Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Are men important?
- Izhar Ben-Shlomo (17 December 1999)
-
Improving our knowlege
- Mar Cruz (17 December 1999)
-
Leonardo:a new angle?
- Leonardo Martin (18 December 1999)
-
Lack of Info on Orgasm
- Aubrey Pilgrim (18 December 1999)
-
Reversed
- Daniel Crowley (20 December 1999)
-
Re: Are men important?
- I Z Ben-Zion (20 December 1999)
-
LEONARDO RIGHT UPRIGHT?
- F Eugene Davis (20 December 1999)
-
Re: Are men important?
- Robert Lacy (21 December 1999)
-
Re: Are men important?
- Erin Pernett (22 December 1999)
-
Physical alignment for coital orgasm
- Edward Eichel (22 December 1999)
-
You cannot argue that men are redundant
- Charles Bradley (23 December 1999)
-
Other subjects
- Louis M Rodriguez (7 January 2000)
-
Sensitivity of BMJ article on MRI imaging of coitus.
- T H H G Koh (7 January 2000)
-
MRI of male and female genitals during coitus and female sexual arousal.
- Andrew Ballaro (17 January 2000)
-
retroversion
- John Hurdley (19 March 2000)
-
Vaginal position in Fig. 3
- Jean Virmont (20 March 2000)
-
Authors' response
- Willibrord Weijmar Schultz, Pek Van Andel (10 May 2000)
|
|
|||
|
Izhar Ben-Shlomo HaEmek Medical Centre, Afula, Israel
Send response to journal:
|
I would like to draw the attention of the authors to the fact, that all 3 women who had no partner experienced an orgasm, whereas only 50% percents of those having intercourse with a partner did. Interesting, isn't it? |
|||
|
|
|||
|
Mar Cruz UCI TOLEDO
Send response to journal:
|
Dear friends: We are absolutely fascinated about your article. We think science do not be limited by our "chastity". Maybe your work can help many people to solve some problems with their sexual relationships. We hope it will be the beginning of a new time of research far away from our usual boring studies. We look forward to hearing of you in some new articles. Yours sincerely m. Cruz |
|||
|
|
|||
|
Leonardo Martin, Consultant Radiologist McMaster University
Send response to journal:
|
Congratulations to Dr. Schultz et al on their millenium paper.Truly a Dutch treat and one that will garner world attention for them and the BMJ for all the right or wrong reasons. But is the experimental design structure wanting? As with many of our own such personal research experiences on this same topic, Leonardo's volunteer was not subject to a 1.5 Tesla magnetic field, a force which perhaps could "boomerang" anyone's "22 cms". I am concerned the conclusions drawn may be "premature" and "phallatious". Further investigation may be warranted. Congratulations again on a very creative presentation. |
|||
|
|
|||
|
Aubrey Pilgrim Retired
Send response to journal:
|
Thank you for the excellent images and report. I am a retired doctor of Chiropractic. I have several reference books, but I cannot find any good explanation of the physiology and mechanism of an orgasm. I have had a prostatectomy and can still have an orgasm, though not as pleasurable as before my operation. Since I do not have to manufacture semen, I should be able to have orgasms every few minutes. But there is a very long refractory period- sometimes days. It appears to me that there must be some component involved in orgasm. I would appreciate any information you can send to me. Thank You Aubrey Pilgrim |
|||
|
|
|||
|
Daniel Crowley, Consultant Tralee, Ireland
Send response to journal:
|
Does the article by Schultz et at not bring into question our reliance upon the face to face position as the norm? While it is undoubtedly a more social approach to the matter, is it less "straight"forward than the alternative. Is there a scanner big enough to test this hypothesis? |
|||
|
|
|||
|
I Z Ben-Zion, Senior Consultant Sexology Clinic-Soroka Med. Center, ISRAEL
Send response to journal:
|
Yes- But this finding is not unusual: Masters& Johnson had almost the same results. Many wemen fake... |
|||
|
|
|||
|
F Eugene Davis, HIGH SCHOOL SCIENCE TEACHER STAMFORD PUBLIC SCHOOLS,STAMFORD CT. USA
Send response to journal:
|
LEONARDO'S MODELS ARE UPRIGHT. IT WOULD NOT BE SUPRISING IF DIFFERENT COITAL POSITIONS BENT THE PENIS IN DIFFERENT WAYS. HIS DEPICTION MAY WELL BE CORRECT. THE MISSIONARY POSISTION MAY BE RESPONSIBLE FOR THE POOR ORGASMIC RESPONSE REPORTED BY THE FEMALE SUBJECTS. THE PENIS IN THIS POSISTION IS BENT BY FORCE AGAINST THE POSTERIOR VAGINAL WALL WHICH RECIEVES THE MOST STIMULATION, WHILE THE PENIS IS BEING PULLED AWAY FROM THE ANTERIOR WALL WHICH HAS THE GREATER ENERVATION. THUS HUMAN SEXUAL ANATOMY SEEMS TO BE DESIGNED FOR REAR ENTRY AS PRACTICED BY LOWER MAMALS WHERE, PRESUMABLY, GREATER STIMULATION OF THE ANTERIOR VAGINAL WALL OCCURS AND AND THE SEMEN IS DEPOSITED CLOSER TO THE OS. GENE DAVIS |
|||
|
|
|||
|
Robert Lacy teacher Portland Public Schools Oregon, USA
Send response to journal:
