Orgasm

"Orgasmic dysfunction in females is commonly reported in the general population with little consensus on its aetiology. We performed a classical twin study to explore whether there were observable genetic influences on female orgasmic dysfunction. Adult females from the TwinsUK register were sent a confidential survey including questions on sexual problems. Complete responses to the questions on orgasmic dysfunction were obtained from 4037 women consisting of 683 monozygotic and 714 dizygotic pairs of female twins aged between 19 and 83 years. One in three women (32%) reported never or infrequently achieving orgasm during intercourse, with a corresponding figure of 21% during masturbation. A significant genetic influence was seen with an estimated heritability for difficulty reaching orgasm during intercourse of 34% (95% confidence interval 27–40%) and 45% (95% confidence interval 38–52%) for orgasm during masturbation. These results show that the wide variation in orgasmic dysfunction in females has a genetic basis and cannot be attributed solely to cultural influences. These results should stimulate further research into the biological and perhaps evolutionary processes governing female sexual function."

"Until recently, little research has explored female sexual function (Berman et al. 1999), and yet women commonly report sexual dysfunction. For example, over 50% of women in the UK report at least one sexual problem lasting a month or more during the previous year (Mercer et al. 2003), and around a quarter have never or rarely achieved orgasm during the previous three months (Dunn et al. 2002). There is controversy over whether the problem has a real medical basis, or whether it has partly been created by the media, pharmaceutical advertising and cultural expectations (Moynihan 2003). Whereas studying male sexual function is widely accepted (with a recent increase following the release of drugs like Viagra), the female orgasm is less well studied. This lack of scientific interest may be partly attributable to the previous consensus that the female orgasm has no clear role in reproduction. This view was challenged by research showing that the orgasm helped facilitate sperm retention (Morris 1967; Fox et al. 1970). Further evidence for the orgasm's reproductive role comes from studies linking it with the menstrual cycle (Matteo & Rissman 1984; Baker & Bellis 1995). More recently, this was corroborated in other studies showing that desire for pregnancy subconsciously predicted timing of the female orgasm to be just after that of the male (Singh et al. 1998). Studies such as these are obviously difficult to conduct, and there is still a lack of agreement among experts about the role of the female orgasm in humans. While differences in sexual function between women were known to exist, these have been largely attributed to cultural, religious and psychological factors. No study has explored family history or genetic factors—which might indicate or refute a biological or evolutionary basis for the variation. We therefore performed a classical twin study comparing the similarities in identical and non-identical twins to explore whether there were observable genetic influences on variation in female orgasmic function."

"Results: Orgasm induced elevations in cardiovascular parameters and levels of plasma adrenaline and noradrenaline. Plasma prolactin substantially increased after orgasm, remained elevated over the remainder of the session, and was still raised 60 minutes after sexual arousal. In addition, sexual arousal also produced small increases in plasma LH and testosterone concentrations. In contrast, plasma concentrations of cortisol, FSH, beta-endorphin, progesterone, and estradiol were unaffected by orgasm. Conclusions: Sexual arousal and orgasm produce a distinct pattern of neuroendocrine alterations in women, primarily inducing a long-lasting elevation in plasma prolactin concentrations. These results concur with those observed in men, suggesting that prolactin is an endocrine marker of sexual arousal and orgasm."

"There is a notable gap between heterosexual men and women in frequency of orgasm during sex. Little is known, however, about sexual orientation differences in orgasm frequency. We examined how over 30 different traits or behaviors were associated with frequency of orgasm when sexually intimate during the past month. We analyzed a large US sample of adults (N = 52,588) who identified as heterosexual men (n = 26,032), gay men (n = 452), bisexual men (n = 550), lesbian women (n = 340), bisexual women (n = 1112), and heterosexual women (n = 24,102). Heterosexual men were most likely to say they usually-always orgasmed when sexually intimate (95%), followed by gay men (89%), bisexual men (88%), lesbian women (86%), bisexual women (66%), and heterosexual women (65%). Compared to women who orgasmed less frequently, women who orgasmed more frequently were more likely to: receive more oral sex, have longer duration of last sex, be more satisfied with their relationship, ask for what they want in bed, praise their partner for something they did in bed, call/email to tease about doing something sexual, wear sexy lingerie, try new sexual positions, anal stimulation, act out fantasies, incorporate sexy talk, and express love during sex. Women were more likely to orgasm if their last sexual encounter included deep kissing, manual genital stimulation, and/or oral sex in addition to vaginal intercourse. We consider sociocultural and evolutionary explanations for these orgasm gaps. The results suggest a variety of behaviors couples can try to increase orgasm frequency."

"The idea of thinking yourself to orgasm is not new. In the early 1970's, the Masters and Johnson research team documented the strong connection between sexuality and thought. The connection is particularly strong in women, says Dr. Ian Kerner, author and sex therapist. "The brain is the most powerful sex organ," he says. Men, he adds, have a much harder time making themselves climax without any touch whatsoever, but there are documented cases in women."

