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Sex Research.
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ADVERSARIA
Commentaries,Remarks,and Notes
Pertainingto Sex Research
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.
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
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.
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.
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
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-
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."
References
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F., BELZER,
G. E., JR., COMOLLI,
J., MOGER,
W., PERRY,
J. D., & WHIPPLE,
B.
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E. G., JR., COMOLLI,
J., MOGER,W., PERRY, J. D., & WHIPPLE,B.
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SEXUALITY,SCIENCE,AND SOCIALRESPONSIBILITY:
THE GEORGETOWN SCANDAL
JeffreyJ. W. Baker