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Contributors: WWS initiated and coordinated the formulation of the study hypothesis, designed the protocol, and participated in data collection, interpretation of the findings, and writing of the paper; he is guarantor of the study.

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Contributors: WWS initiated and coordinated the formulation of the study hypothesis, designed the protocol, and participated in data collection, interpretation of the findings, and writing of the paper; he is guarantor of the study.

PvA had the original idea for the present study, and participated in formulation of the study hypothesis, data collection, interpretation of the findings, and writing of the paper. IS, together with her partner, participated in the first two experiments and helped design the protocol.

EM participated in the execution of the study, particularly data collection and interpretation of the magnetic resonance findings. To find out whether taking images of the male and female genitals during coitus is feasible and to find out whether former and current ideas about the anatomy during sexual intercourse and during female sexual arousal are based on assumptions or on facts.

Magnetic resonance imaging was used to study the female sexual response and the male and female genitals during coitus. Thirteen experiments were performed with eight couples and three single women. During female sexual arousal without intercourse the uterus was raised and the anterior vaginal wall lengthened.

The size of the uterus did not increase during sexual arousal. Taking magnetic resonance images of the male and female genitals during coitus is feasible and contributes to understanding of anatomy.

The semen was supposed to come down from the brain through a channel which can be seen in the spine of the man. In the woman the right lactiferous duct is depicted as originating in the right female breast and ending in the genital area. Even a genius like Leonardo da Vinci distorted men's and women's bodies—as seen now—to fit the ideology of his time and to the notions of his colleagues, who he paid tribute to. This increase disappeared minutes after orgasm. When sexual excitement without orgasm occurred, the volume returned to normal in minutes.

Masters and Johnson presumed that the greater volume of the uterus was due to engorgement with blood. In Riley et al published an ultrasound study on copulation. We used magnetic resonance imaging to study the anatomy and physiology of human sexual intercourse. Magnetic resonance imaging had already been used as a diagnostic tool to study erectile impotence 7 ; it is particularly attractive for this kind of study because it produces images with exquisite anatomical detail that are clearer than those obtained with ultrasonography or radiography, and—as far as we know—it is safe.

The aim of the study was initially to find out whether taking images of the male and female genitals during coitus is feasible, and later whether former and current ideas about the anatomy during sexual intercourse and during female sexual arousal are based on assumptions or on facts.

The participants pairs of men and women were recruited by personal invitation and through a local scientific television programme. The experimental procedure was explained in a letter sent to respondents along with an informed consent form. Participants were assured confidentiality, privacy, anonymity, and the possibility of withdrawing from the study at any time. After written informed consent had been obtained, the participants were invited to come for a scan when the equipment was available on a Saturday. The tube in which the couple would have intercourse stood in a room next to a control room where the searchers were sitting behind the scanning console and screen.

An improvised curtain covered the window between the two rooms, so the intercom was the only means of communication. Imaging was first done in a 1. To increase the space in the tube, the table was removed: the internal diameter of the tube is then 50 cm.

The participants were asked to lie with pelvises near the marked centre of the tube and not to move during imaging. The echo time was 64 ms, with a repetition time of 4. With this fast acquisition technique, 11 slices of relatively good quality were obtained within 14 seconds. The volunteers were shown the equipment in the two rooms, and personal and gynaecological histories were taken.

The experimental procedure was explained, and all investigators left the imaging room. After a preliminary image for positioning the true pelvis of the woman was taken, the first image was taken with her lying on her back image 1.

Then the male was asked to climb into the tube and begin face to face coitus in the superior position image 2. After this shot—successful or not—the man was asked to leave the tube and the woman was asked to stimulate her clitoris manually and to inform the researchers by intercom when she had reached the preorgasmic stage. Then she stopped the autostimulation for a third image image 3. After that image was taken the woman restarted the stimulation to achieve an orgasm.

Twenty minutes after the orgasm, the fourth image was taken image 4. At the end of the experiment, the images were evaluated in the presence of the participants. Thirteen experiments were performed with eight couples three couples performed two experiments each and three single women. On two Saturdays in experiments 1 and 2 the first couple succeeded with complete penetration that lasted sufficiently long for the images to be taken.

The Philips 1. This gave low quality images with many movement artefacts. In the Siemens Vision 1. Six couples succeeded in partial, though not complete, penetration experiments 3 and In sildenafil Viagra became available in the Netherlands. The two couples in experiments 9 and 11 were invited to repeat the procedure one hour after the man had taken one 25 mg tablet of sildenafil. They succeeded with complete penetration that lasted long enough 12 seconds for sharp images to be taken experiments 12 and In all the experiments this phenomenon occurred in this coital position and was not related to the depth of penetration.

During intromission the pubic bones of the men and the women did not approach each other closely: the female pubic bone stayed about 4 cm cranial to that of the male.

