Author: runels

Female Sex Muscles Part 2

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Transcript (References at the bottom of the page).

You can lift the hood of your car, and you can name the parts: There's the carburetor, there's the radiator. You can take off the cover of your computer and say there's the integrated circuit, that's a diode, that's a resistor, that's a wire, but that doesn't mean you know how those parts work together to make your computer do what it does. So your computer is a system with components that work together, and then there are systems within the systems.

The body is also a system with subsystems within it: the respiratory system, the pulmonary system, and the orgasm system. And we're talking about how the muscles of the pelvis contribute not to urinary continence but to sexual function, not incontinence to sexual function.

The idea is to not only lift the hood of the pelvis and name parts but also to understand how the parts (including the muscles) work together as a system to contribute to sexual function and orgasm (and look at the research that supports understanding of the system).

In previous lessons, we reviewed the hidden clitoris. The hidden lies in intimate proximity with the sex muscles—which is the subject of the rest of this lesson.

From the top and from the bottom

This is the pelvic floor, but there's more to the pelvic muscles than the pelvic floor.

Notice that you can see muscles from the caudal side that you don't see on the cephalad side: caudally, you see superficial transverse perineal muscle, deep transverse perineal muscle, ischiocavernosus, and bulbospongiosus.

Those are not part of the pelvic floor. Some think every muscle in the female pelvis is part of the pelvic floor. But, every muscle in the female pelvis is absolutely not part of the pelvic floor.

Here, you’re seeing the caudal view of the floor where you have puborectalis, iliococcygeus, ischiococcygeal, and coccygeus. So those three together, these first three form the levator ani.

And you can see how if these contract, it's going to pull the anus up, levator ani.

Well, let me pull out the other model because I think it makes it more apparent for you. Okay, so this model has some of the organs in place. We’re going to take out the ovaries, the fallopian tubes, and the uterus. But of course, the vagina has at least muscle cells in it. And so we'll put that aside for now. And then, let's take out the bladder, which has a muscular layer and urethra.

The urethra, or the urinary sphincter, has three layers: two layers of striated muscle and one layer of smooth muscle.

And some of those layers go circumferentially around both the vagina, so it sits like that. And so some of the muscles go that are more distal from the bladder go circumferentially around both the urethra and the vagina.

And then as you get more proximal to the bladder, they just go part of the way. And then you have muscles that go around just the urethra, both circumferentially and longitudinal. But those are, I think, more easy to understand what they do. Now, we have the pelvic floor exposed, and you can look through; this is called the hiatus.

Wait, let's pull out the rectum. Okay, so now you have holes in the pelvic floor. You need them, right? So you need a hole for, if you look at the other side, it makes sense, you need a hole for the rectum, hole for the vagina, hole for the urethra. And those would be the hiatus or the absence of the pelvic floor muscles.

So you have puborectalis that comes down. And let's pull it this way so you can see it better. I'll hold it more still. So you got puborectalis right there. Pubococcygeus comes down right there, iliococcygeus, ischiococcygeus or coccygeus, all of these forming the floor. But look what happens. Now, there's in reality, in the women, of course these muscles are adjacent to each other. And if you look at the other model, it demonstrates ... thanks to my amazing wife, I've talked to her about what it's like to be down there doing surgery and got some of these ideas from her ... but there's not a lot of space right there. And dissecting the deep, transverse perineal muscle away from the pelvic floor would be difficult because they’re abut each other; they touch but have different fibers and different functionalities, which we’re getting to, and how they relate to the sexual function.

So, let’s look back at the pelvic floor. And here's a question to ask yourself:

If you go with the assumption that there is no redundancy and no wasted parts in the body and we want to care for a woman, then we should we not understand every one of these muscles, where they attach and what they do to contribute to sexual function and orgasm?

I do this all the time: I put together stairs for our hot tub the other day, and I had an extra part, which bothered me. I don't think people build something as simple as a do-it-yourself kit for making stairs and throw in extra parts.

So, I don’t think we should look at any part of the woman’s pelvis, including every one of the muscles in her pelvis, and just assume parts of it do not matter—as if the parts we don’t understand are just extra and do not matter.

I guess you could argue that maybe the appendix is an extra part, but not really because it's vestigial, and it’s a part that, because it’s extra, sort of dried up, you might say, or become pygmy size. So if you go with that assumption, there are no extra parts, and every part has a function, then consider this: it is easy to imagine what the bicep muscle does, right? There’s a hinge across our midway in the bicep muscle, and when it contracts, it's easy to see what it does. It brings the radius closer to the humerus, and your elbow acts like a hinge.

Why is the pelvic floor made of muscle and not of tendons?

But if the floor is meant just to hold things in place within the pelvis, why is it a muscle? Why isn't it just fascia, a thick fascial plane, or a tendon or something?

Why was it made to contract and relax?

I think that's a question worth asking. And it gets even more interesting, I think. We'll get to the research shortly, but I think the research makes more sense if you look at the functionality.

So, now with our model, we've lifted away from the pelvic floor, other muscles, and these are the ones I call the sex muscles because they might contribute to, of course, the anus would contribute to fecal continence. But you could argue the ischiocavernosus isn't doing anything for urinary continence, as far as I can see.

But now, let's name them again, and think about, well when it contracts if there are no extra parts and everything has a purpose, what's the purpose of this muscle contracting?

There's no joint. This is why I wanted to cover the mystery of the hidden clitoris before we got to the muscle part of the female orgasm system. It's just so amazingly beautifully designed. I think many of our colleagues just still think of the female genitalia as a tube to put a penis in and to push a baby out of.

There's also a tube for feces to come out of and a tube for urine to come out of. And they're not visualizing everything you're looking at here, but let's think about it.

Okay, (referring to model, see the video), so you've got labia majora, labia minora, urethra, vagina. Then, remember, the root of the clitoris is just above the urethra, and it's all attached. So you've got corpus cavernosi. I never know how to say the word crux. Is that crus or cuss or crux or I don't know what it is, but if you were to say it, I guess say it loudly, so I'm going to call it crus or I think it's crux, but whatever, corpus cavernosi. So you have two of them that lay along the pubic rami and the ischiocavernosus covers them.

And then you have the corpus spongiosus, also part of the clitoris and attached to the root, which is attached to the underbelly of the body of the clitoris. And then you have the glands, clitoris, and that little pink thing right there is Bartholin's gland.

Now think about this: What's the purpose of corpus spongiosus and ischiocavernosus and what's the purpose of transverse peroneal, deep transverse peroneal, superficial and peroneal body?

Even if you can name them, so what, how does it help you have better sex?!

Are we just making a more enjoyable place for a man’s penis?

Sex as a female is both for your pleasure and for your psychology, right, because it's not just about sexual pleasure. I'm not going to start ranting about that, but never forget sexual pleasure is not just about pleasure in the bedroom. It has been studied over and over again that somewhere between 30 and 40% of women have psychological distress because of sexual dysfunction.

Have you ever had a cracked window in a nice car? You don’t really need it fixed; it's not leaking water, but it bugs you.

Now, imagine you have a dysfunctional vagina. Even if you're not using it with your husband, it still bugs you. Even if you don't want a man in your house, it might still bother you because you want to make love to yourself.

So I know that's a sidetrack, but I just never want to forget, this is not just about pleasure, although it is, it's not just about pleasure, it's not just about making babies, although it is, because what brings pleasure to the woman is going to bring pleasure to the man if this is designed properly.

Think about it. If this is designed properly, this is going to make the man orgasm or ejaculate. So if he wants to again, if we're looking at it from propagation of the species, from a Darwinian standpoint, then you want this little device to make the man ejaculate. And then because it feels so good, he's going to want to ejaculate again in a few minutes from now and increase the chances of survival of the species.

And then if it feels good to the woman, even if he's in refractory period, if you're living in a cave somewhere where you haven't yet been exposed to modern mores and religious rules, she might want to have sex with his friend because it felt so good to her.

Watch the feral pussycat in your backyard; she’ll have tomcats lined up back to back, and you know she enjoys it because she does not run away between tomcats.

Some people say, "Well, you're talking about the vagina; you’re pushing for it to be tighter so it feels better to men."

Oh, no, no, no. Sometimes, tighter isn't better for a man. We never say tighter, loose, looser, big, or small; we talk about fit.

Does it fit?

The man loses about 50% of the endothelium of his penis by the time he's 65. So his penis is shrinking. Now, imagine a woman who has delivered several babies; think about what happens to this device (the female sex muscles and the pelvic floor muscles) when she delivers a child.

I'm just sidetracked, but I just wanted to put this in perspective about why we are talking about this. There's the propagation of the species perspective; there’s a pleasure to the man. Don't deny it because that's necessary for the propagation of the species (and for deepening relationships). And then there's also pleasure for the woman, both physical and psychological pleasure for both.

And most of your colleagues, if you're a physician, can't name all these parts.

Not all muscles connect to bone

All right, so here we go. Perineal body or the superficial transverse perineal muscle, deep transverse perineal muscle, bulbospongiosus, ischiocavernosus. And there are no joints associated with those muscles. To help understand muscles without joints, consider the face: the only muscle I know that is not attached to any bone at all is orbicularis oris muscle.1 The orbicular oris muscle does not connect to a bone, it connects to muscles only.

The perineal body is similar to the orbicularis oris in that it IS the connection of multiple muscles—it connects muscle to muscle.

And then you think, okay, what's it doing (the prineal body)?

When the muscles connecting to it contract, there’s no joint movement; there is not joint. And I don't yet have an answer that satisfies me, but here’s what I think is happening: both in men and women, the parasympathetic system causes erection and blood flow in the clitoris. Then, with ejaculation in men and with orgasm in women, you have contraction of the muscles we are discussing.

To understand something, I like to imagine the extremes. So if these muscles became extremely relaxed, like a worn-out rubber band. If all these muscles became like that, superficial transverse peroneal muscle and deep, transverse perineal muscle, if it became relaxed, so there was no tensile strength at all to it, well then with sex, this is not attached to a bone, the introitus is just free-floating, right? Of course, there are tendons on the other side, but this is mostly free-floating.

So when this (see video) becomes contractile, it helps hold the vagina in place. And then when the corpus spongiosum and the ischiocavernosus contract, it would squeeze blood flow, rhythmically if there was orgasm going on, from the corpus cavernosi up into the body and the glands, causing congestion and increased arousal.

And so there's a positive feedback loop.

You're aroused, you have an orgasm, and then with the contractions, there becomes even more arousal, more pleasure. And so you want to play again, and eventually, you make a baby, or you make a deeper, more interesting relationship with your lover.

Okay, so I'm calling these the female sex muscles.

Making things better

Remember one of the studies we looked at involving the clitoris? Even though the clitoris has the most nerve fibers, their understanding, Dr. Paul's, if you remember, was that the root was the most arousing. Now, think about that.

That coincides with Dr. Gräfenberg's idea about the urethra, which eventually evolved into the G-spot named after Dr. Gräfenberg. Let me explain:

If you go just inside the introitus and push up (anteriorly), you are then putting pressure on both the urethra and the clitoral root. Now, once you get past these muscles, what I'm calling the sex muscles, into the vagina itself, the strength goes down (more proximal, towards the cervix), you no longer have the circumferential overlay of the female sex muscles), nor the pubic symphysis anteriorly. Posteriorly, there is only the perineal body and no bone, so when you progress proximally and pass the perineal body, the vaginal wall becomes more mobile.

Relating male masturbation to the female sex muscles

Now, watch a man when he masturbates: There is an increased pleasure if there's a wave of compression. In other words, there may be more compression on one part of the penis, and then that compression moves up and down along the corpus cavernosi, which is exactly what would happen if the female sex muscles were contracting as the penis goes in and out.

In other words, if the introitus was tighter than what's going on inside the vagina. Okay, let's look at the research. Some of that was me going by common sense. Some of it was based on research. Some of it I might've just made up because it sounded good, but I think most of what I said was right.

Relevant William Osler

Remember what William Ocer said?

He said, “If I ask three medical students how long it takes for the fingernail to grow, one will not give it a second thought, another will look it up in the book, and the third will take a silver nitrate stick and put a mark at the base of their fingernail and see how long it takes to grow to the end."

So I think I'm dealing without those students here on this call. We're all students trying to understand what has not been explained adequately and what deserves much more research because the best answers have not yet been found—not even the best questions have been asked.

Okay, let's look at some of that research, and then I'll talk about some of the actual things we have, the technologies and ideas we have to make these muscles work better and deal with the dysfunction that might happen.

How to catch a bird with your hands (and how it relates to the pelvic floor)

My grandmother used to have a saying I was reminded of when I read the research we are about to discuss.

She was a sweet lady who was a little quirky. She had a Jesus picture on every wall, but never went to church unless somebody got married or died. And she's the only person I ever knew in my entire life who I never heard say anything bad about anybody—nobody else I can say that about.

And she used to tell me, "Charles, if you go outside and you sprinkle a little salt on a bird's tail, it won't be able to fly away, and you can catch it with your hands.”

If you think about that, it's the old catch-22, right? Because if you’re close enough to put salt on the bird’s tail, well, you are close enough to catch it without the salt. But, since you can’t get close enough to put the salt, you cannot use the method to catch a bird. So, you could drive yourself insane trying to take that advice (a pretty funny joke to the 5-year-old I was when she told me the method).

The following study reminded me of what my grandmother used to tell me. What they did was they took women and had them do a Kegel. They did bi-digital palpation, so two fingers, the index and the middle finger—they even said which fingers, into the vaginal introitus, about four centimeters in.

So you go four centimeters in or a little bit less than two inches. And then, they instruct the woman to squeeze their levator and anal muscles without activating other groups of muscles. In other words, you can't contract your gluteal muscles, your legs or your abdomen.

Then they palpated the pubococcygeus on each side of the vagina and said, "Do a maximal contraction of the pubococcygeus."

Okay, now they scored the strength of the contraction.

I'm getting to the part about the salt on the tail of the bird; promise it relates.

So then they scored it from a grade zero, no contraction, grade one minor flicker, grade two is a weak muscle contraction, grade three, they're only really starting to feel it, grade four is good, and then grade five is strong. So, grades one through five and zero are nothing. One's a flicker. Not until you get to three do you have something happening.

And if you look at what they snuck in on you—they defined that one muscle, the pubococcygeal muscle, with the pelvic floor muscles. And as you just saw, really is a lot more there, but okay, it's a good way to approximate. It's easy to reach with your finger, easy to identify, you just put your finger in the vagina, feel over to either side and that's it.

Now, here's the fun part. When they graded them on the female sexual function index. I love this study. They looked at it, and they saw, as you would expect, that those with stronger muscles had better sex.

But here's the part about the salt on the tail. Now, what do you do with that?

Here's the catch-22. If you have a weak contraction—nothing or a flicker, how do you exercise something you can't move? You identify those with no strength so they can exercise the muscle, but they cannot exercise the muscle.

So, let me put it a different way: I want you to build up your bicep. Here's a dumbbell. Now, do some dumbbell curls, but while you build your bicep, I do not want you to move your bicep.

There is an answer to the salt-on-the-tail dilemma, and I'm getting to one of those answers. And I realized with some coaching, even a flicker could be eventually coached up into something stronger—but try building your bicep muscle in the gym by just “flickering” it.

But I've got a way to maybe do better than that, and I'll get to it in a second.

Bioelectric activity of the pelvic floor and sex

Here's another one: strength and bioelectrical activity of the floor.

There are so many pelvic floor muscle studies out here. And they verified the primary outcomes or level of strength, pelvic floor muscles, and then measured biological activity and sexual function and related it to both stress incontinence and sex.

And what do you think?

As you would expect the people who had weaker muscles and stress incontinence, those with stress incontinence have lower sexual desire and bioelectrical activity with the correlated parameters. Pelvic floor muscle strength of a lower degree correlates with the worse severity of urinary loss, and lower strength correlates with the relationship between the domains of sexual function (all domains of FSFI were involved except for desire).

Training the pelvic floor improves sex

So here's another one. Effects of pelvic floor muscle training on sexual function and satisfaction. In conclusion, pelvic floor muscle training is effectively improving sexual dysfunction and satisfaction and urinary symptoms.

Now, remember the definition of the pelvic floor; when you do a Kegel, remember those female sex muscles I was showing you, ischiocavernosus, superficial and deep transverse peroneal muscle, and bulbospongiosus—those are not the pelvic floor.

A fun female sexercise that you cannot do

Let me demonstrate: if you're a female, right now, close your eyes, concentrate real hard and contract your ischiocavernosus.

Got it?

Now, contract your bulbospongiosus.

If you had trouble thinking about how to do that, well, so would everybody else on the planet. So, doing Kegels does not improve the strength of the female sex muscles!

So what could you do?

How many pelvic floor studies does it take to change the world?

Here’s another study. And you realize these are just samplings; there are so many freaking studies out there about the pelvic floor. Do we really need another one?

Pelvic floor muscle training can improve sexual function, whatever we've known it. We've known it for probably 20, 30, I don't know, when did Dr. Kegel think of this exercise? I'm embarrassed I don't know the history of that, but I think it was about 40 years ago.2

Treatments

Let me swap back over to my picture, and let's think about things to do to treat sexual function by thinking about pelvic muscles.

Okay, so in that study, where they talked about pelvic floor muscles and they could feel either a flicker or nothing at all, in those who had lesser degrees of sexual satisfaction, they were talking about puborectalis; that's what they were palpating. You can see (see video) that your finger goes in; you just feel to the side, you are on puborectalis.

Now, what are some things that can go wrong?

One of them is you can get dyspareunia from the pelvic floor, just like you can get a muscle spasm or a tear or an injury to your back muscles. You can have problems with the pelvic floor.

Imagine a 10-pound baby blasting through that hiatus (looking at video), as they call it. And then what's going to happen to these muscles?

