How to Build a Dick (The Social Construction of Genitalia)

From The New Inquiry, Vishnu Strangeways takes a social constructionist view of how we understand and co-create the idea of gentalia. Even at the level of biology, where XX and XY are most common (46.XX, 46.XY) there is no clear sexual binary but, rather, a collection of standard alignments, as well as a collection of variations . . . including 47.XXY (at risk for Klinefelter syndrome), 47.XYY, 48.XXXX, 48XXXY, 48XXYY and 48XYYY; and although increasingly rare, also 49XXXXX, 49XXXXY, 49XXXYY, 49XXYYY and 49XYYY.

Further, even in "normal" XY and XX individuals, the expression of secondary sexual characteristics can vary considerably (size, shape, alignment, coloring, and so on). There is no specifically "normal" genitalia, only a spectrum that incorporates a range of normal. Intersex people add a whole other layer to this, partly because it is not always obvious at birth and may not show up until puberty, if at all.

Consider these statistics:

Not XX and not XY	one in 1,666 births
Klinefelter (XXY)	one in 1,000 births
Androgen insensitivity syndrome	one in 13,000 births
Partial androgen insensitivity syndrome	one in 130,000 births
Classical congenital adrenal hyperplasia	one in 13,000 births
Late onset adrenal hyperplasia	one in 66 individuals
Vaginal agenesis	one in 6,000 births
Ovotestes	one in 83,000 births
Idiopathic (no discernable medical cause)	one in 110,000 births
Iatrogenic (caused by medical treatment, for instance progestin administered to pregnant mother)	no estimate
5 alpha reductase deficiency	no estimate
Mixed gonadal dysgenesis	no estimate
Complete gonadal dysgenesis	one in 150,000 births
Hypospadias (urethral opening in perineum or along penile shaft)	one in 2,000 births
Hypospadias (urethral opening between corona and tip of glans penis)	one in 770 births
Total number of people whose bodies differ from standard male or female	one in 100 births
Total number of people receiving surgery to “normalize” genital appearance	one or two in 1,000 births

Add to that, then, the discussion below about how we create our ideas of genitalia from conversations with peers, from sex education, from media, or (increasingly) from pornography, and the range of possible expressions is so staggeringly large that the "sexual binary" becomes laughable.

How to Build a Dick

By Vishnu Strangeways
October 27, 2014

Rorschach test, card #2, 1921

At the level of identity, genitals are made neither in the womb, nor in surgery, but in the mind.

Thinking critically about ­genitals—how they look, what they are, what they mean—feels like repeating a familiar word so many times that it starts to sound weird and implausible. The physical properties of genitals feel certain, but the material of this certainty is often hazy guesswork, drawn less from experience than from the imaginative processes that give our ideas of things substance in the mind.

As we grow up, many of us build our idea of genitals from a patchwork of clumsy childhood discoveries, chaste textbook renderings, and the aesthetic valorized in mainstream porn. This early understanding of what genitals should look like can even survive encounters with bodies that don’t correspond to it. Reality apparently doesn’t always have sufficient power to undermine our fixed and abstract mental images. It’s as if the idea of genitals is more real than their physical form, or the latter is real only insofar as it confirms the former.

This is partly because commonplace concepts of gender treat biological sex as determinative in a violent logic: Genitals means sex means gender. Essentialist accounts of gender appeal to medical science to reiterate a mind/body or gender/sex binary, without considering how scientific truth claims are shaped by the paradigm from which they have emerged. These accounts are often at odds with some of the physical realities they describe, such as the prevalence of sex chromosomes beyond XX/XY, or external genitalia that don’t resemble traditional archetypes of penis-testicles and vulva-clitoris-vagina.

