What’s Going On in There?

The Diverting World of Coital Imaging

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hough two will lie down, the bed is a single. It is a hos­pital bed, but more enticing than most. The bottom sheet is crisp and smoothed, and the bedclothes have been turned down invitingly, at an angle. Two sets of towels and hospital johnnies are stacked neatly at the foot. The effect is not unlike that of the convict’s last meal: a weak bid for normalcy and decency in what will shortly be a highly abnormal and, to some people’s minds, indecent scenario.

For the first time ever—after hours and behind locked doors in an exam room in the Diagnostic Testing Unit of London’s Ffeart Ffospital—a scientist is attempting to cap­ture three-dimensional moving-picture (or “4-D,” time being the fourth dimension) ultrasound footage of human genitalia in the act of sexual congress. Jing Deng, a senior lecturer in medical physics at University College, Lon­don, Medical School, has made his name developing a new technique for viewing anatomical structures in motion. His Web site includes fairly astonishing 4-D ultrasound foot­age of, for instance, beating hearts. This kind of imaging gives surgeons a preview of the structure they’ll be operat­ing on, in motion and from any perspective. It allows them to see precisely what the problem is and how they might best approach it, long before picking up the scalpel. Deng’s paper on the imaging of the musculature of a pair of puck­ering lips—undertaken to help a plastic surgeon hone his strategy in a cleft palate follow-up operation—made it into the Lancet, more or less the New Yorker of medical journals.

In his most recent paper, Deng filmed a 4-D “erect­ing penis.” With genital imaging, the hope is that the tech­nology might afford better diagnostics and more detailed insights into surgical options for patients with vascular or structural abnormalities, such as Peyronie’s disease, in which scar tissue in the erectile chamber on one side of the penis causes painful, crooked erections.

Deng is the first to gather moving images of inter­nal sexual anatomy, but not the first to use ultrasound to study sex. In 2007, a team of French researchers scrutinized images of a woman’s clitoris as she contracted a certain pel­vic floor muscle (the levator ani). They noticed that this contraction—which other researchers have shown to be triggered reflexively during penetration—pulls the clitoris closer to the front wall of the vagina. “This could explain the particular sensitivity of the G spot and its role in orgasm,” the team wrote. And without ultrasound, no one would ever have known.

In the penis paper, Deng mentioned the possibil­ity of one day soon capturing an ultrasound sequence of real-time two-party human coitus. Though the first few scans would be dry runs to see if the technique works and whether it reveals anything new about coital biomechanics, Deng envisions the scan as a potentially useful diagnostic
tool—for instance, in teasing apart the possible causes of dyspareunia (painful intercourse).

I sent Dr. Deng an email asking permission to come to London to observe the first scan. He wrote back immediately.

Dear Ms. Roach, Many thanks for your interest in our research. You are welcome to interview me in London. . . . However, to arrange a new in-action would be very difficult, mainly due to the difficulty in recruiting volunteers. If your organization is able to recruit brave couple(s) for an intimate (but non­invasive) study, I would be happy to arrange and perform one.

My organization gave some thought to this. What couple would do this? More direly, who wanted to pay the three or four thousand dollars it would cost to fly them both to London and put them up in a nice hotel? My organization balked. It called its husband.

‘You know how you were saying you haven’t been to Europe in twenty-five years?”

Ed was wary. It was not all that long ago that his agree­able nature, combined with a touching and foolhardy incli­nation to help his wife with her reporting, landed him in a Mars and Venus relationship seminar that involved talking to strangers about his “love needs.”

I pushed onward. “What if I offered you an all-expense — paid trip to London?”

Ed sensibly replied that he would want to know what the catch was.

I read aloud to him from an information sheet that Dr. Deng had emailed. “Dynamic 3D ultrasound imaging is a non­invasive and harmless technique which has been used for clinical imaging of activities of unborn babies. We are investigating whether
this technique can be used to reveal more information on how vari­ous body parts work during various activities. . .