They're not as big as your bicep, they are relatively thin.

And then there's sexual trauma, and then there's just being alive. Your Valsalva when you have a bowel movement, or you ride your bicycle, and you fall, or you climb your cliff, if you're a rock climber woman, or you just slip and fall…and things get injured.

How to see the future of medicine

One way to get some clues about the future of medicine is to look at what they are doing with athletes who make a hundred million dollars per year or race horses that sell for a hundred million dollars.

If you look at that science or at what is provided to these two categories of creatures, you get a clue about the future of medicine—they are testing results in the laboratory of performance and do not have time to wait for the FDA or the AMA.

Even if you're only a high school athlete (not the 100-million-a-year professional), male or female, what did you do when you injured a muscle?

You had physical therapy with massage and vibration and strength building with contraction and relaxation.

You had pressure points, and you had nutrition.

And then, if you had a really bad tear of a muscle, you might immobilize it, or you might do a trigger point injection with corticosteroids.

PRP for the athlete’s muscles

If you are a $100 million quarterback and you tear your thigh muscle, I promise there is one thing that you're going to get that you probably will not see when a mother delivers her baby (unless it’s by one of the obstetricians in our group) And I'm about to show it to you.

Let me put that a different way: there's probably something that you did not get when you delivered your baby, but it's routinely done for professional athletes. So when you injure your muscles delivering a child, in my opinion, you get less use of available technology than what a quarterback gets, even a college quarterback, when they injure a muscle or a tendon.

A study came out this year showing how platelet-rich plasma, because of growth factors that activate pluripotent stem cells to grow new tissue, was used to heal a tendon tear (see references). There are hundreds of studies like this in the sports medicine literature regarding muscle repair.

Let's see if I can pull up a few of them.

I have some representative ones here. I'll throw these in the chat box, too, so you can copy-paste the references.

But what happens if you don't inject PRP and you tear a muscle? I hope this makes you angry; it aggravates me. It should at least aggravate you, or you’re on the wrong call … if you tear a muscle in an elite athlete and then it heals without treatment, there’s fibrosis, there’s loss of strength, there could be loss of function, and the healing time can be prolonged. And if you miss a day of work and you're making $100 million a year, then whoever's paying your salary doesn't like it.

So what do they do?

They inject it with platelet-rich plasma, and studies show that it activates pluripotent stem cells and attenuates the ill effects. You don't have as much fibrosis, you recover your strength faster, and you avoid dysfunction of the muscle that was torn, whether it was the thigh muscle, back muscle, or whatever was injured.

So, back to what we’re talking about, this is just one, and I just copied and pasted other representative studies.

So, one thing that you can do to help with recovery would be just good nutrition. So you have healing.

You could have a massage, which could be pleasant if it is a massage of the pelvic floor. Again, I'm just thinking of analogies between a quarterback for the Dallas Cowboys, a mother who just delivered a child or a mother who delivered a child 20 years ago, and now she's postmenopausal and trying to recover the muscles that were damaged or atrophied some with time.

And those studies have been done: just like a man's bicep atrophies, a woman's pelvic muscles atrophied. Notice I didn't say pelvic floor, pelvic muscles, including transverse perineal muscle, et cetera.

So you could have a physical therapist. You could have cortisone if you had a tear, but you would never do that to a quarterback (weakens the muscle), although it’s still being done for pelvic floor tenderness in regard to dyspareunia in women.

But if you're a quarterback, you would never have that done because you're going to have atrophy. Even in the joints, it's been found that you'll have immediate pain relief if you inject joints with cortisone. But if you watch the joint over a year, you have less joint destruction and even repair with platelet-rich plasma, where you have continued atrophy or even acceleration of osteoporosis and degradation of the joint when you use cortisone.

So why are we still injecting pelvises with cortisone instead of with platelet-rich plasma as is done if it's the muscle of an athlete?

A muscle is a muscle is a muscle. I don't know, but thankfully, you’re on this call, and you can help us change that. So now, what do you do? So you've got a massage, which could be your lover; it could be yourself.

You have trigger point release, and there's a whole science about that out there.

Your pelvic floor physical therapist could do it. But now that you know the anatomy, you can think about what you could say or do, tell your lover to do or do for yourself if you wanted to release tension in the pelvic floor or one of these other muscles like transverse peroneal, superficial or deep or your peroneal body.

So you have trigger point release, or you could do acupuncture.

All these things are done with athletes. You could do vibration; that could be fine. You could also do heat or ice; both of those things are used with the injured athlete.

And then platelet-rich plasma we just talked about. We've been doing it for a decade now, more than a decade, 13 years we've been doing a modified O-Shot® procedure: You still have PRP into the anterior vaginal wall, and into the clitoral body but also into the pelvic muscles, into trigger points.

We have about 1,500 people trained and licensed to do the procedure, but there are 35,000 gynecologists, 20,000 urologists, and 100,000 primary care physicians in the US alone. We need more people who know how to do this, so help us spread the word.

And I think there’s going to be a modification of the O-Shot® that also involves injecting the perineal body with platelet-rich plasma, easy to find, easy to palpate, and that would increase the strength of ischiocavernosus and bulbospongiosus as well as superficial and deep transverse peroneal muscles.

How to turn a flicker into an athletic contraction

Remember we talked about what do you do for the woman who can only flicker or do nothing? How do you train that muscle? She cannot do a Kegel. It's like catching a bird with salt on the tail. If she could move the muscle well, she wouldn’t need to train it, but since she couldn’t move it at all, she couldn’t train it. So she's caught.

Well, that's where your Emsella machine comes in, and there are other devices; but, I think this is probably the Cadillac. And they don't pay me any money to say that. There used to be a vibrator called an intensity, which they called muscle contraction. I've heard it's gone out of production, but even that was not as powerful as an Emsella machine. And I'll show you what it looks like (see links and video).

Enhanced Emsella riding technique for female sex muscle development

But if you're going to use it for sexual function versus urinary incontinence, you should modify the way it's done.

If you go to the O-Shot directory, those who have an Emsella machine, it costs as much as a house, so most people don't have one. But if you find someone who has that icon by their name, then they not only do the O-Shot, but they could combine injecting the pelvic muscles, not just the pelvic floor but the pelvic muscles with PRP along with the O-Shot for sexual function and urinary incontinence. And the Emsella is a Tesla magnet that causes contraction.

So here's their website, but it causes contraction. They're showing contraction of the pelvic floor, but I'm about to show you how to modify the way it's done so that you are contracting not just the pelvic floor but the female sex muscles.

For dyspareunia in the pelvic floor, it could be injecting platelet-rich plasma with a modified O-Shot® procedure by one of our providers combined with pelvic floor physical therapy, good nutrition, and having sex.

I love that part of our aftercare instructions is usually to go have sex. But it should be one of our people so they know how to do the O-Shot® procedure properly. It's not just a shot. People need to know how to make the plasma correctly, how to activate it, where to inject it, and how to inject pain-free.

It's not just throw that needle up in there anywhere. You can hurt people, not damage them, but you can make them hurt. You can cause pain, and if you don’t know what you’re doing and preparing it, you could be unsafe.

So our people know how to keep it safe. And our people offer money back; they’re not going to keep your money if you don't get better. We're not stealing from people and not going to treat you if they don't think they can get you better.

Okay. So, that would be one modification for pelvic floor tenderness with dyspareunia. The other modification for just a super-enhanced sexual enhancement could be improving orgasmic function or arousal, which could be what we already know.

Remember, I don't have to prove this; we know that exercising the pelvis; I just showed you one of literally hundreds of studies showing exercising the pelvis leads to better sexual function.

And then I showed you studies showing that injecting platelet-rich plasma leads to enhanced and improved muscle function, and now you're combining improved muscle function from the exercise physiology research with muscle function with the Emsella, and then you have some good sex and combine that with just good relationships.

Never forget that's an important part of the female. All the rest of the female sexual orgasm system applies. All of it: endocrine, the brain, the spinal cord, the clitoris, the urethral tract, all the components. Some we've covered, and some we haven’t; it all still applies.

But I think with that, unless there are questions, we will call it a day. Let's see what we got. No questions. So, hopefully, that's helpful. Eventually, I'll send the PDF transcript out of this that's edited and tightened up some. And I hope that if you are a patient or a physician, you found something helpful here to make life better.

Have a good day.

Footnotes

  1. For a little joke, you can tell your friends, another definition of the kiss is the anti juxtaposition of two orbicular oris muscles in the state of contraction. ↩︎
  2. I looked it up, it was about 60 years ago (in the 1940s) ↩︎

More about Emsella<--

References

Brækken, Ingeborg H., Memona Majida, Marie Ellström Engh, and Kari Bø. “Can Pelvic Floor Muscle Training Improve Sexual Function in Women with Pelvic Organ Prolapse? A Randomized Controlled Trial.” The Journal of Sexual Medicine 12, no. 2 (February 1, 2015): 470–80. https://doi.org/10.1111/jsm.12746.
Celenay, Seyda Toprak, Yasemin Karaaslan, and Enver Ozdemir. “Effects of Pelvic Floor Muscle Training on Sexual Dysfunction, Sexual Satisfaction of Partners, Urinary Symptoms, and Pelvic Floor Muscle Strength in Women with Overactive Bladder: A Randomized Controlled Study.” The Journal of Sexual Medicine 19, no. 9 (September 1, 2022): 1421–30. https://doi.org/10.1016/j.jsxm.2022.07.003.
Edenfield, Autumn L., Pamela J. Levin, Alexis A. Dieter, Cindy L. Amundsen, and Nazema Y. Siddiqui. “Sexual Activity and Vaginal Topography in Women with Symptomatic Pelvic Floor Disorders.” The Journal of Sexual Medicine 12, no. 2 (February 1, 2015): 416–23. https://doi.org/10.1111/jsm.12716.
Ferreira, Clicia Raiane Galvão, Wenderk Martins Soares, Caren Heloise da Costa Priante, Natália de Souza Duarte, Cleuma Oliveira Soares, Kayonne Campos Bittencourt, Giovana Salomão Melo, et al. “Strength and Bioelectrical Activity of the Pelvic Floor Muscles and Sexual Function in Women with and without Stress Urinary Incontinence: An Observational Cross-Sectional Study.” Healthcare (Basel, Switzerland) 11, no. 2 (January 6, 2023): 181. https://doi.org/10.3390/healthcare11020181.
Lutz, Robert H., Justin E. King, Timothy C. Sell, Charlotte L. Early, and Emma M. Nguyen. “Platelet-Rich Plasma Treatment of a Quadriceps Tendon Tear in a Collegiate Basketball Athlete.” Current Sports Medicine Reports 22, no. 11 (November 2023): 370–74. https://doi.org/10.1249/JSR.0000000000001115.
Omodei, Michelle Sako, Lucia Regina Marques Gomes Delmanto, Eduardo Carvalho-Pessoa, Eneida Boteon Schmitt, Georgia Petri Nahas, and Eliana Aguiar Petri Nahas. “Association Between Pelvic Floor Muscle Strength and Sexual Function in Postmenopausal Women.” The Journal of Sexual Medicine 16, no. 12 (December 1, 2019): 1938–46. https://doi.org/10.1016/j.jsxm.2019.09.014.

Regarding PRP for Muscle Strength & Repair

Agarwal, Varsha, Ambika Gupta, Harneet Singh, Mala Kamboj, Harsha Popli, and Suman Saroha. “Comparative Efficacy of Platelet-Rich Plasma and Dry Needling for Management of Trigger Points in Masseter Muscle in Myofascial Pain Syndrome Patients: A Randomized Controlled Trial.” Journal of Oral & Facial Pain and Headache, November 28, 2022. https://doi.org/10.11607/ofph.3188.
Aguilar-García, Daniel, J. Andrés Fernández-Sarmiento, María del Mar Granados Machuca, Juan Morgaz Rodríguez, Pilar Muñoz Rascón, Rocío Navarrete Calvo, Yolanda Millán Ruiz, et al. “Histological and Biochemical Evaluation of Plasma Rich in Growth Factors Treatment for Grade II Muscle Injuries in Sheep.” BMC Veterinary Research 18, no. 1 (November 12, 2022): 400. https://doi.org/10.1186/s12917-022-03491-2.
Bernuzzi, Gino, Federica Petraglia, Martina Francesca Pedrini, Massimo De Filippo, Francesco Pogliacomi, Michele Arcangelo Verdano, and Cosimo Costantino. “Use of Platelet-Rich Plasma in the Care of Sports Injuries: Our Experience with Ultrasound-Guided Injection.” Blood Transfusion 12, no. Suppl 1 (January 2014): s229–34. https://doi.org/10.2450/2013.0293-12.
Bubnov, Rostyslav, Viacheslav Yevseenko, and Igor Semeniv. “Ultrasound Guided Injections of Platelets Rich Plasma for Muscle Injury in Professional Athletes. Comparative Study.,” n.d., 5.
Graca, Flavia A., Anna Stephan, Benjamin A. Minden-Birkenmaier, Abbas Shirinifard, Yong-Dong Wang, Fabio Demontis, and Myriam Labelle. “Platelet-Derived Chemokines Promote Skeletal Muscle Regeneration by Guiding Neutrophil Recruitment to Injured Muscles.” Nature Communications 14, no. 1 (May 22, 2023): 2900. https://doi.org/10.1038/s41467-023-38624-0.
Le, Adrian D.K., Lawrence Enweze, Malcolm R. DeBaun, and Jason L. Dragoo. “Platelet-Rich Plasma.” Clinics in Sports Medicine 38, no. 1 (January 2019): 17–44. https://doi.org/10.1016/j.csm.2018.08.001.
Middleton, Kellie K, Victor Barro, Bart Muller, Satosha Terada, and Freddie H Fu. “Evaluation of the Effects of Platelet-Rich Plasma (PRP) Therapy Involved in the Healing of Sports-Related Soft Tissue Injuries.” The Iowa Orthopaedic Journal 32 (2012): 150–63. http://www.ncbi.nlm.nih.gov/pubmed/23576936.
Moraes, Vinícius Y, Mário Lenza, Marcel Jun Tamaoki, Flávio Faloppa, and João Carlos Belloti. “Platelet-Rich Therapies for Musculoskeletal Soft Tissue Injuries.” The Cochrane Database of Systematic Reviews 12 (January 2013): CD010071. https://doi.org/10.1002/14651858.CD010071.pub2.

Regarding Emsella

Azparren, Javier, and Judson Brandeis. “HIFEM PROCEDURE ENHANCES QUALITY OF LIFE OF ELDERLY MEN WITH POST-PROSTATECTOMY INCONTINENCE,” n.d., 6.
Evans, Kimberly, and Julene B Samuels. “FEMALE URINARY INCONTINENCE AND SEXUAL FUNCTION AFTER THE HIFEM® PROCEDURE,” n.d., 2.
Gözlersüzer, Özlem, Bestami Yalvaç, and Basri Çakıroğlu. “Investigation of the Effectiveness of Magnetic Field Therapy in Women with Urinary Incontinence: Literature Review.” Urologia Journal, January 9, 2022, 03915603211069010. https://doi.org/10.1177/03915603211069010.
He, Qing, Kaiwen Xiao, Liao Peng, Junyu Lai, Hong Li, Deyi Luo, and Kunjie Wang. “An Effective Meta-Analysis of Magnetic Stimulation Therapy for Urinary Incontinence.” Scientific Reports 9 (June 24, 2019): 9077. https://doi.org/10.1038/s41598-019-45330-9.
Hwang, Ui-Jae, Min-Seok Lee, and Oh-Yun Kwon. “Effect of Pelvic Floor Muscle Electrical Stimulation on Lumbopelvic Control in Women with Stress Urinary Incontinence: Randomized Controlled Trial.” Physiotherapy Theory and Practice 0, no. 0 (April 18, 2022): 1–10. https://doi.org/10.1080/09593985.2022.2067508.
Samuels, Julene B. “HIFEM TECHNOLOGY – THE NON-INVASIVE TREATMENT OF URINARY INCONTINENCE,” n.d., 7.
Samuels, Julene B, and Kimberly Evans. “FEMALE SEXUAL FUNCTION AND URINARY INCONTINENCE AFTER HIFEM® PROCEDURE,” n.d., 1.
Samuels, Julene B., Andrea Pezzella, Joseph Berenholz, and Red Alinsod. “Safety and Efficacy of a Non‐Invasive High‐Intensity Focused Electromagnetic Field (HIFEM) Device for Treatment of Urinary Incontinence and Enhancement of Quality of Life.” Lasers in Surgery and Medicine 51, no. 9 (November 2019): 760–66. https://doi.org/10.1002/lsm.23106.
———. “Safety and Efficacy of a Non‐Invasive High‐Intensity Focused Electromagnetic Field (HIFEM) Device for Treatment of Urinary Incontinence and Enhancement of Quality of Life.” Lasers in Surgery and Medicine 51, no. 9 (November 2019): 760–66. https://doi.org/10.1002/lsm.23106.
Silantyeva, Elena, Dragana Zarkovic, Evgeniia Astafeva, Ramina Soldatskaia, Mekan Orazov, Marina Belkovskaya, Mark Kurtser, and Academician of the Russian Academy of Sciences. “A Comparative Study on the Effects of High-Intensity Focused Electromagnetic Technology and Electrostimulation for the Treatment of Pelvic Floor Muscles and Urinary Incontinence in Parous Women: Analysis of Posttreatment Data.” Female Pelvic Medicine & Reconstructive Surgery 27, no. 4 (April 2021): 269–73. https://doi.org/10.1097/SPV.0000000000000807.
———. “A Comparative Study on the Effects of High-Intensity Focused Electromagnetic Technology and Electrostimulation for the Treatment of Pelvic Floor Muscles and Urinary Incontinence in Parous Women: Analysis of Posttreatment Data.” Female Pelvic Medicine & Reconstructive Surgery 27, no. 4 (April 2021): 269–73. https://doi.org/10.1097/SPV.0000000000000807.

