Let’s REALLY talk about pee or not for a moment.

Who would have thought seven women could create so much angst? Seven women, a bunch of research authors and one really badly written sensationalistic headline has had the world of sex all hot and bothered the last few weeks culminating in the hashtag #notpee.

The whole conversation surrounding this article has got me thinking about a lot; sexology research methods, how asking questions connects with being sex positive, how do we really talk about orgasm, media literacy and do we always understand what we are talking about. Human sexuality is such an infinite area of discussion and how we study sex; through sexology is such an interdisciplinary field of academia there has to be a legitimate place for all research right? To genuinely understand the entirety and complexity of human sexuality we need to be constantly creating hypotheses and evidence, questioning, observing and building a better understanding of what sex is, one little bit at a time.

As women we need to talk about sex. We need to keep creating safe spaces for women to talk about sex on our terms and be heard. When a woman says the fluid her body expels during sex does not look like, smell like or taste like “pee” than I believe her, I have no reason not too. But does this not mean I can’t go and look further into what is being discussed? By writing what I’ve written here am I really negating these other women? By wanting to understand a bit more and pass on what I’ve found am I dismissing the physical experiences of women, removing their sexual agency, ignoring real pleasure felt by real women?

NO.

When I first read this article I really couldn’t understand the fuss. It’s another study done within urology to try to better understand the physiological workings of the female body. But then I started reading a bit more and, I think I understand the issue, but I could be wrong.

It is true there is very limited research on the inner workings of our bodies ‘down there’ outside of reproductive medicine/science. Misunderstandings and misconceptions about the organs and structures of the female body, attitudes about women and really bad social policy – otherwise known as misogyny, have limited not only the interest in furthering academic knowledge of women’s bodies but the publication and discussion of what is known. There is some, justified, scepticism of science/medicine and women’s sexuality. The pathologising of women’s sexual desires and the absolute shaming and condemnation that has tared women for generations is, and continues to be real and science, or the lack of it is partially to blame.

But here’s the thing, we now have access to this knowledge in ways that we never have had before. The internet has opened up the world of science to those who wish to explore it. This, alongside the spaces women are creating to explore and discuss sex in the abstract and the lived experience open up more social capital for us, in the world of sex! These relationships, networks and avenues of gaining and sharing knowledge have to be empowering and beneficial for us. Knowledge is power not just power for me or power for you but power for all women.

So as my, somewhat limited, contribution to the #notpee conversation I’m going to try and add some facts to the picture. Looking at the biology of what is being discussed does not, in any way shape or form, minimise or discount the lived experiences of women. By adding this stuff to the conversation I am not trying to shut down or prove wrong the women who have shared what gushing is to them. While I can and do quite freely acknowledge that both science and medicine is still male dominated and that the study of women’s bodies as sexual (outside the confines of reproduction) is relatively new, I don’t see how adding biology to this conversation can be harmful.

I don’t have the answers, I wish I did. Sex for me is becoming a larger and larger jigsaw puzzle that, every time I think I’m starting to understand, I find something else I can add to my ‘need to figure out’ list. But what I do know I can share and I can reference. So here goes.

 First things first;

Understanding the biological aspects of sex can seem quite simplistic and in a way it is. By focusing on the what is we can get a better picture of the what could.

Understanding the biological aspects of sex is not meant to be some kind of checklist in which we compare our own experiences. While this knowledge allows us to better know when something isn’t feeling right or that something may be wrong and in need of further checking (please do no consult Dr Google!) it can, in no way, be representative of every experience every woman will ever have. It’s just not possible to do so. Observing rather than experience sex isn’t the way to go. You become some what of a spectator to your sex life, never fully being able to feel what you are engaging with. This is really not healthy and minimises the pleasure and the entirety of experiences for yourself and your partners.

There are often extreme diversity in each of our subjective experiences of sex, that this seemingly simplification that biology provides cannot and does not explain the intensity, beauty and capacity of sex.

Once again these are my own words (referenced) and my own understandings. I am not ‘an expert’; I have no big fancy letter combinations to my name. I am a woman who has an interested in challenging and changing the way we talk about sex.

