A Tale of 2 G-Spots
When cosmetic gynecologist Adam Ostrzenski, MD, set out to discover the elusive G-spot, the part of a woman's anatomy supposedly responsible for orgasm, he followed a flawed premise – but the media missed it, instead focusing on the poor study design (or lack thereof).
The discovery of the G-spot in a lone elderly corpse and the lack of information on just what Dr. O found make one wonder how the paper even made it into the Journal of Sexual Medicine, a peer-reviewed publication from Wiley. Less obvious is trouble with a different G – the guanine in genes.
Gynecology Meets Genetics
Dr. O's inspiration to dissect deeper into the tissues of the cadaver's vaginal wall than had been done before, he told me when he was into his third day of media interviews, was a 2008 paper describing "the G-spot gene." It "has already been incorporated into the Affymetrix GeneChip," he wrote in the article and repeated on the phone.
I'd read the G-spot genetics paper and knew something was amiss, so I asked Dr. O how, exactly, a gene could specify a body part. He again referred to the 2008 article, which mentions Affymetrix, a company that manufactures tiny chips (microarrays) fringed with DNA pieces used to assess gene expression in clinical research samples. "I have no clue what this means, but for me, if it has a genetic component, then I believe everybody should have it," he told me, "it" referring to the mysterious G-spot.
Incredulous at his misinterpretation, once off the phone I quickly reread the 2008 paper, and there it was, published in BMC Genomics: G-spots cause incorrect expression measurement in Affymetrix microarrays."
A G-spot, in genetics, is a stretch of four guanines in DNA: GGGG. Such repeats are well known to disrupt enzymes that replicate DNA, and they also affect the functioning of DNA probes affixed to chips. That's what the referenced paper is about -- not a bump beneath the vaginal wall that swells upon contact, first described by Ernest Grafenberg in 1950 and named the G-spot in Beverly Whipple's 1982 book The G Spot.
Because both English and genetics are not native languages to Dr. O, his mix-up over the two meanings of "G-spot" is perhaps understandable. But the failure of the reviewers and journal editor to even realize the error is astonishing.
After alerting Dr. O to the guanine/Grafenberg confusion, I felt it my duty to warn Andrew Harrison, author of the BMC Genomics article on the GGGGs gumming up the microarrays, that the tabloids might be contacting him for a quote or two on his G-spot gene. He was no stranger to semantic confusion. "Shortly after the discovery I was looking for meetings on RNA to present the results. I was very tempted to speak at this society's annual event (RNA: the Romantic Novelist's Association)," he e-mailed back.
A Cluster of Grapes?
Despite the challenges of redundant terminology, the anatomical G-spot has been in need of discovery since Dr. Grafenberg began calling women "frigid" for not having one. The search for the nebulous erogenous zone has included testimonials, a twin study assessing "self-reported G-spots," and various anatomical meanderings into the neighborhood (it's not the ducts and glands clinging to the urethra, or in the vagina, or the vestibular bulb, nor the "clitoral complex.")
Dr. O decided to go right to the source, and dissected, layer-by-layer, the tissue atop the perineal membrane, in a just-deceased 83-year-old in Warsaw. And he found what looks like a string of purple grapes within a bluish sac, near a white cord. "The G-spot appeared to be erectile tissue without any palpable gland within the tissues," he wrote, alongside figures displaying the G-grapes.
But the paper immediately raises several questions, all blasted across the Web the microsecond the embargo passed.
Question 1: Why did Dr. O discover the G-spot in the 83-year-old cadaver from Warsaw, as opposed to, say, a 24-year-old cadaver from Altoona?
It was a matter of access. Dr. O wanted a fresh body, not a pickled one, which can alter the tissues. "Forensic medicine in the U.S. wouldn't give me permission for the dissection," he told me. So he got permission to take biopsies from the old lady in Warsaw who'd just died of blunt force trauma to the head, her vaginal tissues intact, unassaulted, and having lasted a lifetime.
"This case study in a single cadaver adds to the growing body of literature regarding women's sexual anatomy and physiology," glowingly wrote the journal's editor-in-chief in the news release. Case reports are okay in medical journals, for a rare condition perhaps, but claiming discovery of a new body part – a spleen, for example -- requires finding it in more than one body. We humans vary. Dr. O is well aware of this, so next month he will tackle a series of cadavers representing various decades.
Question 2: What, exactly, IS the G-spot?
Alas, Dr. O had to return the grape-like mass to the body for burial, so he didn't have a chance to do the histology that would identify what he'd discovered. The chain of grapes in their bluish sheath, said a friend who is an anatomy authority and would kill me if I used his name here, said it looks like a hematoma, a pooling of blood that happened when the owner of said spot maybe bumped her crotch into something years ago.
Dr. O's paper includes measurements, in case size matters.
The stretched-out grapes measured 8.1 mm by 1.5-3.6 mm, and were 0.4 mm tall – a little like what comes out when my cat sneezes. Dr. O defined a head, middle, and tail part. A ropy structure emanating from the tail could be the vein providing the blood in my friend's hematoma scenario. Instead, Dr. O said that the grapes are reminiscent of the cavernous tissue of a flaccid penis that rises to attention with an inflow of blood. (In a hematoma the blood is outside blood vessels; in an erection, it's inside.) And the G-spot is at a 35o angle from the urethra, meaning that it isn't where most folks had been looking for it, at least not in the unfortunate Polish woman.
Dr. Ostrzenski feels that he has made a significant discovery that, if confirmed, should change textbook depictions of female pelvic anatomy. (I'm a co-author on two human anatomy and physiology textbooks, among other things, and will wait for more data.)
Assuming the G-grapes are the G-spot, Dr. O foresees "clinical and commercial components that I believe will make a lot of noise." Clinically, finding the G-spot may finally settle the debate over whether female orgasm can have dual origins, if appropriately controlled experiments can be conducted on women capable of responding. And G-spot defects might open up a new medical specialty.
G-spotplasty – yes, it's already being pitched – isn't the only commercial application of the discovery. The fact that the grapes must distend upward to affect sensation suggests how vibrators might be improved, Dr. O said, adding that he's working with a group of patients to alter technique for better gratification. It entails a switch from tapping to a circular motion, he said, but that was TMI for me. He seemed to be enjoying our conversation a little too much.
I don't really care about the status of the G-spot. My greater concern is with the peer review process that this paper passed. And EurekAlert! posted it! The journal's legit, the official publication of the International Society for Sexual Medicine and the International Society for the Study of Women's Sexual Health. Acceptance is competitive, and it ranks a respectable 9 out of 69 journals in urology or nephrology.
I submitted my blog on the guanine snafu to Scientific American, than waited anxiously for the news coverage of this latest chapter in the G-spot saga. But the next morning, as the reports arrived, minute-by-minute on the Google News scroll, nary a journalist or sexpert, it seemed, had picked up on the G-spot confusion that even the author of the much-discussed paper, Dr. O, had missed. Why?
The "G-spot gene" reference came towards the end of the paper, although it was the first thing Dr. O said to me. A blogger or reporter going with just the news release, not talking to the source, but perhaps using a quote from one of the sex experts only too willing to provide background on this perenially hot topic, would have missed the fact that the very impetus for the study was based on confusion. I'm afraid that with today's crazily accelerated news cycle, too few take the effort to track down a paper's references. Maybe it's because we expect a peer-reviewed journal to find the errors.
For my efforts my name will be enshrined in the errata of the Journal of Sexual Medicine. Said my husband, "Way to market your book Ricki -- going down in history as the woman who killed the discovery of the G-spot!"
Someone had to do it.
Photo credit: bandita via Flickr