© 2010 International Society for Sexual Medicine

Controversies in Sexual Medicine

Who’s Afraid of the G-spot? jsm_1613 25..34

Emmanuele A. Jannini, MD,* Beverly Whipple, PhD, RN, FAAN,† Sheryl A. Kingsberg, PhD,‡
Odile Buisson, MD,§ Pierre Foldès, MD,¶ and Yoram Vardi, MD**
*Course of Endocrinology and Medical Sexology, Department of Experimental Medicine, University of L’Aquila, Italy;
†
Professor Emerita, Rutgers University, NJ, USA; ‡Division of Behavioral Medicine, University Hospitals Case Medical
Center, MacDonald Women’s Hospital, Department of Reproductive Biology, Case Western Reserve University School of
Medicine Cleveland, OH, USA; §Centre d’échographie, Saint Germain en Laye, France; ¶Hôpital de Saint Germain en
Laye, Clinique Louis XIV, Saint Germain en Laye, France; **Neuro-Urology Unit, Rambam Health Care Center and
Technion Faculty of Medicine, Haifa, Israel

DOI: 10.1111/j.1743-6109.2009.01613.x

ABSTRACT

Introduction. No controversy can be more controversial than that regarding the existence of the G-spot, an
anatomical and physiological entity for women and many scientists, yet a gynecological UFO for others.
Methods. The pros and cons data have been carefully reviewed by six scientists with different opinions on the
G-spot. This controversy roughly follows the Journal of Sexual Medicine Debate held during the International
Society for the Study of Women’s Sexual Health Congress in Florence in the February of 2009.
Main Outcome Measure. To give to The Journal of Sexual Medicine’s reader enough data to form her/his own opinion
on an important topic of female sexuality.
Results. Expert #1, who is JSM’s Controversy section editor, reviewed histological data from the literature demon-
strating the existence of discrete anatomical structures within the vaginal wall composing the G-spot. He also found
that this region is not a constant, but can be highly variable from woman to woman. These data are supported by the
findings discussed by Expert #2, dealing with the history of the G-spot and by the fascinating experimental evidences
presented by Experts #4 and #5, showing the dynamic changes in the G-spot during digital and penile stimulation.
Experts #3 and #6 argue critically against the G-spot discussing the contrasting findings so far produced on the topic.
Conclusion. Although a huge amount of data (not always of good quality) have been accumulated in the last 60 years,
we still need more research on one of the most challenging aspects of female sexuality. Jannini EA, Whipple B,
Kingsberg SA, Buisson O, Foldès P, and Vardi Y. Who’s afraid of the G-spot?. J Sex Med 2010;7:25–34.
Key Words. G Spot; Vaginal Orgasm; Vagina; Clitoris; Skene Glands; Female Ejaculation

V ery few issues in sexology, and now also in

sexual medicine, instigate so much reactivity
as those related to the female orgasm in general
and to G-spot in particular. It is an old story: the
goddess Hera blinded the poor Tiresias just
because the soothsayer revealed scientific truths on
the female orgasm [1]. But some sexologists and
feminists are still afraid of the G-spot, considered,
with a dramatically prescientific mentality, a male
attempt to recoup importance for vaginal penetra-
tion after the celebration of the clitoris during the
sexual revolution. Their claims are mostly based
on a poorly researched review article, written by an
author who is almost unknown in academic medi-
cine and who never published on the field, where
the G-spot has been defined as a “a modern gyne-
cologic myth” [2].
Some women are able to reach orgasm without a
direct stimulation of the external clitoris but just
with the mechanical stimulation of the vagina.

J Sex Med 2010;7:25–34 25

Controversies in Sexual Medicine
Others do not reach the vaginally activated orgasm,
despite different partners and different instruments
used. These statements can be hardly denied. The
term “G-spot” was used by two researchers, Beverly
Whipple (who kindly accepted to write the para-
graph on the history of the G-spot) and John D.
