Orgasm (from Greek οργασμός orgasmos, from organ to mature, swell, also sexual climax) is the sudden discharge of accumulated sexual tension during the sexual response cycle, resulting in rhythmic muscular contractions in the pelvic region characterized by an intense sensation of pleasure.[1][2] Experienced by males and females, orgasms are controlled by the involuntary or autonomic nervous system. They are often associated with other involuntary actions, including muscular spasms in multiple areas of the body, a general euphoric sensation and, frequently, body movements and vocalizations are expressed. The period after orgasm (known as a refractory period) is often a relaxing experience, attributed to the release of the neurohormones oxytocin and prolactin.[3]
Human orgasms usually result from the stimulation of the penis in males, typically accompanying ejaculation, and the clitoris in females.[2][4][5] Stimulation can be by self-practice (masturbation) or by a partner (penetrative sexual intercourse, non-penetrative sex, and other erotic sexual activities). In addition, partners simultaneously stimulating each other's sex organs by mutual masturbation, penetrative intercourse, or other rhythmic inter-genital contact may experience simultaneous orgasms.
In a clinical context, orgasm is usually defined strictly by the muscular contractions involved during sexual activity, along with the characteristic patterns of change in heart rate, blood pressure, and often respiration rate and depth.[1] This is categorized as the sudden discharge of accumulated sexual tension during the sexual response cycle, resulting in rhythmic muscular contractions in the pelvic region.[1][2] However, definitions of 'orgasm' vary and there is sentiment that consensus on how to consistently classify it is absent.[6] At least twenty-six definitions of orgasm were listed in the journal Clinical Psychology Review.[7]
There is some debate whether certain types of sexual sensations should be accurately classified as orgasms, including female orgasms caused by G-Spot stimulation alone, and the demonstration of extended or continuous orgasms lasting several minutes or even an hour.[8] The question centers around the clinical definition of orgasm, but this way of viewing orgasm is merely physiological, while there are also psychological, endocrinological, and neurological definitions of 'orgasm'.[6][7][9] In these and similar cases, the sensations experienced are subjective and do not necessarily involve the involuntary contractions characteristic of orgasm. However, the sensations in both sexes are extremely pleasurable and are often felt throughout the body, causing a mental state that is often described as transcendental, and with vasocongestion and associated pleasure comparable to that of a full-contractionary orgasm. For example, modern findings support distinction between ejaculation and male orgasm.[7] For this reason, there are views on both sides as to whether these can be accurately defined as orgasms.[9]
Orgasms may be achieved by a variety of activities. In men, sufficient stimulation can be achieved during vaginal or anal sexual intercourse, oral sex (fellatio) or masturbation/non-penetrative sex. In women, orgasm can be achieved during vaginal sexual intercourse, oral sex (cunnilingus) or masturbation/non-penetrative sex. It may also be by the use of a sensual vibrator or an erotic electrostimulation, and can additionally be achieved by stimulation of the nipples, uterus, or other erogenous zones, though this is rarer.[10][11] In addition to physical stimulation, orgasm can be achieved from psychological arousal alone, such as during dreaming (nocturnal emission for males or females)[7][9][12][13] or by orgasm control. Orgasm by psychological stimulation alone was first reported among people who had spinal cord injury (SCI).[12] Although SCI very often leads to loss of certain sensations and altered self-perception, a person with this disturbance is not deprived of sexual feelings such as sexual arousal and erotic desires.[12]
Orgasms can be multiple or spontaneous,[14][15] and some non-sexual activity may result in a spontaneous orgasm. Orgasms can also be involuntary, as the result of forced sexual contact as during rape or sexual assault, and are often associated with feelings of shame caused by internalization of victim-blaming attitudes.[16][17] The incidence of those who experience unsolicited sexual contact and experience orgasm is very low, though possibly under-reported due to shame or embarrassment. Involuntary orgasms additionally happen regardless of gender.[17]
Scientific literature focuses on the female orgasm significantly more than it does on the male orgasm, which "appears to reflect the assumption that female orgasm is psychologically more complex than male orgasm," but "the limited empirical evidence available suggests that male and female orgasm may bear more similarities than differences. In one controlled study by Vance and Wagner (1976), independent raters could not differentiate written descriptions of male versus female orgasm experiences".[9]
In men, the most common way of achieving orgasm is by the stimulation of the penis.[2] This is usually accompanied by ejaculation. It is possible for a man to have an orgasm without ejaculation (known as a "dry orgasm") or to ejaculate without reaching orgasm (which may be a case of delayed ejaculation, a nocturnal emission or a case of anorgasmic ejaculation).[7][15] Men may also achieve orgasm by stimulation of the prostate (see below).[18]
"The traditional view assumes there are two stages of orgasm in males: emission following orgasm, almost instantly followed by a refractory period."[15] In 1966, Masters and Johnson published pivotal research about the phases of sexual stimulation.[1][19] Their work included women and men, and, unlike Alfred Kinsey in 1948 and 1953,[20] tried to determine the physiological stages before and after orgasm. Masters and Johnson argued that, in the first stage, "accessory organs contract and the male can feel the ejaculation coming; two to three seconds later the ejaculation occurs, which the man cannot constrain, delay, or in any way control" and that, in the second stage, "the male feels pleasurable contractions during ejaculation, reporting greater pleasure tied to a greater volume of ejaculate".[15] They reported that, unlike females, "for the man the resolution phase includes a superimposed refractory period" and added that "many males below the age of 30, but relatively few thereafter, have the ability to ejaculate frequently and are subject to only very short refractory periods during the resolution phase". Masters and Johnson equated male orgasm and ejaculation and maintained the necessity for a refractory period between orgasms.[15]
