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Objectives: To explore, in an age perspective, women's lifetime sexual techniques and the extent to which they had led to orgasm. To relate these techniques and current erotic perceptions to orgasmic function in women sexually active during the last 12 months and to describe the relative impact of orgasmic function/dysfunction on their sexual well-being. Methods: A nationally representative sample of 18- to 74-year-old women (N = 1,335) participated. Nearly all were heterosexual. Current orgasmic capacity was broadly and subjectively classified into: no, mild, or manifest dysfunction. Sexual techniques and erotic perceptions were recorded together with level of sexual satisfaction. Results: Generational differences characterized age at first orgasm and intercourse, types and width of sexual repertoire, and also current erotic perceptions, while orgasmic dysfunction and distress caused by it were less age dependent. Likely protectors of good orgasmic function, mainly against manifest dysfunction, were: a relatively early age at first orgasm, a relatively greater repertoire of techniques used--in particular having been caressed manually or orally by partner(s), achievement of orgasm by penile intravaginal movements, attaching importance to sexuality and being relatively easily sexually aroused. In turn, among other aspects of female sexual function women who did not have orgasmic dysfunction or distress were particularly likely to be satisfied with their sexual life. Conclusion: Besides providing data on matters frequently said to be sensitive this investigation shows that women's generation and with it several long-ranging aspects of women's sexual history and their feelings of being sexual are important indicators of their orgasmic and thereby their overall sexual well-being. When (in clinical practice) establishing treatment strategy for women with orgasmic dysfunction due respect should be given to these factors.
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J Sex Med 2006;3:5668 © 2005 International Society for Sexual Medicine
Blackwell Science, LtdOxford, UKJSMJournal of Sexual Medicine1743-6095Journal of Sexual Medicine 20052006315668Original ArticleOrgasm, Sexual Techniques, and Erotic Perceptions in WomenFugl-Meyer et al.
On Orgasm, Sexual Techniques, and Erotic Perceptions
in 18- to 74-Year-Old Swedish Women
Kerstin S. Fugl-Meyer, PhD,* Katarina Öberg, MSc, Per Olov Lundberg, MD, PhD, Bo Lewin, PhD,§
and Axel Fugl-Meyer, MD, PhD
*Andrology Center, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of
Neuroscience, Rehabilitation Medicine; Department of Neuroscience, Neurology; §Department of Sociology;
Department of Neuroscience, Rehabilitation Medicine, Uppsala University, Uppsala, Sweden
DOI: 10.1111/j.1743-6109.2005.00170.x
Objectives. To explore, in an age perspective, women’s lifetime sexual techniques and the extent to which they had
led to orgasm. To relate these techniques and current erotic perceptions to orgasmic function in women sexually
active during the last 12 months and to describe the relative impact of orgasmic function/dysfunction on their sexual
Methods. A nationally representative sample of 18- to 74-year-old women (N = 1,335) participated. Nearly all were
heterosexual. Current orgasmic capacity was broadly and subjectively classified into: no, mild, or manifest dysfunc-
tion. Sexual techniques and erotic perceptions were recorded together with level of sexual satisfaction.
Results. Generational differences characterized age at first orgasm and intercourse, types and width of sexual
repertoire, and also current erotic perceptions, while orgasmic dysfunction and distress caused by it were less age
dependent. Likely protectors of good orgasmic function, mainly against manifest dysfunction, were: a relatively
early age at first orgasm, a relatively greater repertoire of techniques used—in particular having been caressed
manually or orally by partner(s), achievement of orgasm by penile intravaginal movements, attaching importance
to sexuality and being relatively easily sexually aroused. In turn, among other aspects of female sexual function
women who did not have orgasmic dysfunction or distress were particularly likely to be satisfied with their sexual life.
Conclusion. Besides providing data on matters frequently said to be sensitive this investigation shows that women’s
generation and with it several long-ranging aspects of women’s sexual history and their feelings of being sexual are
important indicators of their orgasmic and thereby their overall sexual well-being. When (in clinical practice)
establishing treatment strategy for women with orgasmic dysfunction due respect should be given to these factors.
