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Female ejaculation

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Female ejaculation (colloquially known as squirting or gushing[1]) refers to the expulsion of noticeable amounts of clear fluid by human females from the paraurethral ducts through and around the urethra during or before orgasm. The exact source and nature of the fluid continues to be the topic of debate among medical professionals.[2]

Introduction

In questionnaire surveys, 35–50% of women report that they have at some time experienced the expulsion of fluid during orgasm.[3][4][5] Other studies find anywhere from 10–69%, depending on the definitions and methods used.[6][7] For instance Kratochvíl (1994) surveyed 200 women and found that 6% reported ejaculating, an additional 13% had some experience and about 60% reported release of fluid without actual ejaculation.[8] Reports on the volume of fluid expelled vary considerably[9] from amounts that would be imperceptible to a woman, to mean values of 1–5 ml,[10] although much higher volumes have been reported.

Historical accounts

The suggestion that women can eject fluid from their genital area as part of sexual arousal has been described as "one of the most hotly debated questions in modern sexology".[2] Female ejaculation has been discussed in anatomical, medical, and biological literature throughout recorded history. The interest devoted to female ejaculation compared to the basic acceptance of its male counterpart has been questioned by feminist writers.[11]

Ancient world

Middle-Eastern accounts

There are innuendos alluding to female ejaculation in books of the bible. Biblical scholars attest to the fact that there are erotic references to lovemaking techniques in the bible, and that includes female arousal, orgasm and ejaculation.[12] One example is the Song of Solomon, in which three verses might be understood as references to female ejaculation (4:11-12, 4:14-15, 5:1)[citation needed]. One of these reads:

A garden enclosed is my beloved, my spouse; a spring shut up, a fountain ready to burst.
(Song of Solomon 4:12)

Eastern accounts

References to female ejaculation also exist later in Indian erotic texts, such as the Kama Sutra of Vatsyayana (Bechtel 1996) and the sixteenth century Ananga-Ranga.[6][13] Many Indian temples including Khajuraho (Madhya Pradesh), Konark Sun Temple (Orissa) and Vijayanagara temples (Karnataka) have carved images depicting female ejaculation. The Kama Sutra states (II,1: 186) that[14]

The semen of women continues to fall from the beginning of the sexual union to the end, in the same way as that of the male

Chinese sex handbooks, such as Secret Methods of the Plain Girl by Su Nu Ching (Sui Dynasty 590–618 AD) also describe ejaculation "Copious emissions from her inner heart begin to exude outward".[2][15][16]

Greek and Roman accounts

Greek and Roman writers accepted female ejaculation as normal and pleasurable, but there was debate as to whether the fluids, like male ejaculate, were progenitive (contained generative seed).[11] De Graaf claims that Galen mentions Herophilos (335–280 BC) as describing a prostate-like organ in the fourth century BC, although this is debatable.[17] Aristotle (384–322 BC) did not believe that the fluids were progenitive,[11][18] whereas Hippocrates (460–370 BC)[19] and Galen (129–200 AD) stated that they were, the two semen theory.[20]

In the Generation of Animals, Aristotle argues that the function of the fluid is pleasure, not procreation;[21]

Some think that the female contributes semen in coition because the pleasure she experiences is sometimes similar to that of the male, and also is attended by a liquid discharge. But this discharge is not seminal...The amount of this discharge when it occurs, is sometimes on a different scale from the emission of semen and far exceeds it.

Hippocrates stated that "the ejaculate of the mans runs together with that from the woman", [2] while Galen differentiated procreative and pleasurable female fluids, attributing the latter to what he described as the prostate.[22][23]

The fluid in her prostate ...contributes nothing to the generation of offspring...it is poured outside when it has done its service...This liquid not only stimulates...the sexual act but also is able to give pleasure and moisten the passageway as it escapes. It manifestly flows from women as they experience the greatest pleasure in coitus...

Eventually it was this two semen theory that prevailed in Arabic, and then Western medical teaching. [24]

Western literature

16th to 18th century

In the 16th century, the English physician Laevinius Lemnius, refers to how a woman "draws forth the man's seed and casts her own with it".[25] In the 17th century, Francois Mauriceau described glands at the urethral meatus that "pour out great quantities of saline liquor during coition, which increases the heat and enjoyment of women".[26] This century saw an increasing understanding of female sexual anatomy and function,[27] in particular the work of the Bartholin family in Denmark.

