Anatomy and physiology of the clitoris, vestibular bulbs, and labia minora with a review of the female orgasm and the prevention of female sexual dysfunction

Clinical Anatomy

Volumn 26, Issue 1, 2013, Pages 134-152

  Puppo, Vincenzo ^a  

^a Centro Italiano di Sessuologia CIS   (Italy)

Author keywords

clitoris; G spot; orgasmic dysfunction; penis; sex education; urethra; vulva

Indexed keywords

AGING; ANATOMICAL VARIATION; CLITORIS; CORPUS CAVERNOSUM; ESTHETIC SURGERY; FEMALE SEXUAL DYSFUNCTION; HUMAN; INNERVATION; LABIUM MINUS; MUSCLE CONTRACTION; ORGASM; PENIS; PERINEUM; PREPUCE; PRIORITY JOURNAL; REVIEW; SEX DIFFERENCE; SEXUAL AROUSAL; SEXUAL BEHAVIOR; SEXUAL EDUCATION; URETHRA; VAGINA; VESTIBULAR BULB;

CLITORIS; FEMALE; HUMANS; MALE; ORGASM; PENIS; SEXUAL DYSFUNCTION, PHYSIOLOGICAL; URETHRA; VULVA;

EID: 84871427426     PISSN: 08973806     EISSN: 10982353     Source Type: Journal    
DOI: 10.1002/ca.22177     Document Type: Review

References (138)

1. Abdulcadir J, Margairaz C, Boulvain M, Irion O,. 2011. Care of women with female genital mutilation/cutting. Swiss Med Wkly 140: w13137.
2. Abdulcadir J, Boulvain M, Petignat P,. 2012. Reconstructive surgery for female genital mutilation. Lancet 380: 90-92.
3. Abdool Z, Thakar R, Sultan AH,. 2009. Postpartum female sexual function. Eur J Obstet Gynecol Reprod Biol 145: 133-137.
4. Acién P, Acién MI,. 2011. The history of female genital tract malformation classifications and proposal of an updated system. Hum Reprod Update 17: 693-705.
5. Addiego F, Belzer EG, Comolli J, Moger W, Perry JD, Whipple B,. 1981. Female ejaculation: A case study. J Sex Res 17: 13-21.
6. American College of Obstetricians and Gynecologists. 2007. ACOG Committee Opinion No. 378: Vaginal "rejuvenation" and cosmetic vaginal procedures. Obstet Gynecol 110: 737-738.
7. Andersson KE,. 2011. Mechanisms of penile erection and basis for pharmacological treatment of erectile dysfunction. Pharmacol Rev 63: 811-859.
8. Argiolas A, Melis MR,. 2003. The neurophysiology of the sexual cycle. J Endocrinol Invest 26 (3 Suppl): 20-22.
9. Arntzen BW, de Boer CN,. 2006. Priapism of the clitoris. BJOG 113: 742-743.
10. Basson R, Brotto LA, Laan E, Redmond G, Utian WH,. 2005. Assessment and management of women's sexual dysfunctions: Problematic desire and arousal. J Sex Med 2: 291-300.
11. Battaglia C, Battaglia B, Busacchi P, Paradisi R, Meriggiola MC, Venturoli S,. in press. 2D and 3D ultrasound examination of labia minora. Arch Sex Behav; DOI 10.1007/s10508-012-9899-5 0000
12. Bellemare S, Dibden L,. 2005. Absence of the clitoris in a 13-year-old adolescent: Medical implications for child and adolescent health. J Pediatr Adolesc Gynecol 18: 415-418.
13. Benoit G, Delmas V, Gillot C, Jardin A,. 1987. The anatomy of erection. Surg Radiol Anat 9: 263-272.
14. Braun V,. 2010. Female genital cosmetic surgery: A critical review of current knowledge and contemporary debates. J Womens Health 19: 1393-1407.
15. Brody S, Costa RM,. 2011. Vaginal orgasm is more prevalent among women with a prominent tubercle of the upper lip. J Sex Med 8: 2793-2799.