Perry, to name the sensitive area felt through the
anterior vaginal wall, halfway between the back of
the pubic bone and the cervix, along the course of
the urethra [3].
The data in the available literature have differ-
ent levels of evidence.
1. Histological studies are very consistent. The
G-spot (or area) is composed of individually
different amount of cavernosal tissue from the
inner clitoris [4], exocrine glands (Skene’s
glands, the female counterpart of the prostate
[5]), muscles, and nerves within the anterior
vaginal wall [6,7]. The urethra seems also to play
a major role in the G-spot. The whole bio-
chemical machinery of excitation is especially
expressed in these structures (all nitric oxide
synthases, phosphodiesterase type 5) [8], as well
as specific markers of prostatic tissue (prostate
specific antigen (PSA), human protein 1, chro-
mogranin) [7]. In fact, application of alprostadil
to the G-spot area is effective in women with
female sexual arousal disorder [9]. Studies are in
progress to determine how many of these struc-
tures and how much are under hormonal (i.e.,
under testosterone) control changing on the
basis of the cycle phase or the menopausal state.
The histological “picture” of the G-spot is
very well defined, but this “picture” changes
when comparing anterior vaginal walls from
different women. This explains contrasting data
on this anatomical region as well the different
ways to define it. Moreover, examinations of
vaginal wall innervations have shown that there
is no single area with a greater density of nerve
endings [10]. A study of 110 biopsy specimens
drawn from 21 women concluded that there is
no single specific vaginal locus with greater
nerve density and thus argued against the
G-spot [11]. However, the urethral sponge does
contain sensitive nerve endings as well as erectile
tissue. Furthermore, it is evident that sensitivity
is not determined by neuron density alone.
2. Echo scan imaging [12–14] or urodynamics [15]
may be helpful in localizing the G-spot, as
reviewed by Buisson and Foldès later in this
26
paper. However, some papers refute the evi-
dence on the G-spot. For instance, Schultz
et al. was unable to find by magnetic resonance
imaging (MRI) the “widening of the vaginal
canal, structures suggesting a Gräfenberg spot,
or a separate reservoir of fluid indicating female
ejaculation” [16]. However, this statement was
based on a single scan obtained from a single
woman!
3. Sexual stimulation of the G-spot seems to
produce a variety of feelings: discomfort, sen-
sation of urination, or pleasure. With additional
stimulation, the area may begin to swell, and
then produce an intense orgasm, possibly
together with a semen-like (although less
viscous) fluid emission, the so-called “female
ejaculation,” thought to be the product of
Skene’s glands. This part of the story needs
more studies and more clear evidence: for
instance, the papers which have yielded positive
evidence for female ejaculation involve small
participant samples [17] and have some meth-
odological biases [18].
4. The absence (or the low expression of one or
more of the G-spot components) is not a
disease or a dysfunction: orgasm is achievable
by any woman properly stimulated and with
a good relationship with her own body and
environment.
5. Nomenclature is the final problem: words such
as “female ejaculation,” “urethral sponge,”
“urethral–vaginal space,” “anterior vaginal
wall,” “inner clitoris,” “female prostate,”
“Kobelt plexus,” vaginal vs. clitoral orgasm, and
G-spot/area itself need to be revised in light of
new evidence. A consensus conference of the
International Society for Sexual Medicine
(ISSM) would be an excellent instrument to
accomplish this task.
Finally, I have to say few words as rebuttals to
the opinions of the two excellent colleagues who
are . . . afraid of the G-spot. Dr. Kingsberg is using
the elegant argument that “the location of the
G-spot is more likely found in a woman’s brain
than in her vagina.” Who disagrees? I am sure that
humans have sex not only with something between
their legs, but definitively with something which is
between their ears. Yes, orgasm is a perception,
under strict brain control (Is this the reason why
orgasm from penetration is frequently referred as
deeper than that obtained from the external stimu-
J Sex Med 2010;7:25–34
 Controversies in Sexual Medicine
lation of the clitoris?) but arising from muscular
contractions triggered by stimulation of discrete
areas . . . between the legs.