Fugl-Meyer KS, Öberg K, Lundberg PO, Lewin B, and Fugl-Meyer A. On orgasm, sexual techniques, and
erotic perceptions in 18- to 74-year-old Swedish women. J Sex Med 2006;3:56–68.
Key Words. Epidemiology; Risk Factors/Comorbidities; Female Orgasmic Disorder
his article is one in a series of reports [1–5]
focusing on female and male sexual dysfunc-
tions using data from a cross-sectional investiga-
tion on “Sex in Sweden” performed in 1996 and
published first in Swedish and later in English [6].
The main objectives of this explorative analysis
are: (i) to describe some coital and masturbatory
techniques in Swedish women; (ii) to relate these
techniques and some current erotic perceptions to
the orgasmic experience; (iii) to relate the relative
frequencies of the techniques and erotic percep-
tions to the orgasmic function during the last
12 months; and (iv) to relate this experience to
gross level of sexual well-being. The overall aim is
to provide professionals working within sexual
medicine/sexology further epidemiologically
Orgasm, Sexual Techniques, and Erotic Perceptions in Women 57
J Sex Med 2006;3:5668
based data on correlates of orgasmic function/dys-
function to be taken into account when dealing
therapeutically with women who seek help for
orgasmic dysfunction.
In the field of epidemiological sexual medicine
research, one major difficulty is the definition of
orgasm, especially regarding the emphasis given to
subjectively experienced as opposed to objectively
measured signs of orgasm [7]. Levin [8], for
instance, recorded in 1981 that he could list 13
different definitions. Twenty years later, twice as
many definitions of orgasm were listed [9]. In spite
of problems of exact definition, there is neverthe-
less a certain historical consensus on the nature of
orgasm. According to Laqueur [10], orgasm was
in antiquity regarded as the “summa voluptas
accompanying the final blast of the heated body.”
Masters and Johnson [11] were perhaps not so
extremely medicalizing as often thought when
they stated that orgasm is a psychophysiological
experience occurring within, and made meaning-
ful by, a context of psychosocial influence.
Recently, an expert committee [7] after delibera-
tions arrived at approximately the following: an
orgasm in the human female is a variable, transient
peak sensation of intense pleasure. The committee
then listed a series of accompanying physiological
In this descriptive epidemiological report,
orgasm is defined broadly and idiosyncratically:
“an orgasm is an orgasm.” In other words, the
women themselves defined the extent to which
they had been or were orgasmic. In the words of
the philosopher von Wright [12], this is a “third
person’s hedonic judgement,” meaning that
hedonic quality is brought into consciousness.
The judgment is related to the goal she has, her
“standing want” [13].
A good partner relationship is closely related to
having no orgasmic dysfunction [14,15]. Sociode-
mographic factors, such as age, education, social
class, and a history of having been sexually abused,
generally have no or weak associations with differ-
ent levels of orgasmic function [4,16]. In the
United Kingdom, Dunn et al. [14] reported signif-
icant associations between anxiety or depression
and orgasmic dysfunction. Also in the United
Kingdom, Osborn et al. [17] found that having
a psychiatric disorder is closely associated with
orgasmic dysfunction.
Major indicators of Swedish women’s orgasmic
dysfunction are their experiences of men partner’s
erectile and ejaculatory (early as well as delayed)
dysfunctions. This is particularly true when
comparing manifest with no orgasmic distressful
dysfunction, while there are generally small differ-
ences for mild vs. no such dysfunction [5].
Other factors clearly likely to accompany a
good ability to reach orgasm for those who have a
partner are being satisfied with partner relation-
ship, family life, psychological health, and satisfac-
tion with life as a whole. These findings indicate
that over a broad spectrum orgasmic women are
well adapted to their life situation [5].
Orgasm can be achieved by women through
different sensory mechanisms. The two most
important are: external sensory stimulation of the
vulva, the clitoris in particular, and the surround-
ing skin and mucosal areas; internal sensory stim-
ulation of the pelvic area and the vaginal walls.
