How do urologists and gynecologists test and analyze fluids expelled during female ejaculation?
Executive summary
Urologists and gynecologists use biochemical assays, urine markers, and imaging to distinguish two main phenomena—small-volume “female ejaculation” from paraurethral (Skene’s) glands and large-volume “squirting” that often originates in the bladder—and key laboratory markers include prostate-specific antigen (PSA), creatinine/urea, fructose and pH [1] [2] [3]. Studies report mixed results: some samples show PSA or prostatic acid phosphatase consistent with glandular origin, while others match urine chemistry, so clinicians rely on combined biochemical testing plus clinical history and sometimes ultrasound to interpret findings [2] [4] [5].
1. How clinicians frame the problem: two fluids, two hypotheses
Current clinical literature divides expelled fluids into a scant, milky “female ejaculate” produced by paraurethral/Skene’s glands and a larger clear “squirting” or transurethral expulsion that often reflects bladder contents; researchers and clinicians test with that taxonomy in mind [6] [5]. This framing drives which tests are ordered: if the event sounds like “true” ejaculate, labs look for prostatic markers; if it resembles squirting, tests look for urine chemistry [1] [2].
2. Typical laboratory tests: PSA, prostatic enzymes, creatinine and urea
Biochemical analysis focuses on prostate-specific markers such as PSA and prostatic acid phosphatase (PAP) to signal a Skene’s/“female prostate” contribution, and on creatinine/urea concentrations to indicate urinary origin; differences in these analytes have been reported between ejaculate-like fluid and urine [1] [3] [4]. Published case series show some women’s expelled fluid contains measurable PSA while others’ fluids are chemically indistinguishable from urine, so labs compare multiple markers rather than relying on a single result [2] [5].
3. Additional chemical and physical measurements clinicians use
Beyond PSA and urea/creatinine, researchers measure fructose (seen in some reports), osmolarity, pH, density and even viscosity to characterize samples; one cross-sectional study reported pH 5.4, osmolarity ~269 mOsm/kg, density ~1,032 g/L, and detectable fructose and low PSA in sampled fluids [7]. These parameters help differentiate glandular secretions from dilute urine and to consider possible reproductive functions hypothesized by some researchers [7] [8].
4. Imaging and procedural context: when labs alone aren’t enough
Clinicians sometimes add ultrasound during stimulation or before/after to see if the bladder empties into the urethra; a study using dye and ultrasound showed bladder filling during arousal and emptying after squirting, supporting a urinary origin for some events [4] [5]. Combining imaging with timed sample collection reduces misclassification and helps interpret whether a positive PSA comes from Skene’s secretions that mixed with urine or from bladder-retained material [2] [5].
5. Why results vary: biological diversity and methodological limits
Published work shows variation: some women’s samples contain PSA or PAP, others’ do not; some fluids chemically match urine, others don’t [2] [3]. Researchers note anatomical variation in Skene’s glands, possible backflow from glands into the bladder, and small sample sizes and different collection methods as reasons for conflicting findings [2] [5]. Available sources do not mention a single, universally accepted laboratory protocol that settles these discrepancies.
6. Clinical implications and competing interpretations
One line of research treats female ejaculate as a bona fide prostatic secretion potentially with roles such as antibacterial protection or sperm-supportive chemistry; another emphasizes that much “squirting” is urinary in origin and should be classified as coital incontinence or bladder expulsion [3] [6]. Both interpretations appear in peer-reviewed reviews and case studies, and clinicians must present both possibilities when counseling patients [1] [6].
7. Practical takeaways for patients and clinicians
When analyzing expelled fluid, expect clinicians to collect a properly labelled specimen, test for PSA/PAP and creatinine/urea, possibly measure fructose and pH, and—if needed—use imaging to observe the bladder; interpretation combines lab results with clinical history and observed events [7] [4] [5]. Given persistent research gaps and mixed findings, definitive statements about function or universal origin are not supported in the available literature [2] [5].
Limitations: this summary relies on the cited studies and reviews; available sources do not mention a standardized, universally followed diagnostic protocol endorsed by an international society for testing female ejaculatory fluids [2] [1].