Ed wanted to know which various body parts. I skipped ahead on the information sheet. For instance, I skipped the paragraph that says, “For a dry penile scan, a volunteer is asked to lie on the bed facing down, and place his penis through a hole in the bed into an artificial vagina. The ‘vagina’ is made of (harmless) starch jelly.”

“Urn, let’s see,” I said. Volunteers will be asked to place their body parts of interest. . .’ So it’s basically just the body parts of interest. We could take a day trip to Stonehenge, see a couple plays. Jeremy Irons is in something, he has a big beard now.”

Ed doesn’t care about Stonehenge or Jeremy Irons. But he agreed anyway.

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t is a simple and noble goal: To reveal more information on how various body parts work during various activities. In the case of the activity known as sexual intercourse, it is an undertaking that began five centuries ago. In 1493, the art­ist, inventor, and anatomist Leonardo da Vinci drew a series of sketches of the commingled nether regions of a man and a woman. Known as “the coition figures,” these cross­sectional cutaways were meant to reveal the arrangement of the reproductive organs during sex.[36]

Leonardo* learned about anatomy by studying cadav­ers. When I came across the coition figures, I assumed— erroneously, ludicrously, you might even say—that Leonardo had managed to wrestle two cadavers into the missionary position, and then cleave the joined couple lengthwise. The assumption wasn’t entirely far-fetched; the anatomist spoke of dissecting hanged murderers (the only bodies made available for dissection), whose corpses, owing to the hanging, often, as Leonardo wrote it, “have this member rigid.”

But the coition figures were not drawn from cadavers. In the frankly titled journal paper “On the Sexual Inter­course Drawings of Leonardo da Vinci,” South African anatomist A. G. Morris points out that Leonardo’s dis­secting years commenced some twenty years after the sex figures were drawn. Leonardo was working from a series of ancient, and anatomically fanciful, Greek and Arabic medical texts. If he’d been working from a careful dissec­tion of cadaver loins, presumably Leonardo would not have left out the ovaries and the prostate. Nor would he have drawn a tube connecting the woman’s womb and breast, reflecting the medieval belief that breast milk was formed from (gack!) diverted menstrual blood. Not surprisingly, the mechanics of the act are also misportrayed. The penises in some of Leonardo’s sketches have pushed clear through the cervix, which has opened up, Pac-Man-like, to accom­modate them.

The next artist-cum-scientist to apply his motley tal­ents to sex was the gynecologist Robert Latou Dickinson.

From the 1890s to the 1930s, Dickinson gathered data for his eclectic and groundbreaking Atlas of Human Sex Anat­omy. He did make use of cadavers—preserved parts, not whole bodies—but he regarded them askance, for, as he put it, “there is marked contrast. . . between the quick and the dead… . The post-mortem uterus droops, the scrotum sags, the anus gapes widely.” Whenever he could, Dick­inson took his data from the living. He made tracings of wombs from X-rays and crafted, over the years, 102 plaster casts of patients’ hymens, vulvas, and vaginas in all their various forms and states.[37]

It would seem, from looking through Dickinson’s books, that there was no line of inquiry or request that the man shied away from. Including, “Would it be okay if I slid this test tube up your vagina?” The test tube was sunk repeatedly at differing angles, yielding the surprisingly var­ied profiles of women’s vaginal cavities. Figure 57 in his Atlas shows us three life-size outlines, one inside the other, in the manner of those humane society logos with the bird silhouette inside the cat silhouette inside the dog. In place of pets, we have “long post-menopause” inside “virgin” inside “vigorous and varied coitus.” The last one is as big as a grown-up’s mitten.

The test tube also served as Dickinson’s solution to the challenge of drawing the genitals during the actual act of
sex. He assumed that the glass tube would follow the tra­jectory of the penises that had come before it. Thus, he could tell the angle of the penis relative to the woman’s various reproductive organs and, by shining a light into the test tube and peering down the length of it, he could see where the tip made contact during sex. Figure 91 shows a cutaway of a vagina with the tube inside and the words “Test-Tube of 13Л Inch Demonstrates Penis Action” written along its side like a slogan on a hardware store yardstick.