When I studied anatomy, we learned the prescriptive architecture of biological sex as if it were inevitable fact. Yet our textbooks included depictions of bodies that didn’t conform to the supposedly universal forms, presenting them as strange and pathological. In medical school, few people could see that the very existence of these bodies was an effective critique of the certainty of biological sex. Outside the framework of my studies, I became increasingly suspicious of normative standards of sex and gender. Armed with experiences and critiques drawn from elsewhere in my life, I grew more and more critical of how medicine understands and processes gender by excluding those bodies that cannot be coherently inscribed into the present gender regime.

Even by medicine’s own scientific account, the human body does not automatically provide us with a strong distinction between “maleness” and “femaleness.” In early fetal development, the cells that go on to form reproductive tracts and genitals are initially indifferent, regardless of the embryo’s sex chromosomes. The building blocks for all reproductive and genital eventualities exist in the early embryo concurrently, waiting for cues. For the first trimester the external genitals remain indistinguishable: Each anatomical aspect has the genetic potential to be another with the right encouragement (glans of penis or glans of clitoris, surface of penis or labia minora, scrotum or labia majora, or in variable combinations of neither).

When a baby is born, if doctors think its genitals deviate from the expected norm, its body is surgically reconfigured. These bodies that differ from the genital ideal are often seen as aberrations. When we try to reflect objectively on how bodies are understood as “male” or “female,” we can see that the popular understanding of genitals as either/or doesn’t reflect the reality that the potential forms of external genitalia are in fact unpredictably multiple.

The idea that genitals have multiple potentials and that we can build them to fit our idea of them is important when it comes to genital reassignment surgery. This elegant surgery reconfigures anatomy on an aesthetic, functional and sensual level. Metoidoplasties, for example, bring forward the clitoris and unite it with skin from the labia to form a functional penis and scrotum. Phalloplasties involve taking skin from the arm or abdomen to produce a functional penis that, with an implanted device, can sustain erections capable of penetrative sex. In both phalloplasty and metoidoplasty, the presence of a former clitoris as the new penis head provides the same arc of sensation that transmits as sexual pleasure. In vaginoplasties where a new vagina is formed, the head of the former penis relocates to become the clitoris, while inversion of the remaining penile skin and scrotum produces a fully sensate vagina. (These are technical terms and don’t necessarily reflect the patients’ preferred terms for their genitals.)

Not all trans people choose surgical treatments, but for those who do, studies demonstrate that genital-­reassignment surgery is very effective. Individuals report relief of the symptoms of their dysphoria, low rates of regret, and high levels of patient satisfaction. The data that demonstrates this may rely on grim cost-benefit analyses of medical interventions, but they clearly show that gender treatments make a difference in the lives of many trans people. Gender surgery, like all surgery, reconfigures a body’s capacity to meet its own needs and, as such, can mean as much or as little of anything to anyone. For many I’ve seen, it can offer some liberation not only from dysphoria but also from the oppression they face when navigating gender in social contexts—being able to use gendered toilets without the fear of violence, or having the type of sex they want to have. Post-gender critiques that remonstrate against gender surgery for upholding physical gender norms re-enact the oppression they pretend to fight. I suspect they arise from an inability or refusal to conceive of others’ gender dysphoria. These critiques imply that trans individuals are to blame for somehow inadequately dealing with oppression.

It’s clear that there is no universal experience of dysphoria. Many trans people experience no genital dysphoria at all. For some, dysphoria is concentrated around noticing the incongruence between the gender they understand themselves as and the gender they are assigned. For others, dysphoria exerts itself as a visceral weight that can cause as much pain as physical injury, an unconscious process in which the body is the passive recipient of its distress.

Critics of gender surgery may be right that the link between genital anatomy and gender is dubious, but trying to deny trans people important surgery puts the emphasis in entirely the wrong place. In fact, more careful thought shows that the bodies of cis-gendered individuals have an equally problematic relationship to biological sex. Cis people’s identification of their anatomy with their gender also relies on the residual power the idealized forms of genitals have in our imagination. These forms are only attempts to capture reality, and are not reality itself. At the level of identity, genitals are made neither in the womb, nor in surgery, but in the mind.

