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In all, 340 women participated in the online survey (English version 189; German version 151) from April 2010 to October 2011. Seventeen entries were excluded because the women were less than 18 years of age, and three entries were excluded because of double entries identified by identical data and IP address so the final study population consisted of 320 adult women.
The geographical distribution was as follows: 113 entries came from the USA (35.3%), 105 from Germany (32.8%), 30 from Austria (9.4%), 27 from the UK (8.4%), 16 from Canada (5.0%) and 9 from Australia (2.8%). The remainder of the participants came from India (4), Saudi Arabia (3), Switzerland (3), Sweden (2), Norway (1), the Netherlands (1), Spain (1), Italy (1), Bulgaria (1), Pakistan (1), China (1) and Iran (1).
The mean age of the 320 female participants was 34.1 years (sd ± 11.1; age range 18–73 years). As regards partnership, 108 women were in a stable (unmarried) relationship, 90 were single, 88 were married and 34 had a variety of partners (Table 1). As regards sexual orientation, 238 women were heterosexual, 74 were bisexual and 8 were homosexual. Concerning maternity, 161 participants were nulliparous when completing the questionnaire, 43 had one child, 61 had two children, 42 had three children and 13 women had more than three children. With regard to previous gynaecological diseases, 279 women had undergone no gynaecological surgery, 29 women had had a hysterectomy, nine had undergone a curettage, three had undergone incontinence surgery, and one had undergone marsupialization of an infected Bartholini's cyst. Twenty-nine women (9.1%) reported a history of one or more UTIs.
Table 1. Characteristics of study population.
|Online survey entries (n = 320)|| || |
|Median age, years (±sd)||34.1||(±11.1)|
|Partnership, n (%)|| || |
|Sexual orientation, n (%)|| || |
|Births, n (%)|| || |
|Gynaecological surgeries, n (%)|| || |
|Bartholini cyst marsupialization||1||(0.3)|
The respondents' median age at first ejaculation was 25.4 years (sd ± 10.6). One woman reported ejaculation at the early age of 7 years; the oldest participant (73 years) experienced her first ejaculation at 68 years.
The frequency of ejaculation was ‘a few times a week’ in 101 participants (31.6%), ‘a few times a month’ in 91 (28.4%), ‘daily’ in 62 (19.4%), and ‘monthly or less frequent’ in 66 (20.6%) (Table 2). Asked about the percentage of ejaculations in relation to sexual activities, 47 of 247 women (19.0%) stated that they ejaculate during 91–100% of their sexual activities. A further 35 (14.2%) reported an ejaculation frequency of 1–10%. The median frequency of ejaculation during sexual activity was 57% (sd ± 33%).
Table 2. Female ejaculation frequency.
|Ejaculation frequency (n = 330)||n||%|
|A few times during a week||101||(31.6)|
|A few times during a month||91||(28.4)|
|Once a month||28||(8.8)|
|Less than monthly||24||(7.5)|
Triggers for first ejaculation were a new partner in 75 participants (23.4%) but a further 72 reported no real trigger (22.5%) and 91 (28.4%) women were unable to answer the question.
By the participants' own definitions, female ejaculations were clitoral orgasms in 167 women and vaginal orgasms in 168 women (multiple-choice question). Twenty women experienced spontaneous ejaculation (6.3%), including 13 potential ejaculations during sleep (4.1%).
Anatomically, 141 women (44.1%) did not know where the fluid emissions during orgasm came from, 54 (16.9%) named the vagina as the source of ejaculation, 51 (15.9%) identified a swelling on the anterior vaginal wall, and 74 women (23.1%) described the urethra as the source (48 outer meatus, 26 inner urethra) (Table 3).
Table 3. Ejaculation anatomy and volumes.
|Perceived source of ejaculation (n = 320)|
|Anterior vaginal wall (‘reservoir’)||51||(15.9)|
|External urethral meatus||48||(15.0)|
|Ejaculate volumes (n = 320)|| |
The volume of the ejaculate was approximately 0.3 mL in 39 (12.2%) women, 15 mL in 58 (18.1%), 60 mL in 93 (29.1%), 150 mL in 49 (15.3%), and more than 150 mL in 81 women (25.3%). The colour of the ejaculated fluid was described as being ‘clear as water’ by 266 women (83.1%), ‘white, milky’ by 74, and ‘yellow’ by 4 (Table 3).
Asked whether the study participants knew other women who ejaculated, 158 (49.4%) replied in the affirmative and 162 (50.6%) in the negative. As regards their personal opinion on the possible incidence of female ejaculation, the commonest response (by 100 women; 31.3%) was ‘10%’ as the supposed incidence.