Dickinson was eager to rebut claims being made that a man’s penis, during sex, drives straight on into the cer­vix and that the two interlock, as Leonardo had drawn. Among Dickinson’s papers is a manuscript of a 1931 article by Marie Carmichael Stopes, entitled “Coital Interlock­ing.” Stopes, best known for founding Britain’s first family planning clinic, was a bit out of her element here.* She had no M. D. She had trained as a paleobotanist, not as an anatomist. Nonetheless, Stopes claimed to have observed forty-eight examples of the cervix opening wide and then “closing round the glans penis as a result of the stress of sexual excitation.” The first case, she writes, was a “direct observation in myself.” Stopes’s claims were, to use her terminology, “poo-poohed” by gynecologists—including Dickinson, who penciled exclamation marks up and down the margins of his copy of her paper. Still, you have to mar­vel at a woman who, in the 1920s, in the name of science, was masturbating with a speculum in place and a mirror between her legs.

Dickinson, wielding his test-tube spyglass, found that interlocking—or at least its precursor, head-on penis-cer­vix contact—was a far rarer occurrence than Stopes had suggested. It seemed to be limited to women whose cervix and uterus were abnormally positioned and to those in the “knee-chest” posture.[38]

Dickinson’s discovery landed loudly in the fledgling field of fertility. Many physicians at that time were preach­ing that the failure of a couple to achieve a good interlock resulted in infertility. Now they’d need to look elsewhere for the culprit. Developers of early birth control tech­niques paid heed as well. Stopes had claimed that because the penis docked inside the cervix and thus delivered its payload directly into the uterus, a dose of spermicide in the vaginal cavity was of no use. This was wrong. (It was of limited use, but useful nonetheless.)

If the cervix truly did open wide and then clamp down on the tip of the penis, this could spell trouble for condom users. Indeed, Stopes cites a letter to the editors of the Brit­ish Medical Journal, in which a Dr. Maurice B. Jay was called upon to see a woman with a unique and troubling situation down under. She explained that during sex earlier that day, something inside her had grabbed and torn away a piece of her husband’s condom and then gripped it so firmly that she couldn’t pull it free. Upon examining the woman, Dr. Jay determined that the rottweiler inside was her own cervix. Jay writes in his letter that he found two inches of the sheath “firmly fixed in the cervical canal,” adding that “some force was required to pull it out.”

A letter published the following week questioned Dr. Jay’s conclusions and nominated muscle spasms in the vagina as the mystery condom ripper. Either Dr. Jay was in need of a gynecological refresher course, or the woman did indeed have a grasping cervix. My conclusion, a con­clusion you will encounter many times in the course of these pages, is that the sexual anatomy and responses of the human female are as uniform and predictable as the weather.

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t would be eighty years before someone took the coital — imaging baton from Dickinson and ran with it. In 1991, Dutch physiologist Рек van Andel was looking at a cross­sectional MRI of a professional singer’s mouth and throat as she put up with what must surely have been the worst acoustics of her career and sang “aaaah” inside an MRI tube. The image, van Andel said, brought Leonardo’s sex figures to mind, and he found himself wondering whether it would be possible to “take such an image of human coitus.”

Van Andel teamed up with gynecologist Willibrord Wei — jmar Schultz, radiologist Eduard Mooyaart, and business anthropologist[39] Ida Sabelis. Dr. Sabelis’s anthropological role in the project is not explained in the paper; however, as you will see from her account of the project, no one can accuse her of being a lame duck in the proceedings:

In the autumn of 1991, Рек phoned my partner Jupp. Whenever he does that, he mostly has some­thing special on his mind. The point was to visual­ize with a modern scan how it really shows when a man and a woman are making love. . . . Рек sug­gested it should be just something for us, [because] we are slim, and because of our background as acrobats. . . .