Some accounts of the social construction of gender still maintain biological sex as a kind of underlying basis, to be either tolerated or changed. But the more I read and the more I see, the less certain I am about biological sex. Perhaps the body doesn’t automatically suggest gender as much as we think but has to be given a gender in order to operate in the world. If biological sex is less a case of a simple binary with pathologized aberrations and more like a spectrum, where does the binary originate from, how does science uphold it, and what motivates it to do so?

It could be that it arises from a tendency to explain the most things in the simplest possible terms, which would make sense given the relatively low prevalence of non-XX/XY chromosomes and ambiguous genitalia at birth. But even by this account, the perception of some people’s genital anatomy as normal relies on a socially upheld idea of gender. Bio-essentialist theories of gender are, ironically, inadequate as descriptions of the human body; all they account for is the persistence of the social construction of gender.

Born-this-way gender biology is a historical accumulation of empirical findings and personal subjectivities, precariously held together by the veneer of objective reality afforded by scientific method. The male/female binary is perpetuated by the myth that sex chromosomes are XX or XY, and XX and XY are perfectly formed penises or vaginas, and perfectly formed penises or vaginas are boys or girls, with all deviations from this entering the realm of pathology. But the idea that the body exists objectively is false. External genitals, like all other aspects of gender, are the result of interpretation. They can be reinterpreted.

​Mind-Blowing Facts Men Don't Know About Women Is Blowing My Mind (from Jezebel)

It's interesting to me what men and women do not know about each other's private bits - and how many things get passed on as truth that have little or no basis in reality. Perhaps high school sex ed should have a little more show-and-tell.

This amusing article is by Tracy Moore at Jezebel.

​Mind-Blowing Facts Men Don't Know About Women Is Blowing My Mind

Tracy Moore

Friday, 8.22.14

While it's safe to say we should all have a working knowledge of how the human body works, it's also quite obvious that definitions of what constitutes common knowledge vary widely, and nowhere is this often truer than when it comes to what we know about the opposite sex, and vice versa.

In a list over a Frisky, author Rebecca Vipond Brink recounts a list of "mind-blowing" facts that men allegedly don't understand or misunderstand about women. Some of them are highly dubious to me, unless we are talking about teenage boys who have about as much knowledge of women as they do mixing a proper cocktail. Here are a few examples from her list: 

We have hair all over our bodies.

Brink writes:

Yeah, even on our faces! Crazy, right? I like to think that there's a difference between the hair that grows on a woman's face/all over her body and a mustache and beard, but several guys have made it clear to me that they don't believe that to be true.

For anyone still unclear: Yes, women can grow hair all over their bodies, including their faces. Perhaps because we've been removing it for hundreds of years, it has erroneously created the impression that we are naturally hairless, but we are not. Moving on.

Crotches that smell like perfume only exist in fiction.

Brink wants you to know that vaginas smell like a lot of different stuff: fish, "rank biscuits" if you have a yeast infection. And:

On a good day they smell like … I don't know, salty, ripe fruit? It's never exactly a great smell that you'd want wafting off of your body so that people 20 feet away can smell it (or maybe you do because that's your thing! Respect). Balls stink too, know that.

Dude, don't I know it, re: balls. And while it's also hard to accept that any grown hetero man doesn't know vaginas can smell a lot of ways, or that they smell at all, and that the smell is not naturally one of bouquet-of-flowers-on-rain-swept-misty-morn, let's accept it and go so far as to expound a bit: Vaginas do smell, and they are supposed to, and that's not bad! From a great post on BlogHer by gynecologist Lissa Rankin talkin' 'bout a woman's own special "V-pourri," we learn:

So how is the vagina supposed to smell? It depends. When you're straight out of the shower, your coochie may have no smell at all. When you've just finished running a marathon, it may have a strong musky odor from all the sweat glands. When you're menstruating or giving birth, the flinty-iron smell of blood prevails. When yeast overgrows in the vagina, you may smell like freshly baked-bread or a good malt beer. Right after you've had intercourse, you may smell faintly bleach-like, as semen has a classic odor of its own. And when certain normal bacteria overgrow, they release amines that smell — yup, you guessed it — like fish.