16. Buisson O,. 2010. The G-spot and lack of female sexual medicine. Gynecol Obstet Fertil 38: 781-784.
17. Buisson O, Foldes P, Paniel BJ,. 2008. Sonography of the clitoris. J Sex Med 5: 413-417.
18. Buisson O, Foldes P, Jannini E, Mimoun S,. 2010. Coitus as revealed by ultrasound in one volunteer couple. J Sex Med 7: 2750-2754.
19. Carvalho S, Moreira A, Rosado M, Correia D, Maia D, Pimentel P,. 2011. Female premature orgasm: Does this exist. Sexologies 20: 215-220.
20. Catala M,. 2002. Control of the development of Onuf's spinal nucleus. Prog Urol 12: 340-343.
21. Chalker R,. 2000. The Clitoral Truth: The Secret World at Your Fingertips. New York: Seven Stories Press. p 1-257.
22. Chiarugi G, Bucciante L,. 1975. Istituzioni di Anatomia dell'uomo. Testo-Atlante. Vol 3. 11th Ed. Milano: Casa Editrice Dr. Francesco Vallardi-Societø Editrice Libraria. p 1-950.
23. Cold CJ, Taylor JR,. 1999. The prepuce. BJU Int 83 (Suppl 1): 34-44.
24. Connell K, Guess MK, La Combe J, Wang A, Powers K, Lazarou G, Mikhail M,. 2005. Evaluation of the role of pudendal nerve integrity in female sexual function using noninvasive techniques. Am J Obstet Gynecol 192: 1712-1717.
25. Copcu E, Aktas A, Sivrioglu N, Copcu O, Oztan Y,. 2004. Idiopathic isolated clitoromegaly: A report of two cases. Reprod Health 1: 4.
26. Darling CA, Davidson JK Sr., Jennings DA,. 1991. The female sexual response revisited: Understanding the multiorgasmic experience in women. Arch Sex Behav 20: 527-540.
27. Dickinson RL,. 1949. Atlas of Human Sex Anatomy. 2nd Ed. Baltimore: Williams & Wilkins. p 1-145.
28. Dwyer PL,. 2012. Skene's gland revisited: Function, dysfunction and the G spot. Int Urogynecol J 23: 135-137.
29. Elnashar AM, EL-Dien Ibrahim M, EL-Desoky MM, Ali OM, El-Sayd Mohamed Hassan M,. 2007. Female sexual dysfunction in Lower Egypt. BJOG 114: 201-206.
30. Farage M, Maibach H,. 2006. Lifetime changes in the vulva and vagina. Arch Gynecol Obstet 273: 195-202.
31. Foldes P, Buisson O,. 2009. The clitoral complex: A dynamic sonographic study. J Sex Med 6: 1223-1231.
32. Friedman M, Siegler E, Lowenstein L,. 2004. The vaginal vestibule. J Low Genit Tract Dis 8: 71-72.
33. Ginger VA, Cold CJ, Yang CC,. 2011a. Surgical anatomy of the dorsal nerve of the clitoris. Neurourol Urodyn 30: 412-416.
34. Ginger VA, Cold CJ, Yang CC,. 2011b. Structure and innervation of the labia minora: More than minor skin folds. Female Pelvic Med Reconstr Surg 17: 180-183.
35. Giuliano F, Clément P,. 2005. Physiology of ejaculation: Emphasis on serotonergic control. Eur Urol 48: 408-417.
36. Goldstein I,. 2000. Female sexual arousal disorder: New insights. Int J Impot Res 12 (Suppl 4): S152-S157.
37. Goldstein AT, Burrows LJ,. 2007. Surgical treatment of clitoral phimosis caused by lichen sclerosus. Am J Obstet Gynecol 196: 126.e1- e4.
38. Goldstein I, Meston CM, Davis SR, Traish AM,. 2006. Women's Sexual Function and Dysfunction. Study, Diagnosis and Treatment. London: Taylor and Francis. p 1-784.