Dr. Vardi’s main reason to reject existence of
the G-spot is the presumed absence of sexual con-
sequences after surgery of this region. I am afraid
that, being far from evidence against the G-spot,
this argument seems not in favor of some surgeons
and of their attention to female sexuality. In any
case, I decided to give the last word to Yoram
Vardi, as a tribute to an outstanding scientist and
gentleman, who was the editor of this section of
The Journal of Sexual Medicine, for doing an excel-
lent job, just before me.
Emmanuele A. Jannini, MD
The Gräfenberg spot or the G-spot was named by
Drs. John Perry and Beverly Whipple [19] for the
German obstetrician and gynecologist, Dr. Ernst
Gräfenberg, who wrote about this sensitive area
in 1950 [20]. The G-spot is a sensitive area felt
through the anterior wall of the vagina about
halfway between the back of the pubic bone and
the cervix, along the course of the urethra. It is
easiest to feel the G-spot with the woman lying on
her back. If one or two fingers are inserted into the
vagina, with the palm up, using a “come here”
motion, the tissue that surrounds the urethra will
begin to swell. When the area is first touched, the
woman may feel as if she needs to urinate, but if
the touch continues for a few seconds longer, it
may turn into a pleasurable feeling.
In 1982, Perry and Whipple wrote that “The
G-spot is probably composed of a complex
network of blood vessels, the paraurethral glands
and ducts (female prostate), nerve endings, and the
tissue surrounding the bladder neck” [3]. They
rediscovered this sensitive area while teaching
women Kegel exercises using biofeedback to help
treat stress urinary incontinence (SUI). Some of
the women reported that they emitted a small
amount of fluid from the urethra that was different
from urine during sexual activity and these women
had very strong pelvic floor muscles, whereas
women with SUI have weak pelvic floor muscles
[19]. The women with the strong muscles also
reported that stimulation of a sensitive area felt
through the anterior vaginal wall seemed to trigger
this fluid expulsion.
Perry and Whipple reported that they then had
a physician or nurse practitioner examine 400
women who volunteered to be research subjects.
J Sex Med 2010;7:25–34
The G-spot was found in each of these women.
However, they cautioned that they could not state
with certainty that every woman has a G-spot [3].
They named this area after the first modern
researcher to describe its location. A literature
search found that Dr. Ernst Gräfenberg described
a zone of erogenous feeling that was located along
the suburethral surface of the anterior vaginal wall
[20]. He later went on to write, “An erotic zone
could always be demonstrated on the anterior wall
of the vagina along the course of the urethra . . .
(which) seems to be surrounded by erectile tissue
like the corpora cavernosa (of the penis) . . . In the
course of sexual stimulation, the female urethra
begins to enlarge and can be easily felt” [20].
Gräfenberg was not the first person to describe
this sensitive area; Regnier deGraff, described it in
the 17th century, and called it the female prostate
or corpus glandulosum. Others have described this
area before and since deGraff [3].
Women have reported that they have difficulty
locating and stimulating their G-spot by them-
selves, except with a dildo, a G-spot vibrator, or
similar device (there are over 50 such devices now
available), but they have no difficulty identifying
the erotic sensation when the area is stimulated by
a partner. To stimulate the G-spot during vaginal
intercourse, the best positions are the woman on
top or rear entry, so the average penis will hit the
anterior wall of the vagina [21].
Some women describe experiencing orgasm
from stimulation solely of the G-spot. The orgasm
resulting from stimulation of the G-spot is felt
deep inside the body, and a bearing-down sensa-
tion, similar to a Valsalva maneuver, during the
orgasm is commonly reported [3,22]. Physiologi-
cally, the orgasm from G-spot stimulation is dif-
ferent from an orgasm that is produced by clitoral
stimulation. During orgasm from clitoral stimula-
tion, the end of the vagina balloons out. During
orgasm from G-spot stimulation, the cervix pushes
down into the vagina [3]. Many women experience
a “blended orgasm” when the G-spot and the cli-
toris are stimulated at the same time [3]. However,
it is important to note that not all women like the
feeling of stimulation of the G-spot area.
