madman
Super Moderator
Female Ejaculation and Squirting as Similar but Completely Different Phenomena: A Narrative Review of Current Research (2022)
Zlatko Pastor, MD, Ph.D., Roman Chmel, MD, Ph.D.
Introduction: Women expel fluids of various quantities and compositions from the urethra during sexual arousal and orgasm. These are classified as either female ejaculation (FE) or squirting (SQ). The aim of our analysis was to present evidence that FE and SQ are similar but etiologically different phenomena.
Materials and Methods: A review of studies was performed on fluids expelled from the urogenital tract during female sexual activities using the Web of Knowledge TM (Web of Science Core Collection) and MEDLINE (Ovid) databases from 1946 to 2021.
Results: Until 2011, all-female orgasmic expulsions of fluids were referred to as FE. The fluid was known to be either from the paraurethral glands or as a result of coital incontinence. At present, SQ is considered a transurethral expulsion of approximately ten milliliters or more of transparent fluid, while FE is considered a secretion of a few milliliters of thick fluid. The fluid in SQ is similar to urine and is expelled by the urinary bladder. The secretion in FE originates from the paraurethral glands and contains a high concentration of prostate-specific antigen. Both phenomena can occur simultaneously.
Conclusions: The mechanisms underlying SQ and FE are entirely different. SQ is a massive transurethral orgasmic expulsion from the urinary bladder, while FE is the secretion of a very small amount of fluid from the paraurethral glands.
Introduction
Female sexual arousal is manifested in the genital area primarily through vaginal lubrication, which results from plasma ultrafiltration in the perivaginal vascular plexuses into the lumen of the vagina (Pastor, 2013; Levin, 2003). However, during the orgasm, some women can squirt or expel up to hundreds of milliliters of fluid. Until 2011, due to the similarity to male ejaculation, all fluids expelled during ejaculation orgasm (EO) were considered female ejaculation (FE) without proper distinction among FE, squirting (SQ), or coital incontinence (CI). This ambiguity caused diagnostic confusion and controversial conclusions (Rubio-Casillas & Jannini, 2011). SQ and FE are considered physiological but uncommon sexual responses and CI is a symptom of a disorder, such as urinary incontinence (Pastor, 2013; Pastor & Chmel, 2018). The fluid outflow during sexual activities usually manifests as wetness, secretion, or gushes (Pastor & Chmel, 2018). The uncertainties regarding orgasmic fluid relate particularly to their origin, volume, composition, and expulsion mechanism. Previous studies did not have a uniform, objective methodology and were mostly based on the women’s subjective sensations without adequate diagnostic examination to verify the fluid source, such as ultrasonography, urinary bladder catheterization, and video visualization (Addiego et al., 1981; Bullough et al., 1984; Zaviačič et al., 1988 a,b; Zaviačič, 1999; Zaviačič et al., 2000; Perry & Whipple, 1981; Heath, 1987; Belzer Jr, 1981; Belzer Jr, 1984; Darling et al., 1990; Davidson et al., 1989; Whipple & Komisaruk, 1991; Ladas et al., 2005). The presence of prostate-specific antigen (PSA) has been considered conclusive evidence that EO fluid originates from the paraurethral glands (often referred to as the female prostate in sexological literature), (Bullough et al., 1984; Zaviačič et al., 1988 a,b; Zaviačič, 1999; Zaviačič et al., 2000; Dietrich et al., 2011; Wimpissinger et al, 2015). Although the secretion from the female prostate can contaminate other fluids secreted during sexual activities (Pastor, 2013; Rubio-Casillas & Jannini, 2011; Salama et al., 2015). While the classification and differential diagnosis for EO have been proposed previously, (Pastor, 2013; Rubio-Casillas & Jannini, 2011; Pastor & Chmel, 2018; Salama et al., 2015; Levin et al., 2016; Rogers et al., 2018) it is rarely used both in practice and in studies. The differences among sexual fluids are known at present (Pastor, 2013; Rubio-Casillas & Jannini, 2011; Pastor & Chmel, 2018; Salama et al., 2015; Rodriguez et al., 2021; Schubach, 2001) However, orgasmic fluid excretion is often universally considered FE, and the fluid itself is considered an ejaculate from female prostate because it contains PSA (Rodriguez et al., 2021). This review aimed to clarify the inaccuracies regarding “sexual” fluids and highlight the differences between FE and SQ.