39. Grafenberg E,. 1950. The role of urethra in female orgasm. Int J Sexol 3: 145-148.
40. Gravina GL, Brandetti F, Martini P, Carosa E, Di Stasi SM, Morano S, Lenzi A, Jannini EA,. 2008. Measurement of the thickness of the urethrovaginal space in women with or without vaginal orgasm. J Sex Med 5: 610-618.
41. Halata Z, Munger BL,. 1986. The neuroanatomical basis for the protopathic sensibility of the human glans penis. Brain Res 371: 205-230.
42. Hartmann H,. 1913. Gynecological Operations, Including Non-Operative Treatment and Minor Gynecology. Philadelphia, PA: P. Blakiston's Son & Co. p 1-536.
43. Herbenick DJ, Fortenberry JD,. 2011. Exercise-induced orgasm and pleasure among women. Sex Relat Ther 26: 373-388.
44. Hines TM,. 2001. The G-spot: A modern gynecologic myth. Am J Obstet Gynecol 185: 359-362.
45. Hite S,. 1981. The Hite Report: A Nationwide Study on Female Sexuality. New York: Dell. p 1-664.
46. Hoang NM, Smadja A, Herve de Sigalony JP,. 1991. The reality and usefulness of Halban's fascia. J Gynecol Obstet Biol Reprod 20: 51-59.
47. Ingelman-Sundberg A,. 1997. The anterior vaginal wall as an organ for the transmission of active forces to the urethra and the clitoris. Int Urogynecol J Pelvic Floor Dysfunct 8: 50-51.
48. Jannini EA, Whipple B, Kingsberg SA, Buisson O, Foldès P, Vardi Y,. 2010. Who's afraid of the G-spot. J Sex Med 7: 25-34.
49. Jannini EA, Rubio-Casillas A, Whipple B, Buisson O, Komisaruk BR, Brody S,. 2012. Female orgasm(s): One, two, several. J Sex Med 9: 956-965.
50. Johnson RD, Kitchell RL,. 1987. Mechanoreceptor response to mechanical and thermal stimuli in the glans penis of the dog. J Neurophysiol 57: 1813-1836.
51. Kearney R, Sawhney R, DeLancey JO,. 2004. Levator ani muscle anatomy evaluated by origin-insertion pairs. Obstet Gynecol 104: 168-173.
52. Kilchevsky A, Vardi Y, Lowenstein L, Gruenwald I,. 2012. Is the female G-spot truly a distinct anatomic entity. J Sex Med 9: 719-726.
53. King R, Belsky J, Mah K, Binik Y,. 2011. Are there different types of female orgasm. Arch Sex Behav 40: 865-875.
54. Komisaruk BR, Whipple B, Crawford A, Liu WC, Kalnin A, Mosier K,. 2004. Brain activation during vaginocervical self-stimulation and orgasm in women with complete spinal cord injury: fMRI evidence of mediation by the vagus nerves. Brain Res 1024: 77-88.
55. Komisaruk BR, Beyer-Flores C, Whipple B,. 2006. The Science of Orgasm. Baltimore, MD: Johns Hopkins University. p 1-358.
56. Korda JB, Pfaus JG, Kellner CH, Goldstein I,. 2009. Persistent genital arousal disorder (PGAD): Case report of long-term symptomatic management with electroconvulsive therapy. J Sex Med 6: 2901-2909.
57. Koster M, Price LL,. 2008. Rwandan female genital modification: Elongation of the labia minora and the use of local botanical species. Cult Health Sex 10: 191-204.
58. Larson KA, Yousuf A, Lewicky-Gaupp C, Fenner DE, DeLancey JO,. 2010. Perineal body anatomy in living women: 3-dimensional analysis using thin-slice magnetic resonance imaging. Am J Obstet Gynecol 203:494. e15-e21.
59. Laqueur T,. 1992. Making Sex: Body and Gender from the Greeks to Freud. Cambridge: Harvard University Press. p 1-313.
60. Lenck LC, Vanneuville G, Monnet JP, Harmand Y,. 1992. [Urethral sphincter (G point). Anatomo-clinical correlations]. Rev Fr Gynécol Obstét 87: 65-69.
