Female genital mutilation and cutting: An anatomical review and alternative rites.

The World Health Organization reports that more than 200 million women currently alive have been subjected to female genital mutilation/cutting (FGM/C) worldwide, and three million girls continue to be at risk each year. FGM/C today is women's business. The vulva is formed by the labia majora and the vestibule, with its erectile apparatus. These structures are located under the urogenital diaphragm, behind the pubic symphysis in the anterior perineal region. The clitoris is entirely an external genital organ: the glans and body covered by the prepuce are visible/free while the roots are hidden. FGM/C procedures are classified into four types. Infibulation is the narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning of the labia minora and/or the labia majora, with or without removal of the clitoris. Deinfibulation is necessary to improve health and well-being and to allow intercourse or facilitate childbirth. Clitoral reconstruction is feasible for genitally mutilated patients. Female genital cosmetic surgery should be classed as FGM/C type IV. Both immediate and long-term complications are associated with FGM/C. It remains primarily a cultural rather than a religious practice. Different interventions have been used to persuade communities to abandon it. Alternative rites of passage are seen as an important strategy for eliminating this harmful practice. Such alternative rituals avoid genital cutting and involve educating girls about family life and women's roles, exchange of gifts, celebration, and a public declaration for community recognition. FGM/C is a violation of human rights and must be abandoned. Clin. Anat. 30:81-88, 2017. © 2016 Wiley Periodicals, Inc.

Comprehensive review of the anatomy and physiology of male ejaculation: Premature ejaculation is not a disease.

Human semen contains spermatozoa secreted by the testes and a mixture of components produced by the bulbo-urethral and Littre (paraurethral) glands, prostate, seminal vesicles, ampulla, and epididymis. Ejaculation is used as a synonym for the external ejection of semen, but it comprises two phases: emission and expulsion. As semen collects in the prostatic urethra, the rapid preorgasmic distension of the urethral bulb is pathognomonic of impeding orgasm, and the man experiences a sensation that ejaculation is inevitable (in women, emission is the only phase of orgasm). The semen is propelled along the penile urethra mainly by the bulbocavernosus muscle. With Kegel exercises, it is possible to train the perineal muscles. Immediately after the expulsion phase the male enters a refractory period, a recovery time during which further orgasm or ejaculation is physiologically impossible. Age affects the recovery time: as a man grows older, the refractory period increases. Sexual medicine experts consider premature ejaculation only in the case of vaginal intercourse, but vaginal orgasm has no scientific basis, so the duration of intercourse is not important for a woman's orgasm. The key to female orgasm are the female erectile organs; vaginal orgasm, G-spot, G-spot amplification, clitoral bulbs, clitoris-urethra-vaginal complex, internal clitoris and female ejaculation are terms without scientific basis. Female sexual dysfunctions are popular because they are based on something that does not exist, i.e. the vaginal orgasm. The physiology of ejaculation and orgasm is not impaired in premature ejaculation: it is not a disease, and non-coital sexual acts after male ejaculation can be used to produce orgasm in women. Teenagers and men can understand their sexual responses by masturbation and learn ejaculatory control with the stop-start method and the squeeze technique. Premature ejaculation must not be classified as a male sexual dysfunction. It has become the center of a multimillion dollar business: is premature ejaculation-and female sexual dysfunction-an illness constructed by sexual medicine experts under the influence of drug companies?

Anatomy of sex: Revision of the new anatomical terms used for the clitoris and the female orgasm by sexologists.

Sexual medicine experts and sexologists must spread certainties on the biological basis of the female orgasm to all women, not hypotheses or personal opinions. Therefore, they must use scientific anatomical terminology. The anatomy of the clitoris and the female orgasm are described in textbooks, but some researchers have proposed a new anatomical terminology for the sexual response in women. The internal/inner clitoris does not exist: the entire clitoris is an external organ. The clitoris is not composed of two arcs but of the glans, body, and crura or roots. "Clitoral bulbs" is an incorrect term from an embryological and anatomical viewpoint: the correct term is "vestibular bulbs." The bulbocavernosus muscles are implicated in inferior vaginismus, while the pubovaginal muscle is responsible for superior vaginismus. The clitoral or clitoris-urethro-vaginal complex has no embryological, anatomical and physiological support: the vagina has no anatomical relationship with the clitoris, and the clitoris is a perineal organ while the supposed G-spot is in the pelvic urethra. G-spot/vaginal/clitoral orgasm, vaginally activated orgasm, and clitorally activated orgasm, are incorrect terms: like "male orgasm," "female orgasm" is the correct term. The "vaginal" orgasm that some women report is always caused by the surrounding erectile organs (triggers of female orgasm). The male penis cannot come in contact with the venous plexus of Kobelt or with the clitoris during vaginal intercourse. Also, female ejaculation, premature ejaculation, persistent genital arousal disorder (PGAD), periurethral glans, vaginal-cervical genitosensory component of the vagus nerve, and G-spot amplification, are terms without scientific basis. Female sexual satisfaction is based on orgasm and resolution: in all women, orgasm is always possible if the female erectile organs, i.e. the female penis, are effectively stimulated during masturbation, cunnilingus, partner masturbation, or during vaginal/anal intercourse if the clitoris is simply stimulated with a finger. Clin. Anat. 28:293-304, 2015. © 2014 Wiley Periodicals, Inc.