Results
The articles on female expulsion of fluid during orgasm contain inconsistent results and controversial conclusions. Most studies were based on these traditional premises:
(a) the expelled fluid is a single identical phenomenon usually referred to as FE (Addiego et al., 1981; Bullough et al., 1984; Zaviačič et al., 1988 a,b; Zaviačič, 1999; Zaviačič et al., 2000; Darling et al., 1990; Whipple & Komisaruk, 1991; Ladas et al., 2005; Wimpissinger et al., 2007; Wimpissinger et al., 2009; Wimpissinger et al., 2013).; (b) the source of the fluid is the female prostate ( paraurethral glands) (Zaviačič et al., 1988 a,b; Zaviačič, 1999; Zaviačič et al., 2000; Rogers et al., 2018); (c) FE is highly prevalent (Bullough et al., 1984; Zaviačič et al., 1988 a,b; Zaviačič, 1999; Zaviačič et al., 2000; Heath, 1987; Darling et al., 1990) ; (d) a relatively large volume of fluid is expelled (Bullough et al., 1984; Zaviačič et al., 1988 a,b; Zaviačič, 1999; Zaviačič et al., 2000; Heath, 1987; Goldberg et al., 1983) ; (e) the “sexual” fluid has a high PSA concentration (Zaviačič et al., 1988 a,b; Zaviačič, 1999; Zaviačič et al., 2000; Wimpissinger et al., 2007; Rogers et al., 2018); (f) the expulsion of fluid is provoked by the stimulation of the clitorourethrovaginal complex (Rubio-Casillas & Jannini, 2011; Addiego et al., 1981, Zaviačič et al., 1988 a,b; Zaviačič, 1999; Zaviačič et al., 2000).
*Sources, types, and nature of ejaculation orgasm
*Prevalence of fluids expelled during sexual arousal and orgasm
*Paraurethral glands
*Volume, source, and mechanism of fluid secretion during EO
*Biochemical parameters of the fluid expulsed during SQ and FE
Discussion
The massive orgasmic transurethral expulsion during sexual activity is called SQ, and the SQ fluid originates from the urinary bladder. The term FE should be reserved for the expulsion of a small volume of thick secretion from the female prostate, which can also be asymptomatic. Both phenomena have different etiologies, mechanisms, and manifestations (Pastor, 2013; Rubio-Casillas & Jannini, 2011; Pastor & Chmel, 2018; Salama et al., 2015; Schubach, 2001). Their interchanging causes much confusion and derails the correct identification of the two different phenomena, as we observe in research. In this review, we reported the high prevalence of EO (up to 54%) referred to as FE (Bullough et al., 1984; Heath, 1987; Darling et al., 1990; Wimpissinger et al., 2013) by merging similar but etiologically distinct phenomena (SQ, FE, vaginal lubrication, and CI) that are incorrectly labeled with one umbrella term (FE). We consider SQ a sporadic manifestation of sexual arousal and orgasm that can occur in highly aroused and multi-orgasmic women. A realistic estimation of the prevalence of SQ could be approximately 5% (Masters & Johnson, 1966; Masters et al., 1988).
*Presence of PSA in expelled fluids
*Terminological inaccuracies about the female ejaculate
*Origin, volume, and mechanism of fluid expulsion during female sexual arousal and orgasm
*Biochemical composition and densities of fluids expelled during FE and SQ
*Initiation of SQ and FE according to the anatomic location of sexual stimulation
*Opinions on FE and SQ and their impact on the general population
The diverse conclusions of studies to date reflect how sexual aspects have been incompletely explored. This ambiguity can inadequately affect the opinions of experts and the general population on different “sexual standards.” Inaccurate or incomplete information about FE and SQ as a frequent symptoms of sexual arousal (e.g., one in two women) (Wimpissinger et al., 2013) can cause frustration and mislead women experiencing these symptoms. Moreover, many erotic videos with abundant squirts of sexual fluid are showing this sexual phenomenon as a natural part of orgasm. Unfortunately, it can result in a feeling of sexual imperfection in women without SQ and may set unrealistic expectations for men. On the other hand, although not considered scientifically relevant, erotic videos and other similar materials demonstrate transurethral squirting of a large volume of watery fluid with an extraordinary pressure gradient and thus, at least, dispel doubts about its origin.