Every vagina has its own special smell — a combination of the normal bacteria that live in your vagina, what you eat, how you dress, your level of hygiene, your bowel habits, how much you sweat, and what your glands secrete. Remember that the glands near the vagina also secrete pheromones, meant to attract a sexual partner. So you don't want to deodorize your va-jay-jay so much that it smells like rain. Doing so thwarts the primal function of what your smell is supposed to accomplish. Plus, it interferes with the vagina's natural pH balance and can lead to a whole host of gynecological conditions.

So own your odor, girlfriends.

What's really fishy, though, is this next item from The Frisky post:

Tampons are not sexually satisfying (to most of us, anyway).

Ok, really? Someone had to be told this? I guess there's always someone who doesn't know about something we consider to be common knowledge — see any episode of Jay Leno's Tonight Show segment Jaywalk for endless examples, or any of those reddit posts on stuff doctors had to explain to patients about how anatomy works. But tampons? Sexual? And to be fair, I mean, sure, if don't have a vagina and therefore haven't put a tamp in it, and you also only think of a woman's vagina as a dick-holder, than I guess you would think anything vaguely dick-shaped going in said vagina would be a turn-on. Only it's not. Duh, there's perfunctory aspects of the vagina for the release of menstrual blood and offspring, so assuming all activity near the vagina is only sex-like would be like women assuming every time a man takes a piss, he gets turned on (I realize a man can have a boner while needing to pee). 

You are capable of having cellulite, too.

A'ight, I have to admit I'd literally never thought about men having cellulite, and reading this made me realize that I'd never seen it on a man, either. Brink's post says It's just easier to cover up because it tends to be on your stomach, not your legs.

I Googled a bit further and found a post from Len Kravitz, PhD, explaining that men can get cellulite, but that "90 – 98% of cases occur in women."

The reason cellulite is rarely seen in men (obese and non-obese) is because the epidermis, dermis and uppermost part of the subcutaneous tissue is different in males. Men have thicker epidermis and dermis tissue layers in the thighs and buttocks. More distinctively dissimilar, the first layer of fat, which is slightly thinner in men, is assembled into polygonal units separated by crisscrossing connective tissue (See below).

The differences in subcutaneous fat cell structure in men and women occur during the third trimester of fetus development and are manifested at birth. Variations in hormones between genders largely explain this skin structure deviation. It has been shown that men who are born deficient in male hormones will often have a subcutaneous fat appearance similar to females.

Vaginas don't get "stretched out" from sex.

We've discussed this hotdog-in-a-hallway myth before. In a nutshell: You can't fuck yourself loose, but over time, elasticity changes from aging, not fuckin', got it?

Also I would like to add this one:

Men and women both have smegma.

Jezebel scribe Mark Shrayber didn't know until recently that smegma was not just a dude's dick thing, but a male and female genitals thing. (YOU'RE WELCOME, MARK).

To turn the tables for equality, I'm sure there's dumb stuff I have thought about how dude's parts work, like I don't know really anything about balls, so I'm always wondering if guys dip their balls into various substances, and which one is best? Like, room-temp queso, maybe? And if you don't do that, why in the fuck not?

P.S. My friend wants to know if dudes getting kicked in the balls feels just like really really bad period cramps or what. 

Also boners? Like, WTF does a boner actually feel like? Discuss.

Illustration by Tara Jacoby.

Why would you pee sitting down (if you are a cis male)? But that is not the issue of this story - some men are not able to pee standing up, and some men are gender- or genital-variant. If you are a trans man who wishes to pass, standing at a urinal might be the only to fully pass.