These two regions have entirely different sensory
receptors and afferent innervation [18]. The most
important of the external nerves is the dorsal nerve
of the clitoris continuing in the pudendal nerve on
each side. The pathway of the internal sensory
innervation is less well known. The internal sen-
sory nerve fibers, together with the autonomic
efferent innervation, run through the pelvic plexus
to both the parasympathetic pelvic nerves and to
the sympathetic hypogastric plexus. Some data
also suggest that sensory impulses may go through
the vagus nerve [19]. At the moment it appears
unclear whether specific brain regions are perti-
nent for orgasm [7,20].
Many women have the capacity to obtain mul-
tiple orgasms, that is, they can reach climax on sev-
eral consecutive occasions [21,22]. Orgasm can be
obtained by both clitoral and vaginal stimulation,
but stimulation of both mechanisms usually gives
more intense pleasure. It therefore appears reason-
able to obtain epidemiological information about
the sexual stimulation techniques used by women
and their partners, and the relative frequency with
which those techniques have led to orgasm.
Basic assumptions underlying the objectives of
this investigation were that several sexual tech-
niques and the ability to reach orgasm by them
are influenced by generation. Moreover, it was
hypothesized that a positive sexual self-image and
positive attitudes toward sexuality are beneficial
for current orgasmic function.
This report is based on data obtained in a nation-
ally representative epidemiological investigation
on sexual life in Sweden carried out in 1996 [6].
The investigation was initiated and financed by
58 Fugl-Meyer et al.
J Sex Med 2006;3:5668
the Swedish National Institute of Public Health
and conducted by Lewin in cooperation with four
other researchers. Structured, face-to-face inter-
views were combined with questionnaires/
checklists. All interviewers had been specially
trained for the task. The investigation was
approved by the Ethics Committee of the Swedish
Council for Research in the Humanities and
Social Sciences in 1995.
For a detailed description of the validity, the
methods, and the approximately 800 variables, see
[6] (pp. 31–57). In brief, to cover a broad spectrum
of knowledge about what should be surveyed
representatives from organizations such as the
national associations for sex education, for bat-
tered women and for lesbian and gay rights par-
ticipated in planning meetings. Professional
groups in the field of sexual medicine/sexology
were also consulted. The research team then con-
ducted a number of pilot interviews followed by a
respondent/interviewer review of all items. The
purpose was to ascertain that the respondent’s
actual experience was reflected by the interview/
A random sample of 5,250 women and men aged
18–74 was drawn from the central population reg-
ister; 4,781 remained after exclusion criteria. A
total of 1,335 women participated on a voluntary
basis. Inclusion criteria were: the ability to com-
municate in Swedish, residency in Sweden at the
time of the investigation, and the physical and
mental capacity to participate. The response rate
was 59%.
The distribution of age cohorts—sociologically
([6], p. 63) characterizing different periods in
life—was 18–24 years (N = 212), 25–34 (N = 314),
35–49 (N = 397), 50–65 (N = 310), 66–74
(N = 102).
An informative letter, stating the general aims of
the study, was mailed to the subjects, who were
then telephoned by an interviewer. Those who
then volunteered to participate were asked about
a suitable place for the interview, and nearly all of
them chose their homes. To minimize interviewer/
respondent biases, answers to the variables used in
this report were gathered via questionnaires and
checklists that were returned to the interviewer in
sealed envelopes. Women were asked about the
following variables:
Age at first penetrative coitus and at their first
orgasmic and masturbation experience, if recalled.
One question, related to age, addressed if (yes/no)
the women still had their menstruations.
Sexual Orientation. Two questions addressed the
women’s sexual orientation. These were phrased: if
you think of persons you: q1) have been attracted
to; q2) have been sexually together with, which
gender did they have? Moreover, all questions on
sexual techniques (see below) were phrased so that
respondents could report whether this pertained to
being with a man or a woman.
First Orgasm
The respondents were asked by which sexual
activity they had reached their first orgasm.
