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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 what can prevent orgasm in women.

Orgasm in Women: What Exactly Happens?When women climax, "there are changes throughout the whole body, a head-to-toe experience," says Michael Ingber, MD, a physician in urology and female pelvic medicine and reconstructive surgery at Garden State Urology in New Jersey, and a fellow of the International Society for the Study of Women’s Sexual Health.

RELATED: Healthy Sex: The Ultimate Guide

How Women Achieve OrgasmOne of the ways that women experience orgasm is through a goal-oriented four-step process first described by sex researchers William Masters and Virginia Johnson decades ago.[1]Excitement In a 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.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.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.Resolution The body relaxes, with blood flowing away from the engorged sexual organs. Heart rate, blood pressure, and respiration return to normal.

The Orgasm GapWhile 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.[2] 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.[3]“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.” 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,[4] prioritize clitoral stimulation for couples,[5] 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 OrgasmWomen’s bodies are capable of experiencing orgasm in more ways than one. The most common type is a clitoral orgasm, says Ingber.

Clitoral stimulation has 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 PleasureSome women can also experience orgasm through vaginal stimulation, though it’s not super common. A study published in 2018 in the Journal of Sex & Marital Therapy found that about 18 percent of women could achieve orgasm through penetration alone.[6] 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.

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. It is made up of tissues of the clitoris, urethra, and paraurethral, or Skene's, glands, says Dr. Whipple. Some researchers believe that when stimulated, the G-spot causes intense sexual pleasure in some women; others question whether the G-spot is even real.

A research review published in Sexual Medicine looked at 31 studies on the matter and determined that 63 percent of women reported having a G-spot. However, in anatomic studies, some researchers could identify the G-spot’s location, while others could not. This led the review authors to conclude that its existence remains unproven. What’s more, in the studies that considered it to exist, there was no agreement on the location, size, or nature of the G-spot.[7]This can all make it very confusing for those trying to find their own G-spot. The main thing to remember is that everyone is different. Find what’s pleasurable and works for your body.

Is There Such a Thing as Female Ejaculation?Female ejaculation, sometimes called “squirting,” is another hot topic when it comes to how women experience sex. There’s not a ton of research on how often or why female ejaculation occurs, but there is agreement that it can happen and that it is normal.

According to a research review published in Clinical Anatomy, female ejaculation and squirting are separate. In both instances, fluid is expelled from the vagina. According to the authors, squirting occurs when liquid similar to urine is expelled from the bladder during orgasm. With female ejaculation, fluid that’s typically thick and milky is secreted from the Skene's glands during sexual activity, but it isn’t necessarily associated with orgasm. Both squirting and female ejaculation can occur at the same time. Some women may experience either or both frequently, while others may never experience them.[8]Sensory Pathways, Stimulation, and Orgasm GenerationWomen have also 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.[9] "There are many nerve pathways that are responsible for the experience of orgasm in women," says Whipple.The Female Orgasm: Problems Getting ThereIt is estimated that as many as a quarter of American women have problems experiencing orgasm, and about 10 to 15 percent have never achieved one.[10]While physical problems 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 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 OrgasmWhether the barrier to orgasm is physical, psychological, or a bit of both, there are many ways for doctors and therapists to help you get past it.

Behavioral InterventionsDirected 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 different sexual devices, such as a vibrator to provide increased clitoral stimulation or a dildo crafted for better stimulation of the G-spot. “Additionally, vacuum devices can be used to improve libido and arousal,” says Ingber. “This applies gentle suction to the clitoris.”

Consulting a sex therapist could be very helpful, too. Sex therapists are specially trained licensed 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. They can help you see if issues in your relationship are causing you stress, he adds.

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