In contrast to the two-stage model, Kahn (1939) equalized orgasm and ejaculation and stated that several orgasms can occur and that "indeed, some men are capable of following it up with a third and a fourth".[15] Though rare, Kahn's assertion that "some men are capable of following [an orgasm] up with a third and a fourth" is supported by men who have reported having multiple, consecutive orgasms, particularly without ejaculation.[15] Males who experience dry orgasms can often produce multiple orgasms, as the refractory period is reduced.[15][21] Some men are able to masturbate for hours at a time, achieving orgasm many times.[21] Many men who began masturbation or other sexual activity prior to puberty report having been able to achieve multiple non-ejaculatory orgasms. Some evidence indicates that orgasms of men before puberty are qualitatively similar to the "normal" female experience of orgasm, suggesting that hormonal changes during puberty have a strong influence on the character of male orgasm.[22] Some men have been multiorgasmic since they can recall, while others have learned to achieve multiple orgasms.[15]
A number of studies have pointed to the hormone prolactin as the likely cause of the male refractory period. Because of this, there is currently an experimental interest in drugs which inhibit prolactin, such as cabergoline (also known as Cabeser, or Dostinex). Anecdotal reports on cabergoline suggest it may be able to eliminate the refractory period altogether, allowing men to experience multiple ejaculatory orgasms in rapid succession. At least one scientific study supports these claims,[23] although cabergoline is a hormone-altering drug and has many potential side effects. It has not been approved for treating sexual dysfunction.[23] Another possible reason for the lack or absence of a refractory period in men may be an increased infusion of the hormone oxytocin. It is believed that the amount by which oxytocin is increased may affect the length of each refractory period. A scientific study to successfully document natural, fully ejaculatory, multiple orgasms in an adult man was conducted at Rutgers University in 1995. During the study, six fully ejaculatory orgasms were experienced in 36 minutes, with no apparent refractory period.[24] It can also be said that in some cases, the refractory period can be reduced or even eliminated through the course of puberty and on into adulthood. Later, P. Haake et al. observed a single male individual producing multiple orgasms without elevated prolactin response.[25]
In recent years, a number of books have described various techniques to achieve multiple orgasms. Most multi-orgasmic men (and their partners) report that refraining from ejaculation results in a far more energetic post-orgasm state.[26] One technique for refraining from ejaculation is to put pressure on the perineum, about halfway between the scrotum and the anus, just before ejaculating to prevent ejaculation. This can, however, lead to retrograde ejaculation, i.e., redirecting semen into the urinary bladder rather than through the urethra to the outside. It may also cause long term damage due to the pressure put on the nerves and blood vessels in the perineum, akin to that reported by some males who ride bicycles with narrow seats for extended periods.[27] Men who have had prostate or bladder surgery, for whatever reason, may also experience dry orgasms because of retrograde ejaculation.
Other techniques are analogous to reports by multi-orgasmic women indicating that they must relax and "let go" to experience multiple orgasms. These techniques involve mental and physical controls over pre-ejaculatory vasocongestion and emissions, rather than ejaculatory contractions or forced retention as above. Anecdotally, successful implementation of these techniques can result in continuous or multiple "full-body" orgasms.[28]
Discussions of the female orgasm are complicated by orgasms in women typically being divided into two categories: clitoral orgasm and vaginal (or G-Spot) orgasm.[9] Ladas, Whipple and Perry proposed three categories: the tenting type (derived from clitoral stimulation), the A-frame type (derived G-Spot stimulation), and the blended type (derived from clitoral and G-Spot stimulation); Whipple and Komisaruk later proposed cervix stimulation as inducing a fourth type,[29] though orgasms by means other than clitoral or vaginal/G-Spot stimulation are less prevalent in scientific literature.[9] The concept of "vaginal orgasm" as separate from clitoral orgasm was first postulated by Sigmund Freud. In 1905, Freud stated that clitoral orgasms are purely an adolescent phenomenon and that upon reaching puberty, the proper response of mature women is a change-over to vaginal orgasms, meaning orgasms without any clitoral stimulation. While Freud provided no evidence for this basic assumption, the consequences of this theory were considerable. Many women felt inadequate when they could not achieve orgasm via vaginal intercourse alone, involving little or no clitoral stimulation, as Freud's theory made penile-vaginal intercourse the central component to women's sexual satisfaction.[30][31][32]
The first major national surveys of sexual behavior were the Kinsey Reports.[20] Alfred Kinsey was the first to harshly criticize Freud's ideas about female sexuality and orgasm when, through his interviews with thousands of women,[20] Kinsey found that most women could not have vaginal orgasms.[32] He criticized Freud and other theorists for projecting male constructs of sexuality onto women and viewed the clitoris as the main center of sexual response and the vagina as relatively unimportant for sexual satisfaction, noting that few women inserted fingers or objects into their vaginas when they masturbated. He concluded that satisfaction from penile penetration is mainly psychological or perhaps the result of referred sensation.[32] Masters and Johnson's research into the female sexual response cycle generally supported Kinsey's findings about the female orgasm,[32][33][34] which inspired feminists such as Anne Koedt to speak about the "false distinction" made between clitoral and vaginal orgasms and women's biology not being properly analyzed.[31]
Research, including research by Shere Hite, has found that 70–80% of women achieve orgasm only through direct clitoral stimulation,[35][36][37][38][39] though indirect clitoral stimulation may also be sufficient.[5][33][39] The Mayo Clinic stated, "Orgasms vary in intensity, and women vary in the frequency of their orgasms and the amount of stimulation necessary to trigger an orgasm."[40] Clitoral orgasms are easier to achieve because the tip or glans of the clitoris alone has more than 8,000 sensory nerve endings,[13] as much as or more than the human penis, as well as more than any other part of the human body.[13][41] As the clitoris is homologous to the penis, it is the equivalent in its capacity to receive sexual stimulation.[35][42] It surrounds the vagina somewhat like a horseshoe,[13] with "legs" that extend along the vaginal lips back to the anus.[43] While the G-Spot can produce an orgasm,[13][44][45][46] and the urethral sponge, an area in which the G-Spot may be found, runs along the "roof" of the vagina and can create pleasurable sensations when stimulated, the vagina has insufficient capability of producing pleasure and orgasm in women.[4][13][32][41][47] Go Ask Alice! reports that although vaginal intercourse may promote a satisfying feeling of fullness or closeness with a sexual partner,[48] the vaginal walls "contain relatively few nerve endings, making intense sexual stimulation, pleasure, and orgasm from vaginal-only penetration unlikely" and that "it's generally only the lower third of the vagina that has enough nerve endings to feel any stimulation at all from a penis, finger, toy, or other penetrative object".[41] Negating clitoral legs, only one part of the clitoris, the urethral sponge, is in contact with the penis, fingers, or a dildo in the vagina. The tip of the clitoris and the inner lips, which are also very sensitive, are not receiving direct stimulation during intercourse,[13][36] and so some couples may engage in the coital alignment technique to combat this.[49][50]
