BJOG Journal Club


Paper for discussion

Ostrzenski A, Krajewski P, Ganjei-Azar P, Wasiutynski AJ, Scheinberg MN, Tarka S, Fudalej M. Verification of the anatomy and newly discovered histology of the G-spot complex. BJOG 2014;121:1333–39.

Scenario

A 40-year-old businesswoman who has recently undergone surgery and adjuvant chemotherapy for breast cancer was referred to your menopause clinic because of climacteric symptoms. She is at high risk of recurrence and hormone replacement therapy was not recommended.

During her follow-up appointment, she describes difficulties in having intercourse, including vaginal dryness, lack of desire for intimacy and orgasm. Having tried a number of complementary therapies and relaxation techniques, she is now considering cosmetic genital surgery to improve sexual satisfaction. How would you counsel her?

Description of research

Participants Eight consecutive fresh human female cadavers
Intervention Anterior vaginal wall dissections. Microdissections were stained with haematoxylin and eosin (H&E)
Comparison Two subjects had further immunohistochemical staining (SMA, CD31, D2-40, S100) and the results compared with H&E staining
Outcomes A neurovascular structure in the anterior vaginal wall was identified in each cadaver dissected
Study design A descriptive observational study

Discussion points

  • How is female sexual dysfunction diagnosed and classified?
  • How prevalent is female sexual dysfunction? How is it managed?
  • What is the Gräfenberg area (G-spot)? How did authors in this study identify the G-spot anatomically?
  • What are the potential sources of bias in this study?
  • What is the evidence supporting that the neurovascular structure identified is related to sexual pleasure?
  • List all genital operations for promoting sexual pleasure you are aware of.
  • Explain the differences between cosmetic genital operations and female genital mutilation.
  • After reviewing this paper and its linked mini-commentary, do you think the G-spot exists?

Suggested reading

  • Shifren JL, Monz BU, Russo PA, Segreti A, Johannes CB. Sexual problems and distress in United States women: prevalence and correlates. Obstet Gynecol 2008 Nov;112:970-8
  • Buster JE. Managing female sexual dysfunction. Fertil Steril 2013;100:905-15
  • EYL Leung

  • Women's Health Research Unit, Queen Mary, University of London, London, UK

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