Regarding O-Shot® Procedure for Sexual Function

Cardozo, Linda, and David Staskin, eds. Textbook of Female Urology and Urogynecology. Fourth edition. Boca Raton: CRC Press, Taylor & Francis Group, 2017.
Handy, Ariel B., Amelia M. Stanton, and Cindy M. Meston. “Understanding Women’s Subjective Sexual Arousal Within the Laboratory: Definition, Measurement, and Manipulation.” Sexual Medicine Reviews 6, no. 2 (2018): 201–16. https://doi.org/10.1016/j.sxmr.2017.11.001.
Hersant, Barbara, Mounia SidAhmed-Mezi, Yazid Belkacemi, Franklin Darmon, Sylvie Bastuji-Garin, Gabrielle Werkoff, Romain Bosc, et al. “Efficacy of Injecting Platelet Concentrate Combined with Hyaluronic Acid for the Treatment of Vulvovaginal Atrophy in Postmenopausal Women with History of Breast Cancer.” Menopause 25, no. 10 (2018): 1. https://doi.org/10.1097/GME.0000000000001122.
Jb, Neto. “O-Shot: Platelets Rich Plasma in Intimate Female Treatment,” 2017, 4.
Jhang, Jia-Fong, Shu-Yu Wu, Teng-Yi Lin, and Hann-Chorng Kuo. “Repeated Intravesical Injections of Platelet-Rich Plasma Are Effective in the Treatment of Interstitial Cystitis: A Case Control Pilot Study.” LUTS: Lower Urinary Tract Symptoms 11, no. 2 (2019): O42–47. https://doi.org/10.1111/luts.12212.
Long, Cheng-Yu. “A Pilot Study: Effectiveness of Local Injection of Autologous Platelet-Rich Plasma in Treating Women with Stress Urinary Incontinence.” Scientific Reports, 2021, 9.
Matz, Ethan L, Amy M Pearlman, and Ryan P Terlecki. “Safety and Feasibility of Platelet Rich Fibrin Matrix Injections for Treatment of Common Urologic Conditions.” Investigative and Clinical Urology 59, no. 1 (January 2018): 61–65. https://doi.org/10.4111/icu.2018.59.1.61.
Merhi, Zaher, Serin Seckin, and Marco Mouanness. “REPRODUCTIVE ENDOCRINOLOGY: CASE STUDY Intraovarian PRP Injection Improved Hot Flashes in a Woman With Very Low Ovarian Reserve.” Accessed July 7, 2021. https://doi.org/10.1007/s43032-021-00655-7.
Moccia, Felice, Paola Pentangelo, Alessandra Ceccaroni, Antonio Raffone, Luigi Losco, and Carmine Alfano. “Injection Treatments for Vulvovaginal Atrophy of Menopause: A Systematic Review.” Aesthetic Plastic Surgery, August 14, 2023. https://doi.org/10.1007/s00266-023-03550-5.
Nikolopoulos, Kostis I., Vasilios Pergialiotis, Despina Perrea, and Stergios K. Doumouchtsis. “Restoration of the Pubourethral Ligament with Platelet Rich Plasma for the Treatment of Stress Urinary Incontinence.” Medical Hypotheses 90 (May 1, 2016): 29–31. https://doi.org/10.1016/j.mehy.2016.02.019.
Prodromidou, Anastasia, Themos Grigoriadis, and Stavros Athanasiou. “Platelet Rich Plasma for the Management of Urogynecological Disorders: The Current Evidence.” Current Opinion in Obstetrics & Gynecology Publish Ahead of Print (August 18, 2022). https://doi.org/10.1097/GCO.0000000000000820.
Prodromidou, Anastasia, Dimitrios Zacharakis, Stavros Athanasiou, Athanasios Protopapas, Lina Michala, Nikolaos Kathopoulis, and Themos Grigoriadis. “The Emerging Role on the Use of Platelet-Rich Plasma Products in the Management of Urogynaecological Disorders.” Surgical Innovation, April 28, 2021, 15533506211014848. https://doi.org/10.1177/15533506211014848.
Runels, Charles. “A Pilot Study of the Effect of Localized Injections of Autologous Platelet Rich Plasma (PRP) for the Treatment of Female Sexual Dysfunction.” Journal of Women’s Health Care 03, no. 04 (2014). https://doi.org/10.4172/2167-0420.1000169.
Sanoulis, Vasileios, Nikolaos Nikolettos, and Nikolaos Vlahos. “The Use of Platelet-Rich Plasma in the Gynaecological Clinical Setting. A Review.” 18, no. 3 (2019): 11.
———. “The Use of Platelet-Rich Plasma in the Gynaecological Clinical Setting. A Review.” Hellenic Journal of Obstetrics and Gynecology 18, no. 3 (July 3, 2019): 55–65. https://doi.org/10.33574/hjog.1766.
Sharp, Gemma, Pascale Maynard, Christine A Hamori, Jayson Oates, David B Sarwer, and Jayashri Kulkarni. “Measuring Quality of Life in Female Genital Cosmetic Procedure Patients: A Systematic Review of Patient-Reported Outcome Measures.” Aesthetic Surgery Journal 40, no. 3 (February 17, 2020): 311–18. https://doi.org/10.1093/asj/sjz325.
Zheng, Zhifang. “Materials Selection for the Injection into Vaginal Wall for Treatment of Vaginal Atrophy,” 2021, 11.
Liu, Zhaoxue, Yuan Tang, Jiaojiao Liu, Ruting Shi, Michael Houston, Alvaro Munoz, Yingchun Zhang, and Xuhong Li. “Platelet-Rich Plasma Promotes Restoration of The Anterior Vaginal Wall for The Treatment of Pelvic Floor Dysfunction in Rats.” Journal of Minimally Invasive Gynecology, October 2022, S1553465022009463. https://doi.org/10.1016/j.jmig.2022.10.004.

Female Orgasm System: The Female Sex Muscles

Video review and transcript pending

References

Pelvic Floor

Brækken, Ingeborg H., Memona Majida, Marie Ellström Engh, and Kari Bø. “Can Pelvic Floor Muscle Training Improve Sexual Function in Women with Pelvic Organ Prolapse? A Randomized Controlled Trial.” The Journal of Sexual Medicine 12, no. 2 (February 1, 2015): 470–80. https://doi.org/10.1111/jsm.12746.
Celenay, Seyda Toprak, Yasemin Karaaslan, and Enver Ozdemir. “Effects of Pelvic Floor Muscle Training on Sexual Dysfunction, Sexual Satisfaction of Partners, Urinary Symptoms, and Pelvic Floor Muscle Strength in Women with Overactive Bladder: A Randomized Controlled Study.” The Journal of Sexual Medicine 19, no. 9 (September 1, 2022): 1421–30. https://doi.org/10.1016/j.jsxm.2022.07.003.
Edenfield, Autumn L., Pamela J. Levin, Alexis A. Dieter, Cindy L. Amundsen, and Nazema Y. Siddiqui. “Sexual Activity and Vaginal Topography in Women with Symptomatic Pelvic Floor Disorders.” The Journal of Sexual Medicine 12, no. 2 (February 1, 2015): 416–23. https://doi.org/10.1111/jsm.12716.
Ferreira, Clicia Raiane Galvão, Wenderk Martins Soares, Caren Heloise da Costa Priante, Natália de Souza Duarte, Cleuma Oliveira Soares, Kayonne Campos Bittencourt, Giovana Salomão Melo, et al. “Strength and Bioelectrical Activity of the Pelvic Floor Muscles and Sexual Function in Women with and without Stress Urinary Incontinence: An Observational Cross-Sectional Study.” Healthcare (Basel, Switzerland) 11, no. 2 (January 6, 2023): 181. https://doi.org/10.3390/healthcare11020181.
Omodei, Michelle Sako, Lucia Regina Marques Gomes Delmanto, Eduardo Carvalho-Pessoa, Eneida Boteon Schmitt, Georgia Petri Nahas, and Eliana Aguiar Petri Nahas. “Association Between Pelvic Floor Muscle Strength and Sexual Function in Postmenopausal Women.” The Journal of Sexual Medicine 16, no. 12 (December 1, 2019): 1938–46. https://doi.org/10.1016/j.jsxm.2019.09.014.

Urinary Sphincter

Athanasiou, Stavros, Christos Kalantzis, Dimitrios Zacharakis, Nikolaos Kathopoulis, Artemis Pontikaki, and Themistoklis Grigoriadis. “The Use of Platelet-Rich Plasma as a Novel Nonsurgical Treatment of the Female Stress Urinary Incontinence: A Prospective Pilot Study.” Female Pelvic Medicine & Reconstructive Surgery 27, no. 11 (November 2021): e668–72. https://doi.org/10.1097/SPV.0000000000001100.
Callewaert, Geertje, Marina Monteiro Carvalho Mori Da Cunha, Nikhil Sindhwani, Maurilio Sampaolesi, Maarten Albersen, and Jan Deprest. “Cell-Based Secondary Prevention of Childbirth-Induced Pelvic Floor Trauma.” Nature Reviews Urology 14, no. 6 (June 2017): 373–85. https://doi.org/10.1038/nrurol.2017.42.
Ford, Abigail A., Lynne Rogerson, June D. Cody, and Joseph Ogah. “Mid‐urethral Sling Operations for Stress Urinary Incontinence in Women.” Cochrane Database of Systematic Reviews, no. 7 (2015). https://doi.org/10.1002/14651858.CD006375.pub3.
Indian Journal of Medical Ethics. “Cosmetic Surgical Procedures on the Vulva and Vagina - an Overview.” Accessed January 18, 2022. https://ijme.in/articles/cosmetic-surgical-procedures-on-the-vulva-and-vagina-an-overview/.
Joseph, Christine, Kosha Srivastava, Olive Ochuba, Sheila W. Ruo, Tasnim Alkayyali, Jasmine K. Sandhu, Ahsan Waqar, Ashish Jain, and Sujan Poudel. “Stress Urinary Incontinence Among Young Nulliparous Female Athletes.” Cureus 13, no. 9 (September 2021). https://doi.org/10.7759/cureus.17986.
Kirchin, Vivienne, Tobias Page, Phil E. Keegan, Kofi OM Atiemo, June D. Cody, Samuel McClinton, Patricia Aluko, and Cochrane Incontinence Group. “Urethral Injection Therapy for Urinary Incontinence in Women.” The Cochrane Database of Systematic Reviews 2017, no. 7 (July 2017). https://doi.org/10.1002/14651858.CD003881.pub4.
Lee, Patricia E., Rose C. Kung, and Harold P. Drutz. “PERIURETHRAL AUTOLOGOUS FAT INJECTION AS TREATMENT FOR FEMALE STRESS URINARY INCONTINENCE: A RANDOMIZED DOUBLE-BLIND CONTROLLED TRIAL.” Journal of Urology 165, no. 1 (January 2001): 153–58. https://doi.org/10.1097/00005392-200101000-00037.
Long, Cheng-Yu, Kun-Ling Lin, Chin-Ru Shen, Chin-Ru Ker, Yi-Yin Liu, Zi-Xi Loo, Hui-Hua Hsiao, and Yung-Chin Lee. “A Pilot Study: Effectiveness of Local Injection of Autologous Platelet-Rich Plasma in Treating Women with Stress Urinary Incontinence.” Scientific Reports 11, no. 1 (December 2021): 1584. https://doi.org/10.1038/s41598-020-80598-2.
Nikolopoulos, Kostis I., Vasilios Pergialiotis, Despina Perrea, and Stergios K. Doumouchtsis. “Restoration of the Pubourethral Ligament with Platelet Rich Plasma for the Treatment of Stress Urinary Incontinence.” Medical Hypotheses 90 (May 2016): 29–31. https://doi.org/10.1016/j.mehy.2016.02.019.
O’Connor, Eabhann, Aisling Nic an Riogh, Markos Karavitakis, Serenella Monagas, and Arjun Nambiar. “Diagnosis and Non-Surgical Management of Urinary Incontinence &ndash; A Literature Review with Recommendations for Practice.” International Journal of General Medicine 14 (August 16, 2021): 4555–65. https://doi.org/10.2147/IJGM.S289314.
Oshiro, Takuma, Ryu Kimura, Keiichiro Izumi, Asuka Ashikari, Seiichi Saito, and Minoru Miyazato. “Changes in Urethral Smooth Muscle and External Urethral Sphincter Function with Age in Rats.” Physiological Reports 8, no. 24 (2021): e14643. https://doi.org/10.14814/phy2.14643.
PANDIT, MEGHANA, JOHN O. L. DELANCEY, JAMES A. ASHTON-MILLER, JYOTHSNA IYENGAR, MILA BLAIVAS, and DANIELE PERUCCHINI. “Quantification of Intramuscular Nerves Within the Female Striated Urogenital Sphincter Muscle.” Obstetrics and Gynecology 95, no. 6 Pt 1 (June 2000): 797–800. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1192577/.
Perucchini, Daniele, John O.L. DeLancey, James A. Ashton-Miller, Andrzej Galecki, and Gabriel N. Schaer. “Age Effects on Urethral Striated Muscle II. Anatomic Location of Muscle Loss.” American Journal of Obstetrics and Gynecology 186, no. 3 (March 2002): 356–60. https://doi.org/10.1067/mob.2002.121090.
Perucchini, Daniele, John OL DeLancey, James A. Ashton-Miller, Ursula Peschers, and Tripti Kataria. “Age Effects on Urethral Striated Muscle I. Changes in Number and Diameter of Striated Muscle Fibers in the Ventral Urethra.” American Journal of Obstetrics & Gynecology 186, no. 3 (March 1, 2002): 351–55. https://doi.org/10.1067/mob.2002.121089.
Samy Tahoon, Ahmed, Hossam El-Din Hussein Salem, and Assem Anwar Abdo Mousa. “The Role of Platelet Rich Plasma Injections in Cases of Stress Incontinence.” Preprint, May 14, 2022. https://doi.org/10.32388/KG77ZQ.
Wiśniewska-Ślepaczuk, Katarzyna, Agnieszka Pieczykolan, Joanna Grzesik-Gąsior, and Artur Wdowiak. “A Review of Aesthetic Gynecologic Procedures for Women.” Plastic Surgical Nursing 41, no. 4 (October 2021): 191–202. https://doi.org/10.1097/PSN.0000000000000400.
Zhou, Shukui, Kaile Zhang, Anthony Atala, Oula Khoury, Sean V Murphy, Weixin Zhao, and Qiang Fu. “Stem Cell Therapy for Treatment of Stress Urinary Incontinence: The Current Status and Challenges,” n.d. https://doi.org/10.1155/2016/7060975.
Zubieta, Maria, Rebecca L. Carr, Marcus J. Drake, and Kari Bø. “Influence of Voluntary Pelvic Floor Muscle Contraction and Pelvic Floor Muscle Training on Urethral Closure Pressures: A Systematic Literature Review.” International Urogynecology Journal 27, no. 5 (May 2016): 687–96. https://doi.org/10.1007/s00192-015-2856-9.

Female Orgasm System | Clitoris | Bulb and Root

Transcript

Here's a pdf version of this transcript<--

Hello. Thank you, guys, for showing up again today. We took a couple of weeks off from our review of the female orgasm system. And now, we are ready to roll again.

Even Medical School Does Not Teach all of the Anatomy of the Female, and that Matters

When I was a kid, I remember wondering, "What the heck does the vagina look like?"

And then, as I got older and had girlfriends and then went to medical school and learned what the vagina is like, I was somewhat disappointed to realize that often it is thought about as if it were just a simple birth canal and a urinary tract and the elegance of the parts were not really discussed.

It turns out, my disappointment was not misplaced. An article that came out this year in the Journal of Sexual Medicine made a big point of the fact that not knowing about the female genital anatomy is not insignificant (Peters, 2023); if we don't think about the parts—all of the parts—then we do not know best how to treat dysfunction.

Another article demonstrated that, of seven medical schools in the Chicago area, only one was teaching all of the components of the clitoris (Codispoti, 2023). And the irony is that, in that article, they did not even test for all the parts. They left one of the components of the anatomy, the clitoral root, out of their evaluation of the curriculum.1

What is the “Female Orgasm System”?

There are two components of the female orgasm system that I think are most nebulous. Not only are they unseen, they are less discussed and more vaguely conceptualized by most physicians. Before we think about them, take 30 seconds to review what we were doing with this series of lessons: a systems analysis of the female orgasm.

Systems analysis first involves, "What's the purpose of all the parts working together?"

There is overlap; some parts work in both the respiratory and cardiovascular systems. Some parts of the urinary system are in the reproductive system or in the orgasm system. But, when you have a discreet set of parts that perform a specific function (in this case, sexual arousal in females, not reproduction, but sexual arousal, sometimes leading to orgasm)—then that is a separate system.

You can become more and more detailed by dividing each component, each subcomponent, and each sub-sub-component going on for infinity into the sub-particle level and eventually into ethics, philosophy, and mathematics (since everything is related to everything). But, clinically and practically, first-order components are most important to help women to better health and marriages.

You cannot really think about how all the parts work together if you do not even think about “What are all the parts?”

Two Nebulous Parts of the Female Orgasm System

An article showed that (looking at medical schools) not all the parts are even being taught. I made a sketch (see the video) from a detailed article showing the suspensory ligament, prepuce (the hood), body, and glans. In the sketch, you will also see the root and the bulb; these two components of the female orgasm system seem nebulous to most people.

The Bulb of the Clitoris

At one time, the bulb was considered part of the labia, but it is contiguous with the body of the clitoris. And so, most people consider it, now, to be equivalent to the corpus spongiosum of a male and as just as much a part of the clitoris as the corpus spongiosum is to the penis.