Accounts that the vagina is capable of producing orgasms continue to be subject to debate because in addition to the vagina's low concentration of nerve endings, the G-Spot's location is inconsistent and appears to be nonexistent in some women, and may be an extension of another structure (such as the Skene's gland or the clitoris, which is a part of the Skene's gland).[5][44][45][47][51] "Reports in the public media would lead one to believe the G-Spot is a well-characterized entity capable of providing extreme sexual stimulation, yet this is far from the truth," stated scholars Kilchevsky, Vardi, Lowenstein and Gruenwald in a 2012 Journal of Sexual Medicine article.[47] Masters and Johnson were the first to determine that the clitoral structures surround and extend along and within the labia. In addition to observing that the majority of their female subjects could only have clitoral orgasms, they found that both clitoral and vaginal orgasms had the same stages of physical response. On this basis, they argued that clitoral stimulation is the source of both kinds of orgasms.[33][34] Likewise, Australian urologist Dr. Helen O'Connell's 2005 discoveries about the size of the clitoris show that clitoral tissue extends considerably inside the vagina, which may invalidate the hypothesis that clitoral and vaginal orgasms are of two different origins.[5] While some studies, using ultrasound, have found physiological evidence of the G-Spot in women who report having orgasms during intercourse,[45][46] O'Connell asserts that the clitoris's interconnected relationship with the vagina is the physiological explanation for the conjectured G-Spot and experience of vaginal orgasms, taking into account the stimulation of the internal parts of the clitoris during vaginal penetration.[5] Having used MRI technology which enabled her to note a direct relationship between the legs or roots of the clitoris and the erectile tissue of the "clitoral bulbs" and corpora, and the distal urethra and vagina, O'Connell stated, "The vaginal wall is, in fact, the clitoris. If you lift the skin off the vagina on the side walls, you get the bulbs of the clitoris—triangular, crescental masses of erectile tissue." O'Connell, who had made the claims in 1998, and her team were already aware that the clitoris is more than just its glans – the "little hill". They reasoned that it is possible that some women have more extensive clitoral tissues and nerves than others, and therefore whereas many women can only achieve orgasm by direct stimulation of the external parts of the clitoris, for others the stimulation of the more generalized tissues of the clitoris via intercourse may be sufficient.[5]
O'Connell's findings were criticized by Vincenzo Puppo, who states that O'Connell and other researchers use imprecise terminological and anatomical descriptions of the clitoris. "Clitoral bulbs is an incorrect term from an embryological and anatomical viewpoint, in fact the bulbs do not develop from the phallus, and they do not belong to the clitoris: 'clitoral bulbs' is not a term used in human anatomy, the correct term is the vestibular bulbs," stated Puppo, arguing that the "anterior vaginal wall is separated from the posterior urethral wall by the urethrovaginal septum (its thickness is 10–12 mm)" and that the "inner clitoris" does not exist. "The female perineal urethra, which is located in front of the anterior vaginal wall, is about one centimeter in length and the G-Spot is located in the pelvic wall of the urethra, 2–3 cm into the vagina," Puppo stated. "The male penis cannot come in contact with the venous plexus of Kobelt (situated until the angle of the clitoris) or with the roots of the clitoris (which do not have sensory receptors or erogenous sensitivity) during vaginal intercourse." Puppo did, however, dismiss the orgasmic definition of the G-Spot that emerged after Ernst Gräfenberg, stating that "there is no anatomical evidence of the vaginal orgasm which was invented by Freud in 1905, without any scientific basis".[52]
In contrast to Puppo's belief that there is no anatomical relationship between the vagina and clitoris, other researchers continue to support the hypothesis that G-Spot orgasms are the result of clitoral stimulation, reaffirming that clitoral tissue extends into the vagina even where the related G-Spot would be located.[47][53] "My view is that the G-Spot is really just the extension of the clitoris on the inside of the vagina, analogous to the base of the male penis," said Kilchevsky. Because humans all start out as female in the womb and therefore the penis is essentially an enlarged clitoris, changed by male hormones, Kilchevsky believes that there is no evolutionary reason why females would have two separate structures capable of producing orgasms and blames the porn industry and "G-Spot promoters" for "encouraging the myth" of a distinct G-Spot.[53] If the argument is that vaginal orgasms help encourage sexual intercourse in order to facilitate reproduction, then vaginal orgasms would not be significantly difficult to achieve,[39][47] a predicament that is believed to be the result of nature easing the process of child bearing by drastically reducing the number of vaginal nerve endings.[4] However, one study, published 2011, which was the first to map the female genitals onto the sensory portion of the brain,[54] keeps "the possibility of a discrete G-Spot viable". When a Rutgers University research team asked several women to stimulate themselves in a functional magnetic resonance (fMRI) machine, brain scans showed stimulating the clitoris, vagina and cervix lit up distinct areas of the women's sensory cortex,[54] which means the brain registered distinct feelings between stimulating the clitoris, the cervix and the vaginal wall – where the G-Spot is reported to be. "I think that the bulk of the evidence shows that the G-Spot is not a particular thing," stated Komisaruk, head of the research findings. "It's not like saying, 'What is the thyroid gland?' The G-Spot is more of a thing like New York City is a thing. It's a region, it's a convergence of many different structures."[47]
In some cases, women, or less often men,[15] either do not have a refractory period or have a significantly short one and thus can experience a second orgasm, or others, soon after the first. Additionally, most women do not experience a refractory period immediately after orgasm, and, in many cases, are capable of attaining additional, multiple orgasms through further stimulation.[14] After the first orgasm, subsequent climaxes may be stronger or more pleasurable as the stimulation accumulates. For some women, the clitoris is very sensitive after climax, making additional stimulation initially painful.[55]
