The female orgasm is a series of pleasurable physical sensations and feelings which occurs following, and represents the peak in, sexual stimulation. Orgasm in females is a complex multidimensional phenomenon involving both physical and emotional components. However, not a lot of research has been conducted about the female orgasm and the physical and emotional changes which accompany it are not properly understood.
Many authors have attempted to define the female orgasm but as yet there is no universally accepted definition, and those which do exist tend to disagree on the about the relative importance of physical and emotional components of the female orgasm. For the most part, existing definitions fail to integrate the physical and emotional dimensions of orgasm into a single definition.
Some defintions (e.g.”spastic vaginal contractions occurring at highest tension level”) primarily emphasise the physical aspects of orgasm, while others (e.g. “subjective perception of the most intense point in a series of increasingly pleasurable sensations elicited by sexual stimulation”) primarily emphasise psychological aspects. It has been argued that definitions which integrate both physical and emotional dimensions of orgasm (e.g. “sudden, intense sensation just prior to genitopelvic contractions“) better represent the true nature of the female orgasm.
A range of techniques for measuring the female orgasm have been developed. The techniques can be classified as:
- Objective: techniques which measure physiological or hormonal changes or physical symptoms and identify the timing of orgasm based on these events; or
- Subjective: techniques which ask individuals to rate the nature, timing or other aspects of their orgasm experience.
A number of researchers have noted that the results of objective and subjective enquiries about orgasm do not always agree. For example, an individual’s subjective rating of the timing of the orgasm, may not correspond to the timing of physical changes such as muscle contractions. Most likely, this is because some of the physical experiences of orgasm are not perceived to be part of the orgasmic experience (e.g. a woman may indicate her orgasm finishes when muscle contractions become less intense, rather than when they cease to occur altogether).
Objective techniques for measuring the female orgasm use physical and hormonal changes as indicators of when an orgasm begins and ends. In many cases these are measured simply, using standard techniques (e.g. heart rate measurement). However, specialist devices have also been developed. The most commonly used indicators of the female orgasm, and the techniques by which they are measured, are:
- Increased prolactin and oxytocin levels – measured by taking continuous blood samples and examining the amounts of these hormones in the blood;
- Tachycardia – an increased heart rate, measured with a heart rate monitor;
- Increased blood pressure – measured with a blood pressure monitor;
- Vasocongestion of the genital organs – swelling of the genital tissues due to increased blood flow, measured with device known as a photoplethysmograph, which is inserted into the vagina or anus during sexual stimulation. It is a tampon-shaped device which measures vaginal pulse amplitude (VPA) or how much blood is circulating each time the heart beats. The device also shines a tiny light and measures the amount of light reflected in the vagina as an indicator of vasocongestion (because vasocongestion alters the vaginal walls and the amount of light they reflect).
Subjective techniques for measuring the female orgasm involve asking individuals to rate various physical and emotional aspects of their orgasmic experiences, typically using a questionnaire with a series of questions about each aspect of the orgasm.
The physical aspects of orgasm which may be measured include:
- Building sensations;
- Flushing sensations;
- Flooding sensations;
- Shooting sensations;
- Throbbing sensations; and
- General spasms.
The emotional aspects include:
- Pleasurable satisfaction;
- Emotional intimacy; and
Various types of female orgasm are often distinguished in medical and other texts and women’s orgasms are often classified according to these types. Evidence suggests that the physiological and hormonal changes as well as the physical sensations experienced during orgasm are similar amongst the different “types” of orgasm. However, there is evidence that the emotional aspects of orgasm differ between some types of orgasm, most prominently between self or masturbation induced or partner induced orgasms.
Female orgasms can be classified according to the locations around the body at which the orgasmic sensations are felt. According to this classification system, female orgasms are usually grouped as those involving the whole body (typically orgasms induced by vaginal penetration) and those involving only localised sensations in the genitopelvic region (typically induced through clitoral stimulation).