Some women experience an expulsion of a small
amount of fluid (about 3–5 cc) from the urethra
with G-spot orgasms (as well as with orgasms
resulting from stimulation of other areas). The
fluid produced by this “female ejaculation” has the
appearance of watered-down, fat-free milk. It is
27
Controversies in Sexual Medicine
chemically similar to seminal fluid but is different
from urine [17,23–25]. Researcher Milan Zaviacic
conducted hundreds of studies on autopsy speci-
mens and concluded that the fluid is from the
paraurethral glands, which recently have been
named the “female prostate gland” [26]. Whipple
and Komisaruk stated that, based on research,
in some cases, these three distinct entities, the
G-spot, orgasm, and female ejaculation, may be
related, while in other cases, they are not related
[27]. Many men enjoy stimulation of their pros-
tate, which can produce an orgasm that is accom-
panied by a bearing-down sensation similar to that
described by women when they experience an
orgasm from G-spot stimulation [3].
Not all researchers have been able to locate the
G-spot; thus, there is some controversy about it.
Other researchers consider the G-spot obvious. It
may be that researchers use different methods of
stimulation (and thus obtain different results) in
studying the G-spot area or that not all women have
a sensitive G-spot area. One group of researchers
recently studied 20 women and observed a correla-
tion between vaginal orgasms and the thickness of
the “clitoris urethra–vaginal complex also known as
the G-spot” [13]. Therefore, pressure exerted
against the anterior vaginal wall may be more effec-
tive if the G-spot area is thicker, according to this
new research. However, the careful terminology
(clitoris urethra–vaginal complex) used by the
researchers refers to the fact that there are several
different organs in this highly complex body
region. Komisaruk, Whipple, Nasserzadeh, and
Beyer-Flores state that this area may include: (i) the
anterior vaginal wall; (ii) the urethra; (iii) the
Skene’s glands (including the paraurethral glands
or female prostate gland); (iv) perhaps the other
glands in this region (vestibular glands, Bartholin’s
glands); (v) the surrounding muscle and connective
tissue; and (vi) perhaps the crura of the clitoris [28].
The effect of G-spot stimulation might primarily
be the result of stimulation of just one structure
(such as the female prostate gland) or it might be
the result of stimulation of several sensitive struc-
tures that are close together.
More recent research from our laboratories has
documented that self-stimulation of the area of the
G-spot produces a very strong analgesic effect,
which is also activated naturally during labor. We
have documented, using functional MRI of the
brain, that orgasm from self-stimulation of the
area of the G-spot activates the same brain regions
28
in women with and without complete spinal cord
injury (SCI) as are activated during orgasm from
self-stimulation of the cervix of the uterus. The
same brain regions are also activated in women
without SCI during orgasm from G-spot self-
stimulation, from clitoral self-stimulation, and
from imagery alone, with no touching of the body
(see [29] for review).
There is much more to be studied in terms of
female sexual responses and it behooves research-
ers to listen to women and then to validate their
pleasurable sensual and sexual experiences in labo-
ratory studies.
As has been written in the final chapter of the
first book on The G-spot, if G-spot stimulation feels
good, then women should enjoy it, but they should
not feel compelled to find the G-spot. This is not a
goal that women and their partners should strive to
achieve [3]. Women need to be encouraged to enjoy
what they find pleasurable and not set up finding
the G-spot or experiencing orgasm or female ejacu-
lation as a goal. People need to be encouraged to
regard the G-spot as one area of sensual and sexual
pleasure that some women enjoy.
Beverly Whipple, PhD, RN, FAAN
Rarely has a debate over the existence or not of an
anatomical structure garnered such vast attention
from the general (dare I say lay) public as the
controversy over the G-spot. In fact, thanks to
Ladas, Whipple, and Perry’s 1982 hit book, The
G-spot and Other Recent Discoveries about Human
Sexuality [3], the G-spot has become a cultural
truism. Had it not been for the wide acceptance of
the G-spot’s existence, where would it be today in
sexual medicine (i.e., would we be able to find it)?