So what is this wet stuff?

What are we actually talking about here? Well to really simplify we are talking about the physiological response in the central nervous system and the genital region that our bodies undergo during sexual arousal. But let’s pull this apart a little bit more.

 Gushing

Gushing (colloquially referred to as squirting) or a gushing orgasm during sex/masturbation is quite a common physiological reaction to sexual stimulation that more and more women are admitting to experiencing. While there is still much debate (as we’ve seen over the last few weeks) gushing is characterised by significant fluid elimination when either extremely sexually aroused or having and orgasm.

The reason gushing has become the ‘it’ topic is because of THIS study in which seven women who self identified as experiencing this gushing emptied their bladders and were stimulated to orgasm; either self stimulation (2) or with a partner (5). Each woman underwent a pelvic ultrasound of their bladder after urination, just before orgasm was reached and after they had experienced their gushing orgasm to measure the amount of urine within the bladder. Biochemical analysis was done on all three of the samples to assess the concentration of urea, uric acid, creatinine and prostate-specific-antigens (PSA).

The results showed that:

All of the ultrasounds done prior to orgasm for all seven women showed noticeable bladder filling.

The third ultrasound after orgasm showed that the bladder had been emptied.

Biochemically all three samples taken from all seven women showed comparable urea, uric acid and creatinine concentrations.

In the first urine sample from six out of the seven women prostate-specific-antigens were not found but in the second and third samples five out of the seven women had prostrate-specific-antigens.

Biochemically the fluid is urine – with noticeable PSA.

So what does this really mean?

That 100% of women, in this study, were seen to have a full bladder pre orgasm and an empty bladder post orgasm.

What does this tell me?

That the bladder is the only organ/structure within the vagina/vulva region which is capable of producing such quantities of liquid that is reported by women as occurring during stimulation and/or orgasm.

If we actually stopped and thought about it would we really be able to see that this is actually right? Let’s look at the ‘bits and bobs’ of the area I’m talking about.

Bartholin glands

Two ‘pea sized’ glands located in the labia minora of the vulva; these glands produce a clear fluid during the excitement phase of the sexual response cycle and not during orgasm (1) so “play only a small role in vaginal lubrication” (2)

.Basal Vaginal Fluid

In a non-arousal state the vagina is covered with a thin layer of basal fluid; essentially ultrafiltered blood plasma; water, some salts and small proteins. This fluid isn’t produced from one particular source but is a mixture of fluids from the entirety of the reproductive tract. (3)

Vasocongestion

During arousal increased blood flow causes significant swelling of the vaginal tissue causing increased ‘sweating’ “ultrafiltrate percolating” between the vaginal epithelial cells”, creating an excess of “clear, slippery and smooth lubricant”,(4) an increase of the Basal fluid constantly found within the vagina.

Urethra/bladder

The female urethra, as opposed to the one found in men, is, on average 4cm and is the tube which allows the contents of the bladder to be expelled.

Ernest Grafenberg M.D (the ‘father’ of the G Spot) wrote that the urethra “also seems to be surrounded by erectile tissues like the corpora covernosa. In the course of sexual stimulation, the female urethra begins to enlarge and can be felt easily. It swells out greatly at the end of orgasm. The most stimulating part is located at the posterior urethra where it arises from the neck of the bladder”

Greafenberg concluded that the “anterior wall of the vagina along with the urethra is the seat of a distinct erotogenic zone”. (5)

 Skene’s glands or the paraurethral gland

Located on the anterior wall vagina, towards the lower end of the vagina, these glands, sometimes knows as the “female prostate” ‘are considered to be the primary site of PSA secretion”; (6)

In women these glands are wrapped around the urethra (just as the prostate gland is in men). Interestingly, the position of these glands is where the illusive and highly debated “G-Spot” is said to be.