The clitoral/vaginal classification system and the general belief that there is a difference between clitoral and vaginal orgasms, stems from the psycho-analytical work of a philosopher named Sigmund Freud. He believed that vaginal orgasm was qualitatively different from clitoral orgasm and that a woman could only achieve vaginal orgasms once she had sexually matured. No evidence has been produced to support this theory. On the contrary, objective evidence suggests that the physical changes which occur during orgasm are similar whether it is induced through clitoral or vaginal stimulation. However, women typically find it easier to achieve orgasm with clitoral stimulation than without.
Subjective differences in orgasmic sensations experienced from clitoral or vaginally induced orgasm have been reported. Women report clitoral orgasms are more physically intense and satisfying but sensations are localised to the pelvic region. Vaginal orgasms on the other hand are said to be more psychologically intense and satisfying, and to produce widespread, whole body sensations.
Orgasms induced through penetrative vaginal sex (also referred to as coital orgasms) are often compared to those which involve other means of sexual stimulation (also known as non-coital orgasms). The basis of this separation is similar to that which separates vaginal and clitoral orgasms, except it also involves aspects of a partner’s involvement. A partner is always involved in an orgasm which occurs as a result of penetrative vaginal sex and may also be involved in a non-coital orgasm. Research has shown that sex with a partner involves emotional intimacy which is absent in self induced orgasm.
This classification system is most concerned with the presence or absence of a partner during orgasm, rather than the stimulation techniques used to induce orgasm.
Orgasm occurs in response to sexual stimulation, and thus women who are sexually stimulated, either through partnered intercourse or masturbation, can experience orgasm.
Evidence suggests that virtually all women can experience an orgasm although some never do, either due to physical or psychosocial factors. The degree of sexual stimulation required to cause an orgasm varies from woman to woman. Female orgasm in response to visual, without physical sexual stimulation has been recorded, but typically fairly intense sexual stimulation, and particularly clitoral stimulation is necessary to induce orgasm.
In Australia, a national survey of sexual practices and experiences found that 28.6% of women reported that they had had difficulty achieving orgasm at least once in the month prior to the survey. The survey did not ask women if they had ever experienced an orgasm. Women who were 50-59 years of age were more likely to report difficulty achieving orgasm than women in younger age groups (41.9% of 50-59 year olds reported this difficulty, compared to 25-29% for 19-49 year olds).
How often does a female experience orgasm?
The frequency with which a woman experiences orgasm is directly related to the frequency with which she engages in sexual activity, either with a partner or through self or visual stimulation.
Some women experience an orgasm every time they have sex, while others never experience an orgasm. The majority of women experience orgasm sometimes but not others.
The capacity for women to have multiple orgasms has also been noted, however this phenomenon is poorly understood. Numerous factors have been identified as influencing a woman’s ability to orgasm.
Female sexuality and sexual function, including a woman’s ability to orgasm, is influenced by both physical and psychosocial factors.
Some researchers studying the nature of female orgasms have suggested that psychosocial factors may be more influential than physical factors in determining when and if women orgasm. There is some evidence from research studies to support these opinions. For example, there is evidence that women who feel highly relaxed and emotionally intimate at the time of orgasm give their orgasms higher satisfaction and pleasure ratings than women who find their orgasms highly sensory in the physical sense (e.g. women who report strong physical sensations such as throbbing, flushing and spasms). There is also evidence that aspects of a woman’s society (e.g. social perceptions regarding whether or not females should enjoy sex) influence a woman’s capacity to orgasm.
Research has shown that a woman’s ability to orgasm is associated with satisfaction with her sexual relationship and partner. For example, one large study found that the frequency with which a woman achieves orgasm and her satisfaction with the orgasms she experiences, are both associated with the perceived quality of her relationship and her satisfaction with her partner. Another study reported that the more satisfied a woman was with her relationship, the higher they rated the pleasure and satisfaction of their orgasms.
A woman’s emotional responses influence her sexual arousal, and are therefore also likely to influence her ability to orgasm. Psychological disorders such as depression, but also issues like self esteem and body image, decrease sexual response in women and in doing so make it less likely that women with these conditions will experience an orgasm.