Regular difficulty reaching orgasm after ample sexual stimulation, known as anorgasmia, is significantly more common in women than in men (see below).[40] In addition to sexual dysfunction being a cause for women's inability to reach orgasm, or the amount of time for sexual arousal needed to reach orgasm being variable and longer in women than in men, other factors include a lack of communication between sexual partners about what is needed for the woman to reach orgasm, feelings of sexual inadequacy in either partners, a focus on only penetration (vaginal or otherwise), and men generalizing women's trigger for orgasm based on their own sexual experiences with other women.[4][38][56][57] Masters and Johnson found that men took about 4 minutes to reach orgasm with their partners. Women took about 10–20 minutes to reach orgasm with their partners, but 4 minutes to reach orgasm when they masturbated.[4] Scholars Weiten, Dunn and Hammer reasoned, "Unfortunately, many couples are locked into the idea that orgasms should be achieved only through intercourse [penetrative vaginal sex]. Even the word foreplay suggests that any other form of sexual stimulation is merely preparation for the 'main event.'... ...Because women reach orgasm through intercourse less consistently than men, they are more likely than men to have faked an orgasm."[4] In the first large-scale empirical study worldwide to link specific practices with orgasm, reported in The Journal of Sex Research in 2006, demographic and sexual history variables were comparatively weakly associated with orgasm. Data was analyzed from the Australian Study of Health and Relationships, a national telephone survey of sexual behavior and attitudes and sexual health knowledge carried out in 2001–2002, with a representative sample of 19,307 Australians aged 16 to 59. Practices included "vaginal intercourse alone (12%), vaginal + manual stimulation of the man's and/or woman's genitals (49%), and vaginal intercourse + manual + oral (32%). Encounters may also have included other practices. Men had an orgasm in 95% of encounters and women in 69%. Generally, the more practices engaged in, the higher a woman's chance of having an orgasm. Women were more likely to reach orgasm in encounters including cunnilingus".[58]
There is some research suggesting that women's vaginal orgasm consistency is associated with being told in childhood or adolescence that the vagina is the important zone for inducing female orgasm. Other factors include how well women focus mentally on vaginal sensations during penile-vaginal intercourse, the greater duration of intercourse, and preference for above-average penis length.[59] Other studies suggest that women exposed to lower levels of prenatal androgens are more likely to experience orgasm during sexual intercourse,[56] and that vaginal orgasm is more prevalent among women with a prominent tubercle of the upper lip.[60] "A prominent and sharply raised lip tubercle has been associated with greater odds (odds ratio = 12.3) of ever having a vaginal orgasm, and also with greater past month vaginal orgasm consistency (an effect driven by the women who never had a vaginal orgasm), than less prominent lip tubercle categories." However, lip tubercle was not associated with social desirability responding, or with orgasm triggered by masturbation during penile-vaginal sex, solitary or partner clitoral or vaginal masturbation, vibrator, or cunnilingus.[60] An empirical study carried out in 2008 provides evidence for Freud's implied link between inability to have a vaginal orgasm and psychosexual immaturity. In the study, women reported their past month frequency of different sexual behaviors and corresponding orgasm rates and completed the Defense Style Questionnaire (DSQ-40), which is associated with various psychopathologies. The study concluded that a "vaginal orgasm was associated with less somatization, dissociation, displacement, autistic fantasy, devaluation, and isolation of affect." Moreover, "vaginally anorgasmic women had immature defenses scores comparable to those of established (depression, social anxiety disorder, panic disorder, and obsessive–compulsive disorder) outpatient psychiatric groups." In the study, a vaginal orgasm (as opposed to a clitoral orgasm) was defined as being triggered solely by penile–vaginal intercourse.[61] According to Wilhelm Reich, the lack of women' capacity to have a vaginal orgasm is an artifact of our culture. Our culture suppresses genitality and, hence, instills castration anxiety not only in boys but also in girls. This creates a secondary drive in the predominance of penis envy and clitoral orgasms. According to Reich, Freud and traditional psychoanalysis mistook these secondary drives as primary, natural functions. If a society would allow children to develop their sexuality in a natural way, such secondary drives would rarely occur.[62]
In both sexes, pleasure can be derived from the nerve endings around the anus and the anus itself, such as during anal sex. It is possible for men to achieve an orgasm through prostate stimulation alone.[18] The prostate is located next to the rectum and is the larger, more developed[63] male homologue to the Skene's glands (which are believed to be connected to the female G-Spot).[64]
"For some men, prostate stimulation produces an orgasm that they describe as 'deeper,' more global and intense, longer-lasting, and associated with greater feelings of ecstasy than orgasm elicited by penile stimulation only."[11] For women, other than nerve endings found within the anus and rectum, anal pleasure may be achieved through clitoral "legs" — extensions of the clitoris stretching along the vaginal lips back to the anus.[43] The G-Spot, considered to be interconnected with the clitoris,[5][11] may also be accessible through anal penetration; orgasms other than those derived by clitoral legs are made possible because only a thin membrane separates the vaginal cavity from the rectal cavity, allowing for indirect stimulation of the clitoris or G-Spot.[11][65][66][67] Only a small percentage of women are able to orgasm from this type of stimulation alone.[67] Direct stimulation of the clitoris, G-Spot, or both, during anal sex can help some women to enjoy the experience and reach orgasm.[66]
The aforementioned orgasms are sometimes referred to as "anal orgasms,"[67][68] but experts generally believe that orgasms derived from anal penetration are the result of the anus's proximity to the clitoris or G-Spot in women, and the prostate in men, rather than orgasms originating from the anus itself.[11][66][67] Jack Morin, however, has postulated that "anal orgasm" has nothing to do with the prostate orgasm, although the two are often confused.[69]
In some women, stimulation of the breast area during sexual intercourse and foreplay, or just the simple act of having their breasts fondled, creates mild to intense orgasms. Research has suggested that the sensations are genital orgasms caused by nipple stimulation, and may also be directly linked to "the genital area of the brain,"[54][70] though at least one account has suggested that the orgasms radiate from the breasts.[71] An orgasm is believed to occur in part because of the hormone oxytocin, which is produced in the body during sexual excitement and arousal. It has also been shown that oxytocin is produced when a man or woman's nipples are stimulated and become erect.[72]