|
Is your implication prevanlent in your letter parading an agenda? Manual stymulation done by either sex is most often successful whereas intercourse in the above experiment surely offers a rather odd venue for intercourse! How can you compare these two situations and pose such a question? |
|||
|
|
|||
|
Erin Pernett
Send response to journal:
|
I would have to agree with Mr. Lacy. I'm not sure what that question has to do with anything brought up in the article, but I would like to say that between manual stimulation to orgasm alone, and manual stimulation in addition to intercourse to achieve orgasm, the latter is the most intense and better of the two. So yes, men are important, but so is how you feel about your partner, how comfortable you are with your body, and freely expressing yourself. |
|||
|
|
|||
|
Edward Eichel, Director Heterosexual Education & Research Council of the U.S., New York City
Send response to journal:
|
Sexology could surely benefit from the contribution of MRI scanning, as initiated in the study by Schultz, van Andel, Sabelis, and Mooyaart. However, the low resolution of their current MRI images (as stated) and an inattention to kinetic factors of coital interaction may, as yet, limit their investigation of coital orgasm. I am the principal researcher of the study "The technique of coital alignment and its relation to female orgasmic response and simultaneous orgasm"(1988).(1) The hypothesis of a basic physical alignment that facilitates female sexual response may have appeared to be a bold claim when first published. In the last decade several controlled studies have replicated the model defined, and reported effectiveness of the coital alignment technique (CAT) in the treatment of hypoactive sexual desire. (2,3,4) The CAT research specifies criteria for the understanding of coital orgasm that should be considered in future MRI experimental design and conclusions. Factors include the positioning of the man and the woman and their pattern of sexual movement. Logically, the juxtaposition of the genitalia--which is altered in movement--can either facilitate or inhibit sexual response. I am currently animating the same Kendall drawing reproduced in the MRI study to compare aligned and unaligned coitus. A direct correlation between physical stimulation, sensation, and sexual response will be demonstrated. The animation will clarify why masturbation is less complete and satisfying than the no-hands orgasm that is possible with intercourse. (5) (Yes, it appears that men and women need each other. Sorry about that!) The MRI researchers acknowledge, "it was not possible on these magnetic resonance images to distinguish between the vaginal wall, the urethra, and the clitoris." This is unfortunate as the clitoris and the urethra are the critical sites of stimulation for female coital orgasm. The MRI images presented indicate that the genital contact in coitus, as performed, could not produce a complete sexual response. That may explain why sexual responses were reported as "superficial." The male pelvic override position ("riding high") places the external base of the male penis in direct contact with the clitoris and urethral meatus of the female. My original study defined and illustrated the kinetics of clitoral stimulation, but did not specify the urethral stimlation that also occurs in alignment. The histologic research of Zaviacic (6, 7) has identified the locus of prostatic tissue in the female urethra as "immediately behind the urinary meatus" - and not necessarily related to the G-spot. This finding provides evidence of an elegant anatomic design for orgasm that is activated in the process of coital alignment. (The finding will be elaborated in the published Proceedings of the XIVth Congress of the World Association for Sexology.) When the MRI imaging allows more detailed recording, the anatomy of coital orgasm may be documented and confirmed in the most minute detail. The MRI research is a welcome innovation - a venture that brings attention to an enigmatic problem of male-female relating that has been chronic and universal. Respectfully, Edward Eichel References: (1) Eichel EW, De Simone Eichel J, Kule, S. The technique of coital alignment and its relation to female orgasmic response. J Sex Marital Ther. 1988; 14: 129-141. (2) Pierce AP. The coital alignment technique (CAT): An overview of studies. in press with J. Sex Marital Ther. (3) Hurlbert DF. A comparative study using orgasm consistency training in the treatment of women reporting hypoactive sexual desire. J Sex Marital Ther. 1993; 19: 41-55. (4) McVey TB. Depression among women with hypoactive sexual desire: analysis and effect on treatment outcome. Canadian Journal of Human Sexuality. 1997; 6: 211-220. (5) Hurlbert DF. The coital alignment technique and directed masturbation: a comparative study on female orgasm. J. Sex Marital Ther. 1995; 21: 21-29. (6) Zaviacic M. The female prostate: Nonvestigal organ of the female. A reappraisel. J Sex Marital Ther. 1987; 13: 148-152. (7) Zaviacic M, Zaviacicova A, Holoman IK, Molcan J. Female urethral expulsions evoked by local digital stimulation of the G-spot: Differences in the response patterns. Journal of Sex Research. 1988; 24: 311-318. Note: I am currently working on an educational video that focuses on the technique and anatomy of coital orgasm. The video will be made available to health field professionals and the general public. |