Alternatives were: masturbation/manual genital
caressing (by partner)/oral sex/penile vaginal pen-
etration/anal sex/during sleep/“other ways.”
Sexual Techniques
Women could respond yes or no to the experience
of the following sexual activities: masturbation;
manual genital caressing by self and by partner;
cunnilingus; fellatio; the use of “vibrator/artificial
penis/or other sex toy,” here termed dildos, alone
or with partner; partner/penile–vaginal inter-
course; and anal sex. Approximate time since most
recent intercourse, not exclusively penetrative, was
noted. Those who had had intercourse during the
preceding 12 months were regarded as sexually
Masturbation Techniques
Women were asked which part of the genitals they
mostly stimulated if having masturbated. Alterna-
tives were the clitoris/the vagina/the clitoris and
vagina equally/neither clitoris nor vagina.
Orgasmic Quality
To highlight whether the quality of orgasm was
affected by penile–vaginal penetration, respon-
dents were asked (yes/no) which of the following
alternatives described their experience of orgasm:
best with the penis in the vagina/plays no role/
worse with the penis in the vagina. They were also
asked to respond yes or no if they had ever had an
orgasm solely by the movements of the penis, and
if they had ever achieved orgasm without stimula-
tion of the clitoris.
Current Erotic Perceptions
The women were asked if they felt that they more
easily than most people: (i) fell in love; and (ii)
became sexually aroused. Their alternatives for
both questions were yes or no. Having (yes) or not
having (no) sexual fantasies was an aggregation of
Orgasm, Sexual Techniques, and Erotic Perceptions in Women 59
J Sex Med 2006;3:5668
five questions, mostly on different focuses of fan-
tasies. The respondent was also asked how impor-
tant sex was in her life at the moment. Alternative
answers were among a five-graded scale: not at all
important/rather unimportant/neither unimpor-
tant nor important/rather important/very im-
portant. The scale has subsequently been
dichotomized into rather and very important vs.
the other scale steps.
Orgasmic Function/Dysfunction
Each woman who had been sexually active during
the preceding year judged her level of orgasmic
function (per se) by answering the question: “It
happens that the woman has difficulties reaching
orgasm. Has this happened in your sexual life dur-
ing the last 12 months?” If dysfunction per se pre-
vailed, the woman answered a question: “Has this
been a personal problem for you?” (personally
distressing orgasmic dysfunction). Answers, to both
questions, were given along a six-graded scale: “all
the time, nearly all the time, quite often, hardly
ever, quite rarely, never.” For simplification we
[4,5] have elsewhere described a trichotomy of this
scale into manifest dysfunction (occurring all the
time, nearly all the time, quite often), mild dys-
function (occurring quite rarely, hardly ever) indi-
cating that the dysfunction occurs sporadically.
The alternative “never” gave at hand that no
orgasmic dysfunction had occurred during the last
year. Level of dysfunctional distress was described
Sexual Well-Being
The level of sexual well-being was measured by
the statement: “My sexual life is” taken from the
LiSat-11 checklist [23]. Answering alternatives
were: “very satisfying, satisfying, rather satisfying,
rather dissatisfying, dissatisfying, very dissatisfy-
ing.” This scale can with validity be dichotomized
into very satisfied/satisfied (which denotes a high
level of sexual well-being) vs. the other four alter-
natives (denoting a low level). Using this dichot-
omy it was shown that satisfaction with sexual life
is not age dependent [23], in Sweden, in the age
span studied here; but it is very closely related to
not having a steady partner. In fact, among those
who had a partner more than 60% had a high level
of sexual satisfaction, while this was the case for
slightly above 20% of the singles.