Would it have fallen into obscurity along with
other theories based on little scientific evidence? It
is ironic that Gräfenberg’s hypothesis [20] has
been used to provide anatomical support for one
such theory with little methodologically rigorous
evidence—Freud’s theory of the vaginal orgasm.
This “vaginal transfer theory” holds that clitoral
responsivity must be superseded by vaginal orgasm
in mature women. Is this an example of the blind
leading the blind or the blind leading to going blind
if a woman touches her own G-spot?
While my colleagues have been charged with
the task of debating the existence of the G-spot as
an anatomical area located on the anterior wall of
the vagina one-third of the way up from the
vaginal opening, my task is to address the question
J Sex Med 2010;7:25–34
 Controversies in Sexual Medicine
of whether the G-spot should more accurately be
considered a placebo response. From a pragmatic
perspective, as an anatomical structure, it has not
been easily been made evident, albeit allowing for
a pronoun shift from an “it” to a “there,” reflecting
the concept of a sensitive “area.” The neurophysi-
ology of the vagina itself is poorly understood and
there is scant evidence to support the hypothesis
that vaginal innervation is correlated with sexual
sensation and function [11].
One of the major sources of data in support of
the existence of a G-spot has been from associated
research investigating the existence of female
ejaculation and the supposition that the parauer-
thral (Skene’s) glands are the female equivalent of
a prostate [4]. Other researchers have suggested
that stimulation of the G-spot results in sexual
pleasure due to its proximal location to the bulbs
of the clitoris [30].
A second source of support has been from
research using behavioral methodology, again a
downstream source of evidence. These are reports
of intense pleasurable sensation and intense
orgasms as the result of stimulation of the G-spot
area. For example, Addiego et al. [17] presented the
first report case report of a woman for whom stimu-
lation of the anterior vaginal wall made the area
expand by 50%, and that self-reported levels of
arousal/orgasm were “deeper” when the G-spot
was stimulated. Goldberg et al. [31] examined 11
women by palpating the entire vagina in a clockwise
fashion. They reported a specific response to stimu-
lation of the anterior vaginal wall in four of the
women. However, even under the most rigorous of
experimental methods, it is difficult to reach the
G-spot without “accidentally” stimulating other
areas along the way. This would be absolutely the
case in a nonexperimental, sexual encounter using a
finger, penis, or other objects de pleasir.
The excitement generated by the potential
existence of a G-spot is due to the theory that
stimulation supposedly results in high levels of
pleasurable sexual sensations and powerful
orgasms [3]. Therefore, I propose that the location
of the G-spot is more likely found in a woman’s
brain than in her vagina. In other words, I submit
that the G-spot is inaccurately named and should
instead be more correctly labeled the P-spot where
P stands for placebo. A placebo effect is a medical
phenomenon in which an inactive substance like
sugar or distilled water or even a designated “spot”
improves a condition simply because a person has
J Sex Med 2010;7:25–34
the expectation that it will. Placebos have measur-
able physiologic effects. For example, if subjects
will speed up their pulse rate, increase their blood
pressure, and improve reaction time after being
told they have taken a stimulant, imagine the effect
of telling a subject what stimulating the G-spot is
supposed to do! Beliefs about what effect the
placebo will have are related to changes in the
body’s neurological regulatory systems found in
the higher cerebral cortex. Furthermore, although
stimulation of the G-spot is considered to result in
intense orgasms (so strong, in fact, as to relegate
the clitoral orgasm to second-class status),
researchers still have no definitive explanations for
what triggers orgasm [32]. Therefore, if female
orgasm is so nebulous, how confident can we be
about a G-spot?