Limitations and weaknesses of the review
This review has some limitations. First, it includes studies with conflicting terminology, inconsistent methodology, and limited use of imaging methods to objectively confirm their conclusions (Addiego et al., 1981; Bullough et al., 1984; Zaviačič et al., 1988 a,b; Zaviačič, 1999; Zaviačič et al., 2000); (Heath, 1987; Belzer Jr, 1981; Belzer Jr, 1984; Darling et al., 1990; Davidson et al., 1989; Whipple & Komisaruk, 1991; Ladas et al., 2005). The heterogeneity of the analyzed studies caused difficulties in their comparison. Second, all selected studies were assessed to maximize objectivity. However, some of them were inaccurate and had generally accepted conclusions (Ladas et al., 2005). Third, it was difficult to justify some opinions on FE and SQ when only a limited number of studies were available to support the conclusions of this review (Pastor, 2013; Rubio-Casillas & Jannini, 2011; Pastor & Chmel, 2018; Salama et al., 2015; Schubach, 2001). Nevertheless, this review refuted some traditional misconceptions concerning FE and SQ, which were not confirmed by adequate research methods, by studying relevant scientific studies and generally accepted anatomical and physiological facts.
Conclusion
Relevant and robust studies confirmed that FE and SQ are entirely different physiological sexual phenomena with low prevalence in women. FE and SQ are not a common part of female sexual arousal and orgasm. Incorrect assessment of the manifestation of these phenomena can significantly disrupt a couple’s sexual life and cause substantial misconceptions about human sexuality. The use of precise definitions and terminologies may refine the differential diagnosis of FE and SQ and facilitate further research in this field.
Zlatko Pastor, MD, Ph.D., Roman Chmel, MD, Ph.D.
Introduction: Women expel fluids of various quantities and compositions from the urethra during sexual arousal and orgasm. These are classified as either female ejaculation (FE) or squirting (SQ). The aim of our analysis was to present evidence that FE and SQ are similar but etiologically different phenomena.
Materials and Methods: A review of studies was performed on fluids expelled from the urogenital tract during female sexual activities using the Web of Knowledge TM (Web of Science Core Collection) and MEDLINE (Ovid) databases from 1946 to 2021.
Results: Until 2011, all-female orgasmic expulsions of fluids were referred to as FE. The fluid was known to be either from the paraurethral glands or as a result of coital incontinence. At present, SQ is considered a transurethral expulsion of approximately ten milliliters or more of transparent fluid, while FE is considered a secretion of a few milliliters of thick fluid. The fluid in SQ is similar to urine and is expelled by the urinary bladder. The secretion in FE originates from the paraurethral glands and contains a high concentration of prostate-specific antigen. Both phenomena can occur simultaneously.
Conclusions: The mechanisms underlying SQ and FE are entirely different. SQ is a massive transurethral orgasmic expulsion from the urinary bladder, while FE is the secretion of a very small amount of fluid from the paraurethral glands.