From Pacific Standard.

Do You Have to Pee Standing Up to Be a Real Man?

By Alice Dreger • February 13, 2014 

This simple idea, encouraged by medical texts of the past that taught deviation from the norm would lead to confused sexuality and gender identity issues, has put a surprising number of babies under the knife.

•

In contemporary American culture, much is still demanded of “real men”: To be commanding and composed. To be courageous and chivalrous. To be rugged, strong, and low-voiced. And to be able to pee standing up.

Males are sometimes born with a urinary meatus (what kids might call “the pee hole”) somewhere other than the tip of the penis, which can make it difficult to meet this last demand. The opening might be farther down the head, on the shaft, or even on the scrotum. When this happens, and a doctor notices it, a newborn lad gets hit with a diagnosis of hypospadias. Often, he will be referred to a surgeon for “correction.”

How many boys are born with hypospadias is a matter of some dispute. Environmental hormone disruptors—including those found in some medications for hair loss and prostate cancer—increase chances of a male fetus developing hypospadias, and so the rate of hypospadias in America is probably increasing every year. Right now, American medical textbooks put the frequency at around one in 150 to 250 live male births, which would make it pretty common. That frequency would mean that, when you’re shopping in Costco, chances are so is a man born with hypospadias. When you’re in a major sports stadium, chances are you’re surrounded by a few hundred such men.

In fact, hypospadias might be much more common than even that, and may have always been. In 1995, the Journal of Urology published a stunning—and generally ignored—study out of Germany that showed that urologists have unreasonably strict expectations for penises. These physicians looked at a group of 500 men and found that only 55 percent could be labeled “normal,” according to medical standards. Of the 500, fully 225 counted as having hypospadias.

The team observed that “it remains unclear whether the tip of the glans [penis] is truly the normal site” for the urethral opening. The physicians also questioned whether surgical “correction” of hypospadias was necessary, given what they admitted was the “significant complication rate” of “reparative” surgeries—and given these men seemed to have figured out how to use their penises to their own satisfaction.

Yet every day in America, baby boys are put under anesthesia and under the knife to “fix” hypospadias. This involves moving the meatus to where surgeons believe it’s “supposed” to be (regardless of the German study’s findings). In mild cases of hypospadias, this is often a relatively simple surgery, and most of the time comes with no complications. In more significant cases, moving the meatus involves having to surgically build more urethra (the tube that carries urine and, in males, semen). That’s when things can get especially tricky.

The risks of “hypospadias repair” surgeries include wounds opening up on the penis (fistulas), scar tissue building up inside the urethra (stenosis), chronic pain at the surgical site, and chronic infections. For some boys, surgical “repairs” to their penises turn out to be downright destructive—even devastating. Jim Lake, a 54-year-old counselor who works in the Chicago area, has had 17 major urological surgeries to try and undo the damage that followed the surgical “correction” performed on his penis when he was just a baby. The medical literature has a special name for boys and men like Jim: hypospadias cripples.

Make no mistake: this “crippling” isn’t caused by the hypospadias; it’s caused by the complications of surgeries to “fix” hypospadias. In the vast majority of cases, initial “repair” of hypospadias is not done because a boy’s health is being actively compromised by this anatomical quirk; his health is not. In fact, in most cases, the surgery increases the odds a boy is going to suffer from urological problems. If what you care about is improving physical health, in most cases you would not go through with “hypospadias repair.”

And consider one of the most shocking findings of the German study: “all but 6 [of the 225 men diagnosed with hypospadias] were not aware of any penile anomaly, all but 1 homosexual patient have fathered children…. [A]ll patients participated in sexual intercourse without problems and were able to void in a standing position with a single stream.” So why label them as anything but normal?