|||
|
|
|||
|
Charles Bradley
Send response to journal:
|
In response to the percent of men obtaining erections and the women reaching orgasims, you have to compare similarities. The men in question probably had difficulty because of the scene, i.e. prying eyes, instruments, strange partners, etc. I am sure that masterbating men would have had as much success having orgasims as the masterbating women, i.e. familiar methods, familiar imagery, and familiar virtual lovers. Also, if women found it necessary to become physically aroused (erections) in the same setting, they too probably experience difficulties. You cannot argue that men are redundant. The mind is a wonderful and very successful sex organ. |
|||
|
|
|||
|
Louis M Rodriguez, Computer technician San Jose, California, USA
Send response to journal:
|
Gentlemen, I read your article concerning human sexual response with great interest. It occurred to me that, in order to avoid the problems you had with your subjects (specifically as only one of the males was able to complete intercourse), that you should use actors and actresses from the porn industry. As you well know, pornographic films demand a perfect performance, so these people are especially trained to complete the sexual act under all types of conditions, and in front of a camera and a movie crew. Thanks for such a fascinating paper. Sincerely yours, Louis M. Rodriguez |
|||
|
|
|||
|
T H H G Koh, Neonatologist NICU, Kirwan Hospital for Women, Thuringowa, QLD 4817, Australia
Send response to journal:
|
Dear Editor, I am aware of a consultant paediatrician who got into trouble for giving a copy of the interesting and innovative article by Schultz et al (1) to the chief nurse in his department for her to distribute to the nursing staff. In the past it has been the practice of this particular consultant to print out on a Friday (the current issue of BMJ published on the Saturday is available on line a day earlier: at 10am Australia Eastern Time on Friday) articles of interests and distributing it on that day to the nursing and medical with the phrase "Ladies, thanks to modern technology these are the articles coming out in tomorrow's BMJ". It transpired that some members of the nursing staff were offended by the article and lodged a complaint. The consultant, who enjoys a friendly professional relationship with all of the nursing colleagues and has had an unblemished 20 year history of his character, ended up having to write a letter of apology to his nursing colleagues for having caused offence. He was mortified. I am interested to know whether any of the readers of the BMJ have similar experiences? Comments from the editor would be welcomed. 1. Willibrord Weijmar Schultz, Pek van Andel, Ida Sabelis, and Eduard Mooyaart. Magnetic resonance imaging of male and female genitals during coitus and female sexual arousal. BMJ 1999; 319: 1596-1600 |
|||
|
|
|||
|
Andrew Ballaro
Send response to journal:
|
Editor- Schultz et al. (1) fail to comment on the methodological limitations of their highly original study. Their conclusion that 'the penis during intercourse in the missionary position has the shape of a boomerang' requires further supportive data. The crura of the penis are firmly attached to the pubic rami, and the body of the penis is anchored proximally to the symphysis pubis by the suspensory ligament. Distally, the body of the erect penis is variably flexible about this point, depending on the degree of tumescence, and will therefore conform to a limited extent to any position in which it is placed. The confines of a 50cm MRI tube are unlikely to allow enough flexion in abduction of the female hips for tilting of the female pelvis and the true 'missionary position' to occur. Without data pertaining to the position of the female pelvis in this study any statement regarding the true shape of the penis during intercourse in the 'missionary position' are without foundation. References 1. Schultz W, van Andel P, Sabelis I, Mooyaart E. Magnetic resonance imaging of male and female genitals during coitus and female sexual arousal. BMJ 1999;319:1596-600. Andrew Ballaro |
|||
|
|
|||
|
John Hurdley, Retired