A study published in the July 2011 Journal of Sexual Medicine was the first to map the female genitals onto the sensory portion of the brain, and concluded that sensation from the nipples travels to the same part of the brain as sensations from the vagina, clitoris and cervix. "Four major nerves bring signals from women's genitals to their brains," said researcher Barry Komisaruk of Rutgers University. "The pudendal nerve connects the clitoris, the pelvic nerve carries signals from the vagina, the hypogastric nerve connects with the cervix and uterus, and the vagus nerve travels from the cervix and uterus without passing through the spinal cord (making it possible for some women to achieve orgasm even though they have had complete spinal cord injuries)." Komisaruk cited one reason for this possibility to be oxytocin, which is also released during labor and triggers uterus contractions. Nipple stimulation triggers uterine contractions, which then produce a sensation in the genital area of the brain. Komisaruk also relayed, however, that preliminary data suggests that nipple nerves may directly link up with the brain, skipping the uterine middleman, acknowledging the men in his study who showed the same pattern of nipple stimulation activating genital brain regions.[54]
Most women do not experience this effect when the breasts are stimulated. According to one study that questioned 213 women, 29% of them had experienced an orgasm of this kind at one time or another.[10]
Masters and Johnson were some of the first to study the sexual response cycle in the early 1960s, based on the observation of 382 women and 312 men. They described a cycle that begins with excitement as blood rushes into the genitals, then reaches a plateau during which they are fully aroused, which leads to orgasm, and finally resolution, in which the blood leaves the genitals.[1]
In the 1970s, Helen Singer Kaplan added desire to the cycle, which she claimed preceded sexual excitation. She noted that the emotions of anxiety, defensiveness and the failure of communication could interfere with desire and hence orgasm.[73]
In the late 1980s and after, Rosemary Basson proposed a more cyclical alternative to what had largely been viewed as linear progression.[74] In her model desire feeds arousal and orgasm, and is in turn fueled by the rest of the orgasmic cycle. Rather than orgasm being the peak of the sexual experience, she noted that is just one point in the circle and that people could feel sexually satisfied at any stage, reducing the focus on climax as an end-goal of all sexual activity.[75]
As a man nears orgasm during stimulation of the penis, he feels an intense and highly pleasurable pulsating sensation of neuromuscular euphoria. These pulses begin with a throb of the anal sphincter and travel to the tip of the penis. They eventually increase in speed and intensity as the orgasm approaches, until a final "plateau" (the orgasmic) pleasure sustained for several seconds.[15]
During orgasm, a human male experiences rapid, rhythmic contractions of the anal sphincter, the prostate, and the muscles of the penis. The sperm are transmitted up the vas deferens from the testicles, into the prostate gland as well as through the seminal vesicles to produce what is known as semen.[15] The prostate produces a secretion that forms one of the components of ejaculate. Except for in cases of a dry orgasm, contraction of the sphincter and prostate force stored semen to be expelled through the penis's urethral opening. The process takes from three to ten seconds, and produces a pleasurable feeling.[9][15] Ejaculation may continue for a few seconds after the euphoric sensation gradually tapers off. It is believed that the exact feeling of "orgasm" varies from one man to another.[9] Normally, as a man ages, the amount of semen he ejaculates diminishes, and so does the duration of orgasms. This does not normally affect the intensity of pleasure, but merely shortens the duration.
After ejaculation, a refractory period usually occurs, during which a man cannot achieve another orgasm. This can last anywhere from less than a minute to several hours, depending on age and other individual factors.[15]
A typical woman's orgasm lasts much longer than that of a man.[14][55][76][77] Women's orgasms have been estimated to last, on average, approximately 20 seconds, and to consist of a series of muscular contractions in the pelvic area that includes the vagina, the uterus and the anus.[76] For some women, on some occasions, these contractions begin soon after the woman reports that the orgasm has started and continue at intervals of about one second with initially increasing, and then reducing, intensity. In some instances, the series of regular contractions is followed by a few additional contractions or shudders at irregular intervals.[76] In other cases, the woman reports having an orgasm, but no pelvic contractions are measured at all.[78]
Women's orgasms are preceded by erection of the clitoris and moistening of the opening of the vagina. Some women exhibit a sex flush, a reddening of the skin over much of the body due to increased blood flow to the skin. As a woman nears orgasm, the clitoral glans moves inward under the clitoral hood, and the labia minora (inner lips) become darker. As orgasm becomes imminent, the outer third of the vagina tightens and narrows, while overall the vagina lengthens and dilates and also becomes congested from engorged soft tissue.[79] Elsewhere in the body, myofibroblasts of the nipple-areolar complex contract, causing erection of the nipples and contraction of the areolar diameter, reaching their maximum at the start of orgasm.[80] The uterus then experiences a series of between 3 and 15 muscular contractions[citation needed]. A woman experiences full orgasm when her uterus, vagina, anus, and pelvic muscles undergo a series of rhythmic contractions. Most women find these contractions very pleasurable.
Researchers from the University Medical Center of Groningen, the Netherlands, correlated the sensation of orgasm with muscular contractions occurring at a frequency of 8–13 Hz centered in the pelvis and measured in the anus. They argue that the presence of this particular frequency of contractions can distinguish between voluntary contraction of these muscles and spontaneous involuntary contractions, and appears to more accurately correlate with orgasm as opposed to other metrics like heart rate that only measure excitation. They assert that they have identified "[t]he first objective and quantitative measure that has a strong correspondence with the subjective experience that orgasm ultimately is" and state that the measure of contractions that occur at a frequency of 8–13 Hz is specific to orgasm. They found that using this metric they could distinguish from rest, voluntary muscular contractions, and even unsuccessful orgasm attempts.[81]
Since ancient times in Western Europe, women could be medically diagnosed with a disorder called female hysteria, the symptoms of which included faintness, nervousness, insomnia, fluid retention, heaviness in abdomen, muscle spasm, shortness of breath, irritability, loss of appetite for food or sex, and "a tendency to cause trouble".[82] Women considered suffering from the condition would sometimes undergo "pelvic massage" — manual stimulation of the genitals by the doctor until the woman experienced "hysterical paroxysm" (i.e., orgasm). Paroxysm was regarded as a medical treatment, and not a sexual release.[82] The disorder has ceased to be recognized as a medical condition since the 1920s.
