by Ernest Gräfenberg, M.D.
Editing and Commentary
by John D. Perry, Ph.D.
Originally edited, April 1983
Editor's 1996 commentary is included as notes at the end of the text; however, owing to the magic of hypertext, you can click on underlined links, read the associated note, and then jump back to your place in the text, automatically. The Commentary was written after reviewing Gary Schubach's IASHS Doctoral Research Project "Urethral expulsions during sexual arousal and bladder catheterization in seven human females" ( September, 1996).
1950 | 1953 |
| A rather high percentage of women do not reach the climax in sexual intercourse. The frigidity figures of different authors vary from 10-80 per cent and come closer to the statistics of older sexologists. Adler (Berlin) came to the conclusion that 80 per cent of women did not reach the sexual climax. Elkan guessed that 50 per cent suffered from frigidity, while Kinsey found it to be 75 per cent. Hardenberg's figures have a very wide range from 10 to 75 per cent. | [l] For the last 700 years from Albertus Magnus, the learned Archbishop of Cologne, to Alfred Kinsey, the not less learned University professor of Indiana, many pamphlets and books have been published about orgasm of women. The number is not as high as it would have been, had it concerned a sexual disturbance of man, because it was not acceptable to society to mention such matters regarding women openly. |
| Many of these statistics cannot be compared, since the various authors use different criteria. Edmund Bergler sees the condition of euparenia only in vaginal orgasm and so his frigidity figures are naturally much higher than those based on any kind of sexual satisfaction. The restriction to vaginal orgasm, however, does not give the true picture of female sexuality. | |
| [2] The undervaluing of female secrets went so far, that even the meaning of orgasm and the localization of the erotic zones were not exactly recognized. | |
| Lack of orgasm and frigidity are not
identical. Frigid women can enjoy orgasm.
The lesbian is frigid in her relations with a
heterosexual partner, but is completely
satisfied by homosexual loveplays. A
deficient orgasm need not always be
associated with frigidity. Numerous women
have satisfactory enjoyment in normal
heterosexual intercourse, even if they do not
reach the orgasm. Genuine frigidity should
be spoken of only if there is no response to
any partner and in all situations. A woman
with only clitoris orgasms is not frigid and
sometimes is even more active sexually,
because she is hunting for a male partner
who would help her to achieve the fulfilment
of her erotic dreams and desires. Although female erotism has been discussed for many centuries or even thousands of years, the problems of female satisfaction are not yet solved. Even though female doctors (Helena Wright) participate in these discussions nowadays, "the eternal woman" is still under discussion. The solution of the problem would be better furthered, if the sexologists know exactly what they are talking about. The criteria for sexual satisfaction have first to be fixed before we make comparisons. Numerous "frigid" women enjoy thoroughly all the different phases of "necking". Should we count out all variations of sex practices which result in complete orgasm though not vaginal orgasm? Innumerable erotogenic spots are distributed all over the body, from where sexual satisfaction can be elicited; these are so many that we can almost say that there is no part of the female body which does not give sexual response, the partner has only to find the erotogenic zones. It is not frigidity, if the wife does not reach orgasm in intercourse with her husband, but finds it in sexual relations with another partner. One of my patients, who married early a very much older, Irish man and had two children, pestered me persistently with questions as to why she could not experience orgasm. I explained that physically there was nothing wrong with her. Bored by the repeated discussions with her, I finally asked her, if she had tried sex relations with another male partner. No, was the answer and reflectively she left my office. The next day in the middle of the night I was awakened by a telephone call and a familiar voice who did not give her name asked: "Doctor are you there? You are right," and hung up the receiver with a bang! I never had to answer any further sexual questions from her. | |
| In spite of the abundant literature dealing with female orgasm, our knowledge of the mechanism and the localization of the final climax is insufficient. Different orgasms and their stimulation work as a trigger and cause an increase of the sexual "potential" up to the level where the orgasm goes off. One could suppose that the clitoris alone is involved in causing excitation, since this organ is an erotic center even before puberty, though it is aided by other erotogenic zones. | |
| Inflamations of the clitoris, especially below
the prepuce, can make it so hypersensitive
that it loses its ability to produce orgasm.
