Ejaculation Associated With Bladder Muscle Overactivity? - A Journal Article I Read
Well, my friends, this is another installment of A Journal Article I Read - a segment in which I read a lady-gasm related peer-reviewed journal article and try my damndest to summarize the article here for you without taking away too much of the detail and subtlety, yet making it readable and not too long. I do my best to achieve those goals, and that's all I can say.
In these summaries, you can assume that anything I write is a genuine attempt to reflect what is said in the paper - even if it's shortened or summarized. My opinions, if I have any to add will either be inside brackets likes these [me:], or in a section headed in a way that clearly lets you know these are my opinions. All quotes are from this article unless specifically noted.
You can check out the list of all the past 'A Journal Article I Read' Summaries HERE.
Do women with female ejaculation have detrusor overactivity? Cartwright R1, Elvy S, Cardozo L. J Sex Med. 2007 Nov;4(6):1655-8.
My Quick Summary
In order to identify if bladder abnormalities (specifically problems with bladder control) tend to exist in women that claim to ejaculate during intercourse and/or orgasm, the researchers (who have a urogynecology practice) investigated 6 women that claimed to ejaculate and 6 women who claimed to have never ejaculated. They had them fill out a 3-day journal of their peeing situations, and they also did a test where they filled their bladder up and checked to see if they could hold it while doing things like coughing. What they found was that none of these 12 women had issues with bladder control. Although in their practice they have identified some women who they believe misidentified their bladder control problems during sexual activity with ejaculation, this study showed that not all women that claim ejaculation also have bladder problems. They conclude that if women have liquid release during orgasm or intercourse but do not also exhibit other symptoms of bladder control problems, then there need to be no more medical investigation, and these women should be assured that their release is not a problem.
I think this is a really simple, thoughtful, generally well-done study. Although it's quite small and specific, I believe it adds 1 tiny drop into the already quite small pool of knowledge that can be used to help piece together an understanding of sexual fluid expulsion. I also appreciate that this study does not seem to push any agendas and doesn't carelessly confuse ejaculation with orgasm - because they are not physiologically the same thing.
Introduction
"Questionnaire surveys have suggested that 40% to 54% of women have at some time experienced an expulsion of fluid at orgasm [1,2]." There have also been references to female ejaculation throughout history and in more recent discussions by Dr. Graffenburd in the 50's and Beverly Whipple in the 80's who "reported that a minority of women passed small volumes of fluid during heightened sexual arousal or at orgasm."
"Although it is anatomically and physiologically plausible that small volumes of fluid might be expelled from the para-urethral Skene's duct, some sources imply that it is a normal part of female sexuality to discharge large volumes of fluid at orgasm." [Me: "Skene's gland is said to be the female prostate since it is the embryological, yet less developed, equivalent to the male prostate. It wraps around the urethra and can sometimes be felt through the vaginal wall towards the front of the body in the area that is most commonly called the G-spot (although G-spot is also used as a catch-all phrase to describe an imaginary button that causes vaginal orgasms).]
The authors go on to describe how now there 'ejaculation gurus' that try and teach women to ejaculate and porn that shows large volumes of fluid expulsion. "The most anatomically and physiologically plausible explanation is that such fluid is emitted from the bladder."
Maybe partially because of those misleading depictions in porn and the like, it remains controversial what the liquid at ejaculation is - urine, prostate fluid, vaginal secretions, a mixture of the two?
There are some past studies, but many of them have small sample sized and some are not peer reviewed.
Some studies showed higher levels of prostate enzymes than would be expected in urine
One study catheterized 7 women who claimed to regularly experience ejaculation. For all of the women, "large volumes of fluid were passed down the urethral catheter, with the timing of fluid expulsion corresponding with the peak of orgasm." [Me: So, in other words in this study there seemed to be liquid coming from the bladder during sexual arousal even though the bladder had been emptied beforehand].
In the author's urogynocological practice, they often treat women with bladder control issues. A previous study has indicated that orgasm can cause a detrusor (muscle on wall of bladder) contraction that can cause leakage, and women who complain of leakage at orgasm have a high prevalence of detrusor overactivity. However, symptoms of detrusor overactivity do not only include leakage at orgasm or intercourse, but also other bothersome things like urinary urgency and frequency.
The authors, as female ejaculation has become more commonly known, have treated women with a proven detrusor overactivity diagnosis who rationalized the leakage at orgasm as ejaculation. So from this anecdotal evidence, they wanted to see if they would find a connection between ejaculation and detrusor overactivity - and particularly wanted to see if women that self identified as ejaculating also showed this bladder condition. This was not meant to stigmatize but to help counsel women who presented leakage at orgasm and also to maybe better understand the physiology of ejaculation.
Subjects and Method6 participants that self-identified as having experienced female ejaculation and 6 that had not were recruited from the researcher's institution staff. They were between 27 and 41 and having given birth between 0 and 3 times.
They were given a short survey asking about frequency and conditions of ejaculation. All 6 of the 'ejaculating' women said they ejaculated either "often" or "sometimes" and did so either during masturbation or intercourse.
"Each women completed a 3-day bladder diary, documenting the volume and timing of urinary void."
Each woman also completed 2 short validated bladder questionnaires; one asking about perception of desire to void and the other asking about bother associated with lower urinary tract symptoms.
Each woman also underwent 'short provocative ambulatory urodynamics." This is basically a test for detrusor over-activity where a catheter is placed up the urethra and anus, and the bladder is fully filled for about 30 minutes while the participant is asked to do things like coughing and heel bouncing while holding their pee.
Data was analyzed by a blind 3rd party. There was no difference between the groups and so no extra statistical analysis was performed.
Results
There was no indication of detrusor over-activity in either group and the bladder-diaries showed no significant difference between groups.
There was no significant difference between the scores on the validated bladder questionnaires about desire to void. "Almost all the women agreed with the statement, 'I am usually able to finish what I am doing before going to the toilet.'"
The scores for the validated bladder questionnaires about bother associated with lower urinary tract symptoms were "marginally higher (more impairment) in the female ejaculation group." This was due to 2 women in that group who had given birth that "reported occasional bothersome stress incontinence."
Discussion
"This study does not exclude the possibility that female ejaculate is coming from the bladder. It does however, demonstrate that women who report female ejaculation do not necessarily have the associated symptoms or pathophysiology of women who complain of coital incontinence."
This research did not replicate the "symptoms" of an ejaculation. The women were not sexually aroused, so there is still a possibility that for the ejaculating women there is uninhibited detrusor (muscle of bladder wall) contractions at orgasm. A future study in this vein, but with women during sexual arousal and orgasm would be useful and informative.
Like most female ejaculation studies, this sample size was small, and it is possible there was bias in that women who had incontinence issues may not have volunteered for the study.
The researchers also wonder if there could be bias because the ejaculating women in this study did not necessarily experience it frequently. Other past studies have used women that were able to ejaculate at most episodes of intercourse or masturbation.
Conclusions
"Based on our findings, we would recommend that women who report female ejaculation, in the absence of other bothersome lower urinary tract symptoms, do not require further investigation. They should be assured that this is an uncommon, but physiological phenomenon."