SPSSTM version 10.1 was used for all analyses. To
minimize the number of type I errors (but, of
course, thereby increasing the risk of type II
errors) the level of significance was set at
P < 0.010. For computations of differences
between groups, cross-tabulations with χ2, Mann–
Whitney (MW), or Kruskal–Wallis (KW) tests
were performed as appropriate. For analysis of
likelihoods of pairs of variables to co-occur, simple
(univariate) logistic regression with computation
of odds ratios (OR) was chosen. While the odds
ratio is the ratio between the probability for a
particular phenomenon (for instance, orgasmic
dysfunction) to occur when compared with the
probability that it does not do so (for instance, no
orgasmic dysfunction) it does not give the confi-
dence interval from which can be revealed the
closeness of the two phenomena to overlap. In
clinical practice it, to us, appears relevant to be
reasonably sure of how far the 99% confidence
interval is from overlapping, that is, to which
degree the clinician can expect the phenomenon
to be meaningful for the treatment strategy. We
therefore operationally chose to use clinical
meaningfulness as an indicator of how far from
overlapping the lower (if greater than 1.0) or
higher (if lower than 1.0) the confidence interval
of any particular OR was. Accordingly we recently
[5] suggested a dichotomy of significant (P
0.010) ORs into: clinically meaningful (lower level
of confidence interval being 1.5 or if reciprocal
0.67) and possibly clinically meaningful (lower
level >1.0, 1.49 or 0.99, >0.67). In this report
we add one class of clinical meaningfulness,
termed borderline clinically meaningful, its lower
level of confidence interval 1.4 <1.5 or if recip-
rocal 0.67, 0.71.
In the total sample 0.5% reported that they had
only been sexually attracted to women and 0.4%
had had sex only with women. Further 0.2% usu-
ally had been attracted to/had had sex with women
but occasionally with men; while additionally
0.1% reported that they equally often had been
attracted to/had had sex with women and men.
The remaining, nearly 99%, reported that they
were attracted to men and had only had sex with
men. Of those who had been sexually active 99.5%
were heterosexual. Hence, we shall in the text not
specially address the very small number of report-
edly lesbian or bisexual women in this sample.
Furthermore, concerning sexual techniques, when
applicable, 1% or less reported that partner(s) had
been women. Although apparently low this prev-
alence by and large is reasonably congruent with
60 Fugl-Meyer et al.
J Sex Med 2006;3:5668
that reported from other European countries ([6],
pp. 177–182).
Of the 1,335 women, 94% reported whether or
not they had ever reached orgasm. Of these, 3%
had never done so. This was the case for 8% of
the 18- to 24-year-olds and for 2% of all other age
cohorts. Among those who reported that they had
had an orgasm, 93% recalled the age at which this
was first reached (Table 1). For the two youngest
cohorts this happened at a median age of 16. The
age rose successively and significantly up to a
median of 19 in the oldest cohort. Besides a non-
significant difference between the two youngest
cohorts age increased systematically (MW, z: 2.7–
8.6, P < 0.010–0.000) cohort by cohort. While 9%
recalled their first orgasm to have occurred before
their teens, four women reported that they were
at or over 40. One of these was 65 when she had
her first orgasm.
While 88% of the 8- to 24-year-olds had had
penile vaginal intercourse 96–99% of all other
cohorts had engaged in this practice. For the total
sample the age at first penetrative intercourse (see
Table 1) increased significantly with increasing
age cohort. However, the three youngest cohorts
did not differ significantly in this respect; while
these cohorts had a significantly lower age at first
vaginal intercourse than had the two oldest
cohorts (MW, z: 4.3–8.9; P < 0.000).
For all respondents, the most commonly
recalled sources of first orgasm (see Table 1) were
penile vaginal penetration (36%), systematically
more common with increasing age, and mastur-
bation (35%), systematically less common with
increasing age. However, nearly equal proportions
among the two youngest cohorts had these as first
source of orgasm. The third most commonly
reported source of first orgasm was a partner’s
manual caressing of the woman’s genitals (about
20–25% in all age cohorts). Cunnilingus was, age
dependently, the first source for 4%. Among the
other alternatives anal sex was reported by one
woman. Furthermore, 12 women recalled their
first orgasm to have occurred during sleep, and 20
checked the option “other ways.” Within the five
age cohorts there were no significant differences
in source of obtaining first orgasm between those
who had and those who had not been sexually
active during the preceding year.
