Women and Orgasm: Facts About the Female Climax



The female orgasm continues to be the subject of intense scientific interest. Doctors puzzle over the different means by which women can achieve orgasm and the things that can prevent orgasm in women.

Orgasm in Women: What Happens, Exactly?

When women do climax, “there are changes throughout the whole body, a head-to-toe kind of experience,” says Michael Ingber, MD, a physician in urology and female pelvic medicine and reconstructive surgery at the Atlantic Health System in Morristown, New Jersey, and a fellow of the International Society for the Study of Women’s Sexual Health.

How Women Achieve Orgasm

One of the ways women can experience orgasm is through a goal-oriented four-step process first described by the sex researchers William Masters and Virginia Johnson decades ago.

  1. Excitement In this state of desire or arousal, the woman initiates or agrees to sex, and as it commences she finds herself focusing mainly on sexual stimuli. Blood begins to engorge the clitoris, vagina, and nipples, and creates a full-body sexual blush. Heart rate and blood pressure increase. Testosterone and neurotransmitters such as dopamine and serotonin are involved in these processes, says Dr. Ingber.
  2. Plateau Sexual tension builds as a precursor to orgasm. The outer one-third of the vagina becomes particularly engorged with blood, creating what researchers refer to as the “orgasmic platform.” Focus on sexual stimuli drowns out all other sensations. Heart rate, blood pressure, and respiration continue to increase.
  3. Orgasm A series of rhythmic contractions occur in the uterus, vagina, and pelvic floor muscles. The sexual tension caused by lovemaking or self-stimulation releases, and muscles throughout the body may contract. A feeling of warmth usually emanates from the pelvis and spreads throughout the entire body.
  4. Resolution The body relaxes, with blood flowing away from the engorged sexual organs. Heart rate, blood pressure, and respiration return to normal.

The Orgasm Gap

While researchers have carefully studied what happens to women during orgasm, they have also taken note that women do not have orgasms as often as men do in heterosexual sexual encounters. This is known as the “orgasm gap” and is a well-documented phenomenon among those who study sexuality. However, a recent study by doctoral student Grace Wetzel showed that women who don’t have orgasms begin to believe that they are not going to have them and then indeed have fewer of them. This self-fulfilling sexual prophecy leads them to not prioritize their orgasms, which may make their sex lives less satisfying.

“The more orgasms that you have in your relationship, the more you expect to have and the more you want or desire them in that relationship,” Wetzel says. “The lower frequency of the orgasm gap disadvantages women, which may explain why women devalue orgasms. And that’s significant because if they place less emphasis on the orgasm, then they’ll have less pleasure. And if they continue to orgasm less and expect less, then the cycle will perpetuate.” And as orgasm is one of the biggest predictors of sexual satisfaction and consequently a satisfactory relationship, Wetzel says, “there are benefits to working on this within people’s relationships.”

How do you close the orgasm gap? You need to emphasize sexual communication between partners, prioritize clitoral stimulation for couples and de-emphasize the idea that biology stands in the way of a woman’s climax. “It’s not that women are ‘difficult’ to bring to orgasm,” Wetzel says, adding that there’s nothing about their anatomy, genetics, or hormones that keeps women from orgasms — most women are able to have orgasms when they masturbate. Women should take the technique that works best for them in masturbation and bring that to their partnered sex.

Different Types of Stimulation, Different Types of Orgasm

Women are blessed with bodies that are capable of experiencing orgasm in more ways than one.

Some researchers believe that there are as many as 12 types of female orgasms. The most common type is a “clitoral” orgasm, says Ingber.

Clitoral stimulation has been proved the surest route to orgasm. “I think that clitoral stimulation [produces] probably the closest analogue to male orgasm, where you get erectile tissue, there is release, and after release it is uncomfortable to continue,” says Steven R. Goldstein, MD, a professor of obstetrics and gynecology at the New York University Grossman School of Medicine.

Vaginal Stimulation, the G-Spot, and Intense Sexual Pleasure

But some women can also experience orgasm through vaginal stimulation. One group of researchers credit the G-spot, an area named and described by Beverly Whipple, PhD, RN, a professor emerita at Rutgers University in Newark, New Jersey, and a past president of the American Association of Sexuality Educators, Counselors and Therapists (AASECT).

