The female orgasm is a controversial entity, in terms of its origin, forms and even its mere existence. The concept that all orgasms are clitorally mediated is well-known but understudied, and the existence of vaginally-activated orgasm (VAO) as a distinct phenomenon remains to be proven. Some sexologists, including Emmanuele Jannini from L'Aquila University, Italy, believe that the sensory arm of the female orgasm is mediated by the clitorourethrovaginal (CUV) complex. In a recently published study, Jannini and Buisson used echography—a noninvasive ultrasonographical technique—to image the CUV complex during clitoral orgasm and VAO. Three women, all of whom reported VAO during coitus, were included in the study. Echographic imaging was carried out during both manual stimulation of the external clitoral glans and internal stimulation using a wet tampon.

Echographic examination of the clitoris revealed that the clitoral root is not involved in manual stimulation, with movement and crushing of the glans not transferred to the cavernous body. By contrast, vaginal stimulation caused displacement of the clitoral body and reflex perineal contraction that resulted in descent of the clitoral cavernous body. Furthermore, the clitoral root was observed to descend and contact the anterior vaginal wall during vaginal stimulation. Colour Doppler analysis showed enhanced blood flow velocity at the junction of the vagina and cavernous bodies during vaginal, but not external, stimulation. All volunteers were able to reach orgasm during the sessions.

The data suggest a different anatomical basis for each type of orgasm, supporting the existence of, and distinction between, the two. “We believe that our findings may stop the never-ending debate and start a new scientific discussion based on evidence,” comments Jannini. However, he also believes that the data could have wider-ranging consequences, forcing urological surgeons to consider the role of the CUV in sexuality and the potential sexual effects of surgical procedures. The group plan to use echography to further explore dynamic anatomical changes during different orgasms and in various physiological, paraphysiological and pathological conditions.