Such changes occur by masturbation in
elderly woman after the menopause when the
external genitals shrink [p. 146] and become
affected by hypoesterogenism. The
erotogenic power of the clitoris passes then
mostly to the neighbourhood of the genital
organs, to the inside of the small labia or to
the pubic region of the abdomen. The
entrance to the rectum can also become an
erotogenic centre, not for anal intercourse,
but for stimulation with the finger. In one of
my patients vaginal orgasm was lost
completely, but orgasm could be achieved
with a finger in the anus and the penis in the
vagina. Sometimes the breasts help the clitoris in producing erotisation. Kissing the nipples, touching them with the penis, or inserting the penis between the two breasts lead to an orgasm. Cunnilingus or even insertion of the penis in the external orifice of the ear are other illustrations of the variability of the erotogenic zones in females. | [3] The principal erotic area circles around
the clitoris, normally aided by other
erogenic spots in the vagina. The clitoris is
the erotic centre in childhood, during
virginity and becomes the refuge after the
menopause. In old age per se a woman may
have a normal sex life, since sex desire after
the menopause may not differ from what it
was before menopause starts. As a matter of
fact, sometimes the erotical response is
better than before, because the fear of
pregnancy has disappeared. [4] The entire clitoris does not have the same sexual response. The tip of the clitoris covered by the prepuce is the center of erotic reaction and not the crura clitoridis. The vulva itself has no erotic response. This fact was well known even to the court physician of the Empress Maria Theresia, who recommended, that the clitoris of her Majesty, for better stimulation "diutius esse tittilandam". |
| Some investigators of female sexual
behaviour believe that most women cannot
experience vaginal orgasm, because there
are no nerves in the vaginal wall. In contrast
to this statement by Kinsey, Hardenberg
mentions that nerves have been demonstrated
only inside the vagina in the anterior wall,
proximate to the base of the clitoris. This I can confirm by my own experience of
numerous women. An erotic zone could
always be demonstrated on the anterior wall
of the vagina along the course of the urethra.
Even when there was a good response in the
entire vagina, this particular area was more
easily stimulated by the finger than the other
areas of the vagina. | [12] Some sexologists do not believe that
there is a vaginal orgasm at all, because the
wall of the vagina contains only few nerves,
if any. [Page 120] I am sure that the nerves are not needed since the sexual reaction depends chiefly on the corpora cavernosa, particularly those of the urethra. [5b] There is, however, a small erotogenic zone along the anterior vaginal wall corresponding to the course of the urethra. The female urethra is very short, 2 to 3 cm, lies very superficially and has its own corpora cavernosa which becomes larger during sexual stimulation and decreases in size after the orgasm is completed. The reaction is greater at the posterior urethra, where the urethra arises from the trigonum of the bladder.. |
| Women tested this way always knew when the finger slipped from the urethra by the impairment of their sexual stimulation. During orgasm this area is pressed downwards against the finger like a small cystocele protruding into the vaginal canal. | [6a] [Page 119] The female partner is
always aware of the fact that the finger or
penis loses contact with the vaginal part of
the urethra, and she adjusts herself to this by
changing her position. By bearing down, the
anterior wall protrudes within reach of the
urethra, resembling a small cystocele. |
| It looked as if the erotogenic part of the
anterior wall tried to bring itself in closest
contact with the finger. It could be found in
all women, far more frequently than the
spastic contractions of the levator muscles of
the pelvic floor which are described as
objective symptoms of the female orgasm by
Levine. After the orgasm was achieved a
complete relaxation of the anterior vaginal
wall sets in. Erotogenic zones in the female urethra are sometimes the cause of urethral orgasm. I have seen two girls who had stimulated themselves with hair pins in their urethra. The blunt part of the old fashioned hair pin was introduced into the urethra and moved forwards and backwards. During the ecstasy of the orgasm the girls lost control of the pin which went into the bladder. Both girls felt ashamed and tried to hide the incident from their mothers until a huge bladder stone had developed around the pin as the centre. One stone was removed by suprapubic, and the other by vaginal cystotomy. A third hair pin entered the bladder and before the bladder was inflamed it was angled out via the urethra. Since the old hairpins are no more in use, pencils are used for urethral onanism. They are longer than the hairpins and do not glide into the bladder so easily, though they cause a painful urethritis. Urethral onasism may happen in men as well. I saw a patient with a rifle bullet which glided into his bladder. He had played with it while he was lonesome on duty on New Years Eve. | [5a] When Lena Levine connects orgasm with spastic contractions of the levator muscle she confuses cause and effect. Certainly, the levator muscle does participate in the general upheaval of internal and external glands, but this is only a secondary reaction. Orgasm cannot be provoked by manual stimulation of the levator which is a voluntary muscle. The release of flatus or even some urine at the height of orgasm does not prove any causal relationship |