Most hypospadias “repairs” performed by surgeons occur because of an untested, Freudian belief that you can’t grow up a “real man” if you urinate and ejaculate from somewhere other than the very tip of your penis. Urology texts of the past made it pretty plain: if you don’t “fix” hypospadias, a boy might be so messed up in his gender identity that he’ll grow up gay. Few urologists today seem to believe that sexual orientation is caused by how one pees, but many still think boys’ psychological health absolutely depends on being able to pee standing up. There’s no evidence for this. Why insurance covers it, even when there is no good evidence it is necessary or beneficial, remains a mystery.

I have heard some contemporary surgeons insist that hypospadias repair is done for a “medical” reason—to ensure a boy can eventually successfully impregnate a woman though intercourse. But there are simpler, non-surgical solutions to the problem of ejaculating somewhere other than the penis’s tip, including one reported in a late-19th-century British medical journal. In that case, a man with hypospadias was reported to have impregnated his wife by ejaculating onto a long-handled spoon and inserting it into her vagina.

Of course, we have better tools today. Through my work on this subject, a few years ago I met a man with “uncorrected” hypospadias who had opted for a high-quality turkey baster. He observed to me that, so far as he and his wife were concerned, they had the best of all possible worlds: he had no trouble with erections, orgasms, and intercourse—he was healthy—and yet he couldn’t accidentally get his wife pregnant. When they wanted to conceive, they just engaged in a private thanksgiving.

Nevertheless, parents of boys with hypospadias are often led to believe “corrective” surgery is necessary and worth the risks. Urologists don’t typically suggest that, before consenting to surgery, parents talk to the men in the Hypospadias and Epispadias Association (HEA) support group, of which Jim Lake is the incoming president.

Tiger Devore, a clinical psychologist now completing his service as HEA’s president, told me in a recent phone interview that he sees signs of pediatric urologists backing off of “hypospadias repair,” and that those changes in attitude break down along generational lines. Devore attended the International Pediatric Urology Task Force on Hypospadias in Las Vegas last September, and there he observed younger urologists being much more hesitant to push “corrective” surgery, especially in relatively minor cases, because of the risks.

Devore’s observation reminded me of a set of conversations I had with one pediatric urologist. About 15 years ago, this urological surgeon told me he wished I’d stop saying that hypospadias repair was motivated by a latent homophobia—it was a necessary surgery, he said. When I ran into him a couple of years ago, he admitted to me that my activist colleagues and I had been winning in our attempts to get his colleagues to move away from so many “repair” surgeries for hypospadias. I asked him to what he attributed the change. Without pause, he replied, “American culture has really come around on the gay thing.”

Could it be that surgeons and parents have really worried that a child left to grow up with atypical genitals will be at greater risk of gender identity and sexual orientation “problems”? Well, when I was editing a handbook for parents of these children in 2005, and I asked specialist clinicians what questions parents typically had when faced with a newborn with atypical genitals, the number one question was: Will my child be gay?

After working in this field for almost 20 years, I do not believe that most parents (or physicians) are trying to eliminate the possibility of a gay child through “corrective” surgery. I don’t see this as a eugenicist agenda. I think when parents ask Will my child be gay?, most of the time they are asking something more complicated, something genuinely compassionate: Will my child be able to know love, as I have known love?

But I do think it is the case that we still have a very tangled and too often unexamined confusion over genital variation and its meanings. We need an approach that is much calmer, more organized, and less anatomically naïve. Less surgical in its “corrective” fantasies.

So what are the options, at least for hypospadias?

A pediatric psychologist asked me something like this a couple of years ago, specifically in reference to a three-year-old boy on his service. The boy was born with hypospadias and his parents had decided early on against surgery. The mother was now feeling some anxiety because the boy, whose hypospadias made it so he had to sit to pee, was noticing how boys usually stand to pee while girls sit. The psychologist was calling to ask me if I knew of a simple prosthetic option so that this boy could try standing to pee.

