoma 38 + ++ ++
4 54 Acutemonocyticleukemia 13 + ++ +
5 NewbornAsphyxia 155 + + +
6 6 hours Pulmonaryhyoplasia 4 + + +
7 61 years Cerebralinfarct 14 + + +
8 67 Ovariancarcinoma 8 + + +
9 71 Lymphoma 7 + + +
10 78 Asthma 7 + + +
11 83 Cerebraland myocardial
infarcts 5 + + +
12 51 Cervicalcarcinoma _c + + +
13 49 Carcinomatosis 10 + - +
14 49 Myocardialinfarction 23 + - +
15 82 Coloncarcinoma 10 + - +
16 41 Scleroderma 9 +
17 57 Uppergastrointestinalbleed 9 +
18 58 Ovariancarcinoma 16 +
aProstatespecificacidphosphatase.
bProstatespecificantigen.
CSurgical
speciman.
Ft4rtherResearch
The next step in demonstrating the reality of female ejaculation would be to
demonstrate the presence of a markerfor the ejaculate that does not appearin
the other urethralproduct-urine. Such a differencebetween the ejaculate and
urine would have to be shown in repeated samples taken from several cases
while under direct, scientific observation. A methodological problem arises
from the fact that both products are delivered through the same tube-the
urethra. Previous reports (Addiego et al. 1981; Goldberg et al. 1983) show
probable contamination both ways. All subjects have been asked for samples
of urine before and after ejaculating. The before sample would be con-
taminated by the continuous, insensible secretion of the urethral glands into
the urethra; the after ejaculation sample, by the remaining ejaculate. The
Goldberg study recognizes this latter contamination. Concerning the after-
ejaculation urine specimen they stated "the initial flow as well as a midstream
collection were obtained so that a sample which was not 'contaminated'by the
woman's ejaculate could be obtained" (p. 33). They did not, however, publish
the chemical data on both these specimens. Their "results of the fluid analyses
did not confirm the findings reported by Addiego et al. [1981] T-tests con-
ducted on each of the six comparisons . . . failed to reveal any significant dif-
ferences [sic] between urine and the ejaculated emission with respect to PAP,
urea, creatinine, pH and glucose" tp. 34).

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208 ADVERSARIA

Scott and Huggins (1942),researchingphosphatase activity in human urine,

claimed:
highvaluesof acidphosphatasein the urineof adultmalescanbe explainedon
the basis of admixtureof prostaticfluid.Prostaticfluidin manis richin acid
phosphatase,ureteralurinehas lowactivity;voidedurinein the adultmalehas
highacidphosphatasecontent;removalof the prostatein the adultcausesthe
enzymeof the urineto fall to low levelswhichareof the sameorderof ureteral
urines.(p. 111)
They also mentioned "an insensible secretion of the prostate which is likewise
nearly constant' (p. 111).
To factor in these contaminants, multiple glass tests of acid phosphatase (or
other markers)in urine should be conducted in female subjects. Following this
forwards and backwards contamination line of thinking, pre-ejaculatory
samples of urine should not be taken in order to avoid urinary contamination
of the ejaculate. However, a turnaroundof thinking would clear up the prob-
lem. Rather than use a marker in the ejaculate, a marker, or markers, that
exist only in urine should be sought and shown to be absent in ejaculate (not
preceded by a urine sample). Tests for odors and colors immediately come to
mind-two qualities my patients have used to convince themselves that their
"wet spot in the bed" is "not urine.2'

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SEXUALITY,SCIENCE,AND SOCIALRESPONSIBILITY:
THE GEORGETOWN SCANDAL

JeffreyJ. W. Baker

Sexology, like biology-a conglomerateof separatedisciplines,is still a

relativelyyoungfieldand,in my opinion,probablystill has a longwayto go in
its development.Yet as a biologist, I find it fascinatingto note that this
developmenthas somewhatparalleledthe developmentof genetics early in
this century.If this is, indeed,the case, sexologistscan learnfromour past
mistakes.
In the 1920s, professionalsocieties in genetics did not considerit their
responsibilityto speakout aboutthe politicalmisuseof theirfieldto promote
racistviews and legislation.I urge sexologiststo heed this examplebecause
you workas professionalsin a worldin whichsex and sexuality.areused to
justify the exerciseof powerby one genderoveranother,andwherepersons
whose sexual preferenceshappento be minorityones, may be brutalized
politically,emotionally,and even physically.
JeffreyJ. W. Bakeris a cofounderof the Sciencein SocietyProgramat Wesleyan
University,Middletown,CT.
Requestsfor reprintsshouldbe sent to JeffreyJ. W. Baker,Sciencein SocietyPro-
gram,WesleyanUniversity,Middletown,CT06457.

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