The uterus was raised by 2. The changed configuration of the bladder was caused by penile stretching of the anterior vaginal wall during intromission, plus the raising of the uterus and the increase in bladder size as it filled.

The subjective level of sexual arousal of the participants, men and women, during the experiment was described afterwards as average. Midsagittal image of the anatomy of sexual intercourse experiment In the pre-orgasmic phase the anterior vaginal wall lengthened by 1 cm and the uterus rose within the pelvis. This is a typical response in all experiments except one experiment During sexual arousal without coitus, the position and size of the uterus hardly changed.

It was not possible on these magnetic resonance images to distinguish between the vaginal wall, the urethra, and the clitoris. Midsagittal images of sexual response in a multiparous woman experiment 9 : left at rest; centre pre-orgasmic phase; right 20 minutes after orgasm. It took years, a lobby, undesired publicity, and a godsend two tablets of sildenafil 25 mg to obtain our images.

They show that such pictures are feasible and add to our knowledge of anatomy. We did not foresee that the men would have more problems with sexual performance maintaining their erection than the women in the scanner. All the women had a complete sexual response, but they described their orgasm as superficial. Only the first couple was able to perform coitus adequately without sildenafil experiments 1 and 2. The reason might be that they were the only participants in the real sense: involved in the research right from the beginning because of their scientific curiosity, knowledge of the body, and artistic commitment.

And as amateur street acrobats they are trained and used to performing under stress. The hypothesised anatomy of human coitus, as drawn by Leonardo da Vinci in about and by Dickinson in , could be tested with magnetic resonance imaging.

It has the shape of a boomerang and not of an S as envisaged by Dickinson. Leonardo and Dickinson clearly underestimated the size of the root of the penis. Scanning of the position of the human genitals during coitus gives a convincing impression of the enormous size of the average penis in erection root plus pendulous part is 22 cm and of the volume of vaginal and pelvic space required by the pendulous part of the penis.

Recent research on the anatomical relation between urethra and clitoris showed that 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. Details of the vaginal wall, the urethra, and the bulbs of the vestibule were unfortunately beyond the resolution of our current equipment. However, we were able to see displacement of the uterus upwards and lengthening of the anterior vaginal wall and hardly any change in the position of the uterus during sexual arousal, unless it was caused by intromission of the penis.

In contrast to the findings of Masters and Johnson, 4 our images did not show an increase in the size of the uterus during sexual arousal. These observations are not surprising. Masters and Johnson made their observations with bimanual palpation. Their interpretation may have been caused by the raising of the uterus or filling of the bladder during their experiments.

Magnetic resonance imaging showed strikingly that during female sexual arousal changes occurred in the anterior vaginal wall. These changes took place in the vaginal wall itself the engorgement as such is not visible on the images , through the raising of the uterus, displacement of the uterus caused by penetration of the penis, and through gradual filling of the bladder.

Histological studies 11 , 12 and immunohistochemistry 13 have shown that the anterior wall of the vagina has denser innervation than the posterior wall. This is supported by clinical studies 14 , 15 and research into vaginal sensitivity to electric stimuli 16 in which the anterior vaginal wall—with the urethra behind it—was found to be relatively sensitive.

Hoch's concept of a clitoral-vaginal sensory arm of the orgasmic reflex refers specifically to the anterior vaginal wall and the deeper tissues—the urinary bladder, the periurethral tissues, and Halban's fascia 15 —and our images support this.

What started as artistic and scientific curiosity has now been realised. It has been extremely difficult to investigate anatomical changes during the act of coitus and the female sexual response. Modern magnetic resonance imaging allows exploration of aspects of living anatomy. Taking MR images of the male and female genitals during coitus is feasible. During female sexual arousal without intercourse the uterus rises and the anterior vaginal wall lengthens.

The Polish-German physician and philosopher Ludwik Fleck used images of female genital anatomy to illustrate the cultural conditioning of scientific knowledge. We thank our volunteers for their cooperation, laughter, and permission to publish intimate MR images of them; those hospital officials on duty who had the intellectual courage to allow us to continue this search despite obtrusive and sniffing press hounds; Professor J Kremer for his encouragement to use the scanner to study female sexology and for his critical reading the typescript; and Professor W Mali for offering the use of equipment at the University Hospital Utrecht.

P van Andel does not want to be acknowledged for his idea of using MRI to study coitus. Funding:No additional funding. Competing interests: None declared.

National Center for Biotechnology Information , U. Journal List BMJ v. Willibrord Weijmar Schultz , associate professor of gynaecology , a Pek van Andel , physiologist , b Ida Sabelis , anthropologist , d and Eduard Mooyaart , radiologist c. Author information Copyright and License information Disclaimer. Contributed by Contributors: WWS initiated and coordinated the formulation of the study hypothesis, designed the protocol, and participated in data collection, interpretation of the findings, and writing of the paper; he is guarantor of the study.

Correspondence to: W Weijmar Schultz ln.



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