"Above his desk at Rutgers University, psychology professor Barry Komisaruk has a framed image of what female brain activity looks like during orgasm. It looks like a sunset. Every major region of her brain ignites at the height of climax."

"Results: The results confirmed transient increases in adrenaline and prolactin plasma concentrations. Sexual arousal and orgasm increased the absolute number of leukocytes, in particular natural killer cells (CD3-CD16+CD56+), in the peripheral blood. In contrast, T cell (CD3+) and B cell (CD3-CD20+) subpopulations as well as the production of interleukin 6 and tumor necrosins factor alpha remained unaffected by sexual activity. Conclusion: These findings demonstrate that components of the innate immune system are activated by sexual arousal and orgasm."

"While the records for very young boys are fewer than for boys nearer the age of adolescence and while the calculations for these youngest cases are consequently less reliable, the data do show a gradual increase, with advancing age, in the percentage of cases able to reach climax: 32 per cent of the boys 2 to 12 months of age, more than half (57.1%) of the 2- to 5- year olds, and nearly 80 per cent of the pre-adolescent boys between 10 and 13 years of age (inclusive) came to climax. Half of the boys had reached climax by age 7 years of age (nearly half of them by 5 years), and two-thirds of them by 12 years of age. The observers emphasize that there are some of these pre-adolescent boys (estimated by one observer as less than one quarter of the cases) who fail to reach climax even under prolonged and varied and repeated stimulation; but, even in these young boys, this probably represent psychologic blockage more often than physiologic incapacity. In the population as a whole, a much smaller percentage of the boys experience orgasm at any early age, because few of them find themselves in circumstances that test their capacities; but the positive record on these boys who did have the opportunity makes it certain that many infant males and younger boys are capable of orgasm, and it is probable that half or more of the boys in an uninhibited society could reach climax by the time they were three or four years of age, and that nearly all of them could experience such a climax three to five years before the onset of adolescence."

"Erection is much quicker in pre-adolescent boys than in adults, although the speed with which climax is reached in preadolescent males varies considerably in different boys(Table 32), just as it does in adults. There are two-tear olds who come to climax in less than 10 seconds, and there are two-year olds who may take 10 or 20 minutes, or more. There is a similar range among pre-adolescent of every other age. The mean time required to reach climax was almost exactly 3 minutes, and the median time was under 2 minutes. From earliest infancy until the middle twenties there is no effect of age on this point, although beyond that older males slow up in speed of response (Chapter 6)."

"The most remarkable aspect of the pre-adolescent population is its capacity to achieve repeated orgasm in limited periods of time. This capacity definitely exceeds the ability of teen-age boys who, in turn, are much more capable than any older males (Tables 33, 34, 48, Figure 36). Among 182 pre-adolescent boys on whom sufficient data are available, more than half (55.5%, 138 cases) readily reached a second climax within a short period of time, and nearly a third (30.8%) of all these 182 boys were able to achieve 5 or more climaces in quite rapid succession (Tables 32-34). It is certain that a higher proportion of the boys could have had multiple orgasm if the situation had offered. Among 64 cases on which there are detailed reports, the average interval between the first and second climaxes ranged from less than 10 seconds to 30 minutes or more, but the mean interval was only 6.28 minutes (median 2.25 minutes) Table 33). There are older males, even in their thirties and older, who are able to equal this performance, but a much higher proportion of these pre-adolescent males are so capable. Even the youngest males, as young as 5 months in age, are."

"Results. The literature cites dozens of trials that have attempted to confirm the existence of a G‐spot using surveys, pathologic specimens, various imaging modalities, and biochemical markers. The surveys found that a majority of women believe a G‐spot actually exists, although not all of the women who believed in it were able to locate it. Attempts to characterize vaginal innervation have shown some differences in nerve distribution across the vagina, although the findings have not proven to be universally reproducible. Furthermore, radiographic studies have been unable to demonstrate a unique entity, other than the clitoris, whose direct stimulation leads to vaginal orgasm. Conclusions. Objective measures have failed to provide strong and consistent evidence for the existence of an anatomical site that could be related to the famed G‐spot. However, reliable reports and anecdotal testimonials of the existence of a highly sensitive area in the distal anterior vaginal wall raise the question of whether enough investigative modalities have been implemented in the search of the G‐spot."