More about the bulbs later.

The Root of the Clitoris

But the root is even more nebulous. Let me show you something that I did this morning. I think this will shock you: I went to the AI app that everybody's using now. When you search for the “root of the clitoris” in the new AI application, it says, "The clitoris is a complex organ, highly sensitive organ, female genitalia. It doesn't have a root like a plant does. Instead, it has a visible and internal components,"

I will show you how the root relates to the G-spot, the urethra, and sexual function. Before I do, consider the root from the lover’s perspective (including the woman who loves herself (I am only partly referring to masturbation).

Why the Root Matters in the Lover’s Mind

I have a friend, Anne Kent Rush, who co-authored and illustrated the first massage book published in the United States that was written for people other than physical therapists (Downing, 1972). I first read it when I was about 17, and I’m 63 right now.

Back in the '50s, massage therapists were thought to be people who gave you a happy ending, and their places of business were in the red-light districts. But, Ms. Rush, with her writing did much to change that.

In her book (co-authored with Downing), she gave what I think to be great advice for lovers or massage therapists. She said, "Let your hands talk to the other person about their own body."

So, if you are touching someone's back and you're just rubbing it absent-minded like their back is a piece of meat, that's one thing. But if you can actually see (in your mind’s eye) and say to the person, “Here are your splenius capitis; here are your paraspinal muscles; here is your trapezius; and here are the insertion sites, and here is the full length and beauty of this muscle,” and your hands are gently teaching the person, showing the person, the individual muscles and how miraculous their body-temple is constructed, then they are going to enjoy a beautiful massage.

How much more so if you do the same with the genitalia?

So, translate that idea over to lovemaking and imagine making love to your lover’s genitalia with full knowledge of all the seen and the unseen.

Now imagine the opposite: I have seen very bright physicians come to my workshops, and when we do the hands-on practice of how to do the O-Shot® procedure, and their wife is the model, I am often shocked to see the spouse fumble with the identification of the anatomy while doing a procedure on his own wife. And, I guess I shouldn't be shocked since we just discussed that female genital anatomy is not taught in medical school; so where was he to learn it? From the football coach who taught him sex education in high school?

If you are going to be the doctor to people with vaginas or you are going to be the lover of people with vaginas, even whether the vagina is yours or another person's, it might be helpful to know all the parts so you can love on them or treat them, whatever the case may be.

I acknowledge that, in the heat of passion with the woman you love, no one thinks about the intricacies of the clitoral anatomy. In the heat of passion, it is just sweat and sounds, and no one is speaking like the Oxford English Dictionary or thinking about the intricate connections of the prepuce or the suspensory ligament; that’s not happening.

But, on the other side of that, knowing every part could make you a better lover and it could certainly make you a better physician. Maybe I am overemphasizing the point, but I don't want you to think that I think it is necessary to know every part, to have good love-making, I think it can take things to another level if combined with the rest of your passion and intellect.

I sketched my version of it, a simplified version of the root (see the video). Part of the confusion for the confusion regarding the root is that the multiple planes of the crus and the bulbs make it difficult to illustrate. But, if you look at this dorsal view, you can see the glans, the body, and the clitoris. It comes down to this area, from which the corpus splits away. And it's been dissected, where you can see it on the patient's left, but not on the right (refer to the video).

And then, if you look at the transverse view, you can see one of the corpus cavernosi, coming towards you, and you can see the suspensory ligament. And, as you know, there's another corpus cavernosi going away from you.

So, let me draw it, in just about as simple as I could draw it, which would be like this. Here's glans, and here's corpus cavernosi. But what do you call that? That is not the glans, it's not the body, it's not the corpus cavernosi, it's the root.

In spite of what your artificial intelligence app says. The clitoris does have a root. It is talked about in the research; it is important; and you should know what it is and where it is.

Do we want to just go back to thinking of the introitus, labia, and clitoris as just a glob of tissue, or do we actually want to understand it?

Of course, you do because you're on this call!

Here’s a crucial point from one of my favorite papers regarding female anatomy (Pauls, 2015), discussing the clitoral root,

"It's positioned beneath the skin of the vestibule and forms the connection from the clitoral body to the crura, overlapping with the two bulbs of the vestibule. The root is considered of importance because of the sensation. The convergence of the clitoral erectile bodies may be the most responsive to direct stimulation, owing to its superficial location and its depth of erectile tissue."

Okay? Read that again and tell me the root is not important. I dare you.

Dr. G, the G-Spot, and the Clitoral Root

Now, think about where the root is:

The urethral orifice lies at the most posterior portion of the clitoral root. So, if you go back to this picture, the clitoris is angling down (caudal). And the urethral orifice is near the root.

Now, think about what the G-spot is:

Dr. Grafenberg's big idea was not really regarding a spot. His noticing was that pressure on the urethra, not a spot, the urethra, was the most stimulatory thing possible to a woman’s body. Pressure there resulted in the most amazing orgasms. And he documented or described female ejaculation from stimulating the urethra with pressure on the anterior vaginal wall (Grafenberg, 1950).

Pressure from the anterior vaginal wall against the urethra, the root is right there. The root is very responsive to stimulation (Oakley, 2013). It could be that part of what's happening when you stimulate the so-called G-spot2: pressure there is definitely going also to stimulate the clitoral root.

So, when Dr. Grafenberg described stimulation of the urethra, he was also stimulating the clitoral root.

Corollaries of Acknowledgment of the Clitoral Root

Considering the clitoral root, "What can go wrong?"

Vaginal delivery can tear the area. One of our gynecologists told me that when she delivers the babies of women who suffer genital mutilation, the whole clitoral body can be torn, including the root. It sometimes must be sutured back together postpartum.

Perhaps knowing about the root, should you wish for self-pleasure or pleasuring your lover, knowing that it's not just the vagina and the urethra that matters, but there's a root to the clitoris, from which the corpora and the body originate, like a root, branches coming off of a root. Then, that understanding could make things better.

When Bruce Lee discussed martial arts in his book on fighting (Lee, 2018), he said that after you study the book and learn it, you tear it up and throw it away. When fighting, the individual methods and specific learning go out the window the first time someone hits you in the nose. But, in the art and in instinct that guides the fists will be embedded, the learning from the book discarded. And so it is with lovemaking. You learn the anatomy and then forget the anatomy in the bedroom; still, things could be better with your eyes closed because of what you learned when they were open.

The sensitivity of the clitoral root also explains why size might matter—not big or little or loose or tight, but the best fit between one man and one woman will put pressure on the root—but not too much.

Moreover, assuming that there's something other than penis and vagina sex, knowing and understanding the clitoral root can make a difference to what one might be doing with hands and tongue; back to my analogy, with massage. If you know what's there, and you talk to your lover with your hands and tongue about what you are discovering, that can be much different than if you are only manipulating a big “glob of stuff” you don’t understand.

Disclaimer

Just to avoid as many arrows as possible, with every lesson, I like to remind you that I understand there is much more to a woman than her vagina—that’s the whole point of what we are doing: there is a system, there's the psychology, the sociology, the hormonal milieu, the circulation, so many other things, but why not understand all the parts? And back to the irony, this part (the root) was not included in the test of the medical school curriculum—the testers omitted one of the parts of the system about which they were testing.

To summarize the root:

The root is the intersection of the two corpus cavernosum, the body of the clitoris and the bulbs of the clitoris. It lies above the urethra. It's very responsive to stimulation. And we should know what it is and where it is.

More about the Bulbs

Now, back to the bulbs.

The bulbs are, let's go back to this picture (see the video); the bulbs are up to seven centimeters long. The bulb, look at it, it lies just along the edge of the labia minora and is contiguous with the body and the glans clitoris, and fills that space with tissue that is also both erectile and trabecular.

A lesson from the penis

Reconsider men for a moment. By the time a man reaches 65, he loses about 50% of the endothelium. With women, Delancey and others have documented that the nerves and muscles of the clitoris and urethra atrophy; in his cadaver studies (see multiple references listed below).

Further, we know that platelet-rich plasma causes neurogenesis and angiogenesis (see references). When we do our O-Shot® procedure, we're injecting the body of the clitoris, which is connected to the root, the crura, and the corpus spongiosum, or the bulb. As expected, after this injection, a woman’s sex can improve dramatically. (See representative references regarding the O-Shot® procedure here<—).

This cutaway view (see video), I think, is also very illuminating. I love this paper. And because you can see they're holding the body of the clitoris. They've cut away just along the edge of the labia minora. And you can see the bulb or the corpus spongiosum, right there, lying underneath the mound of the labia majora. Now, the tissue of the labia majora, so it's lying above.

Let's go back and look at this picture. Here is the introitus. So, it stops beneath the urethra, near Bartholin's gland, at the upper part of the introitus.

So, looking back here, it would go down, beneath the urethra, and it would come over, lying beneath the mound of the labia majora. And, remember, it's erectile and has sensation.

Now, when we do our O-Shot, we are injecting the body of the clitoris. When we do the Vampire Wing Lift® procedure, we inject PRP into the anterior half of the labia majora. And I don't propose that we are always accurately inserting that needle in the center of the corpus spongiosum. But there's enough volume there that there would definitely be a field effect that improves the function of the bulbs.

When you treat the hair, you don't have to cover every millimeter. If you're within a centimeter of an area, you are going to affect hair growth. And, oftentimes, you'll even see improvement in the skin of the forehead because there's a field effect. Platelet-rich plasma recruits pluripotent stem cells that migrate to the area and propagate regeneration of healthy tissue, collagen, nerve, and blood flow. And it's not just where the lumen of your needle happens to be exactly within a millimeter of the area intended.

So, I think I'm okay with being more lucky than smart. My original idea of doing the Vampire Wing Lift® procedure was injecting and restoring volume and rubor, like we do with the Vampire Facelift® procedure. I didn't really contemplate the idea that, in all likelihood, we're also improving the sensation and function and restoring some of the volume of the bulb or the corpus spongiosum.

So, the bulb lies in a triangular space of three to seven centimeters. It probably provides some structure that improves sensation with sexual intercourse.

"The bulb or homologous corpus spongiosum, they engorge during arousal, some lubrication function, but also conferring stability on the vaginal walls."

So by this explanation, the bulbs bring the clitoral tissue closer to the vaginal lumen during arousal.

Remember, we looked at a cross-section of the penis within the vagina, and we contemplated the following: “Without structure, there is no pressure."

The penis, without the structure supporting the vaginal walls, would have no pressure against the urethra, the root, the corpus cavernosi, the corpus spongiosum, or the bulb.

Conclusion

The more I read, the more I realize the vastness of what I don't know—even after reading all that I can read. There is much to know and even more to discover.

One year ago, I couldn't have given you a good explanation of what the root of the clitoris is. And now that I know, I have more questions than answers.

I say this to restate that what we're doing here is worth doing. Pointing out, if medical schools don't even teach all the parts of the clitoris, then, I think this project we're doing, defining the Female Orgasm System (it’s parts and how they work together) is worth doing.

I’m so very grateful that you're showing up for these webinars because it motivates me not to stop; it means that maybe at least somebody's interested. And there appears to be quite a few of you guys that are interested. Hope you'll spread the word. I'm not charging for any of this. I'm just putting it out, editing it some, before I put it out, with the mission that people realize that it's not just a glob of stuff down there.

And just knowing the parts doesn't fix anything.

I spoke with a very prominent gynecologist/pelvic reconstructive surgeon, and he proceeded to explain to me all the parts. And I was thinking, "Yep. Know it. Know it. Know it." But, knowing all the parts would be like lifting the hood of your car, but that doesn't mean you know how they're functioning together, as a system, to make your car go down the road."

So, we have, first, I think, to label all the components.

Then, there's this idea: “How are they working together?"

We haven't even gotten to the other parts, like the pelvic floor muscles. "How do they work together to help both with continence and improvement in sexual function?"

And, "How do they work together, with the clitoris and all the rest of the system, to create pleasure?"

But I think that's all I have today. Hopefully, that's helpful. And, hopefully, next time somebody asks you about the parts of the clitoris, you'll know exactly about the root and the bulb.

Have a great day. Goodbye.

References

  1. Codispoti N, Negris O, Myers MC, et al. Female sexual medicine: an assessment of medical school curricula in a major United States city. Sexual Medicine. 2023;11(4):qfad051. doi:10.1093/sexmed/qfad051
  2. DeLancey JOL, Trowbridge ER, Miller JM, et al. Stress Urinary Incontinence: Relative Importance of Urethral Support and Urethral Closure Pressure. J Urol. 2008;179(6):2286-2290. doi:10.1016/j.juro.2008.01.098
  3. DeLancey JO. Structural aspects of the extrinsic continence mechanism. Obstet Gynecol. 1988;72(3 Pt 1):296-301.
  4. DeLancey JO. Structural support of the urethra as it relates to stress urinary incontinence: the hammock hypothesis. Am J Obstet Gynecol. 1994;170(6):1713-1720; discussion 1720-1723. doi:10.1016/s0002-9378(94)70346-9
  5. Downing G. The Massage Book. 25th anniversary ed. Random House : The Bookworks; 1998 (first published 1972)
  6. GRÄFENBERG, Ernest (1950) The role of urethra in female orgasm, in: The International Journal of Sexology vol. III, no. 3: 145-148.
  7. Lee B. Tao of Jeet Kune Do. Expanded ed. Black Belt Books; 2018.
  8. Oakley SH, Mutema GK, Crisp CC, et al. Innervation and Histology of the Clitoral–Urethal Complex: A Cross-Sectional Cadaver Study. The Journal of Sexual Medicine. 2013;10(9):2211-2218. doi:10.1111/jsm.12230
  9. PANDIT M, DELANCEY JOL, ASHTON-MILLER JA, IYENGAR J, BLAIVAS M, PERUCCHINI D. Quantification of Intramuscular Nerves Within the Female Striated Urogenital Sphincter Muscle. Obstet Gynecol. 2000;95(6 Pt 1):797-800. Accessed October 20, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1192577/
  10. Perucchini D, DeLancey JO, Ashton-Miller JA, Peschers U, Kataria T. Age effects on urethral striated muscle I. changes in number and diameter of striated muscle fibers in the ventral urethra. American Journal of Obstetrics & Gynecology. 2002;186(3):351-355. doi:10.1067/mob.2002.121089
  11. Perucchini D, DeLancey JOL, Ashton-Miller JA, Galecki A, Schaer GN. Age effects on urethral striated muscle II. Anatomic location of muscle loss. American Journal of Obstetrics and Gynecology. 2002;186(3):356-360. doi:10.1067/mob.2002.121090
  12. Pauls RN. Anatomy of the clitoris and the female sexual response. Clinical Anatomy. 2015;28(3):376-384. doi:10.1002/ca.22524
  13. Peters B, Ndumele A, Uloko MI. Clinical implications of the historical, medical, and social neglect of the clitoris. J Sex Med. 2023;20(4):418-421. doi:10.1093/jsxmed/qdac044

References-PRP for Neurogenesis

  1. Wu YN, Liao CH, Chen KC, Chiang HS. Dual effect of chitosan activated platelet rich plasma (cPRP) improved erectile function after cavernous nerve injury. Journal of the Formosan Medical Association. Published online March 27, 2021. doi:10.1016/j.jfma.2021.01.019
  2. Yasak T, Özkaya Ö, Ergan Şahin A, Çolak Ö. Electromyographic and Clinical Investigation of the Effect of Platelet-Rich Plasma on Peripheral Nerve Regeneration in Patients with Diabetes after Surgery for Carpal Tunnel Syndrome. Arch Plast Surg. 2022;49(02):200-206. doi:10.1055/s-0042-1744410
  3. Foy CA, Micheo WF, Kuffler DP. Functional Recovery following Repair of Long Nerve Gaps in Senior Patient 2.6 Years Posttrauma. Plast Reconstr Surg Glob Open. 2021;9(9):e3831. doi:10.1097/GOX.0000000000003831
  4. Kuffler DP. Platelet-Rich Plasma and the Elimination of Neuropathic Pain. Mol Neurobiol. 2013;48(2):315-332. doi:10.1007/s12035-013-8494-7
  5. Sánchez M, Anitua E, Delgado D, et al. Platelet-rich plasma, a source of autologous growth factors and biomimetic scaffold for peripheral nerve regeneration. Expert Opinion on Biological Therapy. 2017;17(2):197-212. doi:10.1080/14712598.2017.1259409
  6. Chung E. Regenerative technology to restore and preserve erectile function in men following prostate cancer treatment: evidence for penile rehabilitation in the context of prostate cancer survivorship. Therapeutic Advances in Urology. 2021;13:17562872211026421. doi:10.1177/17562872211026421
  7. Pandunugrahadi M, Irianto KA, Sindrawati O. The Optimal Timing of Platelet-Rich Plasma (PRP) Injection for Nerve Lesion Recovery: A Preliminary Study. Int J Biomater. 2022;2022:9601547. doi:10.1155/2022/9601547
  8. Abo El Naga HA, El Zaiat RS, Hamdan AM. The potential therapeutic effect of platelet-rich plasma in the treatment of post-COVID-19 parosmia. The Egyptian Journal of Otolaryngology. 2022;38(1):130. doi:10.1186/s43163-022-00320-z
  9. Aaraj MA, Boorinie M, Salfity L, Eweiss A. The use of Platelet rich Plasma in COVID-19 Induced Olfactory Dysfunction: Systematic Review. Indian J Otolaryngol Head Neck Surg. Published online June 10, 2023. doi:10.1007/s12070-023-03938-4

