Sonography May Help Unravel the Mystery of the Female Orgasm

I was recently intrigued by a study covered in the science section of several newspapers describing two different types of female orgasm. This study, they reported, was evidence that women can indeed potentially experience different kinds of pleasure from clitoral stimulation and penetration.

My first reaction to this "news" was an eye-roll: surely you could just ask any woman and she’d confirm that, yup, things feel different inside and out? As I looked into the study a little further, this derision turned to mild horror as I read through the details of a method that involved wet tampons and ultrasound probes. I decided to get in touch with one of the researchers and find out what it was all about.

The study in question was published in the Journal of Sexual Medicine by Odile Buisson and Emmanuele Jannini, and it set out to use sonography (ultrasound) to see if there were any anatomical differences relating to the two different types of potential orgasm women report. It’s worth bearing in mind that it had a very small study size of just three subjects—it’s described as a pilot study—but the findings did suggest that, surprise surprise, women aren't all built the same when it comes to sex.

While the results might not be a great revelation, the idea of searching for strictly anatomical evidence for the phenomenon is an interesting one. Jannini, who works at the University of Rome Tor Vergata, has been involved in many other studies into the female sexual experience, from weighing in on the G-spot controversy (which is related to this latest work) to investigating glands that could be responsible for female ejaculation. Suffice to say he’s got a fair bit more scientific expertise on all things orgasmic than the likes of Cosmo magazine.

I talked to him about his discoveries so far, and what he’s found out by using sonography to explore that most mysterious of beasts, the female orgasm. Consider this something of a grownup sex ed class.

Jannini explained the aim of his work: “We’re looking to understand if—this is the main question—if women telling they’re able to experience a vaginal orgasm are basically not hysterical in nature.” That may sound inflammatory, but the idea that such a sexual experience might be all in a woman's head is still a popular one. It also raises one of the key mysteries of the so-called vaginal orgasm: some women say they have them, more say they need something more than just penetration, so even among women there's no consensus on the issue.

I asked Jannini if it wasn’t just obvious that there were generally two types of orgasm women could potentially enjoy. “It should be obvious, in fact!” he agreed. “But since it is a controversial issue, I think it was a good idea to try to find with objective evidence if the possibility to experience such an orgasm.” Perhaps the sole objective evidence that vaginal orgasms weren’t just the stuff of legends, he said, could be anatomical.

In earlier research, he and his collaborators looked at the anatomy of dead bodies. As well as making some interesting discoveries relating to female biochemistry, one finding stood out to Jannini, who trained as an andrologist—a specialist in male health. “We found something which was absolutely incredible to me, because it seems very strange in the beginning: the fact that we found so many differences between one body and another body.” The same isn’t true for healthy men, where despite differences in penis size the microscopic biology remains the same. “I have to add that it’s a little bit boring to study the male, because when you study one you study all,” Jannini added. “It is always more or less the same architecture.”

Seeing so many differences between female bodies, however, was an early indication that there might well be a reason different women get off differently. Jannini also said it’s well-known that women’s anatomy is under a lot more hormonal control than men’s, and can change as a result.

The next step was to study live women, to see if this difference in anatomy actually correlated to different sexual experiences, and that’s where sonography comes in. Jannini referred to using ultrasound for this purpose as a “Columbus’s egg”—a great idea that seems blindingly obvious after the fact. “It’s stupid, because in this moment, how many women are examined by echography (sonography) in their vaginal tract?” he said. “Millions. Echography is very very easy, it’s very common, it’s very safe, it’s used for diagnostic of pregnancy, during pregnancy … It’s very common. But strange enough, nobody was using the echo scan to look at this region and to correlate the echo scan with the perception of the woman.”

In an earlier study, they used sonography on 20 volunteers, who were divided into two groups depending on whether they reported that they could orgasm from penetration alone or not. “Using the echo scan we found a big, huge, great, incredible difference in the anatomy,” said Jannini, noting that this was the case even with the low resolution of ultrasound. What they measured was the size of the “anterior vaginal wall,” which they found was larger in women who could experience a vaginal orgasm.

The most recent study then looked at this in action—i.e. during stimulation. This is where the tampon came in, because it was a way of getting inside without potentially brushing on anything else and contaminating the data. This was a scientific study, after all.

The results suggested that the two types of orgasm did, indeed, appear to be different. “Despite a common assumption that there is only one type of female orgasm, we may infer, on the basis of our findings, that the different reported perceptions from these two types of stimulation can be explained by the different parts of the clitoris (external and internal) and CUV complex that are involved,” the researchers wrote. They inferred this from blood flow patterns in the area.

They explained that the “root of the clitoris” (yeah, it goes down further than you think) wasn’t involved with the purely clitoral orgasm. “In contrast, during vaginal stimulation, because of the movements and displacements, the whole CUV complex and the clitoral roots in particular are involved, showing functional differences depending on the type of stimulation.”

The CUV complex—clitorourethrovaginal complex—is the wincingly scientific word they use for what most of us probably mean by the G-spot, named a “complex” because it in fact refers not to one discrete button-like area but to a whole selection of pleasure-triggering machinery. As Jannini put it to me, “We are sure that there is not any ‘spot’ and we are not sure that the correct name is ‘G,’ but we are definitely sure that there is something.”

Why its existence is so controversial could very well simply be a result of the fact that women’s anatomies differ, and so it’s impossible to cast a catch-all conclusion over the whole orgasm debate. Jannini was careful to emphasise that he wasn’t suggesting one type was better than the other in any way, “because that’s absolutely stupid”—just that they were different.

Anatomy isn’t the be all and end all either (sorry, Freud), as hormones no doubt also play a role, not to mention a whole host of factors like psychology, experience, and so on (the brain is definitely a star player in the sex game). But the main takeaway is that every woman is different, even on an anatomical level, and that could affect their sexual experience.

Jannini is now working on a paper using sonography to try to predict whether women can experience a vaginal orgasm or not, as another way of testing the findings.

Of course, given the small sample sizes in the studies so far, the results can only be taken as an initial interesting observation—and motivation to further investigate the depressingly still rather taboo subject of female sexual pleasure.

“At the end of the story, I’m pretty sure that women saying the vagina is a pleasurable organ are not hysterical,” Jannini said. So at least that's a start.