Finding traces of PSA in gushing is considered evidence (more, more, more and again in the conclusions drawn/arguments made in the most recent French study that the liquid is ejaculation and not urine. These paraurethral glands are of the same embryological origin as the prostrate gland in men and produce essentially the same PSA protein as is found in the prostate gland of men. Both this latest study and studies undertaken prior to it show that” biochemically, the fluid emitted during orgasm showed all the parameters found in prostate plasma” (7)

The theory goes that because the PSA produced in the male prostate is essential to producing sperm and allowing men to ejaculate that the same must apply to women.

The problem however, is that PSA is identifiable in both urine and blood samples and PSA can be found in many non prostatic tissue and fluids (8) including amniotic fluid and “breast tissue” (9)

PSA is identified in both prepubescent girls and women alike, studies have shown that between 38 and 78 percent of women (10) will have identifiable amounts of PSA (greater than 0.1 ng/ml (11) The current French study identifies 71% (five out of the seven) as having PSA in their samples; fitting within the assumed average of women having PSA in urine samples.

If PSA can be found in urine samples of girls who have not orgasmed and in fluid that has no connection to orgasm/ejaculation (amniotic fluid) than can this be evidence used to, somehow, prove that gushing is actually an intense orgasm producing a vast quantity of liquid/ejaculation?

One other question springs to mind.

The paraurethral gland in women is significantly smaller than the prostate gland in men; comparing a walnut to a pea here. If the prostate gland produces around 25% of the total fluid content found in male ejaculate; which only comes to a maximum amount of around a teaspoon/five millilitre, than the total amount of actual liquid produced by the prostate gland itself is relatively small about 1.25 millilitres.

This ‘up to a cup full’ (250 milliliters) of liquid that some women experience (and again I have no reason to doubt this at all) cannot, then, be made up of fluid entirely from the Skene’s glands. Going by the 25% total ejaculate content it would be, at most, 62.5 milliliters of fluid from the Skene’s glands and yet how can the smaller gland (in physical size) produce significantly more liquid?

I haven’t been able to find that answer.

Unlike men, “women are much more variable in their capacity for experiencing orgasm”.(12)  We all experience and perceive our orgasms differently but –––here’s the bottom line. Women find both the means to and the end of gushing extremely pleasurable. Women are in awe of their bodies, sexual partners are bewildered that they can help their woman’s bodies do that. This exists, it is real and it is wanted and this makes gushing; regardless of the overall biochemical makeup of the liquid, okay.

References

Grafenberg, Ernest MD. (1950) The role of urethra in female orgasm. International Journal of sexology.

Hornsteir T. Schwerin J. ( 2012). The biology of woman, Cengage Learning

Levin, R. (2003) The ins and outs of vaginal lubrication. Sexual and Relationship Therapy. Vol. 18. No.4.

Graziottin, A., Gambini, D., & Perelman, M. A. (2009). 19 Female sexual dysfunctions: Future of medical therapy.

Grafenberg, Ernest MD. (1950). The role of urethra in female orgasm. International Journal of sexology.

Efthimiou, et.al. (2012) Determination of the association of urine prostate specific antigen levels with anthropometric variables in children aged 5-14 years. International braz journal of urology. Vol. 30. No. 2 March/April 2010.

Wimpissinger, F et.al. (2007) The female prostate revisited: Perineal ultrasound and biochemical studies of female ejaculation. Journal of sexual medicine.

Diamandis, E. P. (1998). Prostate-specific antigen: its usefulness in clinical medicine. Trends in Endocrinology & Metabolism, 9(8), 310-316.

 Yu, H. Berkel, H (1999) Prostate specific antigen (PSA) in women. The Journal of the Louisiana State Medical Society, 209-13

Efthimiou, et.al. (2012) Determination of the association of urine prostate specific antigen levels with anthropometric variables in children aged 5-14 years. International braz journal of urology. Vol. 30. No. 2 March/April 2010.

Schmidt, S., Franke, M., Lehmann, J., Loch, T., Stöckle, M., & Weichert-Jacobsen, K. (2001). Prostate-specific antigen in female urine: a prospective study involving 217 women. Urology, 57(4), 717-720

Bandcroft, J. (2009) Human sexuality and its problems. Elseuier Health Sciences.

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