Introduction
Female sexual arousal is manifested in the genital area primarily through vaginal lubrication, which results from plasma ultrafiltration in the perivaginal vascular plexuses into the lumen of the vagina (Pastor, 2013; Levin, 2003). However, during the orgasm, some women can squirt or expel up to hundreds of milliliters of fluid. Until 2011, due to the similarity to male ejaculation, all fluids expelled during ejaculation orgasm (EO) were considered female ejaculation (FE) without proper distinction among FE, squirting (SQ), or coital incontinence (CI). This ambiguity caused diagnostic confusion and controversial conclusions (Rubio-Casillas & Jannini, 2011). SQ and FE are considered physiological but uncommon sexual responses and CI is a symptom of a disorder, such as urinary incontinence (Pastor, 2013; Pastor & Chmel, 2018). The fluid outflow during sexual activities usually manifests as wetness, secretion, or gushes (Pastor & Chmel, 2018). The uncertainties regarding orgasmic fluid relate particularly to their origin, volume, composition, and expulsion mechanism. Previous studies did not have a uniform, objective methodology and were mostly based on the women’s subjective sensations without adequate diagnostic examination to verify the fluid source, such as ultrasonography, urinary bladder catheterization, and video visualization (Addiego et al., 1981; Bullough et al., 1984; Zaviačič et al., 1988 a,b; Zaviačič, 1999; Zaviačič et al., 2000; Perry & Whipple, 1981; Heath, 1987; Belzer Jr, 1981; Belzer Jr, 1984; Darling et al., 1990; Davidson et al., 1989; Whipple & Komisaruk, 1991; Ladas et al., 2005). The presence of prostate-specific antigen (PSA) has been considered conclusive evidence that EO fluid originates from the paraurethral glands (often referred to as the female prostate in sexological literature), (Bullough et al., 1984; Zaviačič et al., 1988 a,b; Zaviačič, 1999; Zaviačič et al., 2000; Dietrich et al., 2011; Wimpissinger et al, 2015). Although the secretion from the female prostate can contaminate other fluids secreted during sexual activities (Pastor, 2013; Rubio-Casillas & Jannini, 2011; Salama et al., 2015). While the classification and differential diagnosis for EO have been proposed previously, (Pastor, 2013; Rubio-Casillas & Jannini, 2011; Pastor & Chmel, 2018; Salama et al., 2015; Levin et al., 2016; Rogers et al., 2018) it is rarely used both in practice and in studies. The differences among sexual fluids are known at present (Pastor, 2013; Rubio-Casillas & Jannini, 2011; Pastor & Chmel, 2018; Salama et al., 2015; Rodriguez et al., 2021; Schubach, 2001) However, orgasmic fluid excretion is often universally considered FE, and the fluid itself is considered an ejaculate from female prostate because it contains PSA (Rodriguez et al., 2021). This review aimed to clarify the inaccuracies regarding “sexual” fluids and highlight the differences between FE and SQ.
Results
The articles on female expulsion of fluid during orgasm contain inconsistent results and controversial conclusions. Most studies were based on these traditional premises:
(a) the expelled fluid is a single identical phenomenon usually referred to as FE (Addiego et al., 1981; Bullough et al., 1984; Zaviačič et al., 1988 a,b; Zaviačič, 1999; Zaviačič et al., 2000; Darling et al., 1990; Whipple & Komisaruk, 1991; Ladas et al., 2005; Wimpissinger et al., 2007; Wimpissinger et al., 2009; Wimpissinger et al., 2013).; (b) the source of the fluid is the female prostate ( paraurethral glands) (Zaviačič et al., 1988 a,b; Zaviačič, 1999; Zaviačič et al., 2000; Rogers et al., 2018); (c) FE is highly prevalent (Bullough et al., 1984; Zaviačič et al., 1988 a,b; Zaviačič, 1999; Zaviačič et al., 2000; Heath, 1987; Darling et al., 1990) ; (d) a relatively large volume of fluid is expelled (Bullough et al., 1984; Zaviačič et al., 1988 a,b; Zaviačič, 1999; Zaviačič et al., 2000; Heath, 1987; Goldberg et al., 1983) ; (e) the “sexual” fluid has a high PSA concentration (Zaviačič et al., 1988 a,b; Zaviačič, 1999; Zaviačič et al., 2000; Wimpissinger et al., 2007; Rogers et al., 2018); (f) the expulsion of fluid is provoked by the stimulation of the clitorourethrovaginal complex (Rubio-Casillas & Jannini, 2011; Addiego et al., 1981, Zaviačič et al., 1988 a,b; Zaviačič, 1999; Zaviačič et al., 2000).