There have been very few studies correlating orgasm and brain activity in real time, owing to cultural barriers and technical difficulties. However a series of studies conducted by Gert Holstege and his colleagues at the University of Groningen in the Netherlands have established physiological characteristics which are unique to orgasm, including brain activity, as well as variation in the responses between men and women.
One study examined 12 healthy women using a positron emission tomography (PET) scanner while they were being stimulated by their partners. Brain changes were observed and compared between states of rest, sexual stimulation, faked orgasm, and actual orgasm. "Differences were reported on the brain changes associated with men and women during stimulation. However, the same changes in brain activity were observed in both sexes in which the brain regions associated with behavioral control, fear and anxiety shut down. Regarding these changes, Holstege said in an interview with The Times, "What this means is that deactivation, letting go of all fear and anxiety, might be the most important thing, even necessary, to have an orgasm."[83]
During stroking of the clitoris, the parts of the female brain responsible for processing fear, anxiety and behavioral control start to relax and reduce in activity. This reaches a peak at orgasm when the female brain’s emotion centers are effectively closed down to produce an almost trance-like state. Holstege is quoted as saying, at the 2005 meeting of the European Society for Human Reproduction and Development: "At the moment of orgasm, women do not have any emotional feelings."[84]
Initial reports indicated it was difficult to observe the effects of orgasm on men using PET scan, because the duration of male orgasm was much shorter. However, a subsequent report by Rudie Kortekaas, et al. stated, "Gender commonalities were most evident during orgasm... From these results, we conclude that during the sexual act, differential brain responses across genders are principally related to the stimulatory (plateau) phase and not to the orgasmic phase itself."[85]
Human brain wave patterns have shown distinct changes during orgasm, which indicate the importance of the limbic system in the orgasmic response.[2] Male and female brains demonstrate similar changes during orgasm, with brain activity scans showing a temporary decrease in the metabolic activity of large parts of the cerebral cortex with normal or increased metabolic activity in the limbic areas of the brain.[85]
Orgasm, and sex as a whole, are physical activities that can require exertion of many major bodily systems. A 1997 study in the British Medical Journal based upon 918 men age 45–59 found that after a ten year follow-up, men who had fewer orgasms were twice as likely to die of any cause as those having two or more orgasms a week.[86] A follow-up in 2001 which focused more specifically on cardiovascular health found that having sex three or more times a week was associated with a 50% reduction in the risk of heart attack or stroke. (Note that as a rule, correlation does not imply causation.)
There is some research suggesting that greater resting heart rate variability is associated with orgasms through penile-vaginal intercourse without additional simultaneous clitoral stimulation. As a differential hypothesis, resting heart rate variability measures were unrelated to orgasmic frequency from non-coital sexual activities. The authors concluded that greater resting heart rate variability is associated with orgasms through penile-vaginal intercourse, but not with orgasms from other sources:
Coitally experienced men and women (N=143) had their heart rate measured for 5 minutes and reported the frequency of various sexual behaviors and corresponding orgasms in a recent representative month. Partial correlations and analyses of covariance controlling for social desirability responding were used to examine the associations of sexual activities with time and frequency domains of resting heart rate variability. For men, greater resting SD of HR was associated with greater [penile-vaginal] orgasm frequency. For women, greater resting SD of HR was associated with any vaginal orgasm. These findings remained after controlling for cohabitation. Sexual activities were unrelated to HF. Lifetime number of [penile-vaginal sex] partners was unrelated to SD of HR and HF. Findings are discussed in the context of orgasms through [penile-vaginal sex] enhancing HRV, and greater parasympathetic tone favoring the capacity to engage in [penile-vaginal sex], and in the case of women, to reach vaginal orgasm. The possibility of healthier people having greater resting HRV and more frequent orgasms through specifically [penile-vaginal sex] is also considered.[87]
The inability to have orgasm is called anorgasmia, ejaculatory anhedonia, or inorgasmia. If a male experiences erection and ejaculation but no orgasm, he is said to have sexual anhedonia. Difficulty reaching orgasm after ample sexual stimulation is significantly more common in women than in men,[40][88] though sexual dysfunction is common for both women (43%) and men (31%), and is associated with age and educational attainment.
About 15% of women report difficulties with orgasm, 10% have never climaxed, and 40–50% have either complained about sexual dissatisfaction or experienced difficulty becoming sexually aroused at some point in their lives.[57][88][89] 75% of men and 29% of women always have orgasms with their partner.[90] Women are much more likely to be nearly always or always orgasmic when alone than with a partner.[91] However, in a 1996 study reported in the Journal of Sex Research, 62% of women in a partnered relationship said they were satisfied with the frequency/consistency of their orgasms.[91] Additionally, many women express that their most satisfying sexual experiences entail being connected to someone, rather than solely basing satisfaction on orgasm.[92] Robert Birch of Sexualhealth.com stated, "As statistics based on surveys tend to do, the numbers assigned to female orgasms vary, depending on who was surveyed and who is reporting."[89]
Kinsey's Sexual Behavior in the Human Female showed that, over the previous five years of sexual activity, 78% of women had orgasms in 60% to 100% of sexual encounters with other women, compared with 55% for heterosexual sex.[93] Kinsey attributed this difference to female partners knowing more about women's sexuality and how to optimize women's sexual satisfaction than male partners do.[4] Like Kinsey, scholars such as Peplau, Fingerhut and Beals (2004) and Diamond (2006) found that lesbians have orgasms more often and more easily in sexual interactions than heterosexual women do,[4] and that female partners are more likely to emphasize the emotional aspects of lovemaking.[4]
Specifically in relation to simultaneous orgasm and similar practices, many sexologists claim that the problem of premature ejaculation[94] is closely related to the idea encouraged by a scientific approach in early 20th century when mutual orgasm was overly emphasized as an objective and a sign of true sexual satisfaction in intimate relationships.