After some shifting of dates, 24 of October was fixed as the day. I was worried, now it was really going to happen. . . . What should colleagues say? And neighbors, friends, family? . . . How shall it be in such a sterile white tube? . . . What shall we do when one of us shall get not any sexual arousal in that thing? . . .

Willibrord was waiting for us in the hall. . . . Eduard has tuned the machinery. The window between [the MRI tube] and control-panel is cov­ered with large blue pieces. But how can someone starts such a thing? Again, as in the first conversa­tion with Willibrord, with a talk about the weather. Рек … is telling us about an article he’s going to write. . . . Another cup of coffee and then I say, “Jupp, shall we do something…”

We undress ourselves, lying down on the sledge-bed and are slided in by Eduard. We are lying on our side and facing each other. . . . Con­fined by the space we make the best of it. . . . The first shots are taken: “Now lay down very still and holding your breath during the shot!” . . . We are giggling a lot, because… an erection. . . simply sinks down like an arrow when you have to hold your breathe during many seconds. . . .

It’s becoming pleasantly warm in the tube and

we truly succeed in enjoying each other from time to time in a familiar way When the microphone is telling us that we may come—insofar possible—we burst out into a roar of laughter and some moments later we do what is the purpose. . . . Sniggering we lay down a while before we announce that we just now like to go out. Like buns which are pushed from the oven we are coming outside.

Enthusiasm everywhere, it works and, we get dressed quickly to look at the shots in the con­trol room. Of course some are blurred because of movement. But some other are of an amazing beauty: that we are! Not so much a passport photo for daily use, but surely a shot that shows so much that it makes me speechless. There, it’s my womb and surely, on that place is Jupp, naturally in a way as I know from my own sensation: below the cer­vix. Two days later I’m feeling a kind of pride: we tried and succeeded!

It almost didn’t happen. Lacking funds, the team was initially forced to use the MRI at their local hospital, part of Groningen University. This was an older model that required the couple to hold perfectly still for almost a min­ute, which is how snails but not people have sex. All but one man lost his erection. Only Ida and Jupp were able to “perform coitus adequately” in the MRI tube, which was a mere twenty inches high. Schultz speculates that their suc­cess had to do with their experience as amateur street acro­bats: They were accustomed to performance anxiety and odd physical feats.

Eventually, the team secured permission from a better — equipped hospital whose MRI required scanees to hold still for only twelve seconds. Alas, it was around that time that
a Dutch tabloid got wind of the project. The paper ran a trumped-up story quoting patients with life-threatening conditions who claimed they were having to wait for their MRIs because creepy sex researchers were tying up the machines. Shortly thereafter came the letter from the hos­pital director, rescinding his welcome.

Fortuitously, Schultz’s local hospital had by now upgraded to an MRI with the speedier exposure time, and the team moved their base of operations back to Groningen. But even with the truncated hold time, the men’s erections wilted. The project was shelved for another six years, until a “godsend,” as Schultz put it, arrived on the scene: Viagra. At last, in 1998, two more couples joined Ida and Jupp in the 20-Inch High Club, and the prestigious British Medical Journal published the team’s paper.*

Aside from the intriguing link between street acrobat­ics and erectile function, what has mankind gained from Jupp and Ida? Mankind has gained a tremendous fudge fac­tor should mankind wish to boast about the length of its penis. Before Schultz’s MRIs, few had realized how much of the penis lies hidden below the surface of the skin. The “root” is nearly two thirds again the length of the “pendu­lous part.” So if your erection is, say, six inches long, go ahead and say it’s ten. I’ll back you up.