Sheryl A. Kingsberg, PhD
The existence of the G-spot remains controversial
partly because no appropriate structure and inner-
vation have been clearly demonstrated in this
pleasurable vaginal area. Recently, Gravina et al.
demonstrated that the thickness of the ure-
throvaginal space is larger with women who have a
vaginal orgasm than with women who have a cli-
toral orgasm [13]. It is now scientifically proven
that there is an objective anatomical difference.
However, the cause of the difference in the thick-
ness of this space remains unclear. Dynamic
sonography can provide us with more facts about
the G-spot area.
We placed a 12-MHz sonographic probe on the
top of the vulva of a healthy 40-year-old woman,
capable of achieving vaginal orgasms (i.e., without
direct stimulation of the external clitoris) with no
sexual dysfunction. We made a triplanar 3-D
reconstruction of her clitoris. The coronal planes
of what O’Connell names the “clitoral complex”
[4] contain the most information. It demonstrates
a series of triangles: cavernous bodies, venous
Kobelt plexus, bulbs (because bulbs are located
discreetly posteriorly in the root of the clitoris and
then descend anteriorly) and, lastly, symphysis [12]
(Figure 1). In fact, venous Kobelt plexuses are
entrapped between the double vault formed by
cavernous bodies and bulbs. Sonography demon-
strates that a finger vaginal penetration evokes a
reflex perineal contraction and tightly narrows the
distance between the root of the clitoris (cavernous
bodies and bulbs) and the distal anterior vaginal
wall. When the patient locates her own G-spot
29
Controversies in Sexual Medicine
with her finger, the echoes of the finger are found
at close proximity to the clitoris root and the pres-
sure movement of the finger displaces cavernous
bodies and bulbs [14] (Figure 2).
If the root of the clitoris containing cavernous
bodies, venous Kobelt plexuses, and bulbs are
related to the anterior vaginal wall, why would it
not play a part in the vaginal pleasure? Under
erotic stimulation, neuromuscular reflex [33] and
vasomotor events [34] have been demonstrated.
We suggest that these events could increase the
contact between the vagina and the richly inner-
Figure 2 Echo scan of the human vagina during digital
stimulation. Coronal plane of the root of the clitoris: when
the patient locates her own G-spot with her finger, the echos
of the finger are found at close proximity to the clitoris root
and the pressure movement of the finger displaces cavern-
ous bodies and bulbs. GL = glans; CB = clitoral body;
BU = bulb.
30
Figure 1 Echo scan of human vagina.
The triplanar 3-D reconstruction dem-
onstrates a series of triangles: cavern-
ous bodies, venous Kobelt plexus,
bulbs (because bulbs are located dis-
creetly posteriorly in the root of the
clitoris and then descend anteriorly)
and, lastly, symphysis. CB = clitoral
body; BU = bulb; K = Kobelt plexus;
VA = vagina.
vated and congestive clitoris. To date, it is not
possible to visualize the clitoris during an MRI
coitus [35], but a sonography of an erected penis
penetration allows visualization of the clitoral-
complex modification. We performed the ultra-
sounds during the coitus of a volunteer couple
with the Voluson General Electric Sonography
system (Solingen, Germany), a 12-MHz flat
probe. The woman was in gynecologic position
and her companion penetrated her from a standing
position. We performed a coronal section on the
top of the vulva during the penetration. It becomes
obvious that the coitus creates a completely differ-
ent anatomical entity due to modification of the
way in which the organs are related to each other.
The sonography of the coitus provides us with the
following findings: the root of the clitoris is
ascending and completely widened by the penis.
During the thrusting, the anterior vaginal wall is
crushed against the root of the clitoris (Figure 3).
The Kobelt plexus is a venous plexus entrapped
between the clitoral bodies and the bulbs. It is well
visualized during the coitus and seems to be
repeatedly crushed by the pressure of the penis. It
is likely that a venous pumping effect exists at this
specific location: on the top of the double vault
made of the two cavernous bodies and the two
bulbs. It is very easy to measure the cavernous
bodies and to see the enhanced clitoris’s size as
shown with MRI [36].
