The ins and outs of the vagina

Vaginal vs. clitoral orgasm, the G-spot, the vulva, and the clitoris: the female sex organs and their involvement in arousal and orgasm are shrouded in mystery.

In our increasingly digital world, sex and female body image are often misrepresented. Yet, sex makes people happy and plays an important role in social bonding as well as mental and physical health.

So, it's time to demystify common misconceptions about the female sex organs and their role in sexual pleasure.

We shine a spotlight on how the vagina, vulva, and clitoris work, as well as on what is currently known about the elusive G-spot and the female orgasm.

Inside and out: The vagina and the vulva

The vagina is the muscular tube that links to the cervix, which is the lower part of the uterus.

Also called the birth canal, the vagina allows for the passage of blood and cells in menstruation, the introduction of sperm during sex, and the delivery of the baby and placenta at the end of pregnancy.

The vagina only has a limited number of nerve endings, which is thought to be important to help women cope with the pain of childbirth.

The external part of the female genitals is the vulva. It consists of the labia majora, or the outer fold, the labia minora, or the inner fold, the urethra, and the clitoris. The shape and size of the vulva is unique to every single woman.

In a study involving 32 women, Dr. Haim Krissi - from the Department of Obstetrics and Gynecology at Soroka University Medical Centre in the Ben-Gurion University of the Negev in Israel - and team found a considerable range in the length and width of the different parts of the vulva.

The clitoris: The gateway to sexual arousal

While many people think that the clitoris is a small spot just above the vaginal opening, it is, in fact, a much larger complex. The part most visible is the glans, which is 16 millimeters in length, on average. This is the part that most people will be familiar with.

The glans is covered by the prepuce, which is a skin formed from the vaginal labia. Some people liken the prepuce to foreskin. Hidden inside the pubic bone is the rest of the clitoris, and the entire complex is similar in shape to the penis, with a total length of between 9 and 11 centimeters.

The clitoris is an erectile organ and is thought to be at the heart of female sexual arousal.

In a 2015 review published in the journal Clinical Anatomy, Dr. Rachel N. Pauls - from the Divisions of Female Pelvic Floor Medicine and Reconstructive Surgery at TriHealth/Good Samaritan Hospital in Cincinnati, OH - describes the clitoris as "[...] the centre for orgasmic response."

The clitoris is highly innervated, with the densest concentration of nerve fibres found in the glans. These nerve fibres respond to stimulation by causing swelling of the erectile tissues of the clitoris.

As Dr. Pauls explains, "It is important to note that indirect stimulation of the glans is central to female sexual arousal, but the dense innervation of the glans may lead to extreme sensitivity upon direct stimulation."

That being said, the clitoris is not the only part of the female sex organs that can lead to arousal, according to some. The mysterious G-spot, said to be located inside the vagina, has been equally credited.

Does the G-spot exist?

The so-called Gräfenberg spot, or G-spot - which is named after the German-born physician Ernst Gräfenberg - is a topic of much contention.

While Gräfenberg has been widely credited with finding the purported spot guaranteed to produce sexual arousal, the name was in fact coined by Dr. Frank Addiego and colleagues in a 1981 paper published in the Journal of Sex Research.

The hunt for this elusive structure that promised unlimited pleasure has been on since then.

A study in An International Journal of Obstetrics and Gynaecology by Dr. Adam Ostrenski - from the Institute of Gynecology in St Petersburg, FL - and colleagues describes it as a collection of nerve bundles in the front, or anterior, wall of the vagina.

Using MRI scans, Anastasios Mpotsaris - from University Hospital of Cologne in Germany - and colleagues found a "distinct morphological entity" in 62 percent of study subjects in the same location.

Does this mean that the search is over? No; not all experts agree. Dr. Vincenzo Puppo - from the Centro Italiano Sessuologica in Bologna, Italy - states in an article in the journal Clinical Anatomy that there is no scientific or medical evidence that supports the existence of the G-spot.

