New findings and concepts about the G-spot in normal and absent vagina: precautions possibly needed for preservation of the G-spot and sexuality during surgery.

AIM: The aim of this study was to extend the clinicohistological study to involve the whole normal and absent vagina for confirming the presence of the G-spot and its relation to the surrounding organs and sexuality and to identify certain precautions for its preservation during surgery. MATERIAL AND METHODS: This study was a descriptive randomized prospective study conducted at Kasr El Aini School of Medicine, Cairo University, Egypt. The G-spot was examined in 1500 women, 500 of them having vaginal and vulval surgery done for gynecological reasons. The G-spot was examined for its clinical and histological features and for determining the effect of surgery on its state and function. RESULTS: The G-spot was found to be present in all women. It was a localized spot in 58% and diffuse in 42% of cases. Associated ejaculation was reported in all cases of the localized type and in 24.5% of the diffuse types. Clinical examination was found to be associated with certain local response in 52.7% of the local types. The G-spot was also found to be connected to the hymen in 100%, the urethra in 52.7%, the vulva in 82.2% and the cervix in 10.8% of cases. The mean of the sex scores and sexuality were significantly decreased in surgery involving the G-spot area. Recorded figures were 93.6 ± 3.4 and 88.2 ± 3.3 before and after surgery, respectively. The corresponding figures in the cases having a general spot were 86.4 ± 4.4 and 84.5 ± 2.4, respectively. The G-spot was found in cases of absent vagina to be localized in 59%, generalized in 28.2% and absent in 12.8% of cases. CONCLUSIONS: The G-spot is actually present in all women. It is originally related to the lower urinary tract and it is connected to different parts of the genital tract. It may be localized or generalized. Its integrity is essential for obtaining normal physiological sexuality. Surgery may affect the integrity of the G-spot, so surgical precautions must be carried out to maintain the integrity of this spot and the patient's sexuality.

Reduction clitoro-labioplasty versus clitoro-labiectomy in managing adult onset clitoro-labiomegaly.

OBJECTIVES: To compare a new procedure of reduction clitoro-labioplasty to clitoro-labiectomy in the management of adult onset clitoro-labiomegaly, and to show the disadvantages of the latter procedure that produces female genital mutilation and sexual dysfunction. METHODS: This controlled, descriptive, comparative and prospective cohort study was performed at Kasr El-Aini School of Medicine, Cairo University, Egypt. 47 cases of clitoro-labiomegaly, 12 with known causes of intersex, were diagnosed and treated by reduction clitoro-labioplasty. In addition, a control group of 53 more cases, 6 with known causes of intersex, were followed after treatment by clitoro-labiectomy. Clitoro-labioplasty was performed by excision of the anterior part of the fused corpora after separation at the glans-corporal junction and a reduction in the size of the remaining part of the corpora to reform a normal clitoral size. The neurovascular bundles were essentially preserved during this procedure. The protruded parts of the labia minora are then excised to preserve their normal dimensions. The main outcome measures were the postoperative anatomical result, patient's satisfaction, the pre- and postoperative sex scoring, and sexuality. RESULTS: Restoration of normal anatomy was successfully obtained after clitoro-labioplasty compared to partial or complete loss of these sensitive parts after clitoro-labiectomy. In addition, significant operative and postoperative complications were recorded in 27 cases with clitoro-labiectomy compared to none of the clitoro-labioplasty cases. The sex scores and sexuality improved significantly after the clitoro-labioplasty operation compared to clitoro-labiectomy (p < 0.005). Normalization of the sex scores and sexuality was found to be significantly related to preservation of critical clitoral length necessary for producing clitoral orientation and interest in sexuality. CONCLUSION: The new clitoro-labioplasty technique is able to preserve proper clitoral and labial anatomy and restore normal sexuality. Therefore it must be considered an essential line of treatment for clitoro-labiomegaly.

Reality of the G-spot and its relation to female circumcision and vaginal surgery.