Studies of the ability of women living in different cultural settings around the world have noted that women living in cultures which expect women to enjoy sex are more likely to orgasm than those living in cultures which do not expect women to enjoy sex (e.g. cultures which view sex as primarily for male sexual pleasure). Studies have also noted that women living in societies which support their sexual expression, achieve orgasm more easily than women living in societies which do not support their sexual expression, for example societies which expect women to be sexually passive and not express their feelings of sexual desire.
Women who report feeling guilty about having sex also report more difficulty achieving orgasm, and this guilt is probably largely a result of social perceptions. For example, women who are told by society that sex before marriage is sinful are more likely to feel guilty about engaging in premarital sex than women in societies where premarital sex is considered normal.
Several studies have reported higher rates of anorgasmia (inability to orgasm) amongst older women. The reasons for this are poorly understood. There are a number of hormonal changes which occur with age, particularly decreases in oestrogen and progesterone levels associated with menopause, which may affect a woman’s ability to orgasm as she ages.
There are also many psychosocial factors, including social taboos regarding sexual activity amongst the aged, reduced self esteem and loss of partner, which may affect a woman’s ability to achieve orgasm as she ages.
Declining levels of oestrogen which occur with menopause have been identified as the main cause of changes in genital sensations and genital blood flow which lead more women to complain of sexual dysfunction (including anorgasmia) following menopause. Decreased oestrogen levels are also associated with reduced vaginal lubrication and mood changes, both of which may affect sexual pleasure and a woman’s ability to achieve orgasm.
Some studies have also found that low levels of testosterone are associated with decreased sexual arousal and orgasm. However as testosterone levels in a woman’s body change naturally throughout the menstrual cycle and other hormonal changes also occur naturally at this time, it is unclear whether testosterone changes themselves, or the other hormonal changes which accompany them, are responsible for this effect.
Many medical conditions can lead to changes in a woman’s orgasmic experience, including reduced frequency of orgasm, increased difficulty achieving orgasm and changed sensations during orgasm. Diseases which have been identified as negatively affecting orgasmic capacity in women include spinal cord injury, cancer, rectal disease, anxiety, depression and other psychological disorders. However, it is not clear to what extent the diseases themselves or the medications used to treat them, influence women’s orgasmic function. Surgery involving the genital system (e.g. hysterectomy) may also negatively affect a woman’s ability to orgasm.
Some medications inhibit female sexual arousal, including mood altering medicines used in the treatment of depression and other mood disorders. Women taking these medications often complain that they have difficulty achieving orgasm. Some scientists have suggested that oral contraceptives use may adversely affect a woman’s sexual function (which would in turn reduce her likelihood of experiencing orgasm), by affecting her mood, her body image or her sexual desire. However, other scientists have suggested that oral contraceptives might improve a woman’s sexual function, by reducing anxiety about pregnancy and reducing the pain of some gynaecological problems (e.g. endometriosis). There is currently insufficient evidence to determine which one of these opinions is correct.
A number of sexual behaviours have been reported to facilitate orgasm. One study reported that women achieved orgasm more easily during sexual encounters which involved a lot of foreplay, compared to those which involved minimal foreplay. Playing an active role in the sexual encounter, initiating sex and masturbating were also associated with women having more frequent orgasms during intercourse. Studies have also found that women who orgasm more frequently are more likely to initiate and be active during sex, so it is not clear whether playing an active role in sex facilitates orgasm, or vice versa.
Clitoral stimulation is also an important factor in determining orgasmic ability in women. In one study, the majority of women had reported that clitoral stimulation was more important than vaginal stimulation for achieving orgasm. In another 95% of women reported achieving orgasm during masturbation (usually involving clitoral stimulation) but only 26% reported orgasm during intercourse without clitoral stimulation. Available evidence also suggests that uninterrupted, rhythmic pressure is more conducive to orgasm than varied sexual activity and most effective when it involves stimulation of the external genitalia and particularly the clitoris.
It has also been demonstrated that performance anxiety is associated with high levels of anorgasmia. This would suggest that the more a woman focuses on and becomes anxious about her arousal levels and whether she is likely to experience an orgasm, the less likely she is to experience an orgasm.