For 252 women (78.8%) their ability to ejaculate was an ‘enrichment of their sexual lives’; 33 women (10.3%) were indifferent; 23 women (7.2%) ‘sometimes wished they would rather not ejaculate’; 10 women (3.1%) primarily ‘wished they would not ejaculate’, and two participants considered female ejaculation as a ‘pathological’ phenomenon (Table 4).
Table 4. Impact of female ejaculation on sexual life.
|Impact of ejaculation on participants' sexual life (n = 320)|| || |
|Sometimes I wished I would not ejaculate||23||(7.2)|
|I'd rather not ejaculate||10||(3.1)|
|seen as pathological||2||(0.6)|
|Partner's attitude towards female ejaculation (n = 320)|| || |
|Does not know about it||14||(4.4)|
With regard to their partners' attitudes, 288 women's partners (90.0%) regarded their ejaculation as a ‘positive’ phenomenon in their sexual lives; 16 women (5.0%) had partners who were ‘indifferent’; and two partners (0.6%) had a ‘negative’ attitude. In 14 cases (4.4%) the participants' partners were unaware of the fact that their female partners could ejaculate (Table 4).
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Published literature on female ejaculation dates back more than 2000 years . However, scientific work on women who experience ejaculation on sexual stimulation remains scarce and is usually confined to small numbers of women [4, 12-14]. Most of the work published on female ejaculation centres around the anatomy, histology and imaging studies of the paraurethral glands, or characteristics of the ejaculated fluid and its differentiation from urine [1, 15]. Even in clinics specializing in female sexual function – and female ejaculation in particular – it is almost impossible to obtain data on a substantial number of women who perceive ejaculation. This prompted us to use contemporary online tools to reach a large number of healthy women who experience female ejaculation and to collect data on various aspects of this poorly investigated aspect of female sexual function.
During the 18-month period of the online survey, 340 women completed the online questionnaire; 320 of these were included in the study. This makes the present study the largest collection of data on the nature of perceived female ejaculation. The mean age of the participants was 34.1 years. Apart from this rather unremarkable age distribution of sexually active women, the oldest participant was 73 years of age. According to the free text section that this woman filled out in the survey, she is sexually very active and had her first ejaculation at the age of 68, when she ‘totally let go’ during sex with her husband. In all, just four participants were 60 years or older.
With 61.3% of participants in a stable relationship (including marriage) and 38.8% single or with changing partners, the women's partnership status did not show a specific trend in this sample of women who perceive ejaculation. Sexual orientation was clearly different from previous population-based studies: 74.4% were heterosexual, 23.1% were bisexual and 2.5% were homosexual [16, 17]. The study by Savin-Williams and Ream study  of sexual orientation during adolescence and young adulthood revealed a strict bisexual orientation in only 2.6% of female participants. As discussed in their work, sexual behaviour, attraction and identity must be viewed separately. The relatively high prevalence of bisexual identity in the present study could be explained by a higher degree of ‘online help-seeking’ among these women. In one recent report on sexual identity, Vrangalova and Savin-Williams  stated that recruitment for a study clearly labelled as ‘one about sexuality’ prevents further generalization of findings as regards sexual orientation.
In view of the fact that 50.3% of the women in our study were nulliparous, the number of childbirths a woman experiences does not seem to affect her ‘ability’ to ejaculate. Furthermore, 87.2% of participants had undergone no gynaecological surgery whereas a mere 9.1% reported a history of urinary tract infections. In conclusion, neither births nor gynaecological surgery nor infection had an impact on a woman's capability to ejaculate.
The geographic distribution of the study participants – with a predominance of German-speaking European countries and the USA – was determined by the online publication of the survey through German, Austrian and American platforms. Notably, some women responded from as far as China, India, Saudi Arabia, Pakistan and Iran.
The mean age of onset of female ejaculation was 25.4 years. At the time of completion of the online questionnaire the women had a mean history of ejaculation of 9.5 years (range, <1 year to 36 years).
Various circumstances appear to trigger a woman's first ejaculation and her future disposition to ejaculate. As regards onset, 163 women (50.9%) could not cite any trigger for their first ejaculation whereas 75 (23.4%) experienced their first ejaculation during sexual encounters with a new partner. Besides other triggers, it may be assumed that the capability to ejaculate is linked with a new partnership, masturbation (4.4%) or even ‘training for the ability to ejaculate’ (3.1%) – an established phenomenon in Tantric practice .
The ability to ‘let go’ and experience an orgasm appears to be a very important factor, as are certain techniques of sexual stimulation . Most participants ejaculate at orgasm (‘clitoral’ 52.2%; ‘vaginal’ 52.5%). The concept of vaginal versus clitoral orgasm has not been scientifically established but remains very popular in the general population. The aim of this specific question in the questionnaire was to establish whether ejaculation solely occurs upon stimulation of the anterior vaginal wall (the paraurethral sponge), which it clearly did not. There has been no indication of the fact that the stimulation of a presumed G-spot was an exclusive trigger for ejaculation [21, 22].
