"In trans women who have initiated hormone therapy, but who have not undergone genital reconstruction surgery, difficulty in achieving orgasm was seen to decrease. In one study, the prevalence of orgasmic dysfunction decreased to 29.2% from 46.7% after the initiation of hormone therapy. Whether this finding can be attributed to the simultaneous decrease in gender dysphoria and body dysmorphia associated with the initiation of hormone therapy still needs to be investigated. Ability to orgasm in trans women post-vaginoplasty has also been studied. Due to the unique anatomy of trans women post-operatively, it must be noted that orgasms can occur at multiple locations including the clitoris and prostate via masturbation or vaginal penetration, for example. There is variability in the rates of orgasm post-operatively with studies citing percentages between 40–100%. These studies used the FSFI to assess orgasmic scores and demonstrated ranges of 2.82 to 4.0 out of 6 in comparison to cisgender women without sexual dysfunction who scored an average of 5.1. When analyzing the correlation between sexual activity and achieving orgasm, one study found that direct stimulation of the clitoris had a higher frequency of orgasm when compared to intercourse. In assessing frequency and quality of orgasms post-operatively, studies are inconsistent. While one study reported an increase in orgasm frequency with sexual activity post-operatively, another study of 91 trans women postoperatively found orgasms to occur less frequently in 52.6% of participants and more frequently in 20.5% of participants. Quality of orgasms, when investigated, was found to be more pleasurable postoperatively in 51% of a 218 person study and with no changes in 62.5% of a 31 person study."