De Graaf

The Dutch anatomist Regnier de Graaf, wrote an influential treatise on the reproductive organs Concerning the Generative Organs of Women which is much cited in the literature on this topic. De Graaf discussed the original controversy but supported the Aristotelian view.[17] [28] He identified the source as the glandular structures and ducts surrounding the urethra.

[VI:66-7]The urethra is lined by a thin membrane. In the lower part, near the outlet of the urinary passage, this membrane is pierced by large ducts, or lacunae, through which pituito-serous matter occasionally discharges in considerable quantities.

Between this very thin membrane and the fleshy fibres we have just described there is, along the whole duct of the urethra, a whitish membranous substance about one finger-breadth thick which completely surrounds the urethral canal... The substance could be called quite aptly the female 'prostatae' or 'corpus glandulosum', 'glandulous body'...The function of the 'prostatae' is to generate a pituito-serous juice which makes women more libidinous with its pungency and saltiness and lubricates their sexual parts in agreeable fashion during coitus.

[VII:81]Here too it should be noted that the discharge from the female 'prostatae' causes as much pleasure as does that from the male 'prostatae'

He identified [XIII:212] the various controversies regarding the ejaculate and its origin, but stated he believed that this fluid "which rushes out with such impetus during venereal combat or libidinous imagining" was derived from a number of sources, including the vagina, urinary tract, cervix and uterus. He appears to identify Skene's ducts, when he writes [XIII: 213] "those [ducts] which are visible around the orifice of the neck of the vagina and the outlet of the urinary passage receive their fluid from the female 'parastatae', or rather the thick membranous body around the urinary passage". However he appears not to distinguish between the lubrication of the perineum during arousal and an orgasmic ejaculate when he refers to liquid "which in libidinous women often rushes out at the mere sight of a handsome man". Further on [XIII:214] he refers to "liquid as usually comes from the pudenda in one gush". However it should be noted that his prime purpose was to distinguish between generative fluid and pleasurable fluid, in his stand on the Aristotelian semen controversy.

19th century

Krafft-Ebing's study of sexual perversion, Psychopathia Sexualis (1886), describes female ejaculation under the heading "Congenital Sexual Inversion in Women" as a perversion related to neurasthenia and homosexuality. [29]

"the intersexual gratification among ...women seems to be reduced to kissing and embraces, which seems to satisfy those of weak sexual instinct, but produces in sexually neurasthenic females ejaculation"

It is also described by Freud in pathological terms in his study of Dora (1905), where he relates it to hysteria. [30]

"The pride taken by women in the appearance of their genitals is quite a special feature of their vanity; and disorders of genitals which they think calculated to inspire feelings of repugnance or even disgust have an incredible power of humiliating them, of lowering their self-esteem, and of making them irritable, sensitive, and distrustful. An abnormal secretion of the mucous membrane of the vagina is looked upon as source of disgust."

However, women's writing of that time portrayed this in more positive terms. Thus we find Almeda Sperry writing to Emma Goldman in 1918, about the "rhythmic spurt of your love juices". [11][31] Anatomical knowledge was also advanced by Alexander Skene's description of para-urethral or periurethral glands (glands around the urethra) in 1880, which have been variously claimed to be one source of the fluids in the ejaculate, and now commonly referred to as the Skene's glands.[32]

20th century

Early 20th century understanding

Female ejaculation is mentioned as normal in early 20th century 'marriage manuals', such as TH Van de Velde's Ideal Marriage: Its Physiology and Technique (1926). Certainly van de Velde was well aware of the varied experiences of women. [33]

It appears that the majority of laymen believe that something is forcibly squirted (or propelled or extruded), or expelled from the woman's body in orgasm, and should so happen normally, as in the man's case. Finally it is just as certain that such an 'ejaculation' does not take place in many women of sexually normal functions, as that it does take place in others.