References PRP for Neovascularization

  1. Bindal P, Gnanasegaran N, Bindal U, et al. Angiogenic effect of platelet-rich concentrates on dental pulp stem cells in inflamed microenvironment. Clin Oral Investig. 2019;23(10):3821-3831. doi:10.1007/s00784-019-02811-5
  2. Miłek T, Nagraba Ł, Mitek T, et al. Autologous Platelet-Rich Plasma Reduces Healing Time of Chronic Venous Leg Ulcers: A Prospective Observational Study. In: Pokorski M, ed. Advances in Biomedicine. Advances in Experimental Medicine and Biology. Springer International Publishing; 2019:109-117. doi:10.1007/55842019388
  3. Norooznezhad AH. Decreased Pain in Patients Undergoing Pilonidal Sinus Surgery Treated with Platelet-Rich Plasma Therapy: The Role of Angiogenesis. Advances in Skin & Wound Care. 2020;33(1):8. doi:10.1097/01.ASW.0000615376.97232.0a
  4. Li Y, Mou S, Xiao P, et al. Delayed two steps PRP injection strategy for the improvement of fat graft survival with superior angiogenesis. Sci Rep. 2020;10:5231. doi:10.1038/s41598-020-61891-6
  5. Zhang XL, Shi KQ, Jia PT, et al. Effects of platelet-rich plasma on angiogenesis and osteogenesis-associated factors in rabbits with avascular necrosis of the femoral head. Eur Rev Med Pharmacol Sci. 2018;22(7):2143-2152. doi:10.26355/eurrev20180414748
  6. Nolan GS, Smith OJ, Heavey S, Jell G, Mosahebi A. Histological analysis of fat grafting with platelet‐rich plasma for diabetic foot ulcers—A randomised controlled trial. Int Wound J. 2021;19(2):389-398. doi:10.1111/iwj.13640
  7. Sclafani AP, McCormick SA. Induction of dermal collagenesis, angiogenesis, and adipogenesis in human skin by injection of platelet-rich fibrin matrix. Arch Facial Plast Surg. 2012;14(2):132-136. doi:10.1001/archfacial.2011.784
  8. Araujo-Gutierrez R, Van Eps JL, Scherba JC, et al. Platelet rich plasma concentration improves biologic mesh incorporation and decreases multinucleated giant cells in a dose dependent fashion. Journal of Tissue Engineering and Regenerative Medicine. 2021;15(11):1037-1046. doi:10.1002/term.3247
  9. Fernandez-Moure JS, Van Eps JL, Scherba JC, et al. Platelet-rich plasma enhances mechanical strength of strattice in rat model of ventral hernia repair. Journal of Tissue Engineering and Regenerative Medicine. 2021;15(7):634-647. doi:10.1002/term.3200
  10. Saputro ID, Rizaliyana S, Noverta DA. The effect of allogenic freeze-dried platelet-rich plasma in increasing the number of fibroblasts and neovascularization in wound healing. Ann Med Surg (Lond). 2022;73:103217. doi:10.1016/j.amsu.2021.103217
  11. The clitoral root is thought by some anatomist to be very important to sexual arousal (Pauls,2015); but it is often not mentioned in anatomical descriptions of the vagina. The current author, asked his favorite AI app about the clitoral root, and the AI denied the existence of any such anatomical part. ↩︎
  12. which I always choke on that, because I think it's not really a specific unmovable spot. I think it's just that part of that area, that happens to be most sensitive, at that particular moment, for that woman on that day. It may be different five minutes from now. ↩︎

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Female Orgasm System: Breast

Video and transcript to come  soon.

References

Abramsohn, Emily M, El A Pinkerton, Kristen Wroblewski, Magdalena Anitescu, Kathryn E Flynn, Alexes Hazen, Phil Schumm, and Stacy Tessler Lindau. “Breast Sensorisexual Function: A Novel Patient-Reported Outcome Measure of Sexual Sensory Functions of the Breast.” The Journal of Sexual Medicine 20, no. 5 (May 1, 2023): 671–83. https://doi.org/10.1093/jsxmed/qdad024.
Ford, Clellan S., and Frank A. Beach. Patterns of Sexual Behavior. 1st Harper Colophon ed. New York: Harper & Row, 1972.
Kayner, C. E., and J. A. Zagar. “Breast-Feeding and Sexual Response.” The Journal of Family Practice 17, no. 1 (July 1983): 69–73.
Quisenberry, Walter B. “SOCIOCULTURAL FACTORS IN CANCER IN HAWAII.” Annals of the New York Academy of Sciences 84, no. 17 (December 1960): 795–806. https://doi.org/10.1111/j.1749-6632.1960.tb39114.x.
Robinson, Valerie. Sex and the Breast: Love, Health, and Evolution. Hay House, 2018.
Robinson, V.C. “Support for the Hypothesis That Sexual Breast Stimulation Is an Ancestral Practice and a Key to Understanding Women’s Health.” Medical Hypotheses 85, no. 6 (December 2015): 976–85. https://doi.org/10.1016/j.mehy.2015.09.002.
Weitgasser, Laurenz, Maximilian Mahrhofer, and Thomas Schoeller. “Potential Immune Response to Breast Implants after Immunization with COVID-19 Vaccines.” The Breast 59 (October 2021): 76–78. https://doi.org/10.1016/j.breast.2021.06.002.

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Female Orgasm System: Clitoris

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Female Orgasm System | Systems Analysis: Why You Need It & How to Use It


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1. Systems Analysis: Why You Need It & How to Use It

Thank you for being on the webinar tonight. We are going to talk about the female orgasm system.

I think that we are creating a new paradigm regarding how to think about sexual medicine. Maybe not discovering any new parts, but we're talking about how the parts might work together. Although systems analysis has been applied to respiration, and to digestion, and circulation, I can't see where it's been applied to sexual response. Reproduction, as you know, could take place easily without any libido, orgasmic response, and vice versa. So it seems to me that it's worth talking about.

Most Helpful Reference Regarding Systems Analysis

Now, before we get too much into the details about what a system is, I'm leaning heavily on some references regarding systems analysis, which is becoming a whole new specialty in medicine. The one that has helped me the most, I'll give a shout-out to now by Donella Meadows, called Thinking In Systems: A Primer. I'll give you a copy of this. By the way, anyone who's on this call, you'll get access to a transcript and a video replay of this thing for free.

Call for Help

I feel like we're working together in creating this. I could just do this by myself and think that I got it right, possibly, but then I would be missing out on feedback from a lot of smart people. So I'm hoping that occasionally, as I go through this, I'll be able to stop, and you'll tell me some ideas about how you might correct or augment what I'm talking about. But I'll start with five characteristics. You might want to scratch these down.

How to Know if You Have a System or a Pile of Stuff

These are the five characteristics of how to know if you have a system versus just a pile of stuff.

  1. The first thing is, can you identify parts?

Let's just think about the respiratory system. There's lungs, there's alveoli, there's a trachea. Do the parts affect each other? The diaphragm expands the lungs, which pulls air down the trachea easy.

  1. Do the parts together produce an effect that is different than the effect of each part on its own? Easy, right? The parts together allow us to tag oxygen onto red blood cells, and to dispose of carbon dioxide. Then the last one is, does the effect or the behavior over time persist in a variety of circumstances? It's a little more nebulous, but what I think she's (Meadows,2008) getting at there is, systems tend to be self-preserving.

If you apply those rules to orgasm or sexual response, of course, they're there. There are parts, obviously. There's genitalia; there are hormones.

  1. Do the parts affect each other? Of course. The hormones affect the genitalia. The genitalia affects the brain. The brain affects the hormones and the genitalia.
  2. Do the parts produce an effect that's different than each part on its own? Absolutely. There's an emotional and physical response.
  3. Does the behavior over time persist in a variety of circumstances? We'd say yes to that. So, we have a system.

Do We Really Need Another System?

I think the reason I feel inclined to defend our whole discussion: if it is a system, why has there not been a poster, at least in medical school, if not on the wall of every grade school, explaining how the system works? Just like there's a poster explaining breathing, respiration, the respiratory system, the nervous system, and all that.

I think we could postulate the reasons why that isn't the case.

My best idea about why we're lagging and thinking about sex in terms of the system, like we have with reproduction, breathing, and every other part of the body, is that we haven't had... The past decade or two has produced two things, a greater understanding of how sexuality works, also, with the revolution socially in the idea that it's not just okay for women to have sex. We should help women have good sex.

That's the new sexual revolution, in the 60s it became okay for women to have sex.But since, really around the time of Fifty Shades of Grey, women are rightly demanding that they have access to new ways to improve their sex. There's still a great imbalance. There's over 20 different FDA-approved drugs and devices to help men with their sexuality and only two for women, both of which have come out in the past few years. So, there's an imbalance. I think perhaps, as you guys may know, the clitoris was not even drawn into Grey's Anatomy for a while. There's been a mismatch in interest.

That's why I'm starting with the female orgasm system. There's a male version as well, of course. But we're going to start with a female because I think, both from a scientific revolutionary standpoint and a social standpoint, it's time for this idea to come to fruition now.

Let's go first into some of the ideas about systems and why we should think about systems in general.

What's the Purpose of Thinking in Systems?

Even though we do this largely subconsciously when we practice medicine every day—just living your life every day—you think in terms of systems.

It helps to pull it out and think about the parts of the system. Then, as we go through the various lessons or ideas as we dig into the research over the next few weeks, we can pull out and see how to then tune up the system, either to help with disease or to help a functioning system function even better. So the idea of systems analysis is so embedded that we can take it for granted, and there are systems embedded in systems.

For example, if you have the system of the body that encloses the respiratory system and the circulatory system, which also includes the endocrine system, which has to help control all of that, and that body lives within a social system, which lives within a solar system, which lives within a galaxy.

Where do you draw the boundaries?

If you're considering a system, where do you draw all the boundaries?

To help with that, let's take a really simple system. So someone put a pile of wood in front of your home, and they soaked it with diesel fuel, and then they came to your door and said, "Hey, if you drop a match on this wood, you'll see a fire."

You didn't know about diesel fuel, but you drop the match on the wood, and you conclude that, really, all you need is a match and wood to make a fire. But once you see that you need all three to most ideally create the system of a fire, that's converting that wood into the things that chemical reaction does; then you can be more thoughtful in making a better fire.

I think what's happening, this is my opinion after doing sexual medicine now for a couple of decades, is that more than any other branch of medicine, there was a tendency to not do that—to not think in terms of systems. It doesn't mean we're bad people; it's just that sex was not taught in terms of systems analysis. For example, we know that testosterone can greatly increase the libido of women. That research has been done over and over for the past decade, which is part of the reason it's still astounding that we don't have an FDA-approved form of testosterone for women, and we're having to modify the dosage of medication approved for men.

That's beside the point, which is that you may know the helpfulness of testosterone and give it to a woman to help improve her sexuality, or libido, or orgasmic response. But if you didn't consider, perhaps she's depressed about her marriage, or maybe she's got a microadenoma producing prolactin, and her hyperprolactinemia is basically killing her sex drive, and what she needs is not testosterone, but Dostinex®. Or maybe she needs testosterone and Dostinex®. Without thinking about the whole system, you may give testosterone to that woman, and she may think, "Well, testosterone doesn't work."

Walt Disney used systems to think about how to sell Mickey Mouse; does a woman's orgasm deserve the same attention?

But, it really doesn't mean that testosterone doesn't work. It means it didn't work on that particular woman because there's another part of the system that needed attention. I see this happening a lot in sexual medicine—much more than in other branches of medicine. I'll see a therapist counseling a woman with great volition, much time involved, and much expertise involved about how to have wonderful sex without penis-in-vagina sexual intercourse because the woman might have dyspareunia and achieve great results, without knowing perhaps that we may have a way with our O-Shot® to make that dyspareunia go away. Maybe the therapist didn't consider the whole system in regards to the details of what might be going on with the pelvic floor, and inflammation, and how PRP might decrease inflammatory response.

It goes absolutely the other way, as I just mentioned. You may have someone who does some new radio frequency procedure on the vagina to help with sexual stimulation, and they never take the time to find out that the woman was abused, and she's still being abused by her husband, and she sees sexual stimulation, on her subconscious or maybe even conscious level, as a physical and emotional attack. So her instinct and what she's been conditioned to do is to recoil from it. So you can do testosterone and radiofrequency all day long, but until you consider the whole system...

Or, maybe she's got a spinal cord abnormality or a disc in her spinal column that's interfering with transmission of the nerve impulse. So until the whole system is considered, there's not going to be ideal treatment, and you'll have someone saying, "That didn't work." Another quick analogy is, suppose you gave a bronchodilator to someone with dyspnea, but their shortness of breath is due to profound anemia. If you did that, the person would [inaudible], "Oh, bronchodilators don't work for dyspnea." When really what they needed was a transfusion of two units of packed red blood cells.

It seems almost ridiculous to point that out in the circulatory system, but I see it happening every day in sexual medicine, which is why I'm wanting your help in developing this systems analysis. I think I've got a pretty clear view, but when you're alone with your books for years at a time, I think it definitely helps to rub brains with other smart people that I know. There's a lot of smart people on this call. So feel free to jump in and throw in some ideas, as we go along, into the chat box. I'll talk about them, and eventually they'll get integrated into the book and the poster that comes out of this.

Definition of a System

So a system is a set of parts that work together to accomplish a purpose or multiple purposes. You might be thinking, "When are we going to get to start talking about the clitoris or the hormone part?" Well, we'll start talking about the parts, but there are other parts to the system too. There's stock, there's flow, there's feedback. So for optimal discussion and effectiveness, we need to tease out the parts, and today's lesson was going to be primarily about that.

So, it's a collection of parts working together, accomplishing more than any of the parts separated from the system. They work at the same time. This is why those posters your 6th-grade science teachers showed you were so important. When you explain something in words, you're seeing a linear progression of ideas when what's really happening with the system, it's all working at the same time. Of course, it's helpful to think about each part separately, but to see it happening at the same time with one diagram is very, very helpful, and it emphasizes that it's all doing things and each part is affecting things at the same time.

More About Delineating the Boundary of the System

Now, more about the boundaries of the system. You could start with adrenals in a female making testosterone. Then you could go into the biochemistry of testosterone. The molecular structure of testosterone is chemical bonding, the cell receptors on the vaginal tissue or the brain that are receiving chemical messengers from the... You see what I'm saying? You could do a whole textbook just on the cell receptors. So you go on and on and on, because everything is related to everything, where do you draw the boundaries? And, because you have systems within systems.

If you use as a model of what other body system discussions have pivoted around, it becomes, at least in my opinion, that they've been defined. The borders of the system have been defined by thinking about, what are the first-order considerations that a clinician or a person who's trying to optimize their health. Wellbeing, what are the first order considerations that you would think about to make that better? For example, with the respiratory system, you might think about the alveoli.

But perhaps on your poster, in your first order of consideration, you wouldn't think about the chemical or the cellular makeup of the alveoli, and the ATP, and the mitochondria, and all the metabolism that's going on within the cells of the lining of the lung. You would stop and define it at the level that you would need to think about it when you're trying to get someone well. Of course, that would be different if you're doing research, and you would take it deeper and deeper, to infinity really, because there's no end to that.

Next you would consider not only what's the boundary that you would think of first order for healing, but also for accomplishment of optimal function. This gets to be more politically risky because, as physicians, we're not really supposed to do other than treat disease. You'll lose your license. For example, if you give testosterone to take a normal male and enhance his physical strength, that's considered to be malpractice because the possible detriment from that therapy is considered to be unnecessary and unacceptable to just make someone able to pick up a heavier weight.

But at least so far, the ideas of how to improve sexuality in normal function are less frowned upon because usually, this is important, whatever improved sex is improving overall health. Not always, of course there are drugs that get you thrown in jail and make you sell your refrigerator to buy more of them, and those are illegal. But for most of what we do as a physician, in the process of making sex better, we are usually making the body healthier. As long as we are doing that, I think it's perfectly acceptable. Both my philosophy and what I can see from the position statements of the powers that be, as long as you're doing that, it's okay to take good and make it better.

It's okay to take a person who's able to walk and instruct them to improve their VO2 max, and their anaerobic threshold, because we know that decreases their risk of myocardial infarction. In the same way, that same advice would most likely cause them to have better sex and stronger orgasms. Here's the risk of not using... Well, why not? Why can't I just think, "Well, I can try it, or I can think about it, and not get so deep into the systems analysis?" What happens without it is, people start to under... Not just physicians, but our patients. I think this is huge.

Why Patients Need to Know about the Female Orgasm System for Your Therapies to Work

It's important for us to talk with our patients, in terms of systems analysis, so that they know that we don't think our hammer also functions as a screwdriver and pliers. They need to know that we understand the whole system, and other parts of the system may require another visit to us, another test, or seeing two or three other consultants, a therapist, an endocrinologist, a surgeon, a physical therapist, you get the point.

So I put here, as a very basic example, and it's so basic it's almost insulting but it needs to be said, if you have the proverbial hammer and you're trying to progress the insertion of a screw, you break the screw, and you damage the wood.

You'd think, "Well, okay, that's so simple. Why do you even say that?"

Well, I'll give you an example. Someone did a study of our Priapus Shot®. In the study, they changed the way that they prepared the platelet-rich plasma. They used a saline placebo, which has been shown in multiple studies actually to have effects. So they changed the components, but what they really did was didn't consider the whole system. Metaphorically, it would be like you have the wood example, and you're going to change the diesel to lighter fluid, and then you're going to study that match and tell me whether the match works or not.

By considering the system, you neither underestimate or overestimate the effectiveness of your tool because you're thinking about how other systems might be affecting that part of the system you're studying. That's usually controlled by using inclusion and exclusion criterion when you do research. But I think by emphasizing it, as we do diagnosis and treatment of our patients, they'll be more cooperative because they see the benefits of thinking about everything. Both we and our patients will be less inclined to think that we think we have a magic bullet.