Yes, I replied. And I know about the prosthetic solution because I like to camp. There’s a product called Go Girl, and it’s basically a reusable little plastic funnel. You hold it under yourself when you urinate, and the pee goes shooting out in front. Transgender men (who used to be female) sometimes also use these. I suggested the psychologist buy some of these devices, perhaps in the “camo” color, take them out of the Go Girl package, and show the kid how to use them, in case he wanted to pee standing up. A few bucks spent now and then on this handy product will buy this boy time so he can decide later, when he’s mature enough, if he wants to take on genital surgery risk. By then, too, the surgeries will hopefully be better.

An even better solution than Go Girl came from another family I ran across, a family including a boy born with a small penis and hypospadias. The first set of doctors had suggested sex changing the boy, something that used to be pretty common in such cases. (If you can’t make him into a “real man,” you make him into a girl, right?) Another set of doctors had offered “hypospadias repair.” But the parents, conservative Christians, had decided to let the boy grow up without elective, risky, invasive medical procedures.

In this case, the father took an innovative approach. Hearing about the alleged importance of a boy being able to urinate the way the men around him do, the father decided to sit to pee. Following the father’s lead, so did (and do) all the other men in the family when they are around this little boy: they all sit to pee.

Rather than getting that little boy to come to their norm, they decided to go to his.

What lesson is that little American boy learning about what makes a “real man”: compassion, acceptance, joy, and love. And sitting down to pee. What would be wrong with more men like that?

To watch videos of people born with hypospadias and other relatively uncommon variations on sex anatomy talking about their lives, visit The Interface Project.

Alice Dreger is a professor of clinical medical humanities and bioethics at Northwestern University's Feinberg School of Medicine. She has written for The New York Times, The Wall Street Journal, and The Washington Post. 

More from Alice Dreger

• Born With Unusual Bodies
• Born With Ambiguous Genitalia
• Why Gender Dysphoria Should No Longer Be Considered a Medical Disorder

Battle of the Sexes: The Orgasm Edition by Kayt Sukel

This article by Kayt Sukel was posted at Big Think a couple of weeks ago. Sukel looks at some research on the differences in male vs. female sexual response and orgasm. Men are often accused of not understanding the differences in the ways women respond sexually from how men respond, so this article offers a little step in rectifying that (overgeneralized, in my opinion) complaint.

Battle of the Sexes: The Orgasm Edition

Kayt Sukel on November 4, 2012

 

As I travel around and talk about the neuroscience of orgasm, there is one question I am consistently asked--usually by a particularly curious and outgoing person of the male persuasion: 

"Is my orgasm the same as my female partner's orgasm?"

There are questions about whether neuroscience can provide some answers to a few basic questions.  Can only women have multiple orgasms?  (Or, do women really have multiple orgasms at all?) Is what a man feels when he is reaching climax qualitatively (or quantitatively) the same as what a woman experiences? How are we the same?  How are we different?  Do those differences, if they exist, perhaps enhance (or detract) from sexual pleasure?

These are fascinating questions. But let's stick with the basic one:  is an orgasm the same whether it is experienced by a man or a woman?

Looking at anecdotal evidence, there is a pervasive notion that the male and the female orgasm are different entities altogether.  It's understandable, I suppose.  They can seem very, very different--from arousal to aftermath.  But, as it so happens, older research looking at the brain at orgasm suggested that the male and female orgasms were more alike than different.

Janniko Georgiadis and colleagues at the University of Groningen in the Netherlands compared cerebral blood flow in both men and women both during genital stimulation and at the point of orgasm using positron emission tomography (PET).  They found significant differences in activation patterns during arousal but not orgasm itself.  And they concluded that those differences were likely due to differences in our anatomical equipment--which, when you think about it, makes a lot of sense.  What works on arousing a penis may not be quite as magical when applied to a clitoris. (Though, different strokes for different folks...)

Of course, PET does not have the resolution or speed of a neuroimaging technique like functional magnetic resonance imaging (fMRI).  Could it be the lack of differences between the sexes--differences which seem to many of us to be both obvious and innate--might be detected if we had better tools to examine the question?