A study of female twins and their orgasmic ability reported that genetic differences are responsible for a considerable degree of variability in sexual function between women. However, this is the only study which has examined the role of genetic differences in determining orgasmic ability, and as such further studies are needed to ascertain whether or not genetic factors actually influence orgasmic ability.
Unlike the male orgasm which typically coincides with ejaculation into the vagina of sperm-containing semen, the female orgasm has no obvious reproductive function. However, some theorists have suggested that the female orgasm must play a role in assisting reproduction, because evolutionary selection processes change bodies slowly over time, so that bodies eventually include only those parts and functions essential to reproduction of the species (e.g. the penis serves a direct reproduction function, the fingers allow people to fulfil numerous tasks, without which they would be unable to fulfil their daily requirements such as eating and drinking). These beliefs have lead to much debate about the purpose of the female orgasm and whether or not it serves a reproductive purpose.
A number of theories about the mechanisms by which the female orgasm might enhance reproductive success have been put forward. The most prominent, and one of the few evolutionary theories which there is biological evidence to support, is the somewhat crudely named “up-suck” theory. According to this theory, contractions of the uterus and other genito-pelvic organs involved during the female orgasm create gradient pressure or sucking which assists in transporting sperm into the uterus and retaining it there. As conception (the fertilisation of an egg by a sperm) occurs in the uterus, the chances of conception might realistically be increased if more sperm was sucked into the uterus. However this theory is not widely accepted.
Other theories which argue that the female orgasm serves a reproductive function argue that it plays a more indirect role. For example, some have suggested that the pleasure women experience when they orgasm leads them to have sex more frequently, and therefore increase their chances of conception.
However, there is no scientific evidence to support claims evolutionary selection processes necessitate the female orgasm fulfilling a reproductive role. On the contrary, these arguments have been neatly refuted. Those who argue against the evolutionary selection theories argue that the organs of orgasm (the clitoris in women and the penis in men) originate from the same embryological tissues (tissues in the growing foetus) is male and female foetuses. There is no difference in the appearance of embryological tissues which go on to form the clitoris or the penis, in the initial stages of pregnancy. Changes in the appearance of these tissues only occur after about eight weeks of pregnancy, when male foetuses begin producing their own hormones.
As the capacity to ejaculate is essential for reproductive success in males, the embryological tissues which go on to form the penis are necessary for reproductive success in males. However the embryological tissue necessary to enable the foetus to grow a penis must be present in all foetuses, as in the first eight weeks of foetal development, the foetus has not yet sexually differentiated, that is, it has not yet become either a boy or a girl foetus. When a foetus begins to produce male hormones, it will begin to display male features, including the growth of a penis. However, the embryological tissue which forms the penis in a male foetus does not simply disappear in the absence of male hormones. Instead another organ, the clitoris, develops. Just as males have nipples which do not serve a reproductive function as the female nipples do by allowing a woman to feed her offspring breast milk, neither the clitoris nor the orgasm which it produces serve reproductive functions.
Further evidence to refute claims that the clitoris must have a reproductive function comes from women’s varying responses to sexual stimulation. If the female orgasm was an evolutionary trait which assisted reproduction, one would expect orgasmic response to be highest during sexual acts which enabled reproduction (i.e. penetrative, vaginal sexual intercourse). On the contrary, most women emphasise the importance of clitoral stimulation for achieving orgasm, and the vast majority (>98%) employ at least some form of clitoral stimulation during masturbation. This evidence, combined with evidence from studies of female orgasm in primates, suggests that orgasm does not in fact occur in “normal” reproductive sex in which male orgasm and ejaculation are often considered the end point and of primary importance. Rather they can only occur when the sexual act is focused on providing the female partner sexual pleasure.
It is important to note that orgasmic release is extremely variable and is not essential for sexual satisfaction for women. The traditional model for the human sex response cycle can be represented as Desire®Arousal®Orgasm®Resolution. Women often relate to this model at the beginning of a new relationship. However, in the setting of a long-term relationship, the situation is often rather different.
Sexual desire can occur either as a spontaneous event prior to arousal or can be responsive and occur after arousal or physical stimulation. For many women, sexual arousal and a responsive-type of desire occur simultaneously at some point after the women have chosen to experience sexual stimulation. Further arousal follows, generating a focus upon which to build to potential orgasm.