61. Levin RJ,. 1991. VIP, vagina, clitoral and periurethral glansa-An update on human female genital arousal. Exp Clin Endocrinol 98: 61-69.
62. Levin RJ,. 2002. The physiology of sexual arousal in the human female: A recreational and procreational synthesis. Arch Sex Behav 31: 405-411.
63. Levin RJ,. 2011. The human female orgasm: A critical evaluation of its proposed reproductive functions. Sex Relat Ther 26: 301-314.
64. Levin RJ, Riley A,. 2007. The physiology of human sexual function. Psychiatry 6: 90-94.
65. Lloyd J, Crouch NS, Minto CL, Liao LM, Creighton SM,. 2005. Female genital appearance: 'Normality' unfolds. BJOG 112: 643-646.
66. Magnin G,. 2010. Does the G spot exist. Gynecol Obstet Fertil 38: 778-780.
67. Martin-Alguacil N, Schober J, Kow LM, Pfaff D,. 2006. Arousing properties of the vulvar epithelium. J Urol 176: 456-462.
68. Martin-Alguacil N, Aardsma N, Litvin Y, Mayoglou L, Dupré C, Pfaff DW, Schober JM,. 2011. Immunocytochemical characterization of pacinian-like corpuscles in the labia minora of prepubertal girls. J Pediatr Adolesc Gynecol 24: 353-358.
69. Martinõn-Torres F, Martinõn-Sánchez JM, Martinõn-Sánchez F,. 2000. Clitoris and labia minora agenesisa-An undescribed malformation. Clin Genet 58: 336-338.
70. Masters WH, Johnson VE,. 1966. Human Sexual Response. Boston, MA: Little Brown. p 1-366.
71. Masters WH, Johnson VE, Kolodny RC,. 1988. Masters and Johnson on Sex and Human Loving. Boston, MA: Little Brown. p 1-621.
72. McPencow AM, Guess MK,. 2012. Giving female genital cosmetic surgery a facelift. Maturitas 71: 313-314.
73. Medina CA,. 2002. Clitoral priapism: A rare condition presenting as a cause of vulvar pain. Obstet Gynecol 100: 1089-1091.
74. Meston CM, Hull E, Levin RJ, Sipski M,. 2004. Disorders of orgasm in women. J Sex Med 1: 66-68.
75. Michala L, Koliantzaki S, Antsaklis A,. 2011. Protruding labia minora: Abnormal or just uncool. J Psychosom Obstet Gynaecol 32: 154-156.
76. Munarriz R, Talakoub L, Kuohung W, Gioia M, Hoag L, Flaherty E, Min K, Choi S, Goldstein I,. 2000. The prevalence of phimosis of the clitoris in women presenting to the sexual dysfunction clinic: Lack of correlation to disorders of desire, arousal and orgasm. J Sex Marital Ther 28 (Suppl 1): 181-185.
77. Neill S, Lewis F,. 2009. Ridley's the Vulva. 3rd Ed. Chichester: Wiley-Blackwell. p 1-260.
78. Netter FH,. 2010. Atlas of Human Anatomy. 5th Ed. Philadelphia, PA: Saunders-Elsevier. p 1-624.
79. Nicholas A, Brody S, de Sutter P, de Carufel F,. 2008. A woman's history of vaginal orgasm is discernible from her walk. J Sex Med 5: 2119-2124.
80. O'Connell HE, DeLancey JO,. 2005. Clitoral anatomy in nulliparous, healthy, premenopausal volunteers using unenhanced magnetic resonance imaging. J Urol 173: 2060-2063.
81. O'Connell HE, Hutson JM, Anderson CR, Plenter RJ,. 1998. Anatomical relationship between urethra and clitoris. J Urol 159: 1892-1897.
82. O'Connell HE, Anderson CR, Plenter RJ, Hutson JM,. 2004. The clitoris: A unified structure. Histology of the clitoral glans, body, crura and bulbs. Urodinamica 14: 127-132.
