The authors would like to thank Dr Puppo for his interest in our work [1] and his controversial discussion of some aspects of our study. With regard to terminology, an exact distinction between ‘emission’ and ‘ejaculation’ cannot be made to date. In contrast to vaginal lubrication, fluid expulsion from paraurethral glands usually occurs very rapidly at orgasm. This, together with the fact that paraurethral glands embryologically correspond to the male prostate (that certainly is involved in male ejaculation), underlines that ‘female ejaculation’ can in fact be seen and described as ‘ejaculation’. Even Gräfenberg [2] discerned fluid expulsion at orgasm from excessive lubrication (that at the time he falsely attributed to Bartholini's glands).

The assumption that presence or absence of an ejaculation could be related to a refractory phase following orgasm is a totally new theory, but nothing more than a theory.

The fact that the instrument used to obtain data in our study (online questionnaire) accounts for both its strength and, to a lesser degree, to some limitations is well defined in the two paragraphs after this statement in the discussion section.

Gynaecologists, urologists, and sexologists have been well aware of Dr Puppo's criticism of Gravina's and Jannini's work on the role of the anterior vaginal wall and sexual function, a discussion, Dr Puppo includes extensively into his editorial comment of the present study [3, 4]. To make this long story short, vaginal stimulation (intercourse) does lead to female orgasm regardless of terminological controversies (G-spot, vaginal wall thickness, etc.).

Finally, the last decades have seen a great amount of highly valuable scientific work on female sexual function and dysfunction. It is always the authors' own responsibility to use or establish anatomical or physiological terms as long as their value is seriously discussed in their respective scientific context. Rather than to condemn our colleagues' progress in the field, we should thank them for all the benefits our patients obtained through their work. We must certainly not let the media or unethically practicing colleagues rule the way we perform or report scientific studies.


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