Introduction The existence of the G-spot remains controversial partly because no appropriate structure and innervation have been clearly demonstrated in this pleasurable vaginal area. Using sonography, we wanted to visualize the movements of the clitoris and its anatomical relationship with the anterior wall of the vagina during voluntary perineal contraction and vaginal penetration without sexual stimulation. Aim The aim of this presentation is to provide a dynamic sonographic study of the clitoris and to describe the movements of the quiescent clitoral complex during a voluntary perineal contraction. We aim to visualize the mechanical consequences of the pressure of the anterior vaginal wall with women who claim to have a special sensitivity of the G-spot area and vaginal orgasm. Histology and immunohistochemistry of the G-spot and other female genital tissues are beyond the scope of this study and have not been discussed. Method The ultrasounds were performed in five healthy volunteers with the Voluson® General Electric® Sonography system (GE Healthcare, Zipf, Austria), with a 12-MHz flat probe, and with a vaginal probe. We used functional sonography of the quiescent clitoris with voluntary perineal contractions and with finger penetration without sexual stimulation. Main Outcome Measures We focused on the size of the clitoris (raphe, glans, and clitoral bodies) and of the length of the movements of the clitoris during voluntary perineal contractions. Results The coronal planes during perineal contraction and finger penetration demonstrated a close relationship between the root of the clitoris and the anterior vaginal wall. Conclusions We suggest that the special sensitivity of the lower anterior vaginal wall could be explained by pressure and movement of clitoris’ root during a vaginal penetration and subsequent perineal contraction. The G-spot could be explained by the richly innervated clitoris.

Introduction There is general agreement that it is possible to have an orgasm thru the direct simulation of the external clitoris. In contrast, the possibility of achieving climax during penetration has been controversial. Methods Six scientists with different experimental evidence debate the existence of the vaginally activated orgasm (VAO). Main Outcome Measure To give reader of The Journal of Sexual Medicine sufficient data to form her/his own opinion on an important topic of female sexuality. Results Expert #1, the Controversy’s section Editor, together with Expert #2, reviewed data from the literature demonstrating the anatomical possibility for the VAO. Expert #3 presents validating women’s reports of pleasurable sexual responses and adaptive significance of the VAO. Echographic dynamic evidence induced Expert # 4 to describe one single orgasm, obtained from stimulation of either the external or internal clitoris, during penetration. Expert #5 reviewed his elegant experiments showing the uniquely different sensory responses to clitoral, vaginal, and cervical stimulation. Finally, the last Expert presented findings on the psychological scenario behind VAO. Conclusion The assumption that women may experience only the clitoral, external orgasm is not based on the best available scientific evidence.

Introduction The anatomy and function of the G-spot remain highly controversial. Ultrasound studies of the clitoral complex during intercourse have been conducted to gain insight into the role of the clitoris and its relation to vagina and urethra during arousal and penetration. Aim Our task was to visualize the anterior vaginal wall and its relationship to the clitoris during intercourse. Methods The ultrasound was performed during coitus of a volunteer couple with the Voluson® General Electric® Sonography system (Zipf, Austria) and a 12-MHz flat probe. The woman was in a gynecologic position, and her companion penetrated her with his erected penis from a standing position. We performed a coronal section on the top of the vulva during the penetration. Main Outcome Measure We focused on the size of the clitoral bodies before and after coitus. Results The coronal section demonstrated that the penis inflated the vagina and stretched the root of the clitoris that has consequently a very close relationship with the anterior vaginal wall. This could explain the pleasurable sensitivity of this anterior vaginal area called the G-spot. Conclusions The clitoris and vagina must be seen as an anatomical and functional unit being activated by vaginal penetration during intercourse.

Introduction The prevalence of invasive procedures in diagnosing female sexual dysfunctions and pathologies is high. There is a need for a less invasive evaluation tool and medical imaging of the clitoris may be a solution. The clitoris has already been studied with nuclear magnetic resonance but there are very few sonographic 2D and 3D studies despite the fact that it is a simple, noninvasive, and inexpensive method. Aim This study aims at determining the feasibility of using ultrasound (US) techniques to image the clitoris in sufficient detail to permit evaluation of anatomy for possible use in study. Methods The ultrasounds were performed in five healthy volunteers with the Voluson® GE® Sonography system (GE Healthcare Ultrasound, Zipf, Austria), using one 12-MHz flat probe. Main Outcome Measures The clitoral body's diameter, the length of the raphe. Results The three planes—the cross-section, sagittal section, and coronal section—were revealed making it possible to study the entire organ. Conclusion The sonography is a simple, inexpensive, noninvasive mean which might help for the evaluation of this organ.

The search for the legendary, highly erogenous vaginal region, the Gräfenberg spot (G-spot), has produced important data, substantially improving understanding of the complex anatomy and physiology of sexual responses in women. Modern imaging techniques have enabled visualization of dynamic interactions of female genitals during self-sexual stimulation or coitus. Although no single structure consistent with a distinct G-spot has been identified, the vagina is not a passive organ but a highly dynamic structure with an active role in sexual arousal and intercourse. The anatomical relationships and dynamic interactions between the clitoris, urethra, and anterior vaginal wall have led to the concept of a clitourethrovaginal (CUV) complex, defining a variable, multifaceted morphofunctional area that, when properly stimulated during penetration, could induce orgasmic responses. Knowledge of the anatomy and physiology of the CUV complex might help to avoid damage to its neural, muscular, and vascular components during urological and gynaecological surgical procedures.