The Female Orgasm- What's normal and helpful to achieve one?
It is very common to have women, regardless of age or number of children, bring up the topic of orgasm in pelvic floor therapy. Usually, the topic stems from a worry of being abnormal, not orgasming enough, wanting to orgasm more, or feeling that they are orgasming in the wrong way. Unfortunately, I think society has painted an inaccurate and often unrealistic picture of female pleasure and orgasm. So, I decided to dive in and share some of what we do and don’t know about the female orgasm!
A Finland study performed surveys in 1971, 1992, 1999, 2007, and 2015 with over 100 questions ranging from age of first orgasm with masturbation to occurrence of orgasm with most recent sexual encounter.1 The lowest age range in each year surveyed was 18 years old with the highest ranging from 54 years old in 1971 to 81 years old in 1999. In 2015, 46% of women said they always or nearly always had orgasm with intercourse, but only 6% of women reported always having an orgasm. 16% had an orgasm about half of the time and 38% reported infrequent orgasms. 9% of women reported never having an orgasm with intercourse. 54% of women reported orgasm with clitoral and vaginal stimulation while 34% reported orgasm with clitoral stimulation. 6% of women reported orgasm with vaginal stimulation only.1
The results showed that increased experience and practice of masturbation or experimentation with different partners did not increase frequency of orgasm.1 Instead, more frequent orgasms were a result of mental and relationship factors. For example, mutual sexual initiation, partner’s good sexual techniques, a healthy and emotionally cohesive relationship, and approaching sex with openness and appreciation increased orgasm.1
Here are some responses that lead to increased frequency of orgasms:
- Experiences with a consistent partner were associated with increased frequency of orgasms.1
- About 90% of women usually had orgasms during intercourse when they considered orgasm to be important.
- The likelihood of achieving orgasm during intercourse was higher when happiness was reported in a romantic relationship. It also increased in those who considered sex to be important for happiness.
- When women were more active, such as being on top, changing positions throughout intercourse, and oral/manual sex increased the likelihood of orgasm.
- “Good sexual communication contributed to female orgasm almost as much as favorable sexual techniques”.
- Love-making lasting at least 15 minutes up to 20 minutes allowed orgasm to be achieved more easily.
- Increased sexual self-esteem, accepting of oneself and body were helpful to increase pleasure during intercourse.1
A 2016 article explored the clitoral versus vaginal orgasm discussion and found that women can experience orgasms from one or more areas of sensory input including genital and non-genital areas.2 A 2011 functional MRI, which is an MRI performed during an activity to track the brain’s response, found that there are partially overlapping zones of the somatosensory cortex that are activated with stimulation of the clitoris, anterior vagina, cervix and nipples. 2 The somatosensory cortex is the part of the brain that receives sensory information such as touch, pressure, pain, or temperature.
Based on studies from the 1960s and 1970s, most women require clitoral stimulation, either alone or with vaginal insertion, to orgasm as compared to vaginal insertion alone.2 In fact, about 70% of women experienced orgasm from clitoral stimulation alone while about 26% were able to achieve orgasm with vaginal stimulation alone. This could be explained by the difference in nerves in each area. The lower 1/3 of the genital tract, such as the introitus or vaginal opening, have more nerves including more specific sensory information whereas the upper 2/3 are more nerve sparse. 2
Not only can the areas resulting in orgasm vary from person to person, but there is a wide variety of orgasm function in women.2 Some orgasm regularly while others don’t. Some women may have difficulty achieving orgasm and this can be due to a variety of reasons including stress, partner-related factors, or medications such as SSRIs.2
An interesting hypothesis is that the cervical and uterus contractions associated with orgasm create a facilitation of sperm to move up into the reproductive tract. In 1982, a study looked at the pelvic floor muscle strength and found that it correlated with the pleasure achieved with clitoral stimulation to orgasm.2 A later study in 1995 found that pelvic floor contractions produce the cervical and uterus contractions during orgasm that may help with the hypothesis of sperm facilitation into the reproductive tract.2
Both males and females experience the stages of human sexual response including excitement, plateau, orgasm and resolution.2 There are different types of female orgasm including clitoral, vaginal, or a mixture. Vaginal may include stimulation of the “G-spot” or cervix.
Speaking of the G-spot! This is a commonly used term in normal conversation around intimacy; however, from a medical standpoint there is a lack of consistency regarding its existence and location.
A 2021 systematic review found 31 studies looking at the existence and location of the G-spot.3 There were a variety of study types including surveys, imaging, and anatomical. 62.9% of women reported having a G-spot in survey studies. 55.4% of women were identified with having a G-spot in studies that used digital or instrumental assessment of vaginal walls. 2 of the digital and instrumental studies identified a G-spot in all women while another 2 studies found none. There were many biases to the digital/instrumental studies.3
The 9 imaging studies had contradictory results in terms of existence and nature.3 Ultrasound found that there can be a descent of the front vaginal wall which may increase contact with an object, like a penis, inserted into the vaginal wall. Two of the imaging studies used MRI and the other 7 used ultrasound.3
One anatomical study could identify the G-spot while another could not.3 Studies looking at the nerves of the vaginal walls could not identify an area with increased innervation.
This review concluded that the G-spot does likely exist; however, there is no agreement on the location, size or anatomical makeup. It emphasized that female sexuality, including orgasm, is complex and includes a multitude of factors, such as “hormones, psychological aspects, culture, religion, anatomy, and previous experience”.3 So, if you don’t feel like you have a G-spot or have never found one despite valiant effort, that’s ok! A G-spot is not necessarily needed to orgasm and there is no medical definition of one currently.
Overall, most women orgasm either with clitoral stimulation or clitoral stimulation with vaginal stimulation than with vaginal stimulation alone. This is a question I often get from women who fear they aren’t “normal” because they can’t or haven’t orgasmed with strictly vaginal stimulation. Orgasms have less to do with one specific area and more to do with understanding your individual arousal and cues to facilitate an orgasm, stimulation of the external clitoris, internal clitoris, and/or cervix, and incorporation of other erogenous zones such as nipples, ears, inner thighs, etc. Orgasms are different for each woman. Also, it is common for orgasms to change and adapt over a lifespan. So, the most important takeaway is that orgasms need to be individualized as there is no one size fits all. Understanding your body and the contributors to your arousal and climax with either masturbation or a loving, safe partner are vital to achieving an orgasm whether that be clitoral, clitoral and vaginal, or vaginal.
Written by Jordan Schmidt, PT, DPT
References
- Kontula, O., & Miettinen, A. (2016). Determinants of female sexual orgasms. Socioaffective neuroscience & psychology, 6, 31624. https://doi.org/10.3402/snp.v6.31624
- Pfaus, J. G., Quintana, G. R., Mac Cionnaith, C., & Parada, M. (2016). The whole versus the sum of some of the parts: toward resolving the apparent controversy of clitoral versus vaginal orgasms. Socioaffective neuroscience & psychology, 6, 32578. https://doi.org/10.3402/snp.v6.32578
- Pedro Vieira-Baptista, Joana Lima-Silva, Mario Preti, Joana Xavier, Pedro Vendeira, Colleen K. Stockdale, G-spot: Fact or Fiction?: A Systematic Review, Sexual Medicine, Volume 9, Issue 5, October 2021, Page 1, https://doi.org/10.1016/j.esxm.2021.100435