Instead, he writes, "The G-spot has become in the centre of a multimillion dollar business: G-spot amplification, also called G-spot augmentation, G-Spotplasty, or the G-shot, is a cosmetic surgery procedure for temporarily increasing the size and sensitivity of what some believe to be the G-spot [...]."

This sentiment is echoed by Dr. Pauls, who summarizes that there is no scientific or anatomical evidence that supports the existence of the G-spot.

So, the jury on the G-spot is still out. Whether by G-spot stimulation or not, the female orgasm remains a mysterious and controversial topic.

What happens during orgasm?

The debate about the purpose and routes that lead to women experiencing an orgasm is probably as old as medical science.

Although the male orgasm has a clear role from an evolutionary standpoint, in that it is central to the propagation of the human species, experts have not been able to agree on a similar "purpose" for the female orgasm.

From a physiological point of view, the path to sexual arousal is straightforward.

Dr. Pauls explains, "In simplistic terms, genital arousal is characterized by increased blood flow to the pelvic region. In females, this vascular flow results in clitoral engorgement and erection and accompanying vulvar swelling and vaginal [secretion] of fluid."

"If a threshold is reached, orgasm can follow arousal. Activation of [nerve pathways] triggers pelvic floor skeletal muscle contractions that accompany sexual satisfaction," she adds.

So, should we view orgasms as simply being the result of reflex produced by our nerves? As so often in biology, things are more complicated. Our nerves, of course, transmit sensory signals to our brain, where studies have shown that sexual pleasure is processed similarly to other types of pleasure.

"[...] the mind may be the ultimate sexual organ, which in combination with anatomy can augment sexual enjoyment."

Dr. Pauls

The vaginal vs. clitoral orgasm

The ultimate center that causes the greatest female pleasure remains a topic of debate. Two competing theories exist: the vaginal and the clitoral orgasm.

According to Dr. Puppo, the term "vaginal orgasm" is misleading. He says that "the vagina has no anatomical structure that can cause an orgasm." Instead, "the 'vaginal' orgasm that some women report is always caused by the surrounding erectile organs," he explains.

Dr. Puppo further highlights, "Orgasms with a finger in the vagina are possible in all women, but the partner must also move the hand in a circle to stimulate all the female erectile organs."

On the other side of the argument is psychologist Prof. Stuart Brody, who argues that penile-vaginal intercourse is the route to vaginal orgasm, which he says plays a greater role in sexual satisfaction.

In a review published in the journal Socioaffective Neuroscience & Psychology, Prof. James G. Pfaus - from the Department of Psychology at Concordia University in Montreal, Canada - writes "it is likely that women have an enormous capability to experience orgasms of many different types [...] the subjective experience of it is not necessarily the same for each woman, and can even be different each time a woman has one."

Dr. Pauls also highlights that "[...] pressure on the vagina during sexual activity can result in traction, vibration, and clitoral stimulation."

"It is therefore problematical at best to define a 'clitoral orgasm' as a phenomenon distinct from a 'vaginal orgasm'," she adds.

Because the individual parts of the female sex organs are located very close to each other, it is difficult to identify one particular spot as the ultimate route to pleasure.

One question that remains is whether or not it is necessary to have a definition of different types of orgasms.

Does it really matter?

Every woman's sexual pleasure and orgasm is unique. A recent study showed that only 6 percent of women say that they reach orgasm every time they have sex.

Those involved in researching female sexual pleasure may argue that better knowledge of the routes to orgasm can help those struggling to achieve the satisfaction they desire. But orgasm is only one part of the experience of sex.

"Perhaps it is time," says Prof. Pfaus, "to stop treating women's orgasm as a sociopolitical entity with different sides telling women what they can and cannot experience."

Sexual satisfaction is a unique concept. Whether derived from clitoral stimulation or another route, at the end of the day, the best measure of satisfaction is the pleasure experienced by those involved.