Send response to journal:
|
I was interested in your article but am puzzled that there has been no comment about the uterine retroversion in your MRI scan of intercourse. Is this retroversion usual? Was it observed in other couples? Was it artefactual? |
|||
|
|
|||
|
Jean Virmont, Physicist Ecole Polytechnique, Palaiseau, France
Send response to journal:
|
While Fig.2 shows the uterus in the usual forward position, its orientation is backwards in Fig.3. I am surprised not to see any comment about that. |
|||
|
|
|||
|
Willibrord Weijmar Schultz University Hospital Groningen, Groningen, The Netherlands, Pek Van Andel
Send response to journal:
|
Editor-Between submission and publication of the article "Magnetic resonance imaging of male and female genitals during coitus and female sexual arousal" some minor mistakes have come to light that require correction.1 The legend under figure 4 should read: Midsagittal images of the sexual response in a nulliparous woman (experiment 11): (left) at rest; (centre) pre-orgasmic phase; (right) 20 minutes after orgasm. The reference to figure 4 under ‘Anatomy reveals', line 6, is incorrect, because this figure was not included in the article. In the table of experiments, the year of the first experiment should be 1992 instead of 1991. There errors do not have any consequences on the results of the study. Various reactions to the study have led us to the conclusion that certain aspects require further clarification. Stress during the experiment. Our experiments were not invasive. No instruments were used or whatever. The volunteers (couples/women) were alone. There was no visual contact. They were asked to give a verbal signal when they were ready for the image. The volunteers, especially the women, expressed that the stress was acceptable; they were all very motivated and enjoyed participating in scientific search. This explains why our volunteers agreed to participate in this study. We were told that it had been fun in the MR tube. Therefore, in our opinion, the volunteers were certainly not under more stress, or less aroused than the volunteers in the experiments performed by Masters & Johnson; however, we cannot support this with concrete evidence.2 The length of the penis in erection. The penis reaches maximum erection c.q. length, directly before ejaculation.2 Our volunteers had to lie still while the images were being taken. Maximum erection at the moment an image was taken can therefore practically be ruled out. However, we are talking in terms of a difference in length of a few millimetres, which probably would not have influenced our observations. The shape of the penis in erection. The images showed that during ‘missionary position' coitus, the penis was not straight, but had the shape of a boomerang. This is in agreement with clinical experience. Every gynaecologist knows that vaginal palpation cannot be performed with the fingers straight. The thousands of images of the enormous penis of the classical god of fertility also provide support for the correctness of our MRI observations. In nearly all cases, the bending was identical. Perhaps in ancient times, there was less tendency towards machismo......3 We think that both Da Vinci (in about 1493) and Dickinson (1933) believed that the penis as a whole was a more or less straight structure. In order to achieve the correct proportions, Da Vinci leaned the woman over backwards (Heijmerinck, personal note, 1999). Dickinson did exactly the same, although not as far. In the upper part of his drawing, the abdominal walls deviate somewhat, which from the perspective of human experience, is unusual. Dickinson did manage to correctly envisage the more caudal position of the male pelvis and the mutual configuration of the transected pubic bones during coitus. This showes that in his time, soft tissues were more difficult to map than hard tissues. The limited space in the MR tube. With the equipment currently available, it is not possible to establish how much influence the limited spread of the woman's legs had on our MRI observations. The next generation of ‘wide body' MRI equipment will give the volunteers more room and enable us to review the situation. Contribution of the root of the penis to elongation of the penis in erection. The MR images show that the angle made between the root and pendulous part of the penis in erection lies outside the lower pelvis. Therefore, the root of the penis contributes to the length of the penis in erection. This supports the findings in a Dutch case study "Sexuality following amputation of penis and scrotum": " What is fascinating is that with sexual arousal a kind of erection develops. This swelling has more or less the shape of a volcano and is inconvenient at change of position. That makes us realize that usually during