Ejaculation was slightly more common during masturbation (53.4%) than during intercourse (48.1%). Interestingly, 62 women (19.4%) experienced ejaculation during anal stimulation. A further form of female ejaculation is spontaneous fluid emission (without sexual stimulation), which was reported by 33 women (10.4%); 13 of these experienced ejaculation during sleep. This finding compares well with published data on sexual behaviour and the incidence of masturbation and orgasm among men and women during sleep .
Most of the women surveyed for the study reported ejaculating ‘a few times a week’ (101 women, 31.6%) or ‘a few times a month’ (91 women, 28.4%). ‘Daily ejaculation’ was reported by as many as 62 participants (19.4%), whereas 28 experienced ejaculation ‘once a month’, 24 ‘less than once a month’, and 16 less frequently (Table 2). Regarding sexual activity, Graziottin  found intercourse frequencies among European women to range between two and nine times per month, depending on age group and nationality. Women of all age groups masturbated less than twice per month. In a study of 349 healthy women aged 20–65 years, the median number of days with sexual activity or events per month was 8 days . In a study focusing on community-dwelling women (n = 806), only 49.8% of women aged over 40 years reported sexual activity . In fact, women participating in an online survey on female ejaculation appear to be much more sexually active than the general population.
Female ejaculation certainly does not occur in all instances of sexual activity. Interestingly, 19.0% of women reported ejaculation in more than 90% of sexual encounters.
One reasonable critique against the concept of female ejaculation is the volume of ejaculated fluid compared with the male ejaculate. The source of male seminal fluid is well known. The capacities of the seminal vesicles and the prostate gland correlate well with ejaculated volumes [27, 28]. It is hard to believe that the female paraurethral glands (female prostate) have the capacity to store volumes that account for female ejaculation. High flow rates have been proven for other human glands with a parenchymal morphology. Salivary secretion may achieve flow rates of up to 10 mL/min .
As regards volume, the present study comprising 320 participants confirms data obtained in much smaller samples. The most commonly mentioned volume was approximately 60 mL of ejaculated fluid (by 29.1% women) (Table 3). In this context the questionnaire listed a number of visual options for the participants – such as tablespoons (15 mL) or ‘a few drops’ (0.3 mL). Furthermore, fluid volumes were mentioned in fluid ounces in the English version of the questionnaire, and as 1/8th or 1/16th of a litre in the German version.
Sexual medicine specialists who are familiar with women who ejaculate have been given descriptions of ‘wet sheets’ after an orgasm . Several studies on this subject have led to the exclusion of urinary incontinence as the source of female ejaculation [4, 5, 12, 31-35]. On the other hand, urinary incontinence during sexual intercourse is an underdiagnosed phenomenon, especially in older women [36-39]. From the design of the survey instrument we assume that none of the 320 participants experienced urinary incontinence (question 4); only one woman had undergone surgery for stress urinary incontinence. Urinary incontinence cannot be ruled out in the one participant who reported the onset of perceived ejaculation at the age of 68 years, although this woman quite credibly described her first experience of an orgasm at this age.
The female paraurethral glands, also known as the female prostate or Skene's glands, have been identified as the main source of fluid expulsion during female sexual arousal . The location, volume and anatomy of the ducts of these glands are highly variable in women . Furthermore, the link between the paraurethral glands and stimulation of the anterior vaginal wall remains unclear [6, 41].
Considerations on the anatomical source of female ejaculation obtained from an online survey are obviously subjective in nature. Nevertheless, in view of the fact that women who ejaculate have a relatively strong perception of their genital organs, the authors included a question on the perceived source of fluid expulsions. As regards this aspect, 44.1% stated that they were unaware of the anatomical source of ejaculation, whereas 32.8% believed that the vagina was the source of ejaculation (Table 3). Of these, 106 women, 51 (15.9% of the total) considered a swelling on the anterior wall of the vagina as a possible source of ejaculation. This finding adds to the discussion concerning the anterior vaginal wall and the possible role of urethrovaginal thickness in female sexual function [6, 22]. A further 23.1% of the women attributed fluid emission to the urethra (15.0% to the meatus, 8.1% to the inner urethra). Darling et al.  registered similar data among their respondents: 35.1% of the women mentioned the vagina as the source of ejaculation, 27.5% were uncertain and 18.4% reported the urethra as the source. It has been concluded that even in an experienced population, women who ejaculate are somewhat confused about the source of ejaculation. Altogether, both concepts – vaginal and urethral – support anatomical and histological findings concerning the paraurethral glands, which have ducts opening in either direction [8, 15].