*Sources, types, and nature of ejaculation orgasm
*Prevalence of fluids expelled during sexual arousal and orgasm
*Paraurethral glands
*Volume, source, and mechanism of fluid secretion during EO
*Biochemical parameters of the fluid expulsed during SQ and FE
Discussion
The massive orgasmic transurethral expulsion during sexual activity is called SQ, and the SQ fluid originates from the urinary bladder. The term FE should be reserved for the expulsion of a small volume of thick secretion from the female prostate, which can also be asymptomatic. Both phenomena have different etiologies, mechanisms, and manifestations (Pastor, 2013; Rubio-Casillas & Jannini, 2011; Pastor & Chmel, 2018; Salama et al., 2015; Schubach, 2001). Their interchanging causes much confusion and derails the correct identification of the two different phenomena, as we observe in research. In this review, we reported the high prevalence of EO (up to 54%) referred to as FE (Bullough et al., 1984; Heath, 1987; Darling et al., 1990; Wimpissinger et al., 2013) by merging similar but etiologically distinct phenomena (SQ, FE, vaginal lubrication, and CI) that are incorrectly labeled with one umbrella term (FE). We consider SQ a sporadic manifestation of sexual arousal and orgasm that can occur in highly aroused and multi-orgasmic women. A realistic estimation of the prevalence of SQ could be approximately 5% (Masters & Johnson, 1966; Masters et al., 1988).
*Presence of PSA in expelled fluids
*Terminological inaccuracies about the female ejaculate
*Origin, volume, and mechanism of fluid expulsion during female sexual arousal and orgasm
*Biochemical composition and densities of fluids expelled during FE and SQ
*Initiation of SQ and FE according to the anatomic location of sexual stimulation
*Opinions on FE and SQ and their impact on the general population
The diverse conclusions of studies to date reflect how sexual aspects have been incompletely explored. This ambiguity can inadequately affect the opinions of experts and the general population on different “sexual standards.” Inaccurate or incomplete information about FE and SQ as a frequent symptoms of sexual arousal (e.g., one in two women) (Wimpissinger et al., 2013) can cause frustration and mislead women experiencing these symptoms. Moreover, many erotic videos with abundant squirts of sexual fluid are showing this sexual phenomenon as a natural part of orgasm. Unfortunately, it can result in a feeling of sexual imperfection in women without SQ and may set unrealistic expectations for men. On the other hand, although not considered scientifically relevant, erotic videos and other similar materials demonstrate transurethral squirting of a large volume of watery fluid with an extraordinary pressure gradient and thus, at least, dispel doubts about its origin.
Limitations and weaknesses of the review
This review has some limitations. First, it includes studies with conflicting terminology, inconsistent methodology, and limited use of imaging methods to objectively confirm their conclusions (Addiego et al., 1981; Bullough et al., 1984; Zaviačič et al., 1988 a,b; Zaviačič, 1999; Zaviačič et al., 2000); (Heath, 1987; Belzer Jr, 1981; Belzer Jr, 1984; Darling et al., 1990; Davidson et al., 1989; Whipple & Komisaruk, 1991; Ladas et al., 2005). The heterogeneity of the analyzed studies caused difficulties in their comparison. Second, all selected studies were assessed to maximize objectivity. However, some of them were inaccurate and had generally accepted conclusions (Ladas et al., 2005). Third, it was difficult to justify some opinions on FE and SQ when only a limited number of studies were available to support the conclusions of this review (Pastor, 2013; Rubio-Casillas & Jannini, 2011; Pastor & Chmel, 2018; Salama et al., 2015; Schubach, 2001). Nevertheless, this review refuted some traditional misconceptions concerning FE and SQ, which were not confirmed by adequate research methods, by studying relevant scientific studies and generally accepted anatomical and physiological facts.
Conclusion
Relevant and robust studies confirmed that FE and SQ are entirely different physiological sexual phenomena with low prevalence in women. FE and SQ are not a common part of female sexual arousal and orgasm. Incorrect assessment of the manifestation of these phenomena can significantly disrupt a couple’s sexual life and cause substantial misconceptions about human sexuality. The use of precise definitions and terminologies may refine the differential diagnosis of FE and SQ and facilitate further research in this field.
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