Yet the subject was largely ignored for most of the early part of the century. In 1948, Huffman, an American gynaecologist, published his studies of the prostatic tissue in women together with an historical account and detailed drawings. These clearly showed the difference between the original glands identified by Skene at the urinary meatus, and the more proximal collections of glandular tissue emptying directly into the urethra. [34]

The urethra might well be compared to a tree about which and growing outward from its base are numerous stunted branches, the paraurethral ducts and glands

To date most of the interest had focussed on the substance and structure rather than function of the glands. A more definitive contemporary account of ejaculation appeared shortly after, in 1950, with the publication of an essay by Gräfenberg based on his observations of women during orgasm.[35]

An erotic zone always could be demonstrated on the anterior wall of the vagina along the course of the urethra...analogous to the male urethra, the female urethra also seems to be surrounded by erectile tissues...In the course of sexual stimulation, the female urethra begins to enlarge and can be felt easily. It swells out greatly at the end of orgasm...Occasionally the production of fluids is ...profuse...

If there is the opportunity to observe the orgasm of such women, one can see that large quantities of a clear transparent fluid are expelled not from the vulva, but out of the urethra in gushes. At first I thought that the bladder sphincter had become defective by the intensity of the orgasm. Involuntary expulsion of urine is reported in sex literature. In the cases observed by us, the fluid was examined and it had no urinary character. I am inclined to believe that "urine" reported to be expelled during female orgasm is not urine, but only secretions of the intraurethral glands correlated with the erotogenic zone along the urethra in the anterior vaginal wall. Moreover the profuse secretions coming out with the orgasm have no lubricating significance, otherwise they would be produced at the beginning of intercourse and not at the peak of orgasm.

However this paper made little impact, and was dismissed in the major sexological writings of that time, such as Kinsey (1953)[36] and Masters and Johnson (1966),[37] equating this "erroneous belief" with urinary stress incontinence. Although clearly Kinsey was familiar with the phenomenon, commenting that (p. 612);

Muscular contractions of the vagina following orgasm may squeeze out some of the genital secretions, and in a few cases eject them with some force

as were Masters and Johnson ten years later, who observed (pp 79–80)

Most women do not ejaculate during orgasm...we have observed several cases of women who expelled a type of fluid that was not urine (emphasis in original)

yet dismissed it (p. 135) - "female ejaculation is an erroneous but widespread concept", and even twenty years later in 1982,[38] they repeated the statement that it was erroneous (p. 69-70) and the result of "urinary stress incontinence".

Late 20th century awareness

The topic did not receive serious attention again until a review by Josephine Lowndes Sevely and JW Bennett appeared in 1978.[39] This latter paper, which traces the history of the controversies to that point, and a series of three papers in 1981 by Beverly Whipple and colleagues in the Journal of Sex Research,[40][41][42] became the focal point of the current debate. Whipple became aware of the phenomenon when studying urinary incontinence, with which it is often confused.[43] As Sevely and Bennett point out, this is "not new knowledge, but a rediscovery of lost awareness that should contribute towards reshaping our view of female sexuality". Nevertheless, the theory advanced by these authors was immediately dismissed by many other authors, such as physiologist Joseph Bohlen,[44] for not being based on rigorous scientific procedures, and psychiatrist Helen Singer Kaplan (1983) stated;[45]

Female ejaculation (as distinct from female urination during orgasm) has never been scientifically substantiated and is highly questionable, to say the least.

Even some radical feminist writers, such as Sheila Jeffreys (1985) were dismissive, claiming it as a figment of male fantasy;[46]

There are examples in the sexological literature of men's sexual fantasies about lesbian sexuality. Krafft-Ebing invented a form of ejaculation for women

It required the detailed anatomical work of Helen O'Connell[47] from 1998 onwards to more properly elucidate the relationships between the different anatomical structures involved. As she observes, the perineal urethra is embedded in the anterior vaginal wall and is surrounded by erectile tissue in all directions except posteriorly where it relates to the vaginal wall. "The distal vagina, clitoris, and urethra form an integrated entity covered superficially by the vulval skin and its epithelial features. These parts have a shared vasculature and nerve supply and during sexual stimulation respond as a unit".[48][49][50]

Anthropological accounts

Female ejaculation appears in 20th century anthropological works, such as Malinowski's Melanesian study, The Sexual Life of Savages (1929), and Gladwin and Sarason's "Truk: Man in Paradise" (1956). Malinowski states that in the language of the Trobriand Island people, a single word is used to describe ejaculation in both male and female. [51]

Both the male and female discharge are called by the same name (momona or momola), and they ascribe to both the same origin in the kidneys, and the same function, which has nothing to do with generation, but is concerned with lubricating the membrane and increasing pleasure