"Women diagnosed with complete spinal cord injury (SCI) at T10 or above report vaginal-cervical perceptual awareness. To test whether the Vagus nerves, which bypass the spinal cord, provide the afferent pathway for this response, we hypothesized that the Nucleus Tractus Solitarii (NTS) region of the medulla oblongata, to which the Vagus nerves project, is activated by vaginal-cervical self-stimulation (CSS) in such women, as visualized by functional magnetic resonance imaging (fMRI). Regional blood oxygen level-dependent (BOLD) signal intensity was imaged during CSS and other motor and sensory procedures, using statistical parametric mapping (SPM) analysis with head motion artifact correction. Physiatric examination and MRI established the location and extent of spinal cord injury. In order to demarcate the NTS, a gustatory stimulus and hand movement were used to activate the superior region of the NTS and the Nucleus Cuneatus adjacent to the inferior region of the NTS, respectively. Each of four women with interruption, or "complete" injury, of the spinal cord (ASIA criteria), and one woman with significant, but "incomplete" SCI, all at or above T10, showed activation of the inferior region of the NTS during CSS. Each woman showed analgesia, measured at the fingers, during CSS, confirming previous findings. Three women experienced orgasm during the CSS. The brain regions that showed activation during the orgasms included hypothalamic paraventricular nucleus, medial amygdala, anterior cingulate, frontal, parietal, and insular cortices, and cerebellum. We conclude that the Vagus nerves provide a spinal cord-bypass pathway for vaginal-cervical sensibility in women with complete spinal cord injury above the level of entry into spinal cord of the known genitospinal nerves."

"Women diagnosed with complete spinal cord injury (SCI) at T10 or higher report sensations generated by vaginal-cervical mechanical self-stimulation (CSS). In this paper we review brain responses to sexual arousal and orgasm in such women, and further hypothesize that the afferent pathway for this unexpected perception is provided by the Vagus nerves, which bypass the spinal cord. Using functional magnetic resonance imaging (fMRI), we ascertained that the region of the medulla oblongata to which the Vagus nerves project (the Nucleus of the Solitary Tract or NTS) is activated by CSS. We also used an objective measure, CSS-induced analgesia response to experimentally induced finger pain, to ascertain the functionality of this pathway. During CSS, several women experienced orgasms. Brain regions activated during orgasm included the hypothalamic paraventricular nucleus, amygdala, accumbens-bed nucleus of the stria terminalis-preoptic area, hippocampus, basal ganglia (especially putamen), cerebellum, and anterior cingulate, insular, parietal and frontal cortices, and lower brainstem (central gray, mesencephalic reticular formation, and NTS). We conclude that the Vagus nerves provide a spinal cord-bypass pathway for vaginal-cervical sensibility and that activation of this pathway can produce analgesia and orgasm."

"Our previous research on genital self-stimulation in women identified brain regions that are activated during orgasm. These regions include the nucleus accumbens, anterior hypothalamus (in the region of the paraventricular nucleus), amygdala, anterior cingulate cortex, insula, hippocampus, cerebellum, and paracentral lobule. In the present study, we extend these findings by analyzing the relative time course of activation of these and other brain regions. We find evidence of differential rates of activation among more than 30 discrete anatomical areas on each of the left and right sides of the brain. Based on preliminary analysis of self-stimulation data, genital sensory cortex, thalamus, motor areas, cerebellum, hypothalamus, and substantia nigra are activated earliest. Closer to the onset of orgasm and continuing through orgasm, frontal cortical regions, entorhinal cortex, cingulate cortex, insula, amygdala, and hippocampus become activated. Later in the orgasm, and shortly thereafter, the levels of activation peak in the hypothalamus, nucleus accumbens, and caudate. Thus, leading up to, during, and after orgasm there are marked differences in the temporal profiles of activity (increases and decreases) among specific brain regions. As reported previously (Komisaruk et al, 2004, Brain Research,1024:77) activation evidently occurs in widespread regions throughout the brain during orgasm. The slow time course of the development, duration, and resolution of orgasm (i.e., over seconds and minutes) provides a useful model to elucidate the integration of neural systems mediating the cognitive, emotional, somatic, and visceral components of this intense human experience."

"If you understand the way that the genital system gets to the brain, we can understand pathologies, where there is a blockage—say, in people who don’t have orgasms—where is their system blocked, and why. That’s where we are going now. Once we can understand the natural process, we can understand the pathology and how to attack."

"There is good reason to believe that orgasms while sleeping are not, in fact, the result of genital stimulation, but instead are created in the brain."

"In an open study, sildenafil (Viagra) was prescribed for nine women outpatients who reported sexual dysfunction induced by antidepressant medication, primarily selective serotonin reuptake inhibitors. A 50 mg dose of sildenafil was prescribed, and patients were instructed to take it approximately one hour before sexual activity. They were told to increase the dose to 100 mg on the next occasion if they experienced a partial response or a lack of response to sildenafil. The nine patients, all of whom had experienced either anorgasmia or delayed orgasm with or without associated disturbances, reported significant reversal of sexual dysfunction, usually with the first dose of 50 mg of sildenafil."