83. O'Connell HE, Sanjeevan KV, Hutson JM,. 2005. Anatomy of the clitoris. J Urol 174: 1189-1195.
84. O'Connell HE, Eizenberg N, Rahman M, Cleeve J,. 2008. The anatomy of the distal vagina: Towards unity. J Sex Med 5: 1883-1891.
85. Ostrzenski A,. 2012. G-spot anatomy: A new discovery. J Sex Med 9: 1355-1359.
86. Oyama IA, Steinberg AC, Holzberg AS, Maccarone JL,. 2004. Reduction clitoroplasty: A technique for debulking the enlarged clitoris. J Pediatr Adolesc Gynecol 17: 393-395.
87. Pastor Z,. 2010. G spota-Myths and reality. Ceska Gynekol 75: 211-217.
88. Perry JD, Whipple B,. 1981. Pelvic muscle strength of female ejaculators: Evidence in support of a new theory of orgasm. J Sex Res 17: 22-39.
89. Puppo V,. 2006a. RE: Clitoral anatomy in nulliparous, healthy, premenopausal volunteers using unenhanced magnetic resonance imaging. J Urol 175: 790-791.
90. Puppo V,. 2006b. Sexually responsive vascular tissue of the vulva. BJU Int 98: 463-464.
91. Puppo V,. 2006c. The female penis. Poster Session: Proceedings of the 8th Congress of the European Federation of Sexology, Prague, Czech Republic, June 4-8 2006. Sexologies 1 (Suppl 1). T06-P-13: S44-S45.
92. Puppo V,. 2006d. The importance of the Kegel exercises for the erection of the penis (male and female). Poster Session: Proceedings of the 8th Congress of the European Federation of Sexology, Prague, Czech Republic, June 4-8, 2006. Sexologies 15 (Suppl 1). T06-P-14: S45.
93. Puppo V,. 2011a. Embryology and anatomy of the vulva: The female orgasm and women's sexual health. Eur J Obstet Gynecol Reprod Biol 154: 3-8.
94. Puppo V,. 2011b. The G-spot does not exist. Response by V. Puppo to the article "O. Buisson: The G-spot and lack of female sexual medicine". Gynecol Obstet Fertil 2010; 38: 781-784.
95. Gynecol Obstet Fertil 39: 266-267.
96. Puppo V,. 2011c. Anatomy of the clitoris: Revision and clarifications about the anatomical terms for the clitoris proposed (without scientific bases) by Helen O'Connell, Emmanuele Jannini and Odile Buisson. ISRN Obstet Gynecol 2011: 261464. 5 p.
97. Puppo V,. 2011d. La sessualitø umana e l'educazione a fare l'amore. Con Aggiornamenti 2011. 2nd Ed. Firenze: Vincenzo Puppo. p 1-229. [Kindle Edition]. URL: http://www.amazon.it/sessualit%C3% A0-leducazione-lamore- Aggiornamenti-ebook/dp/B006MQ125I/ref=sr-1-1?ie=UTF8&qid=1324063976&sr= 8-1 [accessed June 2012].
98. Puppo V,. 2012a. Re: Sexual function and attitudes toward surgery after feminizing genitoplasty. R. Fagerholm, P. Santtila, P. J. Miettinen, A. Mattila, R. Rintala and S. Taskinen. J Urol 2011; 185:1900-1904. J Urol 187: 361-362.
99. Puppo V,. 2012b. The Gräfenberg spot (G-spot) does not exista-A rebuttal of Dwyer PL: Skene's gland revisited: Function, dysfunction and the G spot. Int Urogynecol J 23: 247.
100. Puppo V,. 2012c. Female sexual function index (FSFI) does not assess female sexual function. Acta Obstet Gynecol Scand 91: 759.
101. Puppo V,. 2012d. The definition of "have sex" must be unique. Re: Mehta CM, et al. "Sex isn't something you do with someone you do not care about": Young women's definitions of sex. J Pediatr Adolesc Gynecol 2011; 24: 266-271.