It also points out the fact that, because there may not be a magic bullet, unless you just have one system that's part of the system that's broken, then you fix that. Okay, that's the magic bullet. If you have wood piled up, soaked with diesel fuel, then a match is a magic bullet. But if you only have the wood and not the diesel fuel, and you throw a match on a pile of logs, not much is going to happen without some kindling. So there can become this misleading and overestimating because, as a clinician, you may do something that was great with someone, but maybe you nor the person understands that there was a part of the system that was ideal in that instance that may not be in the other. I bring this out because I want to think about just the system mindset, and why I think it's important.

Female Orgasm System: Problems with any one component changes the function of the whole system

You can see this is copyrighted in 1957. This was three years before I was born. Walt Disney apparently sketched out his idea about the whole system of Disney, and how it works. So if you look at it, you have a film, and magazines lead to the film. You have a comic book that leads to a film, which gives new material for the magazine, gets turned into a book, which plugs more film, raw materials for more books, you get more comic strips. All this gets pulled over into Disneyland where people come, it provides additional sales, merchandising. Then you get tied up in here in this thing and you're rotating through. They're selling music.

Everything is selling everything, and everything is pushing everything, and everything is developing everything. That's the Disney system on one piece of paper, and it's how Walt Disney drew it in 1957. Now, that is a different mindset than had he just been thinking, "Let's make a comic book about a mouse." He knew that the mouse was part of this huge system, and that was a huge reason for his success—he thought in systems. Now, let's think about some of the components. Maybe I'll stop here and see if there are any comments before we do go further. Let's see.

Do I have a female sexual questionnaire that you have your patients fill out. Yeah. We will get to that. There's lots of different questionnaires. There's female sexual distress scale and female sexual function index, are the two that I've used primarily. Female sexual distress gives you an overall view. Female sexual function index teases it out to give you an idea about which part of the system might be broken. But as we're talking now, you see that you really can't affect one part of the system without affecting others.

We'll take the endocrine system, for example. If you correct testosterone, you lower thyroid binding globulin, and you raise free thyroid levels if they're on thyroid oral medication without changing the dose. If you give them growth hormone, you raise testosterone levels. If you give them testosterone, you raise growth hormone. If you give them testosterone, you raise estrogen. So moving one thing moves the whole system, which leads to a lot of surprises because a lot of people are just focused on the one thing.

One of the surprises that happened with me is when I first did the study, our very first study we published regarding the O-Shot®, I had someone that only had a female sexual distress scale level of two, which is almost nothing. Basically, she was having great sex. Excuse me, it was one. So, basically no distress at all. But then it turned to a two after our O-Shot® and I found out... I said, "Well, what happened that made it worse?" She said, "My libido got so high my lover couldn't keep up, so I was less satisfied because I didn't have as much. Before, I was fairly satisfied. But then, when my libido went up and he couldn't keep up with me, I became more unsatisfied."

So there can be surprises, and that would be a surprise in the marriage or the family system that happened because we improved her orgasm system, and when he couldn't keep up, it actually made her less satisfied. By the way, that's one of the reasons that there are fewer drugs for women. Because with men, if you have a new drug, you just have to prove that the penis gets harder. For women, unless something's changed, for it to be approved, you have to show that they actually have improved satisfaction, which is different than just having more lubrication, or more blood flow to your clitoris.

Why Call it the ”Orgasm System”?

Just one quick other comment before we go to components. I thought about, what else could you call this thing if we're going to have a new system? Is it really just the reproductive system? We talked about that. You maybe could say it's a subcomponent or subsystem of reproduction because it promotes reproduction. But I think it's more overlap because, obviously, you can have reproduction with almost no libido and no orgasm at all.

So I thought maybe we call it the sexual response system, but to me it feels like orgasm system. You can have response without orgasm, but you're going to always get response when you get an orgasm. So it seems to me like orgasms more encompassing, and perhaps we think about orgasm as the fullest extent of sexual libido and response. So that's my reasoning behind it. But, maybe it winds up being called something else. That's why I'm thinking about that as the reason we call it that.

Now, a little bit more about mindsets, and let's go to components. Everything we think about, another way to think about a system as a model and part of the new specialty of medical systems, as a subspecialty of medicine, involves a lot of mathematical modeling. So you could almost substitute the word model. Everything we know about the world is a systems model, really everything. Our models, they have strong congruence or we'd throw them out. They have reliability, and predictability within the world.

Our Newtonian model of gravity works when it works, but then sometimes it doesn't, according to Einstein. So it works when it does, but then at some level it quits working. So you use a model for as long as it works, but you also have to... Whenever a model falls short of what's happening in the real world, then that's the time to reconsider, is your model correct or not? That's one of the places where systems or models fulfill one of their highest purposes or best purposes because, when you see your ability to not predict or, in our case, treat patients effectively...

Which, let's face it, when the stats are somewhere between 30% and 40% of women have sexual dysfunction even defined as... It doesn't even count unless you have some psychological distress from it, like you've got dyspareunia and you're not distressed by it, that doesn't even count as dysfunction. So when you consider, depending on how you define, count the numbers, what study you look at, somewhere between 20% and 40% of women have sexual dysfunction. Well, our models and our treatments need some rethinking. If we don't even have a diagram about how the whole thing's working, maybe it's time that we do.

Okay, I guess I beat that one to death. Let's talk about the categories or elements of the system because I think that is super important.

Elements of a System

Purpose

First, you have just your paradigm or your purpose of the system. If you're thinking about libido as just one part of the paradigm of reproduction, then it changes how you think about the whole system. As soon as you tease it out as libido and orgasm are a different system versus making a baby, then you're thinking about it changes. There's a beautiful book about scientific revolution that I list here in the references, that's been out now for 40 years. That's usually where the revolution happens. It's usually not an extension of what we already know. It's a change in the paradigm about what we're doing and what the purpose of the system might be.

Stock

Okay. The next part of the system is the stock. Let me show you what I mean by stock, change what you're looking at. I consider myself a student just like you guys, so I hope you'll tell me when there's something you think I should change or add.

But, let me pull up where you can see a diagram. This comes from that Meadows book and others about systems analysis. Just a minute. Okay, share something else. Here's a picture of stock. So, you have something that's coming into... An easy example is, this is your bank. You have money that's coming in from your salary, or whatever you're doing, and it goes into the bank.

Then this is information. In this case, the information is how much is there, and it also rules the flow of the information and the way the system is working, which brings up another important point.

The flow of Information & Watching the System Work

You can't understand a system just by knowing the parts. You have to watch it work. You have to watch the whole system work to understand it. You can't figure it out with it sitting still. Anyway, you put money in the bank. It turns out you're getting some amount of interest, so the interest then changes the amount of money that's flowing into your bank. That arrow, in this case, could probably better be represented by turning, pointing at the actual box of stock.

Feedback Loops: Self-Reinforcing and Balancing

But this would be a self-reinforcing feedback loop. Not a balancing, but a reinforcing feedback loop because the money flowing in grows even if you're not adding to it, because the more money that comes in, the more money is adding interest. So the old proverbial thing by Einstein about it being the greatest wonder of the world, because it just keeps growing, it's a self-enforcing loop. Versus the balancing loop, which would be a feedback loop, which would be... Well, let me just back up again.

So we have material or information that flows, that's stock you have. That's the stuff that's coming in. This could be a bathtub. Then you have the information that changes the flow, and then that flow of information becomes a feedback loop. So I just described a self-reinforcing positive feedback loop. You could have a negative feedback loop where, when left alone, it spirals down. So let's talk about a self-reinforcing and a negative feedback loop in the female sexuality. We'll get to this much more when we get to the actual details of the system.

But if a woman has a good sexual experience, then that memory makes it where she's more easily aroused in the next encounter. Because she's more easily aroused in the next encounter, she has an even better experience, which is thought to be different than how men respond. So, there's a self-reinforcing loop. The reverse could be happening, where she has sexual intercourse, she has pain. Now she associates sexual intercourse with pain, which makes her now have almost some form of vaginismus in her next encounter with her husband, which makes her have more pain because now she's having contraction of the pelvic floor and more dryness because she's not lubricating, because she's afraid, and now she has more pain, so the next time she's even less inclined to have sex.

So now she's in a negative self-enforcing or reinforcing feedback loop. So you've got positive reinforcing, negative reinforcing, and then you have balancing. A balancing feedback loop might be where you have the thyroid gland making thyroid that goes into the body. The hypothalamus, once it sees enough thyroid, turns down the amount that's being made. Where, if there becomes a need for more thyroid, then the hypothalamus turns up the flow of thyroid that's being made. So that would be a balancing loop that keeps the level about the same, versus reinforcing it or making it grow without any changing of anything else. The system itself propagates that way.

Examples

Okay, so what would be the stock in some of the systems we know about? In the respiratory system, the stock would be the oxygenation of red blood cells and the removal or the level of carbon dioxide. So you'd want the oxygenation optimal in the carbon dioxide. Then the information would be feeding back through the carotid sinus to change the respiratory rate. Let's say that you have a flight or fight response, and the sympathetic nervous system causes increased blood flow, and vassal dilatation, and bronchodilation, so you're able to oxygenate more. When you're sleeping, respirations go down and it doesn't take as much tachypnea to keep up.

So the stock and the respiratory system would be that. The stock in the gastrointestinal system would be the transfer of nutrients. Stock can be tangible and intangible. Stock could be affection for your lover, it could be your intellectual understanding of something. So it's not just information that can be intangible, stock can be intangible as well. I'm very open for suggestions here. But my best idea, after thinking about this for a few years, is the stock for the orgasm system would just be sexual desire and arousal. When that reaches some overflow state, then there becomes an orgasm.

At that point, the information would feed back and cause perhaps a decrease in the stock, as in decreased arousal, but there would be increased ability to have arousal on the next encounter. So there would be one negative feedback loop, and one self-enforcing or self-enforcing loop. All of this is functioning in all the systems. I think it's probably most visible when you think about the feedback loops and the endocrine system, but it's there in all of them. You have gastroparesis when you're overfed, so that would be a balancing feedback loop to cause decreased appetite when you have a full stomach, along with all the hormonal things that happen with that as well.

The Sermorelin, that's all the rage now, is just to play on the hormone that's made when you go jogging. You make it naturally every time you do aerobic exercise with the body saying, "Oh, if we're going to do this, we don't need to be carrying a bunch of food around, so let's just go to half a glass of juice and go on." Versus if you don't do the exercise, your appetite's up and you have a different level of caloric intake. So that's some of the ideas about feedback loops. When we're talking about the components of a system, you've got feedback loops, you've got stock, flow of information.

So then the goal of a feedback loop would be that it helps keep the stock at the level that best benefits the system, either replenishing it or depleting it, if that's the goal. Another important point is they can only affect future behavior of the system, so you can't go back in time. So let's say you have a certain amount of money here, then it changes what comes in tomorrow, but you can't change what you had in there yesterday. Which seems basic, but it's important when we start talking about sexual response. Maybe for a more formal definition, it's worth saying a feedback loop is a closed chain of causal relations where the level of stock changes the inflow and outflow due to the system.

Feedback loops can cause stability, but they can also be blockers of change. Reinforcing feedback loops can cause a logarithmic growth or a quick collapse of the system. When I say reinforcing, by their definition, in my mind from a layman's term, I would think reinforcing means growth. But reinforcing could also mean reinforcing negative. For example, libido's up, but then the two-year-old knocks in the door, well then the stock of libido is going to go down because now mama's worried about the two-year-old's fever. Or broken finger, or whatever's causing the two-year-old to scream at the door. So that would be a quick collapse because the information coming in would say, "No, this is not the time to have sex," and there'd be an instant collapse where you could think of a dozen things that might happen in the bedroom that might cause this logarithmically to increase to the point of orgasm.

So reinforcing with this terminology can be negative or positive. Here's something that happened a lot in the endocrine system, and it also happens in the sexual system. There could be long delays in the feedback loop. So, foresight is needed. This happened a lot with my hormone business back when I did more of this. I've treated thousands of women for hormone replacement. You'd give a woman some hormones. Let's say you give her testosterone, libido comes up gradually, but takes about 12 weeks for it to max out, and then she's having great sex.

The same thing happens if she stops the testosterone. So her prescription runs out, or she fails to make an appointment. It might be three months before she notices the drop in libido. Because of that lack of association in time, or close association, there may be confusion about... Frequently, I'm sure hundreds of times, I'd have women think, "I think that testosterone might've been actually helping me." It doesn't mean she wasn't brilliant, it just means the lack of time synchronization made it hard for her to determine.

The other thing that happened was, they would start my testosterone and then they're 12 weeks in, and they start some supplement they picked up at Walmart, and they stop my testosterone and they think the libido is still going on because of the new supplement. They brought some sort of toenail of a exotic plant or... I don't know, I'm making up something. But they bought something that's completely homeopathic bull, but they think they still have a libido because of that, and they didn't need the testosterone because it's six to 12 weeks before they lose the libido from the testosterone. So then they think, "Oh, I don't need that testosterone. I'm doing fine with this toenail of a bumblebee."

So that is important, super important, both as we think about our therapies and as we talk with our patients about what we're doing, so they are educated enough to associate what we're doing. A stock also works like a memory within the system. So there can be this inflow and outflow without that can work separately. So you can have an inflow into your bank, it's there, and then you can have an outflow that is not at the same time. That helps because, like the example I'll just mentioned, the woman stops her testosterone, but she's got this buffer because it's built up, and the metabolic effects and the proteins that were manufactured because of it continue. So, there's not a sudden drop-off because she missed something.

So the stocks might stay the same. If the in equals the out, then there's a dynamic equilibrium. If the in is greater than the out, then there's an increase in stock, and of course vice versa. So they can work independently. Knowing or thinking about stock, within our system of libido, will be important when we proceed to later parts of talking about actual physical parts of the sexual system. Let's see what I've left out here. Okay, two more things and then we'll call tonight, unless you guys have comments or instructions. Hopefully, you'll teach me something that I haven't thought about.

Influencing the System (Tuning It Up to Make Things Better)

System constraints, and ways to influence the system. Now we've talked about the basic parts of the system. We'll talk about principles of influencing the system, and then next week we'll get into the actual parts of the system in regards to sexuality, and start talking about how to influence them.

In a growing system, there must be one reinforcing positive feedback causing growth, and there has to be one constraining feedback to limit growth since no system can grow infinitely in a finite world. I'll say that one more time. If you've got a system, if it's going to grow, you have to have something to reinforce it. But because there's nothing infinite, there's always going to be something restraining it.

The closest I can think to something not restraining it is persistent genital arousal disorder, where there's this positive feedback loop that seems to not be restrained by anything other than just the person's ability to physically give themself an orgasm. The suicide rate in the people who suffer with that problem is higher than the suicide rate in people who have chronic pain, because they cannot... It's so demanding of their energy, and their thought, and their ability to constrain themselves, that they can't function. So, that's the closest I can think of to a positive feedback within the libido sexual orgasm system with the negative feedback being so limited that it's basically maddening for the person.

Of course, if we're going to help someone with their sexuality, we need to know all those restrainers and all those positive reinforcing influences so that we can more intelligently help people. Again, to grow there must be at least one positive feedback loop, to grow the system. There'll always be a negative feedback to limit it, because there's nothing infinite in this planet. Now let's talk about some of the ways to influence the system, and then we'll call it at night, unless you guys have questions. I'm going to list them.

The best description I saw of this was in that Meadows book. I'll go through it with some ideas about how we might apply it in the future. She listed a dozen.

Twelve Ways to Tune the System

  1. Numbers

You can have the numbers, which would be the simplest and the easiest to think about. You've got, so what is the testosterone level? What is the amount of time you're spending with your lover? You got the actual math of it.

  1. Buffers

You have buffers in the systems, which has to do with your stock relative to flows.

  1. The Flow of Stock

You've got the stock and flow structures. That would be 10, we're counting down from 12.

  1. Delays

Number nine would be delays in the system.

  1. Feedback Loops

Next is balancing or feedback loops, reinforcing feedback loops, information flows, rules, and self-organization goals.

And the most overlaying and most influential ways to intervene in the system are paradigms and transcending paradigms, which really gets out there. So a transcending paradigm would be to realize that there really is no always true paradigm. It's what we're doing now, that maybe we need a higher or a different paradigm than what's even being talked about. So letting go and being free to know that maybe what we know is not correct. But, that's a little bit nebulous.

  1. & 12. Paradigms and Transcending Paradigm

Bringing it down one is, what's the paradigm? What is the idea behind an orgasm system? What's the goal of it? How is it organized? What rules does it follow? How does the information flow? What are the feedback loops? What's the stock? What's the buffers? What's the numbers?

 

That's what you need to think about. More complicated than it appears. As I dive into this, I think, "Man, can we really do this?" But, I think we can pull it off.

The Poster

In the end, we just want a poster. It's just a picture. But still, by understanding that picture and slapping it on the wall, we now have this really nice way of thinking about sexuality. For everything we say to our patients, we have a deeper level of knowing that they will feel and they will understand when they get well, sometimes when no one else is able to help them.

You are Part of a Revolution

Okay. Last thing I'll mention here is just this whole idea behind scientific revolution, and then I'll stop unless you guys have questions. We'll call tonight, because it's almost an hour. This is a quote from the book I was recommending you read about, The Structure of Scientific Revolution. When the paradigm enters into a conversation, which it has to do... Right now, we're under the paradigm that sex is important. As arousal changes or increases, self-reinforcing, there's an orgasm, which causes people to bind together and sometimes make a baby, which spills them over into the reproductive system.

That's our paradigm. Within that paradigm, it's useful to recognize our logic will be circular because it will be confined to that paradigm. We come out of that paradigm and we talk to someone who says, "No, there's really no need for that. It's just wanting to have sex as part of reproduction. Get over it." There's no use really having a conversation with that person because their logic is also circular within their paradigm that arousal's just part of reproduction. So if we're going to encounter or embark upon this idea, last thing I'll say is the tips that came from that sex revolution thing, or from that scientific revolution book.