At the very least, the paper laid to rest the hokum about penises routinely interlocking with cervixes. Also, we ^“Magnetic Resonance Imaging of Male and Female Genitals Dur­ing Coitus and Female Sexual Arousal” won the 2000 Ig Nobel Prize in medicine. (The annual Ig Nobel Prize is a parody of the Nobel Prize.) The award afforded Schultz’s team, if nothing else, the oppor­tunity to hobnob with the Scottish emergency room doctors whose paper on toilet-inflicted buttock injuries—“The Collapse of Toilets in Glasgow”—took that year’s Ig Nobel in public health.

learned that the penis—root and stalk together—“has the shape of a boomerang” during intercourse. (Leonardo had drawn it stick-straight.) But not its precise dynamics. If you hurl an uprooted penis into the air, it will not come back to you. It will most likely, and who can blame it, want nothing to do with you.

By far the most jaw-dropping sexual discovery to come to us courtesy of real-time genital scanning is set forth in Israel Meizner’s “Sonographic Observation of In Utero Fetal ‘Masturbation,’ ” a letter to the editor published in theJournal of Ultrasound in Medicine. Still images, two of which accom­pany Meizner’s letter, detail a fetus, seven months old. The first shows the teensy hand poised for action. The second shows the fetus a moment later, “grasping his penis in a fash­ion resembling masturbation movements.” This went on for some fifteen minutes, during which time Meizner stayed tuned but did not document an in utero fetal orgasm[40]

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lessedly, the ultrasound department is running behind.

Ed and I have a half-hour reprieve while the day’s last patients are scanned. We wander up and down the corri­dor. At one end is a door with a sign that reads discharge lounge. “Ew,” says Ed. We find a cafe and order tea. Ed stares at his shoes. He is concerned about his ability to, as Schultz put it, perform adequately. He has taken a “god­send,” however, so he’ll likely manage fine.

“Here we go,” Ed says grimly Dr. Deng walks toward us. He wears khaki trousers and a white lab coat. His age is hard to guess. His hair, though graying, spikes youthfully in all the right places. Though he moved to London ten years ago, he speaks English cautiously and with few deco­rative touches. An occasional “Brilliant” or “Cheers” is the only trace of England in his words. Nuances of humor, like sarcasm, seem to elude him, or maybe he is just preoccu­pied with his tasks. Dr. Deng shows us where the changing room is.

“Regarding the position,” he says when we return in our johnny tops. He wants us on our sides, spoons-style. (This was explained, sort of, in the instruction sheet: We will ask the penis to be inserted into the vagina from his partner’s back.) “I think facing the wall is better,” says Dr. Deng. As opposed to facing him. “That will be more romantic,” he adds. On the wall, someone has hung a painting of a hillside harbor town. As though by looking at it we could convince ourselves that we were off on the Amalfi Coast—or, just as good, that Dr. Deng was. “And I will switch off the lights.”

“Where are the candles and soft music?” says Ed.

“Oh, I am sorry,” says Dr. Deng, straight-faced, cha­grined. Then he brightens. “I can turn on my laptop. I have the soundtrack to Les Miz.” His efforts are sweet though pointless. There is no way to make this situation romantic, normal, sexual. It feels like a medical procedure, something to be got through.

Dr. Deng goes next door and returns with a 9-by-ll envelope and hands it to Ed. Inside is a copy of a U. K. ver­sion of Maxim. “This is very erotic,” he assures Ed. The implication being, I suppose, that the sight of one’s wife in a baggy knee-length hospital johnny and threadbare socks is not.

There comes a moment in cheesy horror films when a man with evil intent reaches up and bolts a door. This is the audience’s cue to fear for the heroes. Fear for us. Dr. Deng has pressed the doorknob lock. I’m running my sentences together. “That’s some fancy machine you’ve got, how did you get interested in radiology, is there a good pub nearby, we’re going to need it.”

Dr. Deng never tells us to lie down, but it seems that that is what must happen.

Ed is pretending to be absorbed by his magazine. I nudge him. “Jupp, shall we do something?”

We get into position while Dr. Deng applies ultrasound gel to the end of the ultrasound wand. The gel conducts ultrasound waves better than air does. Ultrasound gel looks and feels (and works) like the product euphemistically known as personal lubricant.