| Analogous to the male urethra, the female urethra also seems to be surrounded by erectile tissues like the corpora cavernosa. In the course of sexual stimulation, the female urethra beings 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. | [8] Due to the various sizes of the corpora
cavernosa of the clitoris they sometimes
reach far to the posterior vulva. After
orgasm they cannot be felt at all, while filled
with blood they present quite a different
picture. If they are only incompletely filled
they resemble distinct nodules around the
superior aspect of the vagina. [9] The erectile system of the clitoris certainly has connections with the corpora cavernosa of the female urethra. The erectile bodies are located similarly to those of the male urethra in its posterior aspect. Since the urethral corpora cavernosa of both sexes have the same ventral location, the erogenic urethra zones come in best contact if intercourse is performed "more bestiarum". |
| Sometimes patients of Birth Control clinics complain that their sexual feelings were impaired by the diaphragm pessary. In such cases the orgastic capacity was restored by the use of the plastic cervical cap, which does not cover the erotogenic zone of the anterior vaginal wall. Such complaints occured more frequently in Europe than here in U.S.A., and was one of the reasons for giving preference to the cervical cap over the diaphragm pessary. | [11] Even without this operation the erotic area can be changed if it is covered by a diaphragm. As the plastic cervical cap does not interfere with the sexual zone of the urethra, women in Europe prefer it to the vaginal diaphragm. |
| Frigidity after hysterectomy may happen, if the erotogeic zone of the anterior vaginal wall was removed at the time of the operation. The vaginal wall is preserved best by the abdominal subtotal hysterectomy, less by the total [page 147] hysterectomy and least by vaginal gysterectomy when always large parts of the vagina are removed. That is the cause of vaginal frigidity after vaginal hysterectomy observed by LeMon Clark. | [10] Some women complain that the erotic feelings change after vaginal operation. LeMon Clark is right in reporting such changes, especially after vaginal hysterectomy. We find the same or even less erotic response after abdominal hysterectomy. There always have been cases, where parts of the anterior wall of the vagina were removed, or the region of the urethral erogenic zone were damaged due to the operation. Even after abdominal subtotal hysterectomy and after vaginal plastic operation, where the bed of the urethra is displaced, the erotic response might be destroyed. |
| The uterus or the cervix uteri takes no part in
producing orgasm, even though Havelock
Ellis speaks of the sucking in of sperms by
the cervix into the uterus. The non-existence of the uterine suction power was proved by a simple experiment, in which a plastic cervical cap was filled with a contrast oil (radiopac) and fitted over the cervix. The cap was left in for the whole interval between two menstral periods. These women had frequent sexual relations with satisfying orgasm. Repeated X-ray pictures taken during the time when the cap was covering the cervix, never showed any of the contrast medium inside the cervix or in the body of the uterus. The whole contrast medium was always in the cap. The glands around the vaginal orifice, especially the large Bartholin glands, have a lubricating effect. Therefore they are located at the entrance of the vagina and produce their mucus at the beginning of the sexual relations and not synchronously with the orgasm. Sometimes the mucus is produced so abundantly and makes the vulva slippery, that the female partner is inclined to compare it with the ejaculation of the male. Occasionally the production of fluids is so
profuse that a large towel has to be spread
under the woman to prevent the bedsheets
getting soiled. The convulsory expulsion of
fluids occurs always at the acme of the
orgasm and simultaneously with it. If there is
the opportunity to observe the orgasm of
such women, one can see large quantities of
a clear transparent fluid are expelled not
from the vulva, but out of the urethra in
gushes. At first I thought that the bladder
sphincter has become defective by the
intensity of the orgasm. Involuntary
expulsion of urine is reported in sex
literature. In the cases observed by us, the
fluid was examined and it had no urinary
character. I am inclined to believe that
"urine" reported to be expelled during
female orgasm is not urine, but only
secretions of the interurethral glands
correlated with the erotogenic zone along the
urethra in the anterior vaginal wall.