If orgasm is desired, anorgasmia may be attributed to an inability to relax, or "let go." It seems to be closely associated with performance pressure and an unwillingness to pursue pleasure, as separate from the other person's satisfaction. Often, women worry so much about the pleasure of their partner that they become anxious, which manifests as impatience with the delay of orgasm for them. This delay can lead to frustration of not reaching orgasmic sexual satisfaction.[88] Psychoanalyst Wilhelm Reich, in his 1927 book The Function of the Orgasm was the first to make orgasm central to the concept of mental health, and defined neurosis in terms of blocks to having full orgasm. Although orgasm dysfunction can have psychological components, physiological factors often play a role. For instance, delayed orgasm or the inability to achieve orgasm is a common side effect of many medications.
Menopause may involve loss of hormones supporting sexuality and genital functionality. Vaginal and clitoral atrophy and dryness affects up to 50%–60% of postmenopausal women.[95] Testosterone levels in men fall as they age. Sexual dysfunction overall becomes more likely with poor physical and emotional health. "Negative experiences in sexual relationships and overall well-being" are associated with sexual dysfunction.[96][97]
Because male orgasms that expel sperm from the body into the vagina during intercourse may result in conception, researchers have several hypotheses about the role, if any, of the female orgasm in the reproductive and therefore evolutionary process.[39][56] Wallen K and Lloyd EA stated, "In men, orgasms are under strong selective pressure as orgasms are coupled with ejaculation and thus contribute to male reproductive success. By contrast, women's orgasms in intercourse are highly variable and are under little selective pressure as they are not a reproductive necessity."[56] In 1967, Desmond Morris first suggested in his popular-science book The Naked Ape that female orgasm evolved to encourage physical intimacy with a male partner and help reinforce the pair bond. Morris suggested that the relative difficulty in achieving female orgasm, in comparison to the male's, might be favorable in Darwinian evolution by leading the female to select mates who bear qualities like patience, care, imagination, intelligence, as opposed to qualities like size and aggression, which pertain to mate selection in other primates. Such advantageous qualities thereby become accentuated within the species, driven by the differences between male and female orgasm. If males were motivated by, and taken to the point of, orgasm in the same way as females, those advantageous qualities would not be needed, since self-interest would be enough.
Morris also proposed that orgasm might facilitate conception by exhausting the female and keeping her horizontal, thus preventing the sperm from leaking out. This possibility, sometimes called the "Poleax Hypothesis" or the "Knockout Hypothesis," is now considered highly doubtful.
A 1994 Learning Channel documentary on sex had fiber optic cameras inside the vagina of a woman while she had sexual intercourse. During her orgasm, her pelvic muscles contracted and her cervix repeatedly dipped into a pool of semen in the vaginal fornix, as if to ensure that sperm would proceed by the external orifice of the uterus, making conception more likely.[98] Elisabeth Lloyd has criticized the accompanying narration of this film clip which describes it as an example of "Sperm Upsuck."[99]
The clitoris is homologous to the penis; that is, they both develop from the same embryonic structure.[35][42] Stephen Jay Gould and other researchers have claimed that the clitoris is vestigial in females, and that the female orgasm serves no particular evolutionary function. Proponents of this hypothesis, such as Elisabeth Lloyd, point to the relative difficulty of achieving female orgasm through vaginal sex, the limited evidence for increased fertility after orgasm and the lack of statistical correlation between the capacity of a woman to orgasm and the likelihood that she will engage in intercourse.[39][100] "Lloyd is by no means against evolutionary psychology. Quite the opposite; in her methods and in her writing, she advocates and demonstrates a commitment to the careful application of evolutionary theory to the study of human behavior," stated Meredith L. Chivers. "She meticulously considers the theoretical and empirical bases for each account and ultimately concludes that there is little evidence to support an adaptionist account of female orgasm. Instead, Lloyd views female orgasm as an ontogenetic leftover; women have orgasms because the urogenital neurophysiology for orgasm is so strongly selected for in males that this developmental blueprint gets expressed in females without affecting fitness, just as males have nipples that serve no fitness-related function."[100]
Anthropologist/primatologist Sarah Blaffer Hrdy, Dr. Helen O'Connell and science writer Natalie Angier have criticized the "female orgasm is vestigial" hypothesis as understating and devaluing the psychosocial value of the female orgasm. Hrdy stated that the hypothesis smacks of sexism.[101] O'Connell said, "It boils down to rivalry between the sexes: the idea that one sex is sexual and the other reproductive.The truth is that both are sexual and both are reproductive."[5] O'Connell used MRI technology to define the true size and shape of the clitoris, showing that it extends considerably inside the vagina (see above). She describes typical textbook descriptions of the clitoris as lacking detail and including inaccuracies, saying that the work of Georg Ludwig Kobelt in the early 19th century provides a most comprehensive and accurate description of clitoral anatomy. O'Connell asserts that the bulbs appear to be part of the clitoris and that the distal urethra and vagina are intimately related structures, although they are not erectile in character, forming a tissue cluster with the clitoris. This cluster appears to be the locus of female sexual function and orgasm.[5]
At the 2002 conference for Canadian Society of Women in Philosophy, Nancy Tuana asserted that the clitoris is unnecessary in reproduction, but that this is why it has been "historically ignored," mainly because of "a fear of pleasure. It is pleasure separated from reproduction. That's the fear". She reasoned that this fear is the cause of the ignorance that veils female sexuality.[34]
Evolutionary psychologists Christopher Ryan and Cacilda Jethá note in their discussion of the female orgasm how long it takes for females to achieve orgasm compared to males and their ability to have multiple orgasms; noting how especially well suited to multiple partners and insemination this is. They quote primate sexuality specialist Alan Dixson in saying that the monogamy-maintenance explanation for female orgasm "seems far-fetched" because "females of other primate species, and particularly those with multimale-multifemale [promiscuous] mating systems such as macaques and chimpanzees, exhibit orgasmic responses in the absence of such bonding or the formation of stable family units." On the other hand, Dixson notes that "Gibbons, which are primarily monogamous, do not exhibit obvious signs of female orgasm." Although Dixson classifies humans as mildly polygynous in his survey of primate sexuality, he appears to have doubts, when he writes, "One might argue that... the female's orgasm is rewarding, increases her willingness to copulate with a variety of males rather than one partner, and thus promotes sperm competition." Ryan and Jethá use this as evidence for their theory that partible paternity and promiscuity were common for early modern humans.[102]
There are theories that the female orgasm might increase fertility. For example, the 30% reduction in size of the vagina could help clench onto the penis (much like, or perhaps caused by, the pubococcygeus muscles), which would make it more stimulating for the male (thus ensuring faster or more voluminous ejaculation). The British biologists Baker and Bellis have suggested that the female orgasm may have an "upsuck" action (similar to the esophagus' ability to swallow when upside down), resulting in the retaining of favorable sperm and making conception more likely.[103] They posited a role of female orgasm in sperm competition. The observation that women tend to reach orgasm more easily when they are ovulating also suggests that it is tied to increasing fertility.[104] Evolutionary biologist Robin Baker argues in Sperm Wars that occurrence and timing of orgasms are all a part of the female body's unconscious strategy to collect and retain sperm from more evolutionarily fit men[citation needed]. An orgasm during intercourse functions as a bypass button to a woman's natural cervical filter against sperm and pathogens. An orgasm before functions to strengthen the filter.