The special location of the Kobelt plexus seems
also interesting: first, it is located on the top of the
J Sex Med 2010;7:25–34
 Controversies in Sexual Medicine
Figure 3 Echo scan of the human vagina during coitus.
Coronal plane of the coitus. The probe is placed transver-
sally on the top of the vulva in a coronal inclination. The
cavernous bodies are enlarged and pushed up. The bulbs
are partially hidden by the erected penis. Venous Kobelt
plexuses are in a special location on the top of the vault. The
clitoral complex is crushed by the erected penis against the
anterior vaginal wall. The plane of the three parts of the
erected penis is well visualized. BU = bulb; CB = clitoral
body; K = Kobelt plexus; CC = corpus cavernosum.
double vault which is situated on the G-spot area,
then it drains toward vaginal veins and, second, it
seems to have a particular venous organization.
Enlarging a sonographic image of the Kobelt
plexus of a quiescent clitoris, we can see distinctly
the blood whirl; it seems as if there is a kind of
stagnation followed by slow, periodical, and
Figure 4 Color Doppler of the human
vagina. The signal of the venous
Kobelt plexuses on a quiescent clitoris:
there is no flow between the repetitive
releasing of blood, as if the Kobelt
plexuses played the role of a reservoir
for a short time. BU = bulb; CB =
clitoral body; K = Kobelt plexus.
J Sex Med 2010;7:25–34
repeated releases of the blood. With Color
Doppler, on a coronal view, a discontinuous but
regular color signal in the Kobelt plexus is visual-
ized. Measurements demonstrate that the releas-
ing flow is very slow: about 5 cm per second.
There is no flow between the releases as if the
Kobelt plexus played the role of a reservoir for a
short time (Figure 4). The Kobelt plexus is repeat-
edly crushed during the thrusting of the penis in
an area which is full of neurotransmitters [6].
These evidences lead us to ask four questions:
(i) During the coitus, does the root of the clitoris
compressing the Kobelt plexus create a venous
pumping effect and an accumulation of neu-
rotransmitters?; (ii) Does the Kobelt plexus play
the role of a kind of reservoir from which the
accumulated neurotransmitters are released at a
certain moment?; (iii) Does this release of accu-
mulated neurotransmitters cause the sensation
perceived as vaginal orgasm?; (iv) Does the root of
the clitoris participate to the vaginal orgasm, with
different neurologic pathways than those for the
clitoral orgasm?
Medical images open the gate toward a recon-
ceptualization of the G-spot. The G-spot is prob-
ably not a unique anatomical structure but rather a
functional one which involves the clitoral complex
and the vagina during a vaginal penetration. Part
of the solution to a better understanding of the
female sexuality lays undoubtedly in functional
imagery [37].
Odile Buisson, MD and Pierre Foldès, MD
31
Controversies in Sexual Medicine
It was in the early 1950s that the importance of the
anterior vaginal wall became evident in regard to
sexual pleasure and orgasm. This can be attributed
to the German gynecologist Ernst Gräfenberg
[20] who described the existence of an area of high
sensitivity in the anterior vagina, later named the
G-spot. Sixty years later, there is still a wide dis-
crepancy between the questionable existence of
the G-spot on one hand and the mass popularity
and its empowerment on the other.
The first attempt to investigate the existence of
the G-spot was performed by Goldberg et al. [31]
using a standardized manual technique. This study
was conducted by two trained gynecologists in 11
women. Using their methodology, they found the
G-spot in four of them. Other sexology literature
provides only testimonials and anecdotal reports
on the G-spot that describes it as different, pro-
viding sexual arousal and pleasure. On the other
hand, others have demonstrated that also the pos-
terior vaginal wall can similarly elicit an orgasmic
response [38].
Anatomical Concern
Scientific anatomical and imaging evidence for the
existence of the G-spot are quite poor. The only
anatomical structures identified in this area are the
Skene’s glands that may play a role in the stimu-
latory phase of the sexual response and orgasm in
this region. However, no receptors for touch
stimulation and no direct evidence for their
involvement in sensory input have been docu-
mented [39]. Data available today do not provide
any supporting evidence that these glandular
structures are part of the area named the G-spot.