In describing sexual relations amongst the Trukese Micronesians, Gladwin and Sarason state that "Female orgasm is commonly signalled by urination".[52] Catherine Blackledge[27] (p. 205) provides a number of examples from other cultures, including the Ugandan Batoro, Mohave Indians, Mangaians, and Ponapese. Amongst the Batoro, older women teach the younger women "kachapati" (spraying the wall) at puberty. (See also Chalker 2002 pp. 531-2, Ladas et al. 1983 pp. 74-5)

Controversies and debates

The debates in the current literature focus on three threads: whether ejaculation exists or not, the sources and composition of the fluid, and the role of female ejaculation in constructing theories of sexuality. [11] Inevitably such a debate becomes politicised in terms of people's beliefs, and is influenced by popular culture and pornography in addition to physico-chemical and behavioural studies. From a feminist perspective, there is resistance to what has been perceived as a male lens in interpreting the data and construct. More often than not the debate is tied to the existence or not of the G-spot,[18][53] since stimulation of the anterior vaginal wall involves simultaneous stimulation of the para-urethral tissue, the site of the homologous prostatic glands and ducts, and stated source of the ejaculated fluid, and therefore it has been variously stated that stimulation of this spot resulted in ejaculation. These tissues, surrounding the distal urethra, and anterior to the vagina, have a common embryological origin to the prostatic tissue in the male.[54][55]

An example of the difficulties is provided by the contrasting views of Carol Darling and Heli Alzate. [56][57] As Shannon Bell states,[11] essentially they are discussing two different phenomena. In an extensive survey, Darling and colleagues claim support for the existence of ejaculation,[5] while in a sharply critical response, Alzate states that direct experimentation fails to provide any evidence.[58] Alzate states,

the ignorance and/or confusion still prevalent among women about the anatomy and physiology of their sexual organs may make them mistake either vaginal lubrication or stress urinary incontinence for an "ejaculation"

Bell comments that Alzate simply dismisses women's subjective experiences in favour of rigorous scientific proof, and is typical of male sexologists withholding the validity of experience from women. Bell's critique lies at the heart of feminist concerns about this debate, namely a tendency to "disregard, reinterpret, and overwrite women's subjective descriptions". For some, she states, it is more a matter of belief than of physiology.

The discussion entered popular culture in 1982 with the publication of the bestselling The G Spot and Other Recent Discoveries About Human Sexuality, by Ladas, Whipple, and Perry.[59] The book discussed the question of female ejaculation and brought the concept back into discussions of women's sexuality, both in the medical community and among the general public. [2][60][61] This was a popular account of three papers by the authors, the previous year, at the suggestion of Alice Khan Ladas.[40][41][42] Rebecca Chalker notes that this book was largely met with scorn, skepticism and disbelief.[2] The chapter on 'Female Ejaculation' is largely based on anecdotal testimony, and illustrates another issue in the debate, the weight placed on anecdotes and small numbers of observations compared to biomedical investigation and clinical trials. Importantly, a number of the women stated that they had been diagnosed with urinary incontinence. However the book advances another feminist theory, that because women's pleasure in their sexuality has been historically excluded, the pleasure of ejaculation has been either discounted or appropriated by health professionals as a physiological phenomenon.[62] Whipple continued to publicise her discoveries, including a 9 min video made in 1981 Orgasmic Expulsions of Fluid in the Sexually Stimulated Female. The Journal of Sex Research described the debate as 'heated' in 1984.[63] Josephine Sevely then followed up her 1978 study by publishing "Eve's Secrets: A new theory of female sexuality" in 1987, emphasising an integrated rather than fragmented approach to understanding female sexuality, with the clitoris, vagina and urethra depicted as a single sexual organ.[64][65] This not only challenged the traditional fragmentation of female sexuality into clitoral vs. vaginal sensation, but sexualised the urethra, and by reconstructing female sexual anatomy addressed traditional thinking about the differences in male and female genitalia, often described by feminists as phallocentric. [11]

Bell further questions why feminists have not been more outspoken in defence of women's control over female ejaculation, pointing out that the literature frames the discussion in only five separate ways; procreation, sexual pleasure, deviance, pathology, and a scientific mystery. [11] The continuing debate is further illustrated in the angry exchange of letters between the author and researchers in the American Journal of Obstetrics and Gynaecology in 2002 following the publication of 'The G-spot: A modern gynecological myth' by Terrence Hines.[61] Even in 2007,[6][66] and 2008[65] the existence of a female prostate and of ejaculation are described as a matter of debate, and articles and book chapters continue to appear with subtitles such as "Fact or Fantasy".[2]

