Few topics in sexual medicine are as polarizing as women’s orgasms. On one side is an industry-fueled crusade to identify and enhance the so-called center of women’s sexual pleasure — the G-spot. On the other side are scientists equipped with imaging machines showing no conclusive evidence that a single G-spot exists.
The latest controversial update in this debate is an article published in the Aesthetic Plastic Surgery journal in which gynecologist Adam Ostrzenski, a well-known advocate for cosmetic genital procedures, surgically removed an area of tissue around the G-spot of three women who had become unable to reach orgasm through vaginal stimulation (Ostrzenski previously made waves in 2012 when he claimed to have identified the G-spot as a discrete sac in the front vaginal wall). In the years after the procedure, all three women reported a renewed ability to reach orgasm with vaginal stimulation alone, and — not surprisingly — more frequent sex as a result.
As a psychologist who studies sexual health, there are so many concerns I have with this paper, but I’ll focus on just four.
First, the science evaluating G-spotplasty, and other similar genital cosmetic procedures, is fundamentally flawed. Women are told during their pre-treatment consult to expect improvements in sexual response. They then pay out-of-pocket — sometimes significant amounts — for these invasive procedures. Afterward, they’re given post-procedure questionnaires by the same practitioner who delivered the treatment. Each of these factors independently creates a bias that can directly shape a woman’s expectations and, in turn, influence her response. It’s the placebo effect at work: They’re primed to expect an improvement (and paying for it). It’s certainly possible that any reported improvements are due to mechanisms completely unrelated to manipulating the G-spot at all.
Second, there’s a major flaw in the methods of this study: it lacked a control group of women who didn’t undergo surgery, but instead discussed their sexual function with a warm, empathic, and nonjudgmental care provider. Research has found that more than 20 percent of women experience distressing sexual difficulties, but the vast majority of them won’t seek help or speak to a health-care provider. If they did, it’s likely that many of these concerns would dissolve at the hands of an informed clinician armed with solid information about sex: Feeling abnormal is a major contributor to sexual dysfunction, as is anxiety over your own sexual performance, which means we can’t rule out the possibility that these women saw improved orgasms because they were reassured by a confident doctor that they would, and not because of the surgery. When it comes to sex, expectations trump physiology.
Thirdly, there’s still too much we don’t know. We have no information about any adverse effects the three women under Ostrzenski’s care experienced. There was no imaging of the excised area to inform whether there was scarring or other anatomical issues that could lead to long-term concerns and other symptoms. It’s unsurprising, then, that in North America, neither the American College of Obstetrics and Gynecology nor the Society of Obstetricians and Gynaecologists of Canada approve these cosmetic surgical practices meant to improve sexual function.
Fourth, what concerns me greatly about the G-spotplasty is that it rests on the assumption that the G-spot is identifiable in all women, an assumption that remains hotly contested. Our understanding of the underlying anatomy of women’s orgasms is still nascent, and there have been as many studies failing to find a precise G-spot as studies that do.
Moreover, imaging research has shown that the anatomic location of the G-spot overlaps with anatomic areas of the clitoris, an area of tissue much more vast than what can be seen externally. In European studies that monitored couples having sex inside a scanning machine, for example, the images showed that the penis stimulates both the anterior wall of the vagina, where the G-spot is thought to be, and the clitoral complex tissue. If scientists armed with sophisticated imaging technologies and ultra-fine resolutions have yet to definitively isolate this mysterious area, it seems inappropriate for cosmetic surgeons to state so confidently that they can operate on it.
I can understand the allure of a procedure that promises full restoration of sexual pleasure with little to no recovery time — especially now, in an era of quick fixes. But in practice, G-spotplasty harms more than it helps, contributing to a culture that sets unrealistic standards for sexual perfection, while completely ignoring the things that could actually make sex better: education about sexual norms, communication-skills training for couples, body-awareness exercises, and psychological approaches to cultivate sexual desire and arousal. There are other, more effective fixes.
Lori Brotto is the author of Better Sex Through Mindfulness: How Women Can Cultivate Desire.