AIM: To clarify the reality of the G-spot anatomically, functionally and histologically, and to determine the possible effect of female circumcision and anterior vaginal wall surgery on the integrity and function of the G-spot. METHODS: A controlled descriptive and comparative cohort prospective study was conducted at Kasr El Aini School of Medicine, Cairo University, Cairo, Egypt, of 50 uncircumcised and 125 circumcised women with small to moderate anterior vaginal wall descent. Preoperative sexual examination was performed to map the site of the G-spot and other anatomical landmarks on the anterior vaginal wall and to verify the associated circumcision state. Pre- and postoperative sexual assessment and histological examination of different mapped sites in the anterior vagina were also conducted. RESULTS: Histological findings, results of the anatomical and sexual mapping of the anterior vaginal wall and sexual scores were recorded. The G-spot was proved functionally in 144 (82.3%) of women and anatomically in 95 (65.9%). The latter appeared as two small flaccid balloon-like masses on either side of the lower third of the urethra and were named 'the sexual bodies of the G-spot'. These bodies were significantly detected in all histo-positive cases in the circumcised women and in the uncircumcised women who had small or average clitorises. The G-spot was also proved histologically in 47.4% of all cases and was formed of epithelial, glandular and erectile tissue. Sex scores were significantly higher in the histo-positive cases with sexual bodies but significantly dropped after anterior vaginal wall surgery. In contrast, female circumcision rarely alters the scores. CONCLUSION: The G-spot is functional reality in 82.3% of women, an anatomical reality in 54.3% and a histological reality in 47.4%. Anterior vaginal wall surgery usually affects the G-spot and female sexuality, but female circumcision rarely affects them.

Defective sexuality and female circumcision: the cause and the possible management.

AIM: To verify the effect of circumcision on female sexuality and to define the need for clitorolabioplasty in these cases. METHODS: Thirty uncircumcised controls, 30 minorly circumcised, 30 minorly circumcised mutilated, and 57 circumcised cases having clitoral cysts were selected on random bases at Kasr El Aini School of Medicine. Sexuality was assessed by a special questionnaire sheet prepared by the authors to fit the circumcised cases. Clitorolabioplasty and clitoral cyst excision were also done in cases of sexual defects. RESULTS: Sexuality was not affected in minorly circumcised cases. However, sexuality was markedly affected in the mutilated cases. The scores for sex desire and arousal and for orgasm were especially affected in such cases. These defects were not detected in cases having clitoral cysts until late, when cysts enlarged. The role of clitorolabioplasty in restoration of sexuality was confirmed. The loss of certain clitoral and labial bulk, necessary for orienting the woman towards her genitalia and initiating her interest in their function, was responsible for the occurrence of such defects; this was able to be restored by surgery. CONCLUSION: Counseling parents about these sexual defects and asserting the need for correcting the mutilation, which resulted from these circumcisions, are effective steps in banning such procedures.

Role of new sono-imaging technique 'sonocolpography' in the diagnosis and treatment of the complete transverse vaginal septum and other allied conditions.

OBJECTIVE: To evaluate the value of a newly suggested ultrasonographic technique 'Sonocolpography' in diagnosing the complete transverse vaginal septum and other allied conditions and planning their treatment. SUBJECTS AND METHODS: Ten cases of complete vaginal septum, eight cases of atresia and four cases of vaginal aplasia seen at Kasr El Aini School of Medicine, Cairo University were selected for this study. Sonocolpography is done using a vaginal balloon and transabdominal ultrasonography. The efficacy of the latter is assessed in comparison to the conventional transabdominal technique. The different sonographic criteria in the conventional technique and in sonocolpography were determined for the studied cases. A cross-over test was also suggested for anticipating the needed surgery. This is done by pushing the balloon maximally inward and determining the ability of the echoes of the vaginal pouch to accommodate the balloon to stretch and to cross over the defect, in turn determining the needed surgery. RESULTS: Improved ultrasonographic images were successfully obtained for all cases studied. The diagnostic accuracy for these cases was 95.5% for septa, 86.4% for atresia and 90.9% for aplasia. The corresponding figures for the conventional techniques were 54.5, 68.2 and 77.2%, respectively. Sonocolpography was more sensitive and more specific for all cases studied compared to the conventional technique. Planning of the necessary surgery was successfully determined in 16 cases having positive cross-over tests, where excision and direct anastomosis were performed. Surgery planning was also successful in two cases having negative tests and four cases of invalid tests, where more extensive surgery was needed. CONCLUSION: Sonocolpography is a new achievement that is essential for imaging cases of the complete vaginal septum and other allied conditions, and also in planning the associated treatment.