Moreover the profuse secretions coming out
with the orgasm have no lubricating
significance, otherwise they would be
produced at the beginning of intercourse and
not at the peak of orgasm. | [Note that this entire section on fluids was eliminated from the 1953 version.] |
| It is possible to cause an orgasm merely by using some stimulating sentence. Such a reaction follows the laws of the unconditioned reflexes. | |
| The erotogenic zone on the anterior wall of
the vagina can be understood only from a
comparison with the phylogenetic ancestery.
In the most commonly adopted position,
where "the lady does lay on her back", the
penis does not reach the urethral part of the
vaginal wall, unless the angle of the erected
male organ is very steep or if the anterior
vagina is directed towards the penis as by
putting the legs of the female over the
shoulders of her partner. The contact is very
close, when the intercourse is [page 148]
performed more bestiarum or a la vache i.e.,
a posteriori. LeMon Clark is right when he
mentions that we were designed as
guadrupeds. Therefore intercourse from the
back of the woman is the most natural one. This can be performed either in the side-to-side posture with the male partner behind, or better still with the woman in Sims' knee-elbow or shoulder position, the husband standing in front of the bed. The female genitals have to be higher than the other parts of her body. The stimulating effect of this kind of inercourse must not be explained away as LeMon Clark does by the melodious movements of the testicles like a knocker on the clitoris, but is merely caused by the direct thrust of the penis towards the urethral erotic zone. Certain it is that this area in the anterior vaginal wall is a primary erotic zone, perhaps more important than the clitoris, which got its erotic supremacy only in the age of necking. | [7] The location of the erogenic zone on the
anterior wall of the vagina proves that the
human animal is built in the same manner as
the other quadrapeds. In probably the most
commonly adopted position in human
intercourse in the western world where the
female is on her back, the thrust of the penis
does not reach the urethral part of the vagina,
unless the angle of the erect penis is very
steep, or the legs of the female partner are
placed over the shoulders of the male
partner. I agree with LeMon Clark, that man
is designed as a quadruped and therefore the
normal position would be intercourse a
posteriori. [13] It was always difficult to explain the migration of the sexual stimuli from the clitoris into the vagina. We know that orgasm is connected with the development of tbe corpora cavernosa which depends on endocrine functions. The maturity of the endocrine system is necessary for adaquate adult sexual activity. |
| The erotising effect of the coitus a posteriori is very great, as only in this position the most stimulating parts of both partners are brought in closest contact i.e., clitoris and anterior vaginal wall of the wife and the sensitive parts of the glans penis. | |
| This short paper will, I hope, show that the anterior wall of the vagina along the urethra is the seat of a distinct erotogenic zone and has to be taken into account more in the treatment of female sexual deficiency. | [14] In conclusion I like to state as follows: The erogenic zones of the vulva and vagina are characterized by the presence of cavernous tissue. Therefore only the clitoris and the anterior wall of the vagina are the erogenic centres, from which sexual impulses radiate to the surrounding tissues. The importance of the endocrine system as regards this has been over-emphasized. |
| References Adler. The Frigidity of the Female Sex. Berlin, 1913. Elkan. The Evolution of Female Orgastic Ability -- A Biological Survey. Int. J. Sexol., Vol. II, No. 2. LeMon Clark. The Orgasm Problem in Women. Int. J. Sexol., Vol. II, No. 4 and Vol. III, No. 1. Hardenberg. The Psychology of Feminine Sex Experience. Int. J. Sexol., Vol. II, No. 4. Kinsey. Sexual Behavior in the Human Male. Bergler. Frigidity, Misconceptions and Facts. Marriage Hygiene, Vol. I, No. 1. Helena Wright. A Contribution to the Orgasm Problem in Women. Marriage Hygiene, Vol. I, No. 3. Lena Levine. A Criterion for Orgasm in the Female. Marriage Hygiene, Vol. I, No. 3. | [No references were given.] |