"During intercourse, the female orgasm can be elusive. What frustrated woman hasn't wondered: Am I simply, um, put together differently than other women? Kim Wallen, professor of psychology and behavioral neuroendocrinology at Emory University, is busy doing the math to find out. And, yes, he says, simple physiology may have a lot to do with orgasm ease -- specifically, how far a woman's clitoris lies from her vagina. That number might predict how easily a woman can experience orgasms from penile stimulation alone -- without help from fingers, toys or tongue -- during sexual intercourse. In fact, there's even an easy "rule of thumb," Wallen says: Clitoris-vagina distances less than 2.5 cm -- that's roughly from the tip of your thumb to your first knuckle -- tend to yield reliable orgasms during sex. More than a thumb's length? Regular intercourse alone typically might not do the trick."

"Orgasm is fantastic for your brain. A lot of different regions are activated, which means they're getting a lot of blood flow. It's kind of a workout for your brain.""

"For women, it seems, sex is a big turn-off, reveals a brain scanning study. It shows that many areas of the brain switch off during the female orgasm – including those involved with emotion. “At the moment of orgasm, women do not have any emotional feelings,” says Gert Holstege of the University of Groningen in the Netherlands."

"The results of the study are striking. As the women were stimulated, activity rose in one sensory part of the brain, called the primary somatosensory cortex, but fell in the amygdala and hippocampus, areas involved in alertness and anxiety. During orgasm, activity fell in many more areas of the brain, including the prefrontal cortex, compared with the resting state, Holstege told a meeting of the European Society for Human Reproduction and Development in Copenhagen on Monday. In one sense the findings appear to confirm what is already known, that women cannot enjoy sex unless they are relaxed and free from worries and distractions. “Fear and anxiety levels have to go down for orgasm. Everyone knows this but we can see it happening in the brain,” he explains."

"From an evolutionary point of view, it could be that the brain switches off the emotions during sex because at such times the chance to produce offspring becomes more important than the survival risk to the individual. Holstege points to the extraordinary behaviour seen in some animals during the breeding season, such as March hares, when the urge to mate seems to override the usual fear of predators. But Holstege cannot explain why there is such extreme deactivation in so many areas of the brain during orgasm. Only one small part of the brain, in the cerebellum, was more active during female orgasm. The cerebellum is normally associated with coordinating movement, though there is also some evidence that it helps regulate emotions. “We don’t know what activation of the cerebellum corresponds to,” Holstege admits."

"Introduction: The effect of sexual arousal and orgasm on genital sensitivity has received little research attention, and no study has assessed sensation pleasurableness as well as painfulness."

"Scientists have used brain scan images to create the world's first movie of the female brain as it ap-proaches, experiences and recovers from an orgasm. The animation reveals the steady buildup of activi-ty in the brain as disparate regions flicker into life and then come together in a crescendo of activity before gently settling back down again. To make the animation, researchers monitored a woman's brain as she lay in a functional magnetic resonance imaging (fMRI) scanner and stimulated herself. The research will help scientists to understand how the brain conducts the symphony of activity that leads to sexual climax in a woman. By studying people who have orgasms, Professor Barry Komisaruk, a psychologist at Rutgers University in New Jersey and his team hope to uncover what goes wrong in both men and women who cannot reach sexual climax."

"The five-minute movie shows how activity changes across 80 separate regions of the brain in snapshots taken every two seconds. The animation uses a "hot metal" colour scale that begins at dark red and progresses through orange and yellow to white at the highest levels of activity. "The general aim of this research is to understand how the orgasm builds up from genital stimulation and what parts of the brain become recruited and finally build up into an orgasm," said Prof Komisaruk, who presented the work at the Society for Neuroscience annual meeting in Washington DC on Monday. The work has yet to be published in a peer-reviewed journal. As the animation plays, activity first builds up in the genital area of the sensory cortex, a response to being touched in that region. Activity then spreads to the limbic system, a collection of brain structures involved in emotions and long-term memory. As the orgasm arrives, activity shoots up in two parts of the brain called the cerebellum and the frontal cortex, perhaps because of greater muscle tension. During orgasm, activity reaches a peak in the hypothalamus, which releases a chemical called oxytocin that causes pleasurable sensations and stimulates the uterus to contract. Activity also peaks in the nucleus accumbens, an area linked to reward and pleasure. After orgasm, the activity in all these regions gradually calms down."

"Generally, no functional role, except pleasure, is assigned to a women's coital orgasm. Recently, however, researchers have suggested that women can regulate the number of sperm accepted or rejected by manipulation coital orgasm timing. Baker and Bellis (1995) demonstrated that women retain more sperm if coital orgasm occurs after, rather than before male ejaculation. The present study investigated (i) factors associated with coital orgasm frequency and (ii) whether women desirous of becoming pregnant report more coital orgasms after than before their partners. Sixty-nine women rated their desire for pregnancy and answered questions about their sexual behaviors, coital orgasm frequency, and coital orgasm timing in relation to their partners. In regression analysis, coital orgasm frequency was predicted by foreplay duration, masturbation frequency, and active sexual participation; desire for pregnancy did not predict coital orgasm frequency. Desire for pregnancy was predicted by age (negatively), active sexual participation (positively), and positively by orgasm after partner ejaculation. Consistent with the Baker and Bellis hypothesis, frequency of orgasm after partner's orgasm remained a significant predictor for desire for pregnancy after controlling for degree of marital happiness, sexual foreplay duration, and coital orgasm frequency."