Research

Much of the problem in arriving at a consensus relates to a failure to adopt generally agreed-on definitions[67] and to research methodology. Research on this subject has used highly selected individuals, case studies, or very small numbers of subjects, making generalisation difficult, hence the continuing controversies and debates. For instance, much of the research into the nature of the fluid concentrates on trying to determine whether it is urine or not. Problems relate to the difficulties involved in the collection of specimens and of contamination. Since the area of interest is para-urethral glands, it is impossible to completely separate the secretions from urine, especially where there may be retrograde ejaculation back up the urethra towards the bladder. The best data comes from studies where women have abstained from coitus, and where their own urine is used as controls, pre and post orgasm. One way of sorting this out is the use of chemicals that are excreted in the urine, so that any urinary contamination can be detected. Another methodological issue arises from the fact that the composition of the fluid appears to vary with the menstrual cycle,[68] while the biochemical profile of the para-urethral tissues also varies with age.[69] Other issues relate to the sensitivity and specificity of the markers chosen. The key questions are the source of the fluid produced, and its nature.[44] Some findings have been presented in conferences but never published in peer review journals, and many others are in difficult to access resources.

Relation to urinary incontinence

For most of the last century, there was controversy over whether the effect existed at all, and in recent history there has been confusion between female ejaculation and urinary incontinence. Even in 1982, Bohlen explained the accepted wisdom;[44]

The previously accepted notion that all fluid expelled during a woman's orgasm is urine is now being challenged...sexologists must take care not to assume now that any fluid produced at orgasm is "female ejaculate".

However, scientific studies from the 1980s and later have demonstrated that a substance is produced which is distinct from urine, though it shares some qualities, such as alkalinity, with urine.[8] But women claiming to have ejaculations who have agreed to urethral catheterization prior to intercourse expelled large volumes of urine through the catheter at orgasm. There is no doubt that some women are frankly incontinent of urine at orgasm (coital incontinence), [70] which can be distressing. A recent study of women who claim to ejaculate found no evidence of any urological problems, suggesting these two conditions (ejaculation and coital incontinence) are quite distinct physiologically, although perhaps not always distinguishable in a particular woman's mind.[citation needed] For instance Davidson's study of 1,289 women found that the sensation of ejaculation was very similar to that of urination. [4] It may be important to sort out whether there is in fact any incontinence in women who present complaining of this, to avoid unnecessary interventions.[43][71] It is important to distinguish orgasmic ejaculation from vaginal discharges which may require investigation and treatment. However in individual cases, the exact source of any reported discharge may not be obvious without further investigation.

Nature of fluid

Critics of the concept have maintained that ejaculation is merely either stress incontinence or vaginal lubrication. Research in this area has concentrated almost exclusively on attempts to prove that it is not urine[53][72] measuring substances such as urea, creatinine, prostatic acid phosphatase (PAP), prostate specific antigen (PSA),[7] glucose and fructose [73] levels. Early work was contradictory, for instance the initial study on one woman by Addiego and colleagues reported in 1981,[41] could not be confirmed in a subsequent study on 11 women in 1983, [74] but were confirmed in another 7 women in 1984.[75] But in 1985 a different group studied 27 women, and found only urine,[56] suggesting that results depend critically on the methods used.

A 2007 study on two women, involved ultrasound, endoscopic and biochemical analysis of fluid. The ejaculate was compared to pre-orgasmic urine from the same woman, and also to published data on male ejaculate. In both women, higher levels of PSA, PAP, glucose but lower levels of creatinine were found in the ejaculate. PSA levels were comparable to those in males.[6]