Commentary by John D. Perry, PhD
(November, 1996)
"April, 1983": This manuscript was rejected by Clive Davis, editor of the Journal of Sex Research and it remained unread for 13 years. In 1983 the official "backlash" against The G Spot (which was published in mid-1982) was substantial. {Return to text}
"Albertus Magnus" (d. 1280) is the Patron Saint of Natural Scientists; although only canonized by Pius XII in 1931, he was widely recognized in his own day. By reconciling Aristotlian and Platonic thinking, he is credited with making science acceptable in the Western world. In 1996 it seems ridiculous at best to compare Alfred Kinsey to Albertus Magnus, but don't forget that this was written in 1953, apparently just after the publication of Kinsey's book on the Human Female. Forty-three years later it is easy to underestimate what a ground-breaking publication that was! {Return to text}
"various authors": In 1950, Kinsey is referenced as just one of many authorities on the subject of female sexuality; but by 1953, the others (listed here) drop out of the picture. In addition, Grafenberg deletes much of his "pre-Kinsey" speculation on the nature of female sexuality! {Return to text}
"a vaginal orgasm": Kinsey (1953) devoted substantial energy to discrediting the notion of a "vaginal orgasm", which he attributed to Freud. He went so far as to omit from Table 174, page 577, experimental evidence of vaginal sensitivity that contradicted his prejudice [854 to 879 "touch" subjects, but only 578 reported in the vagina-touch section. And, despite the fact that 89-93 percent of subjects reported sensitivity to "pressure" in the vagina, this finding is completely overlooked in the text. Notice Grafenberg's description, in this paper, of the pressure used to stimilate the anterior wall! {Return to text}
"my own experience": In 1950 Grafenberg was quite open to citing personal experience as a source of information; in contrast, note the "objective" nature of the 1953 text. {Return to text}
"erotogenic zone": Grafenberg never used the term "spot" to describe the "zone" or "area" of exceptional sensitivity in the anterior wall of the vagina. The term "G-Spot" was coined by the book's publishers. {Return to text}
"urethral orgasm:" We observe that this entire topic (urethrally stimulated orgasms) was omitted from the 1953 version. {Return to text}
"corpora cavernosa of the clitoris": This theme was picked up and extensively developed by S. Gage et al in the book A New View of Women's Body. Grafenberg probably would have approved of their elaboration. {Return to text}
"plastic cervical cap": The cervical cap is a superior (to the diaphram) contraceptive device that was popular in Grafenberg's day. However, it was withdrawn from the market in order to encourage the use of oral contraceptives. Unlike the diaphram, which can be inserted with minimal self-contact, the cap required greater manual dexterity and familiarity with one's own body. The withdrawal provoked no opposition from sexologists, since (following Kinsey) they did not believe there was any sexually significant zone or spot to be covered by the diaphram anyway. Ironically, those motions most likely to provide stimulation of the anterior wall are also most likely to cause dislocation of the diaphram (but not of the cap). One wonders how many "diaphram failures" could be traced to this simple fact. {Return to text}
"vaginal hysterectomy": Despite Grafenberg's warnings, for three more decades surgeons continued to cut through the anterior wall's "erotogenic zone" with impunity because Kinsey and then Masters and Johnson assured them that there was no sexually significant structure there. Since only a minority of women rely entirely on this vaginal sensitivity for their sexual enjoyment, the majority continue to have sexual feelings after vaginal hysterectomy. The unfortunate minority who didn't learn to enjoy clitoral stimulation are still considered "psych" problems when they report post-hysterectomy loss of sexual enjoyment. {Return to text}