"Orgasms are a truly altered, if fleeting, state of consciousness. And most people (though not all) experience them somewhat regularly. So it's a bit surprising how seldom we talk about orgasms publicly — and scientifically, how little we know about them."

""Their brain activity is very similar to women who have orgasms from physical self-stimulation," Komisaruk says. This even includes heightened activity in the sensory cortex, the area that primarily responds to touch. "Just thinking about stimulation, it turns out, is a very potent way of stimulating this region," he says."

"By the time you actually experience an orgasm, "more than 30 major brain systems are activated," Komisaruk says. "It's not a local, discrete event. There's no 'orgasm center.' It's everywhere.""

"It has generally been assumed that a male's experience of orgasm is different from a female's experience of orgasm. In this study, a questionnaire consisting of 48 description of orgasm (24 male and 24 female) was submitted to 70 judges. These professionals (obstetrician-gynecologists, psychologists and medical students) were to sex-identify the description to discover whether sex differences could be detected. The judges could not correctly identify the sex of the person describing an orgasm. Furthermore, none of the three professional groups represented in the sample of judges did better than any of the other groups. Male judges did no better than female judges and vice versa. These findings suggest that the experience of orgasm for males and females is essentially the same."

"Preliminary work has revealed that only about 7% of women always have orgasms with sex alone, he says, while 27% say they never do. The current research hold-up: developing a reliable, at-home technique for measuring C-V distance, especially one that can deal with stretchy skin. Women with a large C-V distance should not be discouraged, Wallen says. "Personally, I don't think the inability to experience no-hands, penis-only intercourse with orgasm says anything about a happy sex life," he says. "Maybe it could allow couples to be a bit more inventive in how they have sex.""

"In 2 studies with 10 women each, vaginal self-stimulation significantly increased the threshold to detect and tolerate painful finger compression, but did not significantly affect the threshold to detect innocuous tactile stimulation. The vaginal self-stimulation was applied with a specially designed pressure transducer assembly to produce a report of pressure or pleasure. In the first study, 6 of the women perceived the vaginal stimulation as producing pleasure. During that condition, the pain tolerance threshold increased significantly by 36.8% and the pain detection threshold increased significantly by 53%. A second study utilized other types of stimuli. Vaginal self-stimulation perceived as pressure significantly increased the pain tolerance threshold by 40.3% and the pain detection threshold by 47.4%. In the second study, when the vaginal stimulation was self-applied in a manner that produced orgasm, the pain tolerance threshold and pain detection threshold increased significantly by 74.6% and 106.7% respectively, while the tactile threshold remained unaffected. A variety of control conditions, including various types of distraction, did not significantly elevate pain or tactile thresholds. We conclude that in women, vaginal self-stimulation decreases pain sensitivity, but does not affect tactile sensitivity. This effect is apparently not due to painful or non-painful distraction."

"This study investigated the relative effectiveness of specific genital regional self-stimulation in elevating pain thresholds. Anecdotal reports in humans suggest that sexual activity and orgasm decrease a wide variety of human responses to pain and touch, but the phenomenon has not been evaluated objectively. Two types of self-stimulation, pressure and pleasurable, were applied by 10 women to the anterior vaginal wall, the posterior vaginal wall, and the clitoris. Significant increases in pain thresholds but not tactile thresholds occurred when pressure stimulation was applied to the anterior wall of the vagina or when "pleasurable" self-stimulation was applied to any of the three areas. Tactile thresholds were not significantly affected by any genital stimulation condition. However, there was a significant increase in tactile threshold but not pain thresholds in the distraction control condition. On the basis of these findings, we conclude that (a) a sensation of pleasure evoked by genital stimulation can elevate pain thresholds, (b) these pleasurable stimuli were not general "distractants" because they elevated pain thresholds but not tactile thresholds differentially, and (c) genital pleasurable stimuli activate an analgesic process that is distinct from a distraction process."