It's entirely possible.  And very recently, Nan Wise and Barry Komisaruk, researchers at Rutgers University, decided to take a look.  As part of their series of studies on the time course of orgasm--that is, the chain of activation of brain components leading up to, during, and after orgasm--they compared men and women participants self-stimulating to orgasm.  Using fMRI and then a graphical causal modeling analysis technique, they compared effective connectivity, or how blood flow traveled between key areas of the brain like the cerebellum, the paracentral lobule, the nucleus accumbens and the frontal pole (areas that had been identified as important to orgasm in previous studies), as individuals self-stimulated to orgasm.

Wise and Komisaruk presented this work at Neuroscience 2012, the largest neuroscience conference in the world.  The preliminary results suggest that both men and women (whether women were self-stimulating manually or just "thinking off") showed significant activation of the frontal pole feeding back to the paracentral lobule, an area that processes sensorimotor signals from the lower extremities, at the point of orgasm. Think about that--the frontal cortex, an area involved in both planning and inhibition, is projecting back to an area involved with processing sensation.  Does that demonstrate fantasy?  Release?  Control?  Wise and Komisaruk aren't sure.

Yet, all groups showed this same effect.  So perhaps Georgiadis' study wasn't so far off the mark and things aren't as different on the orgasm front as they seem (though, in terms of full disclosure, Georgiadis never did find frontal cortex activation in any of his orgasm studies). 

Or are they?  When the group looked closer at effective connectivity, they did see slightly different activation patterns, both between the sexes and between individuals.  It's hard to know what to make of that.  Wise and Komisaruk are quick to point out that they need more participants to make any hard and fast conclusions about sex differences.

So next time I'm asked about the nature of the male vs. female orgasm, I'll have a little more to add to my explanation.  But my answer will have to be that the scientific jury, at least, is still out.  For now.

What do you think?  Is the male orgasm qualitatively and neurobiologically distinct from the female orgasm?

Photo credit: Vasilchenko Nikita/Shutterstock.com

One in 2000 (Intersex Children)

A lot of social scientists argue over the nature/nurture aspects of gender identity, but there is also a whole other level of complexity. Around 1 in 2000 children is born without clearly defined sexual organs (according to this film), a condition now known as intersex.

According to the Intersex Society of North America, the overall prevalence of children whose sexual anatomy differs from standard male and female is 1 in 100 (a few of the conditions are listed below, there are many more less common ones at their site).

• Not XX and not XY is one in 1,666 births
• Klinefelter (XXY) births are one in 1,000 births
• Total number of people whose bodies differ from standard male or female is one in 100 births
• Total number of people receiving surgery to “normalize” genital appearance is one or two in 1,000 births

This film, One in 2000, looks at the reality of these people's lives.

One in 2000 

Synopsis

Every parent-to-be hopes for a "perfect" baby, but what does that actually mean? Every newborn is different, but some of those differences are scarier to parents than others. Each year an estimated one in two thousand babies are born with anatomy that doesn't clearly mark them as either male or female -- with what is known as an intersex condition. It's a situation that's hard to talk about; it challenges our preconceptions about how things are "supposed" to be.

This provocative documentary demystifies the issue of sexual difference. At a time when five babies a day in the United States are having "gender reassignment" surgery, it argues that there is little evidence that such surgery is beneficial to the child. The program profiles several people born with ambiguous sexual anatomy, who have managed to deal with some very difficult family and social issues, but today are living "ordinary" and productive lives. It also includes a young mother who is matter-of-factly creating the conditions for her intersex baby to do the same.

Interweaving their stories with educational films from the 1950's, ONE IN 2000 invites us to take a serious second look at how the media have dealt with sexual "normality." It will be an invaluable tool for educating and sensitizing parents, young people -- and many in the medical community as well.

Film Credits

Director and Producer: Ajae Clearway