As shown in Table 2, the prevalence of ever
having masturbated or of having used a dildo with
masturbation decreased sharply in the two oldest
cohorts. Nearly 90% of the women had received
or given a partner stimulation manually. For the
majority, more than 80%, partner’s genital caress-
ing had led to orgasm. For this variation, and also
for cunnilingus and fellatio, the youngest cohort
and the two oldest cohorts (particularly the oldest
one) had a lower prevalence of practice, and for
those who had engaged in these practices a lower
prevalence of orgasm was reported. The same age
effect appeared in relation to a partner using a
dildo for her pleasure; while the two oldest
cohorts had a much lower prevalence of experi-
ence with anal sex than had those younger than
50. More than 90% of the women had had pene-
trative intercourse, but between 39% and 46%
had never obtained orgasm through this activity.
Correction of the prevalence of women who had
reached orgasm through the different practices by
the proportions of women who had used them
showed that considerably more women between
18 and 65 had obtained orgasm by manual genital
caressing than by penetrative intercourse. This
Tab le 1 Median age at first orgasm and first vaginal intercourse, and the most common sources of first orgasm (%) as
recalled by 1,241 Swedish women aged 18–74 years
18–24 years
N = 184
25–34 years
N = 301
35–49 years
N = 385
50–65 years
N = 287
66–74 years
N = 84
18–74 years
N = 1,241
Age at first
Orgasm 16 years 16 years 18 years 18 years 19 years 18 years 142.5
Vaginal intercourse 16 years 16 years 16 years 18 years 19 years 16 years 113.9
Sources of first orgasm
Masturbation 46% 49% 33% 24% 7% 35% 79.9
Manually caressed 19% 23% 27% 20% 23% 23% 7.2
Cunnilingus 6% 5% 3% 1% 0 4% 14.6
26% 21% 33% 54% 63% 36% 106.3
Orgasm, Sexual Techniques, and Erotic Perceptions in Women 61
J Sex Med 2006;3:5668
was also true for the 25- to 49-year-olds concern-
ing cunnilingus.
For the 18- to 65-year-olds, a median of five of
the seven different partner-related sexual practices
(receiving and giving manual genital caresses, cun-
nilingus, fellatio, penetrative intercourse, partner
stimulating the woman using dildo, and anal sex)
were experienced in a lifetime. For the oldest
cohort, the median lifetime experience was down
to three.
We did not, unfortunately, register the relative
prevalence of obtaining orgasm by anal sex or by
masturbation. However, we did find that the pre-
ferred masturbation technique was mainly clitoral
stimulation for 69%, while 28% preferred to stim-
ulate both the clitoris and vagina. A small minority
(not fully 3%) only stimulated the vagina. A few
women had chosen none of these options. There
were no significant differences in lifetime mastur-
batory habits among age cohorts. But the ability
to reach orgasm (Table 3) solely by penile move-
ments in the vagina was age independently
reported by about 55%, and a capacity to reach
orgasm without clitoral stimulation was reported
by not fully 50% of women aged 18–65 years,
while fewer in the oldest age cohort had had this
When asked if the quality of orgasm during
heterosexual intercourse was influenced by penile
penetration, 60–65% of women younger than
50, and 75% of those between 50 and 74 experi-
enced better orgasms with the penis in the
vagina. A small minority felt that the orgasmic
quality was lower with the penis in the vagina.