erection not only the deep part of the penis swells, but also contributes to the elongation of the penis! We never gave this a moment's thought".4 This obviously deserves further attention and we therefore plan to obtain MR images of a man following penis amputation. The retroverted uterus. The woman in experiment 10 and 12 (Figure 3) has a retroverted uterus. In the majority of women, the entire uterus is anteverted, and in some it is retroverted, even when the bladder is empty. This is an anatomical variation. We observed the boomerang shape of the penis in all the experiments, irrespective of the anteverted or retroverted position of the uterus and the depth of penetration. The position of the uterus in anteversion or retroversion did influence the changes we saw during the women's sexual response without coitus: under these conditions we did not observe any elevation of the uterus or lengthening of the anterior vaginal wall in the women with a retroverted uterus (experiment 10). Our observations agree with those made by Masters & Johnson who mentioned that there was no tenting effect in women with a retroverted uterus.2 This means that the elevation of the retroverted uterus in experiment 12 (figure 3) must have been the result of penile insertion and expansion of the bladder as it filled. The elevation of an anteverted uterus and lengthening of the anterior vaginal wall that occurs during sexual arousal without penetration indicates that the uterus becomes elevated due to stretching of the vaginal wall i.c. vasocongestion. Apparently, a retroverted uterus causes such over- stretching of the anterior vaginal wall that no changes occur during sexual arousal, or if changes do occur, they no longer lead to visible lengthening or elevation of the uterus. The tenting effect. We observed the tenting effect in all our experiments, with the exception of experiment 10 (uterus in retroversion). This confirms the observations made by Masters & Johnson, which have also been recorded on film.2,5 The surprising degree of indentation and stretching of the anterior vaginal wall during coitus in the missionary position, as described by Riley et al., agrees with our findings.6 Our women volunteers in experiments 1, 2, 10-13 mentioned penile contact with the cervix, which could be confirmed by the images. Riley et al. did not observe this phenomenon in the missionary position, they did notice it once in the female superior position. Palpation of the uterus. Gynaecologists always make sure that the bladder
is empty when performing vaginal examination, in order to feel the uterus
clearly and prevent misinterpretation. The uterus is a very firm muscle
with a tremendous capacity to expand (during pregnancy or because of
fibroids), but that takes some time. In our experiments, no notable
expansion occurred in such a short time.
Bladder size. We did not realize that the bladder would expand so rapidly in such a relatively short time (45 to 90 minutes). With hindsight, we made the mistake of giving the volunteers a cup of coffee (a diuretic!) before the experiments to help them feel comfortable....... But they were asked to empty their bladder before starting the experiment. Obviously volunteers should not drink in the hours before the experiment. It would also be interesting to study in the MRI what happens to the position of the uterus as the bladder fills, without sexual arousal. Future research. The main purpose of the BMJ paper was to show the scientific world that it is possible to perform sexological research in a MRI. So far, there have only been a few experiments and the images do not show details. Further research is necessary to increase our knowledge and check our findings. Extensive MRI studies are required with detailed MR images of coitus in other positions and of the penis in erection without coitus. Willibrord Weijmar Schultz Pek Van Andel University Hospital Groningen, PO Box 30.001, 9700 RB
Groningen, The Netherlands
1 Weijmar Schultz WCM, Van Andel P, Sabelis I, Mooyaart E. Magnetic resonance imaging of male and female genitals during coitus and female sexual arousal. BMJ 1999;319:1596-600. 2 Masters WH, Johnson VE. Human sexual response. Boston: Little, Brown, 1966. 3 Bol P. MRI-seks. NRC Handelsblad, 44, 8 January 2000. 4 Gianotten WL, Kirkerls WJ and Haensel SM. Seks na penis- en scrotumamputatie (Sexuality following amputation of penis and scrotum). Tijdschrift voor Seksuologie 1996;20:215-219. 5 Wagner G. Physiological responses of the sexually stimulated female in the laboratory. (16 mm colour film), Institute of Medical Physiology: Copenhagen, Denmark, 1974. 6 Riley AJ, Lees WR, Riley EJ. An ultrasound study of human coitus. In: Bezemer W, Cohen-Kettenis P, Slob K, Van Son-Schoones N, eds. Sex Matters. Amsterdam: Elsevier, 1992: 29-36. |
|||