Dr. Deng starts by taking some still images. He reaches across Ed to hold the ultrasound wand to my belly. His arm rests on Ed’s hip, a curiously intimate touch in an encoun­ter otherwise strangely devoid of intimacy. For the still images, we must hold still for several seconds, like Victori­ans posing for a tintype, only not like Victorians posing for a tintype.

“Now please make some sort of movement,” says Dr. Deng. And then, in case it’s not clear, in case Ed might be contemplating flapping an elbow or saluting the flag, he adds, “in and out.”

Dr. Deng says he’s pleased with the result. “It’s actually much clearer than I thought it would be. It’s very— Hm. Can you just hold there, for a while? We saved too many data.” Dr. Deng needs to reboot. Fortunately, it takes only a few seconds, sparing Ed the necessity of also rebooting.

Ed keeps up an idle, disaffected rhythm. He and Dr.

Deng chat about their children. I’m taking notes. Or half of me is. I feel like a secretary in a ribald French comedy, sitting calmly at her desk, taking a letter, while the mail- room guy hides in the footwell with his face between her legs.

“You look so young to have a fifteen-year-old,” Ed is saying. “How old are you?”

“I’m forty-five in August.”

“And the little one? How old?”

“Just two and a half. You can ejaculate now.”

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s far as I’m concerned, the only downside to direct imaging of real people having sex is that there will no longer be call for researchers to go out and buy dildos and pliable plastic vaginas from California Exotic Novelties and then bring them back to the lab and make them have sex together. In 2003, a team of evolutionary behaviorists at the State University of New York at Albany published a paper called “The Human Penis as a Semen Displacement Device.” They theorized that man evolved a penis with a ridged glans in order to scoop out the competitors’ semen before depositing his own. (The single gal of prehistory must have been fantastically promiscuous.) This would fit in with the little-known fact that the last portion of a man’s ejaculate contains a natural spermicide—not intended to kill his own soldiers, obviously, but to annihilate the seed of any who come after him.

You can’t buy simulated human semen from California Exotic Novelties, and so the Albany team concocted their own. Several recipes were tried and “judged by three sexu­ally experienced males.” Here is the winning recipe chosen by the judges:

Human Semen

7 milliliters room-temperature water 7.16 grams cornstarch

Mix ingredients together. Stir for five minutes. Yield: one ejaculate

The simulated semen was ejaculated, via syringe, into the vagina, which had been anointed with lubricant (also from California Exotic Novelties). With a video camera roll­ing, three different phalluses—including a Control Phal­lus with no ridge—were inserted and withdrawn. To see how much competitor semen each phallus had managed to scoop out, the vagina[41] was weighed before and after. The results backed the team’s theory: Both of the lifelike phal­luses (or “dongs,” to CEN shoppers) displaced 91 percent of the semen, while the unridged control dong left 65 per­cent of it behind.

The experiment went on for six more pages, but to be honest, they lost me at:

(weight of vagina with semen — weight of vagina
following insertion and removal of phallus)

—:——— ;—- ;————— :—————- :— x 100

(weight of vagina with semen — weight of empty vagina)

To my mind, what happened in Dr. Deng’s exam room bore no more relation to sex than a smile held for a camera does to the real thing. It was perfunctory, self-conscious,

distracted sex. Other than the parts involved, it bore very little resemblance to what goes on between my husband and myself when there’s not a strange man on one side of us and an ultrasound wand on the other. Though they no doubt have their uses, ultrasound movies are a superficial rendering of the complex and varied body-mind meld that we call sex. Sex is far more than the sum of its moving parts.

But you can’t altogether dismiss the parts. If the parts don’t work properly, the sum is moot. For some 18 million American men, they don’t work as they ought to or, at least, as they once did. Next up: the occasionally noble, sporadi­cally ghastly, ever-surreal world of erectile science.