"[T]here were reasons for the acceptance of vaginal orgasm by female manual authors. The strong resistance to masturbatory activities reveals that such women were not internalizing a new prohibition in rejecting clitoral stimulation but extending an existing one. Manuals by women (and the evidence on behavior) also suggest that English women were generally less comfortable with varied sexual practices that were men. For many married women of this generation their sexual aspirations lay in a different direction. Although the theme had been present in the manuals throughout the inter-war period, the 1950s saw the peak of the insistence on vaginal orgasm for women and the peak of the glorification of sexual intercourse as a transcendent, shared emotional experience for the couple. Authors used phrases such as “their spirits as well as their bodies seem to rise together to a flame of ecstasy which is quite indescribable’ or ‘total emotional surrender’. Definitions of marital sexual pleasure incorporated emotion. In ‘’The Golden Notebook’’ (1962) the Rhodesian-born novelist Doris Lessing (b. 1919) made a frequently quoted, classic statement of support for the vaginal orgasm. She wrote that a ‘vaginal orgasm is emotion and nothing else, felt as emotion and expressed in sensation that are indistinguishable from emotion’. In her 1995 autobiography she also commented that ‘when I masturbated in my adolescence it was the vagina and its amazing possibilities I learned about. The clitoris was only part of the whole ensemble.’ In the 1950s, there were many articulate middle-class women who agreed with Doris Lessing and her perception of female sexual experience. They experienced coitus and vaginal orgasm as an emotional experience and they wanted men to participate emotionally also. Men had to alter their attitude to marital sexuality if they were to accommodate this demand, as a shared emotional experience was incompatible with the exercise of conjugal rights. Thus, in a context where male initiation and management of physical sexual activity was still the norm, the vaginal orgasm involved a further step toward the destruction of the double standard."

"“Possibly about a third of civilized women get their climax externally [clitorally]; perhaps another third achieve it mainly in the vaginal passage, and another third achieve it seldom or never. Of women who can reach it from either area it is found that the inner climax is generally-but not quite always-the one most valued. It is held by psychiatrists that the emotional content of the two types of orgasm is different. Most women will confirm this, though there can be no question of the significance being identical for everybody.’’ This revealed considerable problems. According to Malleson, two-thirds of women were not achieving the vaginal orgasms held to be most desirable by Freud, by most sex manual authors, and frequently by women themselves. Less specifically, Helena Wright, who saw London women through her private medical practice and Family Planning clinics, wrote in 1947 that she had kept careful records of her patients’ experiences since 1928, and that ‘sexual satisfaction is not obtained by more than 50 per cent of married women’. Unsurprisingly Macaulay, who advised women to lower their expectations, was more sanguine about female sexual pleasure: ‘The answers I have received on questioning my patients about their sexual life are in complete contrast to the somewhat gloomy figures published by other writers.’ In her second sex manual, published in 1947, Wright commented that ‘Fifteen years ago most workers along this line thought that the main problem [for women] was ignorance.’ This, Wright felt, had changed, revealing another problem, which was that both men and women expected female sexual response to conform to a male pattern: [Men] discover very early in their sexual experience that…a comparatively short time of rhythmic movements of the penis in the vagina produces an orgasm and ejaculation easily and completely…men, therefore, expect that…"

"Masters and Johnson’s major conclusion was that there was only one female orgasm and that it originated in the clitoris regardless of where it was felt. This was in spite of their description of the vaginal response to erotic stimulation, explained here by the Breechers: ‘’The vagina too, responds. It can be thought of as a cylinder or ‘barrel’, which remains in a collapsed state in the absence of erotic stimulation. The Masters-Johnson studies have established that the outer third of this barrel reacts in one way and the inner two-thirds in a very different way during the successive phases of sexual response. As sexual tension mounts during the excitement phase… [t]he cervix and the uterus are pulled back and up…producing a ‘tenting’ of the vaginal walls surrounding the cervix. The net result of these and other changes is a dramatic ‘ballooning’ of the inner two thirds of the vagina. The diameter at the widest point of the ballooning may be three times the diameter of the erotically unstimulated vagina; and the total length of the vaginal barrel may be increased as much as a full inch.’’ Given this physical response the vagina cannot be described as inactive or even passive. However, Masters, and Johnson assumed this to be the case, and their findings focused on what they called clitorical orgasms. The female research subjects were chosen on the basis of their capacity to produce orgasms in the laboratory while under observation. Regarding these women, Masters and Johnson found that as ‘contrasted with the male’s usual inability to have more than one orgasm in a short period, many females, especially when clitorally stimulated can regularly have five or six full orgasms within a matter of minutes’. In this context, with these female subjects, it was found that the most intense orgasms on a physiological level occurred as a result of masturbation, not while engaging in penile-vaginal intercourse. In response to these findings, Dr Mary Jane Sherfey, an American psychoanalyst, concluded in 1966 that ‘biology gives to women an inordinate sexual drive and capacity which had to be suppressed in the interests of maternal responsibility and male property rights with the rise of modern civilisation’."