102. J Pediatr Adolesc Gynecol 25: 225.
103. Puppo V,., Gruenwald I,. in press. Does the G-spot exist? A review of the current literature. Int Urogynecol J; DOI: 10.1007/s00192-012-1831-y. 0000
104. Puppo V, Mannucci A, Abdulcadir J, Puppo G,. 2008a. Clarifications about some theories in sexology and about a correct sexual terminology. Oral Presentation: Proceedings of the 9th Congress of the European Federation of Sexology, Rome, Italy, April 13-17, 2008. Sexologies 17 (Suppl 1). T10-O-25:S147. URL: http://www.youtube.com/watch?v=E52HiDw5bhM&list= PL6319344C678DE495&index=0&feature=plcp [accessed June 2012].
105. Puppo V, Abdulcadir J, Abdulcadir D, Catania L,. 2008b. Embryology and anatomy of the female erectile organs. Poster Session: Proceedings of the 9th Congress of the European Federation of Sexology, Rome, Italy, April 13-17, 2008. URL: http://www. youtube.com/watch?v=kX-2YCiJ12g&list= PL6319344C678DE495& index=13&feature=plpp-video [accessed June 2012].
106. Rees MA, O'Connell HE, Plenter RJ, Hutson JM,. 2000. The suspensory ligament of the clitoris: Connective tissue supports of the erectile tissues of the female urogenital region. Clin Anat 13: 397-403.
107. Rosen RC, Barsky JL,. 2006. Normal sexual response in women. Obstet Gynecol Clin North Am 33: 515-526.
108. Rosenbaum TY,. 2010. Physical therapy treatment of persistent genital arousal disorder during pregnancy: A case report. J Sex Med 7: 1306-1310.
109. Salonia A, Giraldi A, Chivers ML, Georgiadis JR, Levin R, Maravilla KR, McCarthy MM,. 2010. Physiology of women's sexual function: Basic knowledge and new findings. J Sex Med 7: 2637-2660.
110. San Diego Sexual Medicine. 2012. Providers/Female genital anatomy/URETHRA/G-SPOT. URL: http://www.sandiegosexualmedicine.com/?page= providers/anatomy-physiology/female-genital-anatomy [accessed June 2012].
111. Sayer RA, Deutsch A, Hoffman MS,. 2007. Clitoroplasty. Obstet Gynecol 110: 523-525.
112. Schober J, Cooney C, Pfaff D, Mayoglou L, Martin-Alguacil N,. 2010. Innervation of the labia minora of prepubertal girls. J Pediatr Adolesc Gynecol 23: 352-357.
113. Selbmann V, Puppo V,. 2012. L'importanza dei muscoli perineali e degli esercizi di Kegel nella sessualitø umana e per la prevenzione del vaginismo. Oral Presentation: Proceedings of the II Congresso Nazionale Congiunto Societø Italiana della Contraccezione-Federazione Italiana Sessuologia Scientifica, Taormina, Italy, May 24-26. URL: http://www.youtube. com/watch? v=Qldl83FrBGc&list=UUf-EEQfaKa9Sx047E8pBmxg&index=1& feature=plcp [accessed June 2012].
114. Sevely JL,. 1987. Eve's Secrets. A New Theory of Female Sexuality. New York: Random House. p 1-215.
115. Sevely JL,. 1988. The male clitoris. Am J Obstet Gynecol 159: 533-534.
116. Shafik A,. 1995. Response of the urethral and intracorporeal pressures to cavernosus muscle stimulation: Role of the muscles in erection and ejaculation. Urology 46: 85-88.
117. Shafik A, Shafik IA, El Sibai O, Shafik AA,. 2009. An electrophysiologic study of female ejaculation. J Sex Marital Ther 35: 337-346.
118. Shapiro E, Huang H, McFadden DE, Masch RJ, Ng E, Lepor H, Wu XR,. 2004. The prostatic utricle is not a Müllerian duct remnant: Immunohistochemical evidence for a distinct urogenital sinus origin. J Urol 172: 1753-1756.