Five Tips for Leading a Scientific Revolution

Here are the five tips to leading a scientific revolution, which you're part of now on this call, and you're definitely part of if you're part of our Cellular Medicine Association. If you're on this call, you're probably an innovator and have your own other revolutions. Five things before I cough my head off, and then we'll stop. Number one, you keep pointing to the anomalies and failures of the old paradigm. In our case, the reproductive system really doesn't explain how to encourage people to make babies. It just explains how you fertilize an egg. But it doesn't fully explain how you encourage people to increase their chances of having a baby, for example.

But number one, you keep pointing to the anomalies of the current paradigm. In the case of our O-Shot®, for example, the anomaly in the paradigm is that all of the FDA-approved drugs at this account, all two of them, are psych drugs. They're affecting the brain and that is it. But sex has genitals involved in the system as well, and if you have something that's been used in dentistry and wound care for two decades and orthopedics for two decades, to improve the health of the tissue, why not use it to improve the health of the vagina since that is part of the sexual orgasm system. But to do that, we have to bring people in the idea of it being a system and not the proverbial hammer so everything's a nail. In other words, thinking about sex must involve the brain since that's where you think.

So that would be a new paradigm to bring up the idea of using tissue repair and tissue-improved health with callogenesis and neovascularization neurogenesis as part of your improvement of libido. That versus the other example would be in male sexuality. All the current drugs just make what tissues there work harder, if vasodilates or the arterial system that's already there, but does nothing for neovascularization or neurogenesis, but PRP does and shockwave does. So even if you have someone who's getting better on Viagra®, and they're satisfied, why would you not also offer them a therapy that improves blood flow and neurogenesis? Why wouldn't you? Why would you not even maybe offered as prophylactic to prevent ED? That's a different paradigm than just making disease tissue work harder versus creating new healthier tissue.

So one, you keep pointing to the anomalies and failures of the old system. Number two, you keep speaking and acting loudly with assurance from your new paradigm, based on the research always. Number three, you have people with the new paradigm in places of public visibility and power, and we have people on this call that are board certified in multiple specialties. I see names. We have people that are luminaries and professors in various universities, and those are the people... Of course we have the celebrity type patients who speak out for us too. Suzanne Somers did more than any probably one physician to improve the health of women by speaking out about the necessity to think in more finite, granular ways about the female endocrin system, and then women started demanding it.

So number three is, you have people with visibility and power to talk about the new paradigm. Number four is, you don't taste waste time with the reactionaries because, as we just talked about, they're in a different paradigm, you're not going to convince them. We may all be wrong, but we're definitely going to be wrong within their paradigm, as in they will seem not correct within ours, so you're wasting time to talk to a closed mind, closed off within their paradigm. Number five is, you work with the active change agents, which are the people on this call to speak to the open mind, middle ground, those who are not...

It was Max Planck that said, "Scientific revolutions happen one funeral at a time," because you've never really convinced the old school. You must wait for them to die out.

I'm not quite as pessimistic about it. I think there are people of every age that are open to the idea that, especially in the sexual arena, "Hey, what we're doing doesn't work all the time, so maybe we need new therapies and new ways of thinking," which is what we are going to do.

Okay, with that, I think I'm going to end it. It's two minutes away from being an hour. Let's see, a couple of questions. That one I've already answered. Let's see if there's another one. Yeah, think I answered that. What about Vyleesi®? I think we'll get to that when we get to the brain. I'm not discounting the drugs that we have. When we get to how the hormonal system and the brain work, that is definitely a way to help that part of the system. All I'm saying is that there's something other than a brain. In men, we seem to focus more on the genitalia. We have Viagra that makes the genitalia work better. And women, we don't have an FDA-approved drug that does that yet.

Okay. I think with that, I'll call it a night. I hope that piqued your interest in what's possible, and the level of thought that can happen within the system. As we plow into those 12 different ways to affect the system, and the different parts of the system, hopefully, when we're done, we have a beautiful poster that looks pretty enough and simple enough to slap on the wall of a 6th-grade science class, but yet we understand it in a level that allows us to be excellent clinicians. With that, I'll call it a night. I hope you found that helpful. Goodnight.

References

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Draghici S, Khatri P, Tarca AL, et al. A systems biology approach for pathway level analysis. Genome Research. 2007;17(10):1537-1545. doi:10.1101/gr.6202607
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Sayin U. Doors of Female Orgasmic Consciousness: New Theories on the Peak Experience and Mechanisms of Female Orgasm and Expanded Sexual Response. Neuroquantology. 2012;10(4). doi:10.14704/nq.2012.10.4.627
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Zi Z. Sensitivity analysis approaches applied to systems biology models. IET Systems Biology. 2011;5(6):336. doi:10.1049/iet-syb.2011.0015
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Furman D, Hejblum BP, Simon N, et al. Systems analysis of sex differences reveals an immunosuppressive role for testosterone in the response to influenza vaccination. Proceedings of the National Academy of Sciences of the United States of America. 2014;111(2):869-874. doi:10.1073/pnas.1321060111
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He JC, Chuang PY, Ma’ayan A, Iyengar R. Systems biology of kidney diseases. Kidney international. 2012;81(1):22-39. doi:10.1038/ki.2011.314
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Mardinoglu A, Nielsen J. Systems medicine and metabolic modelling. Journal of Internal Medicine. 2012;271(2):142-154. doi:10.1111/j.1365-2796.2011.02493.x
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Systems medicine: A new approach to clinical practice | Elsevier Enhanced Reader. doi:10.1016/j.arbr.2014.09.001
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Rutherford A. The Elements of Thinking in Systems: Use System Archetypes to Understand, Manage and Fix Complex Problems and Make Smarter Decisions. Kindle Direct Publishing; 2019.
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Pavličev M, Wagner G. The Evolutionary Origin of Female Orgasm. J Exp Zool B Mol Dev Evol. 2016;326(6):326-337. doi:10.1002/jez.b.22690
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Basanta S, Nuño de la Rosa L. The female orgasm and the homology concept in evolutionary biology. J Morphol. 2023;284(1):e21544. doi:10.1002/jmor.21544
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Rutheford A. The Systems Thinker, Essential Thinking Skills for Solving Problmes, Managing Chaos, and Creating Lasting Solutions in a Complex World.; 2018.
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Meadows DH, Wright D. Thinking in Systems: A Primer. Chelsea Green Pub; 2008.
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Kox M, Van Eijk LT, Zwaag J, et al. Voluntary activation of the sympathetic nervous system and attenuation of the innate immune response in humans. Proceedings of the National Academy of Sciences of the United States of America. 2014;111(20):7379-7384. doi:10.1073/pnas.1322174111
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www.MeDitorial.cz. What has the new 11th revision of International Classific... Accessed August 7, 2023. https://www.prolekare.cz/en/journals/czech-gynaecology/2022-6-6/what-has-the-new-11th-revision-of-international-classification-of-diseases-classification-brought-in-the-categorization-of-female-sexual-dysfunctions-133031
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Wagner GP, Pavličev M. What the Evolution of Female Orgasm Teaches Us. Journal of Experimental Zoology Part B: Molecular and Developmental Evolution. 2016;326(6):325-325. doi:10.1002/jez.b.22694

Female Orgasm System

Hello,

A system is a group of components that work together to accomplish a purpose.  The Reproductive System produces offspring and propagates the race. The respiratory system removes carbon dioxide and provides oxygen to the cells. The Orgasm System provides pleasure to create deeper relationships and families and recurring sex (promoting the implementation of the Reproductive System).

Systems can share components and not be identical--there can be overlap.  The entire body could be thought of as a system with subsystems like the nervous, gastrointestinal, and endocrine systems.  The endocrine system makes up part of the Orgasm System. One might argue that the Orgasm System is the most complex since it does not work well if any other system malfunctions.

I first introduced the term "Orgasm System" to the medical literature more than a decade ago to promote a methodical, systems-analysis approach to diagnosing and treating sexual problems: exactly as is done with all other systems in the body.

Some of the Major Components of the Female Orgasm System. Problems with any component can affect the whole system. The lines represent feedback loops.

The following free course is for those who provide health care to women and for those who want to understand the beautiful complexity of women (women and those who love a woman).

Any one part of the system (for example, hormones) could fill a textbook, so intricate descriptions of every part of the system will not be part of the course. For this course, the components of the system will be identified, and the relation of the components to each other will be described (feedback loops). By doing that alone, physicians (and their extenders) and counselors  can more effectively take a systems approach to diagnosis and treatment and avoid the mindset that "I have a hammer, so everything looks like a nail."

Often, the counselor is not aware of the intricacies that can be done with hormones and regenerative therapies. And the physician who understands the endocrine system and the anatomy forgets the importance of knowing about past abuse and understanding the nuances of relationships.

Hopefully, by at least laying out the entire system for viewing on one page (as is done with every other body system), both women and those who care for women will facilitate more effective treatments and better sexual health.

I hope you find the course helpful. Feedback is welcome! The course will take place over ten weeks. The lessons will take place live but will be recorded and transcribed for viewing at the convenience of those who register (much will be password protected, even though free).

Register for free on the following form in ten seconds. Please, fill in all fields to help us know we are dealing with real people and not spam bots.

Thank you for your trust,

Charles Runels, MD

Charles Runels, MD
Runels.com
CellularMedicineAssociation.org

P.S. Those who complete the course and take the test successfully will receive a free certificate of completion from the Orgasm College™ certifying an understanding of the components of the Female Orgasm System.

PE in Men (How short is “premature” & how long is “sustained”)

The definition of “premature ejaculation” evolves. The formal definitions (those used by doctors and therapists) work well for conducting research but not so well for bedroom purposes.

For example, the following set of questions are used as a tool to make the diagnosis of “premature ejaculation”; the man (only the man) answers five questions, and the score determines diagnosis:

1. How difficult is it for you to delay ejaculation?

2. Do you ejaculate before you want to?

3. Do you ejaculate with very little stimulation?

4. Do you feel frustrated because of ejaculating before you want to?

5. How concerned are you that your time to ejaculation leaves your partner sexually unfulfilled?

Notice that this survey has no way of directly knowing what the woman thinks; the survey only questions the man.

So, a man who only waits thirty seconds before ejaculation with every encounter, who leaves his lover very frustrated, but who is not concerned with her, and who thinks thirty seconds duration is always adequate would score well on the test and not be diagnosed with premature ejaculation.

Even if the man does worry about the emotions and fulfillment of his lover, the test assumes that his lover will tell him of her frustration; but, many women do not tell their partner of their frustration, and the man is not connected enough to his lover to perceive her feelings.

So, the double bind is that if the man truly loves his wife, then he would be concerned enough to actually score poorly if his partner opened to him about her frustration. But, partly because of his great love, his wife may not risk offending him by voicing her frustration about his sexual endurance.

His love nurtures her love, which (because she fears hurting him) keeps him stupid about her emotions, which leads to less satisfaction for her, a strain on their sex life, and eventually to a fracture of the very love he treasures.

Still, even with the limits of the above survey tool, if the man is alert and is blessed with a lover who is honest with him, the tool converts his answers into a score that can be used to quantify and compare the effectiveness of different therapies.

But this test, and most tests, do underestimate the incidence of premature ejaculation because the researcher has no way to truly know the mind of a woman if only surveying the man. There are many more frustrated women on the planet than the premature ejaculation research would indicate. Remember, around ten percent of women prefer to be in the bed with other women—they enjoy wonderful sex with no penis in the bedroom at all. Sustaining penile tumescence truly is less important than understanding your lover; I cannot stress this enough.

Still, women (at least the ones who enjoy sex) often wish that sex—done in an understanding way—would extend much longer than what the man thinks brings satisfaction. Moreover, I have often found that even when a woman has had an orgasm and thinks she has enjoyed an amazing sexual encounter, even then, after more time, with continued and artfully provided mental and physical attention, she will reach a different level of pleasure and connection, a different dimension of her sexuality, a new side path in her garden of desire that she did not know exists. She discovers herself in extended sex; that is, she finds parts of herself she didn’t know when she explores (with an understanding lover) the farther ends of the paths of her secret gardens. These deeper levels of connection and pleasure are not acknowledged or found under the present definition of premature ejaculation.

Being satisfied with “wonderful,” couples often never find “soul-opening-amazing.”

I am absolutely NOT proposing that men force sex to last longer than what a woman wants on a particular day. But there is a very good chance that your lover is completely content (be grateful for that); but, with more extended lovemaking (always done artfully), you and your lover may find that the stairway to heaven goes much much higher than what you both thought.

So, the current definitions of premature ejaculation work well for research but, maybe, not so well in the bedroom.

A New Definition of “Premature Ejaculation”

In defining “premature ejaculation,” rather than considering only the man’s impression of the sexual encounter, or even an arbitrary number of minutes of sexual intercourse (another way of defining “premature ejaculation”), I propose a new Bedroom-Definition of Premature Ejaculation (in contrast with the research definition):

“Bedroom Premature Ejaculation is when ejaculation blocks the path of either you or your lover to the level of arousal, pleasure, and soul connection that is possible and intended for a specific sexual encounter.”

Important Corollaries to this Definition

By this proposed definition, ejaculation before the point of “possible and intended” pleasure would be considered “premature” regardless of the number of minutes of the encounter: on some days, ejaculation after 1 minute would be absolutely perfect; while with the same couple, on another day (or another time on the same day), ejaculation after 1 hour of vigorous sex may be premature.

This definition of premature ejaculation, Bedroom Premature Ejaculation (BPE) would require that the couple communicate.

Also, avoiding BPE would require that, if the female partner experienced occasions of exceptional appetite, the man would require exceptional, on-demand endurance or else he would (for that couple on that occasion) suffer from bedroom premature ejaculation.

Are You a Golf Cart or a Limo?

I live in a tourist town near the Gulf of Mexico where it is legal for you to drive a golf cart on the street with automobiles. Many people use their golf cart for short trips to the store and are perfectly happy to drive only the golf cart most days. But, those same people would never use their golf cart to drive the five hours it takes to get to the nearest mountains. Most men do not want to be the golf cart, requiring their lover to find another means of transportation if she wants to travel to the mountains.

In art, the masterpiece appears after most people quit.

Every man who considers sex an art worthy of lifetime attention should study how to Extend Sex.

Hope this helps!

Charles Runels, MD

 

 

 

Research about the diagnosis of premature ejaculation<--

Orgasm College™<--

Extend Sex. Chapter 2. The 30-Second Trick

Chapter 2
The 30-Second Trick

Warning: Jack Hammers & Space

Even though, by studying this course, you can become a man who is able to provide jackhammer sex—extended, mindless, unrelenting thrusting for hours and hours and hours (and hours)—actually performing in this way every time you enjoy sex with your lover should not be your goal.

To understand sex as passion, love, and art, to know sex as dangerous strength, and sacred tenderness, listen to George Winston’s piano in his album December. This is not a rhetorical request; buy the album (preferably on vinyl); then listen to its entirety in one session, in the dark, without speaking and without allowing anyone else to speak. Notice the space between notes—the silence. Notice that Winston, on occasion, demonstrates superior finger speed. But, most of the time, when he plays, he shows no need to demonstrate speed or endurance. Instead, he often rests in silence, not to make you want the next note (although you will), but to show you silence. He demonstrates patience and connection to the music, not a need to demonstrate his skill. He gives you the next note only after making you wait longer than you expect; then, when the note comes—you more than hear it.

Here’s another way to hear why extended sex does not equate to good sex: re-listen to Led Zeppelin’s “Stairway to Heaven.” You likely can bring it to mind, but actually re-listen to it. That classic starts with a tinkle, gradually turns into ripping and screaming, before ending with a whispering collapse.

Artful sex and artful music (which at its best is sex) both require rising and falling, spring and fall, exertion and rest. Being able to thrust jackhammer style for hours does not mean that you should.

Conversely, to perform as a master musician, both Winston and Zeppelin must be able to play rapidly with strength and volume; we expect and demand kinetic force at the proper time—or else we put away music as impotent and bland.

Similarly, men should claim the solid mechanics of their penis and learn to maintain speed and force for hours. But such mechanics without art turns sex into a nuisance worse than a child relentlessly banging the keys of a piano.

The Anatomy and Physiology of the 30-Second Trick (They Didn’t Teach You This in High School)

You may wonder why even think about how to extend sex.

The first time that I had sex, the summer of 1978, I was 18; it lasted less than five minutes. The short duration disappointed me (and I’m sure my lover as well).

Because I ran cross-country track during high school (and so was accustomed to running nonstop for hours), I had endurance; but, I needed to discover how to maintain an erection during exertion. But, then, before the end of that summer, after discovering the 30-Second Trick, I could enjoy sex with my lover for hours—literally hours. During those longer sexual encounters, I would see not only my lover orgasm, but also see her cry with pleasure and release: sweating, sobbing, moaning, enjoying orgasm after orgasm, and melting into bliss. So, it seemed to me that, at least on occasion, longer-lasting sex was better than brief sex.

The simple 30-Second Trick that I figured out during that summer, works based on human anatomy. And, even though I did not, in the summer of 1978, understand the anatomy, the 30-Second Trick still worked. But, years later, after better understanding the anatomy, the trick works even better. So, before you practice the trick, take a short look at the relevant anatomy of the penis and the vagina.

In developing from an embryo into an adult, both men and women develop the same parts (even the same genitalia). Like the rest of the body, the genitalia simply develop into different sizes and different (but similar) shapes based on the sex of the person. The corpus cavernosum and the corpus spongiosum develop into a penis in a man and into a clitoris in a woman—but the tissue in both men and women is of the same composition and of similar shape (but of different sizes).