In view of the occasionally large volume of emitted fluid (sometimes 150 mL or more), two further concepts of fluid source must be considered in addition to a purely glandular (parenchymatous) origin: the urethral diverticulum and the mechanism of vaginal gushing [42, 43]. Vaginal gushing – retention and expulsion of vaginal fluid – cannot be ruled out in the present online survey. Regarding urethral diverticula, we lack data showing a direct link between female ejaculation and paraurethral fluid retention. Conversely, ejaculation has never been described as a symptom of urethral diverticula . With clinical data missing – and also difficult to acquire – the real source of fluid cannot be specified.
In the population-based survey by Bullough et al. , 54% of 233 women reported a spurt of fluid at orgasm. However, according to Masters et al. , only 4.7% of 300 women ejaculated. The authors concluded later that just ‘a handful of women’ are able to ejaculate, and some of these suffer from urinary incontinence. In a large mail survey Darling et al.  found 463 (39.5%) ejaculators among 1172 respondents.
According to the definition used in the present study, all of the women who participated in the online survey were able to ejaculate. Hence the actual prevalence of female ejaculation cannot be studied. To obtain information from this cohort of well-informed and experienced women, we included two questions on the participants' supposed incidence of female ejaculation. The data revealed the following: 158 women (49.4%) know women who ejaculate as well, as compared with 162 women (50.6%) who do not know such women among their friends. Asked about the supposed prevalence of female ejaculation, the largest proportion of participants (31.3%) believe that 10% of women are capable of ejaculation. This question – which could obviously elicit no more than a subjective estimate – was derived from the observation that women who ejaculate usually (and naturally) report much higher (supposed) prevalence rates of female ejaculation than women who do not experience the phenomenon. However, in this large sample of women with positive experience in this regard, their ‘guess’ was no higher than previously published prevalence data [2, 13].
The impact of female ejaculation on the participants' and their partners' sexual lives was one of the strongest outcome measures of the present study. For 252 women (78.8%), female ejaculation was ‘an enrichment’ of their sexual lives. A further 33 women ‘didn't care’ while 33 women ‘sometimes’ or ‘always’ wished that they would rather not ejaculate. Only two women (0.6%) considered female ejaculation to be a pathological phenomenon.
In 288 cases (90.0%) the participants' partners viewed the women's ejaculation as an enrichment of their sexual lives; 16 partners (5.0%) were ‘indifferent’, and just two partners had a negative attitude towards their female partner's ejaculation. In 14 cases the partners were unaware of their female partners' ejaculation during sexual encounters.
Altogether, female ejaculation may be regarded as a positive factor in the sexual lives of both the women who experience it and their partners. According to one study, women who ejaculate are more likely to experience multiple orgasms and orgasms of longer duration than women who are incapable of ejaculation .
The instrument used to obtain data – an online survey of healthy women experiencing ejaculation – was a strength as well as a limitation of the study.
A key strength was that the survey reached healthy women who were aware of the perception of ejaculation during sexual stimulation. This ‘perception’ is usually not reported to physicians. This barrier – caused by a certain degree of shame and lack of information – is entirely absent in an anonymous online survey. This advantage has been observed in previous studies based on online surveys [46, 47]. Women participating in the present survey were not recruited from the patients of a clinic – who usually present with some type of symptoms. The online questionnaire permitted women all over the world to enter the study – limited only by online access and language restrictions (English or German).
The instrument was accessible to all members of the public. Multiple inputs were possible and there was little control over the accuracy of the data. As female ejaculation could not be clinically proven in the participants of the study, the terminology of ‘perceived female ejaculation’ was used where applicable. Self-selection of respondents in an online survey on a highly controversial topic like female ejaculation certainly means that the obtained results cannot be directly compared with the sexual health of the general population. In addition, the fact that female ejaculation is sometimes used as a pro or a con in feminist discussions may have motivated the respondents to participate in an online survey .
Interestingly, no obviously false or absurd data sets were registered among 330 entries. Three of the 333 entries were deleted before calculation because of double entries (identical answers and IP addresses). All participants had to tick an informed consent button stating that the inclusion criteria were fulfilled and the data would be handled anonymously.
Today, the present study design is the best means of obtaining such a large body of information on this significant aspect of female sexual function.
Online surveys have become an important tool to investigate certain questions among large groups of individuals not limited by access to healthcare systems or by geographical restrictions. To date, 100 published papers on Pubmed include the term ‘online survey’ in their title.
In conclusion, publication of the online survey on the perception of female ejaculation – aimed at healthy women – evoked immense interest and prompted 320 women to enter data. Female ejaculation and its onset concerns women of all ages. The onset of ejaculation was not triggered by gynaecological or urological disease. Fluid emission usually occurs during orgasm. Most women and their partners perceive the experience of female ejaculation as an enrichment of their sexual lives.