119. Sherfey MJ,. 1973. The Nature and Evolution of Female Sexuality. New York: Vintage Books-Random House. p 1-188.
120. Shtarkshall RA, Anonymous, Feldman BS,. 2008. A woman with a high capacity for multi-orgasms: A non-clinical case-report study. Sex Relat Ther 23: 259-269.
121. Standring S,. 2008. Anatomia del Gray. Le basi anatomiche per la pratica clinica. (It. Tr. 2010. Gray's Anatomy: The Anatomical Basis of Clinical Practice. 40th Ed. New York: Elsevier) Milano: Elsevier. p 1-1576.
122. Stein TA, DeLancey JOL,. 2008. Structure of the perineal membrane in females. Gross and microscopic anatomy. Obstet Gynecol 111: 686-693.
123. Testut L, Latarjet A,. 1972. Trattato di Anatomia Umana. Vol. 6 5th Ed. (It. Tr. Traité d'Anatomie Humaine, neuvième édition. Paris: G. Doin & C.ie) Torino: Unione Tipografico-Editrice Torinese. p 1-676.
124. Thabet SM,. 2009. Reality of the G-spot and its relation to female circumcision and vaginal surgery. J Obstet Gynaecol Res 35: 967-973.
125. Toesca A, Stolfi VM, Cocchia D,. 1996. Immunohistochemical study of the corpora cavernosa of the human clitoris. J Anat 188: 513-520.
126. Van Turnhout AA, Hage JJ, Van Diest PJ,. 1995. The female corpus spongiosum revisited. Acta Obstet Gynecol Scand 74: 767-771.
127. Verkauf BS, Von Thron J, O'Brien WF,. 1992. Clitoral size in normal women. Obstet Gynecol 80: 41-44.
128. Vicentini C,. 2008. Measurement of the thickness of the urethrovaginal space in women with or without orgasm: A rebuttal. J Sex Med 5: 2241.
129. Wallen K, Lloyd EA,. 2011. Female sexual arousal: Genital anatomy and orgasm in intercourse. Horm Behav 59: 780-792.
130. Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA,. 2007. Campbell-Walsh Urology. Vol. 1. 9th Ed. Philadelphia, PA: Saunders Elsevier. p 1-1128.
131. World Association for Sexual Health. 2008. Sexual Health for the Millennium. A Declaration and Technical Document. URL: http://www.worldsexology. org/sites/default/files/Millennium% 20Declaration%20(English).pdf [accessed June 2012].
132. Wünsch L, Schober JM,. 2007. Imaging and examination strategies of normal male and female sex development and anatomy. Best Pract Res Clin Endocrinol Metab 21: 367-379.
133. Yang CC, Cold CJ, Yilmaz U, Maravilla KR,. 2006. Sexually responsive vascular tissue of the vulva. BJU Int 97: 766-772.
134. Yavagal S, de Farias TF, Medina CA, Takacs P,. 2011. Normal vulvovaginal, perineal, and pelvic anatomy with reconstructive considerations. Semin Plast Surg 25: 121-129.
135. Yilmaz U, Soylu A, Ozcan C, Caliskan O,. 2002. Clitoral electromyography. J Urol 167: 616-620.
136. Youtube/newsexology. 2009. RE-O'Connell. The anatomy of the distal vagina: Why J Sex Med has censored this Editorial Comment? URL: http://www.youtube.com/watch?v=VAmU5Q7VLgY&list= UUf- EEQfaKa9Sx047E8pBmxg&index=42&feature=plcp [accessed June 2012].
137. Youtube/newsexology. 2010. Irwin Goldstein vs women's sexual health. J Sex Med. URL: http://www.youtube.com/watch?v= -Pizs2I28RU&list=UUf- EEQfaKa9Sx047E8pBmxg&index=4&feature =Plcp [accessed June 2012].
138. Zaviacic M, Jakubovská V, Belošovi RM, Breza J,. 2000. Ultrastructure of the normal adult human female prostate gland (Skene's gland). Anat Embryol 201: 51-61.