A 2005 twin study found that one in three women reported never or seldom achieving orgasm during intercourse, and only one in ten always orgasmed. This variation in ability to orgasm, generally thought to be psychosocial, was found to be 34% to 45% genetic. The study, examining 4000 women, was published in Biology letters, a Royal Society journal.[105][106] Elisabeth Lloyd has cited this as evidence for the notion that female orgasm is not adaptive.[39][99]
Tantric sex, which is not the same thing as Buddhist tantra (Vajrayana), is the ancient Indian spiritual tradition of sexual practices. It attributes a different value to orgasm than traditional cultural approaches to sexuality. Some practitioners of tantric sex aim to eliminate orgasm from sexual intercourse by remaining for a long time in the pre-orgasmic and non-emission state. Advocates of this, such as Rajneesh, claim that it eventually causes orgasmic feelings to spread out to all of one's conscious experience.[107][108]
Advocates of tantric and neotantric sex who claim that Western culture focuses too much on the goal of climactic orgasm, which reduces the ability to have intense pleasure during other moments of the sexual experience, suggest that eliminating this enables a richer, fuller and more intense connection.[109]
The mechanics of male orgasm are similar in most mammals. Females of some mammal and some non-mammal species such as alligators[110] have clitorises. There has been ongoing research about the sexuality and orgasms of dolphins, a species which apparently engages in sexual intercourse for reasons other than procreation.[111]
Orgasm has been widely described in literature over the centuries. In antiquity, Latin literature addressed the subject as much as Greek literature: Book III of Ovid's Metamorphoses retells a discussion between Jove and Juno, in which the former states: "The sense of pleasure in the male is far / More dull and dead, than what you females share."[112] Juno rejects this thought; they agree to ask the opinion of Tiresias ("who had known Venus/Love in both ways," having lived seven years as a female).[113] Tiresias offends Juno by agreeing with Jove, and she strikes him blind on the spot (Jove lessens the blow by giving Tiresias the gift of foresight, and a long life).[114] Earlier, in the Ars Amatoria, Ovid states that he abhors sexual intercourse that fails to complete both partners.[115]
The theme of orgasm survived during Romanticism and Homoeroticism. Percy Bysshe Shelley (1792–1822), "a translator of extraordinary range and versatility",[116] in FRAGMENT: Supposed to be an Epithalamium of Francis Ravaillac and Charlotte Cordé, wrote phrase "No life can equal such a death.", that has been seen as a metaphor for orgasm,[117] and that was preceded by a rhythmic urgency of the previous lines "Suck on, suck on, I glow, I glow!", alluding explicitly to fellatio.[117] For Shelley, orgasm was "the almost involuntary consequences of a state of abandonment in the society of a person of surpassing attractions."[118] Edward Ellerker Williams, the last love of Shelley's life, was remembered by the poet in "The Boat on the Serchio", which is seen as probably "the grandest portrayal of orgasm in literature":[117]
<poem style="margin-left: 2em">
The Serchio, twisting forth
Between the marble barriers which it clove
At Ripafratta, leads through the dread chasm
The wave that died the death which lovers love,
Living in what it sought; as if this spasm
Had not yet passed, the toppling mountains cling,
But the clear stream in full enthusiasm
Pours itself on the plain.... </poem>
Again, Shelley, in this poem, associates orgasm with death when he writes "death which lovers love".[117] Curiously, in French literature, the term la petite mort (the little death) is a famous euphemism for orgasm;[119] it is the representation of man who forgets himself and the world during orgasm. Jorge Luis Borges, in the same vision, wrote in one of the several footnotes of "Tlön, Uqbar, Orbis Tertius" that one of the churches of Tlön claims Platonically that "All men, in the vertiginous moment of coitus, are the same man. All men who repeat a line from Shakespeare are William Shakespeare."[120] Shakespeare himself was a knowledgeable of this idea: lines "I will live in thy heart, die in thy lap, and be buried in thy eyes" and "I will die bravely, like a smug bridegroom", said respectively by Benedick in Much Ado About Nothing and by King Lear in the homonymous play,[121] are interpreted as an option to die in a woman's lap to experience a sexual orgasm.[122] Sigmund Freud with his psychoanalytic projects, in "The Ego and the Id" (1923), speculates that sexual satisfaction by orgasm make Eros ("life instinct") exhausted and leaves the field open to Thanatos ("death instinct"), in other words, with orgasm Eros fulfills its mission and gives way to Thanatos.[123] Other modern authors have chosen to represent the orgasm without metaphors. In novel Lady Chatterley's Lover (1928), by D.H.Lawrence, we can find an explicit narrative of a sexual act between a couple: "As he began to move, in the sudden helpless orgasm there awoke in her strange thrills rippling inside her..."[124]
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