Pontine control of ejaculation and female orgasm.

INTRODUCTION: The physiological component of ejaculation shows parallels with that of micturition, as both are essentially voiding activities. Both depend on supraspinal influences to orchestrate the characteristic pattern of activity in the pelvic organs. Unlike micturition, little is known about the supraspinal pathways involved in ejaculation and female orgasm. AIM: To identify brainstem regions activated during ejaculation and female orgasm and to compare them with those activated during micturition. METHODS: Ejaculation in men and orgasm in women were induced by manual stimulation of the penis or clitoris by the participants' partners. Positron emission tomography (PET) with correction for head movements was used to capture the pattern of brain activation at the time of sexual climax. MAIN OUTCOME MEASURES: PET scans showing areas of activation during sexual climax. RESULTS: Ejaculation in men and orgasm in women resulted in activation in a localized region within the dorsolateral pontine tegmentum on the left side and in another region in the ventrolateral pontine tegmentum on the right side. The dorsolateral pontine area was also active in women who attempted but failed to have an orgasm and in women who imitated orgasm. The ventrolateral pontine area was only activated during ejaculation and physical orgasm in women. CONCLUSION: Activation of a localized region on the left side in the dorsolateral pontine tegmentum, which we termed the pelvic organ-stimulating center, occurs during ejaculation in men and physical orgasm in women. This same region has previously been shown to be activated during micturition, but on the right side. The pelvic organ-stimulating center, via projections to the sacral parasympathetic motoneurons, controls pelvic organs involved in voiding functions. In contrast, the ventrolateral pontine area, which we term the pelvic floor-stimulating center, produces the pelvic floor contractions during ejaculation in men and physical orgasm in women via direct projections to pelvic floor motoneurons.

How the Emotional Motor System Controls the Pelvic Organs.

INTRODUCTION: The brain has two goals: survival of the individual and survival of the species. It ensures that the body resides in safe circumstances and can obtain sufficient drink and food. It also has to produce and protect offspring. Its most important tool is its motor system, which consists of the voluntary and emotional motor systems. AIM: To explain how the brain uses its emotional motor system to control the pelvic organs. METHODS: Anatomic and physiologic data in cats and humans are used to find out how this motor system works and what parts of the brain and brainstem are involved. MAIN OUTCOME MEASURES: Main outcome is that the brain control of the pelvic organs is a specific descending system. RESULTS: The pelvic organs are innervated by the sacral parasympathetic motoneurons, which are controlled by a specific group of neurons in the pontine brainstem, the pelvic organ stimulating center (POSC). Through long descending pathways, this POSC generates micturition, defecation, and sexual activities by stimulating different groups of sacral parasympathetic motoneurons. In turn the POSC is driven by the periaqueductal gray (PAG), which receives, through the sacral cord, precise information regarding the situation in all pelvic organs. In addition, the PAG receives instructions from higher brain levels such as the amygdala, bed nucleus of the stria terminalis, and various regions of the hypothalamus. Notably, in humans, the most important brain region having access to the PAG is the medial orbitofrontal cortex, which is deactivated in women with hypoactive sexual desire disorder. CONCLUSION: In women with hypoactive sexual desire disorder, deactivation of their medial orbitofrontal cortex produces a decrease in PAG-POSC activation, causing absence of vaginal vasocongestion and lubrication and decreased sexual behavior in general. It often leads to major problems in their personal circumstances. The question is whether new drugs can cure this.

The periaqueductal gray controls brainstem emotional motor systems including respiration.

Respiration is a motor system essential for the survival of the individual and of the species. Because of its vital significance, studies on respiration often assume that breathing takes place independent of other motor systems. However, motor systems generating vocalization, coughing, sneezing, vomiting, as well as parturition, ejaculation, and defecation encompass abdominal pressure control, which involves changes in the respiratory pattern. The mesencephalic periaqueductal gray (PAG) controls all these motor systems. It determines the level setting of the whole body by means of its very strong projections to the ventromedial medullary tegmentum, but it also controls the cell groups that generate vocalization, coughing, sneezing, vomiting, as well as respiration. For this control, the PAG maintains very strong connections with the nucleus retroambiguus, which enables it to control abdominal and intrathoracic pressure. In this same context, the PAG also runs the pelvic organs, bladder, uterus, prostate, seminal vesicles, and the distal colon and rectum via its projections to the pelvic organ stimulating center and the pelvic floor stimulating center. These cell groups, via long descending projections, have direct control of the parasympathetic motoneurons in the sacral cord as well as of the somatic motoneurons in the nucleus of Onuf, innervating the pelvic floor. Respiration, therefore, is not a motor system that functions by itself, but is strongly regulated by the same systems that also control the other motor output systems.