For many women, the anterior wall of the
vagina is an erogenous zone and one of the expla-
nations for its higher sensitivity may be the prox-
imity to the clitoral cavernosal tissue. Mechanical
pressure on the anterior vaginal wall could indi-
rectly stimulate clitoral structures enhancing
sensation of pleasure. This theory has been inves-
tigated by Foldès et al. using ultrasonography [14].
Other imaging modalities, such as magnetic reso-
nance, was used during sexual arousal but did not
show any significant change in the signal intensity,
nor did find any distinct anatomical structure in
this area [16,40].
Recently, some direct anatomical evidence for
the existence of the G-spot as a separate anatomi-
cal entity was suggested by Jannini et al. [13] who
32
described differences in the thickness of the
“urethrovaginal space” which was detected by
ultrasonic measurement, in 20 healthy female vol-
unteers. The urethrovaginal space was found to be
thinner in females without vaginal orgasm com-
pared with those who did experience vaginal
orgasm (nine and 11, respectively). He speculated
that a functional correlation between the thickness
of the “urethrovaginal space” (G-spot) and the
ability to experience vaginal orgasm may exist.
Nevertheless, he was unable to directly demon-
strate that the thickness of this anatomical “space”
generates any mechanism related to the initiation
or involvement of orgasm. Apart from Jannini’s
report, I did not find studies that were able to show
or describe the G-spot anatomically. Moreover,
studies which evaluated biopsies from this area did
not demonstrate nerve ending condensation com-
pared with other regions in the vagina [41]. From
an anatomical and histological point of view and
from the data available, it seems that only very
poor evidence for the existence of a distinct ana-
tomical structure that can be defined as a G-spot
exist.
Sexual Function Postvaginal Surgery
One would assume that gynecological or urologi-
cal interventions in the anterior vaginal wall would
adversely affect sexual function, especially when
considering the possible existence of the G-spot in
this location. Extensive dissection of the anterior
vaginal wall is commonly performed during pro-
cedures such as mid-urethral slings, or repair of
anterior vaginal wall prolapse. These and similar
surgical interventions have the potential to
damage the nerve supply to this area.
There is no current study showing changes in
genital sensation following mid-urethral sling or
prolapse repair. Moreover, when evaluating sexual
functioning in women who underwent these types
of surgeries, a significant improvement in sexual
function was claimed following the repair of ante-
rior vaginal wall prolapse [42]. This fact is a strong
argument against the existence of a distinct ana-
tomical region in the anterior vagina responsible
for sexual pleasure and orgasm.
Conclusions
From a scientific standpoint, there is poor evi-
dence to confirm the existence of the G-spot.
J Sex Med 2010;7:25–34
 Controversies in Sexual Medicine
Objective measures such as MRI and ultrasound
did not provide solid evidence to the existence of
the legendary G-spot. On the other hand, self-
reported levels of arousal during stimulation,
numerous reliable reports and anecdotal testimo-
nials of its existence are available. Another prob-
lematic aspect of the “search for the G spot,”
especially with regard to social pressure and media
coverage, is the fact that many women unable to
reach a vaginal orgasm may become frustrated and
sexually handicapped in their obsessive search for
it. Even more problematic is the fact that some
professionals take advantage of the cultural glori-
fication of the G-spot, and offer interventions such
as “G-spot augmentation.” Only time will tell if
science or human nature and future sexual experi-
ences will provide more information regarding the
existence of this mysterious structure but will
undoubtedly continue to occupy the public’s
imagination.
Yoram Vardi, MD
Corresponding Author: Emmanuele A. Jannini,
MD,Course of Endocrinology and Medical Sexology,
Department of Experimental Medicine, University of
L’Aquila, L’Aquila, 67100, Italy. Tel: +39 0862433530;
Fax: +39 0862433523; E-mail: emmanuele.jannini@
univaq.it
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