"a simple experiment": It was popular in the 1950s to debunk the "uterine suction" theory based on this simple experiment; Masters and Johnson, 1966, even included a photograph of the radio-opaque fluid remaining in the cervical cap after orgasm. However, persons familiar with the laws of physics (or the water-glass-and-playing-card trick of magicians) realize that there was no way that the fluid could be suctioned from the cap, which formed a seal over the cervix. Without air pressure, the fluid could not be drawn into the cervix under any conditions. The experiment proved nothing and the question remains unanswered. {Return to Text}
"no urinary character": Apparently Grafenberg did not attempt any laboratory testing, since his report is only anecdotal here. This assessment will have to be reexamined in the light of Schubach's collection of (watered-down) urine among sexually aroused subjects. {Return to text}
"secretions of the interurethral glands": This was, of course, the origin of the theory
developed in the Perry & Whipple and Belzer research in 1980. It turns out that the
paraurethral or Skene's glands are much more prolific (in some women) than previously
supposed, and histological analysis of the glands reveals prostatic acid phosphatase; i.e.,
they are not merely "vestigial". (Heath, Tepper, etc.) . {Return to Text}
"lubricating effect": This is the beginning of the discussion of female ejaculation; observe that this entire section was deleted for the 1953 version! Did Grafenberg change his mind? Was it simply too controversial? {Return to text}
"large quantities": Unfortunately, "large quantities" is not a precise measurement. The reference to a large towel makes it clear he isn't talking about a few drops, however. {Return to text}
"out of the urethra in gushes": This is perhaps the origin of the original (Robinson) term "gushers", which was used to describe female ejaculation in Miami in 1979. But Robinson believed the source to be "vaginal". {Return to text}
"the penis does not reach the urethral part of the vagina": Apparently Grafenberg was not aware that a primary result of strong voluntary contractions of the pubococcygeus muscle is to lift the penis towards the anterior wall and press it against the "erotogenic zone" located there. Good PC muscles can, to a large extent, make any coitial position conducive to vaginal stimulation. {Return to text}
"normal position would be intercourse a posteriori": The argument from phylogenetic ancestry is "interesting", but there is another option that Grafenberg et al did not even consider; since (as he notes above) "the female partner is always aware of the fact that the finger or penis loses contact with the vaginal part of the urethra, and she adjusts herself to this by changing her position" [6a], the most effective position for intercourse would be female superior! (This was discussed at length in my 1983 SSSS paper and a subsequent article in Forum magazine.) {Return to text}
"migration of the sexual stimuli": It was commonly thought that sexual sensitivity "moved" from the clitoris to the vagina; however, in retrospect, it is now clear that it never left the clitoris, even if the vagina additionally becomes sensitive. In the pre-M&J era, women (and their partners) were discouraged from utilizing the sensitivity of the clitoris to enjoy sex. Now clitoral stimulation is a required part of sex play. {Return to text}
"a distinct erotogenic zone": the erotogenic importance of the anterior wall of the vagina was in 1950 and remained in 1953 a major theme of Grafenberg's paper(s). This theme was denied by Masters and Johnson (1966) and remained dormant until the "G-Spot" research of the 1980s. {Return to text}
Copyright 1996 by John D. Perry, PhD
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