However, physical wellbeing may follow without orgasmic release. The rewards of emotional closeness, such as the increased commitment, bonding and tolerance of imperfections in the relationship, together with an appreciation of the subsequent wellbeing of the partner all serve as the motivational factors that will activate the cycle next time.
The female orgasm induces a range of physiological changes, in the genital and other body systems. Women also experience changing emotions during and following orgasm, and the hormones secreted by their bodies change considerably in response to sexual arousal and orgasm.
There is considerable evidence that genital organs, including the clitoris, vagina and uterus become vasocongested during sexual arousal and remain that way during and following orgasm. This reduces blood flow in some veins and prevents blood flowing out of the genital organs. Pressure and swelling in the tissues surrounding the genitals as well as contractions of genital muscles also reduce blood flow in the genital region, increasing vasocongestion.
The uterus and a number of pelvic muscle groups become active during sexual arousal and orgasm. These muscle groups include:
- The muscles which surround the opening of the vagina and exert pressure on the clitoris,
- The muscles which support the perineum (the tissues between the anus and the genitals) during orgasm;
- The muscles which support what is known as the pelvic diaphragm, or the area of vaginal muscle inside the vagina which typically undergoes spontaneous contractions during orgasm.
The primary physical indicator of orgasm is contractions of the genito-pelvic and/or anal muscles. When these contractions were first observed in women experiencing orgasm, it was found they occurred at 0.8 second intervals and lasted on average for 16.7 seconds (compared to 25 seconds for men). It is however unclear whether or not all women experience vaginal muscle contractions during orgasm. It is also unclear if the commencement and cessation of such contractions signal the beginning and end points of a female’s orgasm, or if such contractions simply occur close to the time of orgasm.
There is now considerable evidence that orgasm induces whole body, and not just genito-pelvic, changes. There is particularly good evidence regarding cardiovascular changes which occur during orgasm, including tachycardia (increased heart rate) and increased blood pressure. For example one study, in which the heart rate and blood pressure of ten women who watched pornography and masturbated to induce orgasm were compared to those of women who watched a documentary film, reported that heart rate and blood pressure of the masturbating women were higher than the documentary film watchers by the time they reached orgasm. Other studies have also noted bodily reactions to orgasm including shuddering, muscle spasms, rigidity, sweating, rocking pelvic motions, facial grimacing and abdominal muscle contractions.
Organs also cause changes in the central nervous system responses.
A woman’s hormone profile (the relative concentrations of different types of hormones in her body) changes distinctly during orgasm. Similar to the hormonal changes which accompany male orgasm, the key hormone change associated with the female orgasm is a substantial increase in levels of a hormone called prolactin. There are however many other subtle hormone changes which women experience during orgasm including changes to the hormones testosterone, cortisol, oestrogen, progesterone and plasma adrenalin.
The brain is also an important source of sexual arousal and orgasm in women. There is evidence that individuals can experience orgasm with no direct stimulation to the genitals. This evidence comes from the orgasms experienced by paraplegics, from orgasms induced hypnotically, from orgasms stimulated by fantasy alone, and from orgasms experienced as a result of stimulation in certain areas of the brain. In addition, there have been reports of orgasm from women who have had a clitoral and labial excision and vaginal reconstruction. This research suggests that the brain be considered as part of the anatomical requirements for orgasmic experience.
It has also been proposed that several different nerve pathways are involved in sexual response:
- the pudendal nerve for clitoral stimulation;
- the hypogastric plexis and pelvic nerve for vaginal stimulation; and
- possibly the vagus nerve directly from the cervix to the brain.
The psychological changes associated with orgasm are measured subjectively, using rating scales. Women typically report feelings of ecstasy during orgasm and feelings of relaxation following orgasm.
Kindly reviewed by Desiree Spierings BA (Psych) MHSc (Sexual Health); Sex Therapist; Director of Sexual Health Australia and Editorial Advisory Board Member of Virtual Men’s Health and Virtual Women’s Health.
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