As another example, the man develops a prostate gland; a woman develops Skene’s glands (also called periurethral glands): both secrete fluid identical biochemically and that tests positive for prostate-specific antigen (PSA)—yes, the woman’s Skene’s glands secrete fluid that contains PSA. Women can even develop cancer in the Skene’s glands that if the same cancer were in a man would be called “prostate cancer.”

Also, the woman’s labia and the man’s scrotum are analogous.

In the man’s embryological development, the testicles descend into the scrotum; in a female, the ovaries remain inside the abdomen; but, both testicles and ovaries serve analogous functions and share analogous anatomical connections.

Also, (and important to extending sex) in both men and women, the spinal nerves travel down the spinal column and branch into the nerves of micturition: the nerves that allow you urinate or to hold your urine in the bladder until you make it to an appropriate place. The spinal nerves (thoracic, lower thoracic, lumbar, and sacral nerves) connect to ganglion; and these nerves also branch to become the pudendal nerve, which extends to the penis and to the prostate gland.

Important: Sensations from the bladder come through the spinal nerves to tell your brain when your bladder is full so you do not urinate on yourself; these same nerves also communicate to your brain the sensations that tell you when your bladder is empty.

When a woman ejaculates (expels fluid from the urethra during orgasm), sometimes the fluid comes from her Skene's glands; but, the fluid of ejaculation can also come from her bladder (she urinates with orgasm)—either way, the same nerves control both urination and ejaculation.

Also, (whether from the bladder or from the Skene’s glands), when a woman or a man releases fluid with orgasm, pleasure increases and emotional response deepens.

Pressure Release Causes Pleasure

Here’s a general principal that applies to both men and women: when a space in the body which has been expanded with a substance to the point of increased pressure then releases that substance to cause a sudden release of pressure, then the release of pressure brings pleasure.

Whether the pressure release is called a bowel movement, popping a zit, urinating, nose-blowing, ear wax extraction, or abscess draining—pleasure occurs with the release. All examples of pressure release do not bring the intensity of pleasure felt with orgasm; but in every case of pressure release, one feels pleasure.

With orgasm, the combination of the release of ejaculate from the Skene’s glands (woman), combined with the simultaneous release of hormones from the pituitary, and sweat from pores can be so physically and emotionally moving that orgasm can be followed by the release of tears of joy and by a change in the woman’s overall physiology—the Chinese, 2000 years ago, called this type of orgasm a “little death.” Indeed, the woman does experience with ejaculatory orgasm an emotional death to that which may be blocking her (mentally, physically, and spiritually), so that she both dies to those blocks and to her old life, and then melts into a resurrected space where she shares ecstasy and clarity with her lover and with her GOD.

The Urge to Urinate Affects the Urge to Ejaculate

I cover the details of a woman’s “little death” in another course of study, Total Surrender Orgasm with Female Ejaculation; that’s a subject for later. For now, the point is that the sensations sent to the brain with both the urge for urination and the urge for ejaculation (for both men and women) are mixed together, all connected to the brain through the same nerves; and because the sensations of both urination and ejaculation travel together to the brain through the same nerves, the dual functions of those nerves make it difficult for the brain to tell the difference between a full bladder and a full prostate gland.

Said another way: you feel the urge to urinate and the urge to ejaculate through the same neuronal pathways to the same part of your brain; therefore, anything that increases your urge to urinate will also increase your urge to ejaculate; and, anything that decreases your urge to urinate will also decrease your urge to ejaculate. In summary,

Increasing the urge to urinate increases the urge to ejaculate; decreasing the urge to urinate decreases the urge to ejaculate!

For the most control of your urge to ejaculate, decrease your urge to urinate so much so that, even if you try to urinate, nothing will come out.

Learning to apply this one concept can change your love-making abilities tremendously.

Factors that Change the Urge to Urinate

Many factors affect the urge to urinate, or even the ability to urinate. For example, some of the cold medications can cause complete urinary obstruction, where a man cannot urinate at all.

Acetylcholine, prostaglandins (some of them released with massage), and nitric oxide are a few of the factors that can affect the urge to urinate. If you study a list of all factors that affect the urge to urinate, the following principle applies: anything that causes relaxation of the bladder neck could make it more difficult to hold your urine (and easier to urinate); these same factors would make it more difficult to hold your ejaculate (or easier to ejaculate).

If something inhibits relaxation of the bladder neck, then it causes contraction of the bladder neck; if something causes contraction of the bladder neck, then it helps you hold your urine and helps you delay ejaculation—therefore helping you extend sex.

Therefore, whatever inhibits relaxation of the bladder neck will help extend sex.

Serotonin going up relaxes the muscles of micturition so you have less urge to urinate (and therefore the urge to ejaculate). Remember, from the last chapter, raising serotonin levels through exercise and light and meditation helps prolong sex; now you understand one of the reasons why.

Nitric oxide also inhibits the efferent firing of the nerves—also decreasing the urge to urinate.

Surgery

In one research study of men undergoing surgery for rectal cancer, researchers measured both urinary and sexual function and saw that with the decreased nerve function in the area, the men in the study saw the ability to prolong sex (sometimes completely losing the ability to ejaculate at all).

Aerobic Exercise

When raising serotonin levels with exercise, in the same way you cannot run only one day and then enjoy fitness for the rest of your life, with methods of avoiding the urge to ejaculate by avoiding the urge to urinate, you get benefits the day of exercise, but they do not carry over to the next day unless you repeat the exercise. The effects may, if you're really fit, start to carry over for more than one day at a time. But usually, the best effect is the day you exercise.

For example, on the female side, there was a study showing that women who have sex right after aerobic exercise can more easily enjoy an orgasm (and they enjoy a stronger orgasm than if they do not exercise). So, part of foreplay could involve going for a walk or a jog or a swim with your lover; the result would be that the man could delay ejaculation and the woman could more easily orgasm. 1

The runner's high only lasts for a day, but your baseline sense of wellbeing gradually goes up when you exercise daily. In the same way, the immediate effects from exercise, from the serotonin, which lead to longer sexual encounters for you and to better orgasms for your lover, those effects are going to be short-lived until you get your baseline serotonin up with consistent daily exercise. The benefits probably peak around the 25-mile-a-week mark.

But if you go for a week or so without exercising at all, then the benefits of exercise can decrease to nothing.

Full-Bladder Sex

All of the above-mentioned ideas can help prolong sex; but, I promised you a 30-second trick that works. Now that you better understand the anatomy, you will better understand why my trick works.

One of the easiest ways to decrease the urge to urinate (and so decrease the urge to ejaculate) is to simply empty the bladder!

Try the following exercise the next time you have sex: have sex with a very full bladder. You will very quickly have the urge to ejaculate.

Empty-Bladder Sex

Then, the next time you have sex, completely (and I mean absolutely completely) empty your bladder less than a minute before you have sex. You want your bladder to be as empty as you can get it. That means that you urinate; and, then as you're urinating, you do the shiver-Kegel where you empty out the last two or three drops. Then, when you start penis-in-vagina sex, you will find a less-than-usual urge to ejaculate.

Remember my definition of premature ejaculation: if you're ejaculating before you (or your lover) want to ejaculate, that's “premature.” I don't care if you have been having sex for 30 minutes or for 3 hours; if both you and your lover are enjoying the intimacy (whether you are doing tantric sex or you are doing circus, wide-open-jack-hammer sex on your neighbor’s roof), if you ejaculate before you want to ejaculate, by my definition, that's premature. That means that sometimes if you ejaculate after 30 seconds, that is not premature because both you and your lover wanted quick sex before leaving for work; but, sometimes, if you ejaculate after 2 hours, but you wanted to go longer, then that would be premature. Your intention, not the clock, defines premature ejaculation.

The 30-Second Trick: Empty-Bladder Sex Followed by Interruption Combined with Urination (ICU)

The next time you have sex, urinate right before you start (less than a minute before putting your penis in your lover’s vagina). Then, after making love for a time, when you feel the first urge to ejaculate (whether you feel that urge after 30 seconds or after an hour), instead of only doing the basic interruption technique, interrupt your thrusting, and urinate! You will be amazed at the difference in the urge when you start back.

Oftentimes, if you urinate immediately before you have sex (which you should if you want to decrease the urge to ejaculate), then, when you feel the first urge to ejaculate and you stop to urinate, you may only feel a few drops come out; then you start back and only a few minutes later, you might again feel the urge to ejaculate—even if it’s only been a few seconds, urinate another drop or two.

After stopping to urinate only once or twice, the urge to ejaculate will decrease dramatically. The urge that's almost unbearable in the beginning of a love-making session will become less and less until you reach the “Safe Zone” (where you can have sex with abandon for hours at a time if you and your lover have the physical stamina)—your urge to ejaculate will quit being a limiting factor at all.

More about the “Safe Zone” can be found in my complete course, Extend Sex, but the main point of this lesson is simply this, the nerves of micturition are the same as the nerves of ejaculation and erection; at least, there's crossover in the sharing of afferent and efferent nerve conduction for both sensation and contraction.

So if you completely take away the signal to urinate, and then you take it away again when that signal recurs, you can greatly decrease or even eliminate the urge to ejaculate.

Further Tips about the 30-Second Trick

Remember the parasympathetic and sympathetic nervous systems we talked about in the previous lessons? The parasympathetic nervous system has to do with erection; parasympathetic becomes dominant when you relax. The sympathetic nervous system kicks in to help you move when you need to “fight or flight”—and the sympathetic system activates with ejaculation.

Here’s a key point: you can enjoy the ability to keep your parasympathetic system active—staying relaxed and avoiding ejaculation while actively having sex—when you are fit. In other words, if you are aerobically unfit (with a low VO2max), then you need to kick in your sympathetic nervous system at a lower activity level—and when your sympathetic nervous system kicks in, then you begin to have a stronger urge to ejaculate. So, being aerobically out of shape makes it more difficult to avoid ejaculation when you enjoy active sex.

Exertion Combined with Relaxation

So one of the things you can practice this week is walking or jogging (with your doctor’s permission) while simultaneously keeping your body relaxed, the muscles of your face, your arms, even your legs should stay relaxed while you walk or jog.

When I ran marathons, I would focus on keeping face, arms, even legs completely relaxed while running (talk with a marathoner to learn more about how this can be done). You can practice this while doing any work, even desk work or reading: simply notice the muscles of your body; notice now; are you contracting muscles that are not needed to do the work in progress?

Are you contracting the muscles of your neck and back now, while reading or listening to this lesson? If so, then right now, breathe in and out deeply and keep reading while letting go of the muscle contraction in your shoulders, back, and arms, and legs.

In other words, practice working your body (sitting is more work than lying supine) while simultaneously relaxing your body so that your parasympathetic nervous system stays dominant, not your sympathetic nervous system.

Then, after you practice walking, running, and sitting while keeping your parasympathetic nervous system dominant; after you practice doing your daily work while staying relaxed; then practice doing the same thing (staying relaxed even during exertion) when you next enjoy vigorous sex.

So, as you enjoy vigorous sex, the idea is that you are aroused, you are into your lover, you enjoy the sensations, you enjoy the sounds and the connection, and the emotion and you actively and forcefully thrust yourself into your lover, but your body stays relaxed while you move.

Whether the motion of you and your lover demonstrates tantric sex that is maddeningly slow, or whether you and your lover grow outrageous with screaming, sweating, panting, and the walls of your house shake so much your neighbors think you are remodeling the kitchen—either way, your body stays relaxed.

If one can sprint a hundred yards at the Olympics and stay relaxed while doing it, then you can enjoy sex and stay relaxed.

Note: If you masturbate to practice these ideas, do the same thing—urinate right before you masturbate and stay relaxed while masturbating. If you practice penis-root massage, either by you or by your lover (see Extend Sex for more details), urinate right before practice, then practice the penis-root massage in the same way, except, if you feel the urge to ejaculate during your penis-root massage, stop, urinate, and then start back.

Where do you aim it?

When you create a state where your parasympathetic nervous system becomes dominant (and your sympathetic system downplayed), you will see much better erection and ejaculation control so that (with practice) you can extend sex much longer. Now, here's the problem and why are you not going to want to do this simple little 30-Second Trick of emptying your bladder before and during sex: your lover will feel frustrated when you stop sex to urinate.

Think about it: she’s moaning, she’s moving in synchrony with your body and both of you move in synchrony with the spinning of the Milky Way, she's on the verge of an orgasm that feels like it will become a prayer of devotion and love and screams and visions of prophecy—but now, you need to stop on that precipice so you can pee!

She's not going to like it.

And so, you should tell her what you are doing and why; inform her that if we do this, once, twice, three times, maybe, it will become easier to prolong sex and we can find that powerful space in prolonged intimacy that is without words.

Keep the Momentum of the Music

In the meantime, when you stop to urinate, to keep from losing all the momentum (though she will usually lose some), she can masturbate while you “take a leak.” If you are outside, taking a leak (urinating) might just meaning taking a step away and aiming at the grass. Or, in your home, you maybe only need to take a few steps to the bathroom. But, when you go to the toilet, now you left the room where a woman who was on the verge of a magic space waits without you. She will not to like it. But she is going to love it when she figures out that by you taking a pause or two, now you can provide for her two minutes or two hours, or a full day of sexual intercourse—whatever she and you desire that day.

Other things you can do to help keep her from feeling frustrated when you practice the 30-Second Trick interruption combined with urination (ICU) include the following:

First, hopefully, you have made it to a psychological place where you are not jealous of a vibrator; let her masturbate with her vibrator until after you urinate and until you climb back into her love saddle. People cloister different ideas about masturbation; some men become furious that their wife might be sexually pleased by anything other than her husband’s penis; you may want to rethink that attitude if that describes you. Just give her something else to play with for the few seconds it takes you to step to a place where you can urinate.

In addition to the vibrator use, another (perhaps more outrageous) thing you can do is to go onto Amazon and buy an old-school, plastic, bedside urinal (like what hangs on the side of a bed in the hospital). Stick that urinal under the bed (it does not look too sexy sitting on the bedside table next to your olive oil and incense). Then, when you need to stop and pee, just turn your back to her, pee into the urinal and you do not need to leave the room. This strategy allows you to still speak words of arousal and to perhaps touch her with one of your hands while you urinate (assuming you like to multitask).

The simple plan that works best for most is to give her instructions (or “permission” or “encouragement” or whatever you want to call it) to keep her arousal heightened with her hands while you step away for a few seconds to the bathroom to urinate.

Remember: once you make it to the Safe Zone, then ICU becomes unnecessary and you can enjoy continuous lovemaking for as long as your VO2 max and your collective desire may allow.

Avoid the Erection Killer

One practice that will help ICU (and the other strategies that I teach) work better is if you do not drink alcohol right before sex. Remember: alcohol (when the man drinks) will kill the 30-Second Trick (ICU) in at least two ways:

First, alcohol is a diuretic; alcohol causes your body to make more urine, which makes it more difficult to keep your bladder empty, which makes it more difficult to avoid ejaculation. Not that you need to be dehydrated to have sex, but if you just guzzled a six-pack and now you go to it, it might make it harder to keep your bladder empty not only because of the extra liquids but also because alcohol causes your kidneys to make more urine (and so your bladder to fill more quickly) for the same amount of liquid consumed.

The second way that alcohol interferes with the implementation of ICU is that you simply can’t focus as well after you drink alcohol; so you have more difficulty perceiving the edge of ejaculation approaching. You need to be able to enjoy the sex with your passion or “lizard brain” while at the same time your left brain stays attentive to the beginning of the edge so that you can stop to urinate before you reach the point of no return. Using both your lizard brain (midbrain) and your left brain at the same time is much easier if you are sober.

Summary

  1. Question: What's the 30-second trick?

Answer: Interrupt penis-in-vagina thrusting for 30-seconds to urinate whenever you feel the urge to ejaculate (Interruption Combined with Urination, ICU); keep the bladder completely empty down to the last drop before and during your sexual encounter.

  1. Daily, practice keeping your parasympathetic system dominant by practicing relaxed activity.

For best results, practice for at least a week all the methods described in the previous lessons in Extend Sex (all the methods, not just the walking). Then. practice ICU and aerobic exercise for the rest of your life.

  1. Carefully notice: how does the feeling (in your head and in your genitals) of the urge to ejaculate change after you urinate? After you stop to urinate, and then resume sex, how does that feel to you compared to simply interrupting sex without urination?
  2. Also, this week, keep your aerobic exercise going (with the goal to consistently do 25 miles a week on foot), especially try to do aerobic exercise right before you have sex. Try to do aerobic exercise at least six days a week; keep a record of miles walked per week so you keep yourself honest with yourself.
  3. Continue to do the other practices we discussed in previous lessons in Extend Sex concerning the adjustment of serotonin and the parasympathetic nervous system.
  4. Every time you have sex, urinate before you start your sexual encounter. Then, while you are enjoying the sexual encounter (either with penis-in-vagina, or penis-in-whatever-orifice sex, or if you're masturbating with you or your lover), while you are enjoying sex, purposefully stop before you ejaculate, urinate, then start back; then, stop and urinate again (when needed to avoid ejaculation), and start back.
  5. Do at least two cycles of ICU before you allow yourself to ejaculate; more is better when practicing.
  6. Do not keep your practice a secret from your lover. Recruit her loving understanding and participation for your pleasure and for hers.

Remember: every love encounter does not need to be an all-night symphony; sometimes, a minuet is absolutely heavenly and more would be an intrusion.

But, when an all-night concert is wanted, I think you will find that my 30-Second Trick (ICU) will help deliver a private “Stairway to Heaven” for both you and your lover.

©2021 Charles Runels, MD

More resources at OrgasmCollege.com , PriapusShot.com, and Runels.com

  1. I do not recommend bicycles at all. They can damage the pudendal nerves that help you feel the pleasure of sex (even with a properly fitted seat. ↩︎