The G-spot is an area felt through the wall of the vagina, an inch or two behind the back of the pubic bone near the junction of the bladder and the urethra and made up of tissues of the clitoris, urethra, and the female prostate gland, says Dr. Whipple. Some researchers believe that when stimulated, the G-spot causes intense sexual pleasure in some women; others question whether women can feel such pleasure at this location at all.

Sensory Pathways, Stimulation, and Orgasm Generation

Women also have been able to have orgasms through stimulation of the breasts or other parts of the body, or through the use of sexual imagery without any touch at all. Researchers have even found a nerve pathway outside the spinal cord, through the sensory vagus nerve, that will lead a woman to experience orgasm through sensations transmitted directly to the brain. “There are many nerve pathways that are responsible for the experience of orgasm in women,” says Whipple.

The Female Orgasm: Problems Getting There

While there are physical problems that can keep a woman from experiencing orgasm, emotions can play a role, too. Some sex researchers say that anxiety and depression can prevent a woman from progressing along the sexual response cycle, says Ingber. Feelings of fear, guilt, distraction, or a loss of control can also affect orgasm. Similarly to men with erectile dysfunction, women can sometimes have problems achieving or maintaining adequate blood flow, says Ingber.


Treatments and Therapies to Help Women Reach Orgasm

It is estimated that as many as a quarter of American women have problems experiencing orgasm.

Doctors and sex therapists use several types of therapies to help women overcome these blocks to orgasm. Directed masturbation, sex education, and behavioral therapy are some of the means a woman might want to investigate if she cannot reach climax. Women may also want to try using a vibrator to provide increased clitoral stimulation, or a dildo crafted to provide better stimulation of the G-spot.


Interventions to Consider for Problems With Orgasm

If behavioral methods are not working and a woman is interested in other intervention, there are solutions better researched for male erectile dysfunction that may help.

Ingber says that “for women having trouble with arousal, similar to men, Viagra [sildenafil] can be used,” he says. “Additionally, vacuum erection devices such as the Fiera can be used in order to improve libido and arousal. This applies gentle suction to the clitoris.”

You may also want to consider acupuncture. Sexuality is a complex intersection of biological, psychological, spiritual, and other factors. Some people believe that traditional Chinese medicine (TCM) may be better than Western medicine in addressing these complexities. In fact, acupuncture is one of the most common treatments used in TCM to help improve a man or a woman’s sexual health.

What Acupuncture Treatments Can Do for You and Your Sex Drive

“Acupuncture is a simple and relatively safe way of restoring qi to those who are deficient,” says Baljit Khamba, ND, an assistant professor of naturopathic medicine at Bastyr University California and a naturopathic doctor in San Diego, referring to the life energy Chinese medicine practitioners believe enhances health and libido.


Medical Treatments for Women With Low Sexual Desire

For postmenopausal women who have little sexual desire and who have had other psychosocial and medical causes of decreased libido ruled out, an off-label use of topical testosterone may be helpful. Ingber notes that a number of studies have shown it is safe and effective, though as this review in the Journal of Women’s Health points out, the long-term effects on cardiovascular risk and breast cancer incidence are not yet known. The International Society for the Study of Women’s Health endorses testosterone therapy for postmenopausal women and notes that limited data also supports the use in late reproductive age premenopausal women with hypoactive sexual desire disorder (HSDD).

For premenopausal women with HSDD, a therapy approved by the U.S. Food and Drug Administration (FDA) called flibanserin ( Addyi) or bremelanotide (Vyleesi ) may be effective, says Ingber. The former is a daily pill, and the latter is an injectable medicine that women can use as needed, he adds.

Consulting a sex therapist could also be very helpful. Sex therapists are licensed, specially trained counselors who may be psychologists, psychiatrists, or other mental health professionals. They aim to help you get to the bottom of your sexual issues. Your therapist will help you work through emotional issues that may be contributing to sexual issues, according to Drogo Montague, MD, a urologist at the Cleveland Clinic in Ohio. The couple may also explore issues causing relationship stress, he adds.

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