"The objective of this study was to test the Betty Dodson method of breaking the female orgasm barrier in chronic anorgasmic women. The aim was sexual and existential healing (salutogenesis) through direct confrontation and integration of both the repressed shame, guilt, and other negative feelings associated with body, genitals, and sexuality, and the repressed sexual pleasure and desire. We conducted a retrospective analysis of clinic data from holistic sexological manual therapeutic intervention, an intensive subtype of clinical holistic medicine (CHM). The patients received 3 × 5 h of group therapy, integrating short-term psychodynamic psychotherapy (STPP) and complementary medicine (CAM bodywork, manual sexology similar to the “sexological examination”). The therapy used the advanced tools of reparenting, genital acceptance, acceptance through touch, and direct sexual clitoral stimulation. A clitoral vibrator was used. Participants were 500 female patients between 18 and 88 years of age (mean of 35 years) with chronic anorgasmia (for 12 years on average) who were participating in the “orgasm course for anorgasmic women”; 25% of the patients had never experienced an orgasm. Our results show that 465 patients (93%) had an orgasm during therapy, witnessed by the therapist, and 35 patients (7%) did not. Postmenopausal women were as able to achieve orgasm as fertile women, as were women who never had an orgasm. No patients had detectable negative side effects or adverse effects. NNT: 1.04 < NNT < 1.12, NNH > 500. Therapeutic value: TV = NNH/NNT > 446. Our conclusions are that holistic sexological manual therapy may be rational, safe, ethical, and efficient."

"The female orgasm is a variable, transient peak sensation of intense pleasure, creating an altered state of consciousness, usually with an initiation accompanied by involuntary, rhythmic contractions of the pelvic striated circumvaginal musculature, often with concomitant uterine and anal contractions, that resolves the sexually induced vasocongestion and myotonia, generally with an induction of well-being and contentment. Findings from surveys and clinical reports suggest that orgasm problems are the first or second most frequently reported sexual problems in women. Between 11 and 60% of adult women suffer from lack of orgasm, depending on factors such as culture and religion. On an individual level, self-insight and a positive attitude towards one’s own genitals and sexuality are important. Female anorgasmia is a significant sexual problem. The woman who lacks orgasm often also lacks desire and joy of sexuality, has low self-esteem, often feels like a sexual failure, and feels sexually wrong and ashamed of herself for not being the “woman she was meant to be”. Perceptions of not being fully able to satisfy her partner sexually are normal and quality of life is often low. The problem of female anorgasmia, from a psychodynamic perspective, often goes back to the parental lack of acceptance of the patient’s genitals, body, and sexuality, often leading to intense feelings of shame and guilt, which seem to be repressed by a denial of physical and sexual needs, and accumulate in the pelvic and genital area. Sexual abuse and sexual traumas from rape and incest often cause lack of orgasm. If self-esteem is low, it is our clinical observation that there can be lack of orgasm from the simple psychological reason that the patient feels she does not deserve such pleasure, or does not know how to get it. It is very likely that anorgasmia is a socially inherited sexual dysfunction, but this has never been investigated scientifically. It is generally believed that anorgasmia, as most other sexual dysfunctions, is caused by a disturbed psychosexual development."

"The female patients in holistic existential therapy and holistic sexology with life-long anorgasmia often find their situation pretty hopeless; many of them have been dysfunctional and incurable for many years or they suffer from conditions for which there has been no efficient biomedical or psychotherapeutical cure. They suffer from a condition that is a serious burden to their marital life, if they have a husband; often the problem makes them unable to find or keep a partner. Often the problem of anorgasmia is caused by traumas from earlier sexual abuse, which needs more effective and direct tools for the induction of healing (salutogenesis)."

"In this study, 500 female patients with often lifelong anorgasmia received direct sexual stimulation of the clitoris during the therapy and 93% of the patients experienced that the procedure solved their problem. The success of this study gives us one more very important tool for holistic medicine. Together with the other tools of holistic manual therapy, such as acceptance through touch and acupressure through the vagina, we now have tools for solving problems related to female sexual dysfunction. We therefore conclude that direct sexual stimulation can be a safe and efficient procedure, and an important new tool in the holistic medical toolbox."

"Despite orgasm being a near-universal human phenomenon, we still don’t know all that much about it. “The amount of speculation versus actual data on both the function and value of orgasm is remarkable,” says Julia Heiman, director of the Kinsey Institute for Research in Sex, Gender and Reproduction in Bloomington, Indiana. It is estimated that one in four women in the US has had difficulty achieving orgasm in the past year, while between 5 and 10 per cent of women are anorgasmic – unable to achieve orgasm at all. But without precise data to explain what happens during this experience, there are few treatment options available for women who might want help."

"Georgiadis argues that the OFC may be the basis of sexual control – and perhaps only by letting go, so to speak, can orgasm be achieved. He suggests this deactivation may be the most telling example of an “altered state of consciousness” and one not seen, as yet, during any other type of activity. “I don’t think orgasm turns off consciousness but it changes it,” he says. “When you ask people how they perceive their orgasm, they describe a feeling of a loss of control.” Georgiadis suggests that perhaps orgasm offsets systems that usually dominate attention and behaviour. “I’m not sure if this altered state is necessary to achieve more pleasure or is just some side effect,” he says. It is possible that the inability to let go and reach this altered state may be what prohibits individuals with anorgasmia from reaching climax."