The remaining, 24% to about 35%, reported
that it did not make any difference whether or
Tab le 2 Prevalence of lifetime sexual techniques and if applicable prevalence (in bold) of those who by the practice had
reached orgasm
Sexual techniques
18–24 years
25–34 years
35–49 years
50–65 years
66–74 years
18–74 years
Masturbation 80 89 84 64 35 77 136.9
Manual genital
91 96 96 88 71 89 66.9 (25.8
(75) (86) (89) (84) (72) (83) 0.000 <<
Caressing partner
87 97 97 86 59 86 137.5
Cunnilingus 83 95 88 69 26 77 235.8 (17.2
(61) (73) (73) (65) (48)*(69) 0.000 <<
Fellatio 78 93 83 54 15 70 282.8
Penetrative intercourse 88 99 99 98 96 96 50.4 (4.6
(54) (57) (56) (61) (56) (56) 0.000 <<
Partner used dildo 11 23 20 6 1 woman 15 55.3 (5.6
(50)*(70) (70) (72)*(1 woman)*(66) 0.000 <<
Self used dildo 22 30 22 7 2 women 19 70.0 (10.5
(75)*(85) (92) (95)*(1 woman)*(86) 0.000 <<
Anal sex 27 28 24 8 2 20 64.5
*Denotes that proportion/number of women having practiced this type of sexual activity was <50.
na = not applicable.
Tab le 3 Prevalence of lifetime ability to reach orgasm with or without stimulation of the clitoris in Swedish women aged
18–74 years
18–24 years
25–34 years
35–49 years
50–65 years
66–74 years
18–74 years
Orgasm, penile movement 51 57 56 56 55 57 4.6
Orgasm, without clitoral
48 48 45 49 39 47 3.6
Is best with penis in vagina 60 65 60 75 75 66 27.1
Makes no difference if
penis in vagina
34 32 36 24 24 31 27.1
Is less good with penis
in vagina
62 Fugl-Meyer et al.
J Sex Med 2006;3:5668
not the penis was in the vagina. Women who
had had their first orgasm with penile vaginal
penetration reported the quality of orgasm to be
best with the penis in the vagina (χ2: 64.8,
P < 0.001), but there were no significant associa-
tions between masturbation techniques and the
experienced quality of orgasm.
Eighty-five percent of the women had been
sexually active during the preceding 12 months.
Further, at the time of the investigation 80% or
more of the 25- to 65-year-old women had a
steady partner (Table 4). As expected, considerably
smaller proportions of the youngest and the oldest
cohorts had steady partners. Unsurprisingly, the
vast majority of those who had a partner had been
sexually active during the preceding year. Fewer of
those who had no steady partner were sexually
active, but still about half to two-thirds of these
younger than 50 were so. A significant decrease in
sexual activity for the two oldest cohorts is evident,
particularly for the single women; and cross-tabu-
lation for the full 18–74 years sample showed a
significant decrease in sexual activity with increas-
ing age. This began with the 50–65 years cohort.
Current Erotic Perceptions
The prevalence of each of the four chosen items
intended to characterize the women’s erotic per-
ceptions at the time of the investigation is given
in Table 5. Whereas there, for the total sample,
were significant age-related decreases in positive
erotic perceptions there are generally small differ-
ences between the three relatively younger
cohorts. As shown, sexual fantasies and impor-
tance ascribed to sexuality prevailed for more than
80% of those younger than 50, but decreased
sharply to about 65% in the 50- to 65-year-olds.
A further decrease in the number of women who
considered their sexuality important occurred in
the oldest cohort. It deserves emphasis that about
60% of the oldest women had sexual fantasies and
nearly half of them attached importance to their
own sexuality. However, while 85–90% of women
who had a steady partner regarded their sexuality
as important, 71% of the 50- to 65-year-olds and
“only” 56% of the oldest cohort did so. Further-
more, 66–77% of those who had no steady partner
attached importance to their sexuality. The corre-
sponding proportions were for the 50- to 65-year-
old and the 66- to 74-year-old women as low as
38% and 33%, respectively. Concerning ease of
becoming sexually aroused, about 15% of those
younger than 50, but considerably fewer of the 50-
to 74-year-olds felt more easily aroused than most.
Up to 13–20% among the youngest cohorts but
only 9% in the oldest cohorts felt that they fell
easily in love. For all of these factors, the decreases
at age 50 and beyond were statistically significant.