Source of fluid

One very practical objection relates to the claims about the volume ejaculated, since this has to come from some storage area in the pelvis, of which the urinary bladder is obviously the largest source. The actual volume of the para-urethral tissue is quite small. By comparison, male ejaculate varies from 0.2–6.6 mL (0.04–1.3 tsp) (95% confidence interval), with a maximum of 13 mL (2.6 tsp).[76] Therefore claims of larger amounts of ejaculate are likely to contain at least some amount of urine. The eleven specimens analyzed by Goldberg in 1983,[74] ranged from 3–15 mL (0.6–3.0 tsp).[75] One source states that Skene's glands are capable of excreting 30–50 mL (6–10 tsp) in 30–50 seconds.[63] but it is unclear how this was measured and has not been confirmed. One approach is to use a chemical like methylene blue (or drugs like Urised which contain it) so that any urinary contamination can be detected.[75] Belzer showed that in a woman he studied, the dye was in her urine, but not her orgasmic expulsion.[40]

PAP and PSA have been identified in the para-urethral tissues, using biochemical and immunohistochemical methods, confirming that the ejaculate likely arises from the ducts in these tissues, in a manner homologous to that in the male.[77][78][79][80][81] Another marker common to the prostate tissue in both male and female is Human Protein 1.[82]

However, studies on the actual penis are very limited compared to those on the tissues of likely origin. PSA occurs in urine, which is elevated in post-orgasmic samples, compared to pre-orgasmic. Simultaneous collection of ejaculate also showed PSA in all cases, but in higher concentration than the urine.[60]

Social significance

Women's sexual functions, and orgasm in particular, remain poorly understood scientifically, as opposed to politically and philosophically.[65][83][84] Regardless of the actual facts relating to the details of female ejaculation, the social significance of the popular accounts through the feminist health care movement has been considerable.[2]

Many women, before learning about ejaculation, experienced shame or avoided sexual intimacy under the belief that they had wet the bed.[63] Others suppressed sexual climax, and sought medical advice for this "problem," and even underwent surgery.[2]

There are, however, concerns. The terminology, such as female prostate and female ejaculation invoke images of the female as merely an imitation of the male, mapping the female body onto the male, as if, like the Galenic view, it was incomplete. [20] By contrast it could equally be argued that the Y chromosome merely modifies a female template. [2][40][53] Furthermore overemphasis of ejaculation may induce performance anxiety.[2] For the reason that 'sameness' has been constructed as a male perspective, some feminists reject the term ejaculation. Others argue it should be retained as a distinctive feminine characteristic distinguishable from the male, and imbued with different properties and purpose. A third concern is that of the increasing 'medicalisation' of women's sexuality, as expressed by Leonore Tiefer which finds its most extreme manifestation in the concept of female sexual dysfunction.[85] Tiefer has expressed concern that overemphasising ejaculation will drive women who might feel inadequate to seek medical attention, [2] as has the Boston Women's Health Collective. [86] Other criticism comes from Barbara Ehrenreich [87] and colleagues who see this new sexuality as one that privileges the male in control, penile retention and body position, but this is denied by others. [11]

Contemporary women's health literature summarises what is considered factual as being that the amount of fluid varies greatly and may be unnoticeable, occurs with or without vaginal stimulation, and may accompany orgasm or merely intense sexual pleasure, and orgasm may occur without ejaculation. Whether it can be learned or not, women report that they can induce it by enhancing their sexual response. [2] Regardless, countless workshops now exist to teach women that learning how to ejaculate is an important form of feminine sexual expression. Sundahl describes it as a birthright and essential part of female creativity. [18]

The presence of chemical markers such as PSA or PAP in the female genital tract has been considered evidence in rape trials,[88] but Sensabaugh and Kahane demonstrated in four specimens, that PAP was an order of magnitude greater in a woman's ejaculate than in her urine. Recently, knowledge that these markers can be of female origin has led to acquittal based on forensic evidence.[55][89]

Many Tantric gurus such as Mantak Chia, among others, educated followers about the existence and the techniques to achieve female ejaculation as far back as the sixties and seventies. By the seventies and eighties, notable American and British Tantric teachers were further popularising it. With the turn of the century it was depicted in pornography. Regardless of proven scientific fact, ejaculation is now firmly embedded in the popular culture, with workshops and videos, as an empowering phenomenon. These depict ejaculation as a spiritual experience.

Censorship

In the United Kingdom, the British Board of Film Classification has banned films alleged to show female ejaculation, claiming that the expert medical advice they received informed them that there is no such thing as female ejaculation, and therefore it was deemed to show urine. [90][91] They later stated instead that they do not take any view on whether female ejaculation exists, only claiming that all examples they have seen thus far during classification have been urination during sex.[92]

See also

References

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