"The orgasm is a strong analgesic. With brain-activation studies of orgasm showing unique patterns of activation in regions implicated in attention, self-awareness and consciousness, researchers believe its study may also help with the control of pain. “Orgasm is a special case of consciousness,” says Barry Komisaruk at Rutgers University in Newark, New Jersey. “If we can look at different ways of inducing orgasm, we may better understand how we can use top-down processing to control what we physically feel.”"

"“This kind of research is incredibly useful,” says Heiman. “Orgasm is tied into the brain’s reward system and likely other important systems as well. There is much we can learn about the brain, about sensation, about how pleasure works and probably much more from this one physical response.”"

"This experiment occurred during the context of an orgasm study. All participants described themselves as being “consistently highly orgasmic” during study enrollment. As there has been support in the literature for a correlation between orgasm reliability and higher hypnotic suggestibility(Bridges, et al., 1985), and imagery ability (Harris et al., 1980), the degree of suggestibility of these participants may potentially have biased the results toward more robust imagery activations than expected. This may have contributed to the lack of robustness of the brain response to the physical stimulation conditions by having the explicit modeling be too suggestive of the actual physical stimulation."

"Our laboratory, the Komisaruk group, has consistently found widespread, regional brain activation leading up to and peaking at orgasm, including frontal and temporal brain regions, while conversely, the Georgiadis group report diametrically opposite results in which the frontal cortex—specifically the right medial orbitofrontal, left lateral orbifrontal, and left dorsolateral cortices—and right amygdala were deactivated during orgasm. And also in contrast with our findings of widespread activation during orgasm, the Dutch group has reported finding reliable orgasm-related activation only in the cerebellum (Georgiadis et al., 2006), and more recently, the pons (Huynhet al., 2013)"

"What happens in the brain that initiates and orchestrates the “going over” from stimulation to orgasm? This is of interest for clinical applications for individuals suffering from the inability to experience an orgasm. We attempted to elucidate this by comparing the stimulation period that immediately precedes the onset of orgasm with that at the onset of orgasm."

"As predicted, the results showed clear evidence that many brain regions were differentially activated during the course of genital stimulation leading up to and culminating in orgasm in these women. These activations include sensory, motor, reward, frontal cortical and brainstem regions, i.e., the genital sensory cortex (paracentral lobule), secondary somatosensory cortex (operculum SII, regions OP1 and OP4), precuneus, inferior parietal lobule, insula, hippocampus, amygdala, cerebellum, supplementary motor area, dorsal and ventral striatum (caudate, putamen, and nucleus accumbens), substantia nigra, the mesolimbic dopamine system (ventral tegmentum), hypothalamus, pons, anterior and posterior cingulate cortex, temporal pole, and the prefrontal cortex."

"Based upon the results of the various analyses of the transition from the later stimulation through orgasm, we conclude that “going over” into orgasm involves a complex interaction between sensory integration, motor, reward, and cognitive region, involving the autonomic nervous system. The evidence of activation of brain regions that control both sympathetic and parasympathetic activity at orgasm in this study of women suggests that, similar to the dual activation involved in orgasm in men (penile erection: parasympathetic function; ejaculation: sympathetic), both divisions of the autonomic nervous system contribute to the process of orgasm in women."

"Overall, our findings lead us to conclude that women’s orgasm is a major neurological event, involving widespread activity in many regions of the brain. Future effective connectivity studies should help elucidate how the activity of these regions develops and is integrated over the course of stimulation, orgasm, and recovery in the totality of the orgasm sequence."

"The findings presented in this dissertation suggest that the brain is capable of responding robustly to both physical “touch” and mental “imagined” stimulation. As physical genital stimulation builds up and culminates in the major neurological event of orgasm, many brain regions implicated in sensory, motor, cognitive, and reward processes are recruited along the way. How these regions interact to create the complex phenomenological experiences of sexual arousal and orgasm are yet to be fully understood. Fortunately, we are at the brink of advances in methodology that will facilitate our ability to address this, and other questions, raised by this dissertation."

"Recent work with real-time fMRI, in conjunction with compatible EEG/MEG, shows promise in allowing us to observe the brain at work (or play). Perhaps this method, in conjunction with effective connectivity data analysis techniques, will permit us to unravel the continuing mysteries of the orgasm sequence. How the various brain regions influence each other, activating and inhibiting one another, to produce the pleasures leading up to and including orgasm may well have applications beyond the bedroom. This method has already been therapeutically applied as a tool for neuro biofeedback, with the goal to increase activity in the left amygdala (Zotev et al., 2014) and insula (Veit et al., 2012), which has been associated with enhanced mood regulation and reduced symptoms of anxiety and depression. It is possible that by studying people who are virtuosos in regulation of their pleasure systems, such as the easily orgasmic women in our study who activated their genital sensory cortex simply by “imagining” genital stimulation, or the population of women who can literally “think” themselves into orgasm, previously studied by our group(Whipple et al, 1992), we will learn more effective strategies for helping mood-challenged individuals exercise the brain’s capacity for self-regulation."