Compared with women who were not sexually
active, those who had been sexually active during
Tab le 4 Prevalence of having a steady partner and of being sexually active in different age cohorts
18–24 years
25–34 years
35–49 years
50–65 years
66–74 years
18–74 years
Has steady partner 65 87 85 80 52 79 90.6
Sexually active
Has partner 99 99 98 87 78 95 49.4
Does not have partner 67 67 58 29 18 50 49.4
Tab le 5 Prevalence of some current erotic perceptions in women aged 18–74 years
18–24 years
25–34 years
35–49 years
50–65 years
66–74 years
18–74 years
More easily falls in love
than most
16 20 13 9 9 14 18.3
More easily aroused
than most
18 12 12 6 7 11 16.9
Has sexual fantasies 92 89 84 63 61 80 124.9
Sexuality is important 83 88 82 65 45 77 112.1
Orgasm, Sexual Techniques, and Erotic Perceptions in Women 63
J Sex Med 2006;3:5668
the last year more often perceived that sexuality
was important in their own life (χ2: 222.0,
P < 0.000), that they had sexual fantasies (χ2: 25.0,
P < 0.000), that they were more easily sexually
aroused than most (χ2: 9.8, P < 0.005), and that
they more easily than most could fall in love (χ2:
7.7, P < 0.01).
Correlates of Orgasmic Function/Dysfunction in
Sexually Active Women
As described in more detail elsewhere [4,5] about
half and up to two-thirds of the sexually active
women described mild orgasmic dysfunction and
roughly 20% had manifest orgasmic dysfunction
(Table 6). Fewer (8–15%) were manifestly dis-
tressed, while between 31% and 45% were mildly
distressed. The 50- to 65-year-olds had a signifi-
cantly (MW, z: 3.48, P < 0.001) higher cumulated
prevalence of manifest and mild distressing dys-
function than had the 25- to 34-year-old women.
This appears to be reflected by the significant
(KW, χ2: 14.9, P < 0.005) age impact for the total
(18–74 years) sample. Otherwise, there were no
significant differences between the age cohorts in
the level of orgasmic dysfunction per se or in terms
of distress. It should be emphasized, however, that
considerably fewer women in the oldest cohort
were sexually active, and had a lower response rate
than the other cohorts. Moreover, as can be seen
in Table 6, there were considerable, although not
systematically age dependent, differences in the
ratio: mild to manifest dysfunctions, ranging
(dysfunction per se) from 1.9 in the youngest to
3.8 in the 35- to 49-year-old women. The latter
cohort also had the highest ratio of distressing
mild to manifest dysfunctions (5.0) about twice
that of the youngest and the oldest cohorts.
In the total (N = 1,335) sample 29% were post-
menopausal and as expected significantly (χ2:
114.9, P < 0.000) fewer among the postmeno-
pausal than among the premenopausal (92%) were
sexually active. In these sexually active women
being pre- or postmenopausal was not significantly
associated (manifest or mild as opposed to no) of
orgasmic function, whether per se or distressing.
In order to determine the likelihood of the var-
ious degrees of orgasmic dysfunctions (per se or
distressing) occurring together with the series of
items given in Table 7, simple (univariate) logistic
regressions were performed. We shall here only
address clinically meaningful and borderline
meaningful ORs. All ORs are nevertheless given
in Table 7, which shows a significant likelihood
(ORs between 2.4 and 5.4) of concurrence
between no manifest orgasmic dysfunction (both
categories) and lifetime orgasm reached by manual
or oral genital stimulation together with the per-
ception that sexuality is important. Furthermore,
the perception that one is more easily sexually
aroused than most women concurs (borderline)
with no orgasmic dysfunction per se, as compared
with both distressful manifest and mild dysfunc-
tions. Reaching coital orgasm solely by penile
movements is clinically meaningfully, and a rela-
tively early age of first orgasm is borderline mean-
ingful factors that are about 2.5 times more likely
to be correlated with an absence of orgasmic
Sexual Well-Being and Orgasmic Function
Simple logistic regression (Table 8) gave at hand
that generally and regardless of age cohort women
with no manifest orgasmic dysfunction were much
more likely to be satisfied or very satisfied with
their sexual life than those with manifest dysfunc-
tions, whether per se or distressing. This was not
the case for no vs. mild dysfunction per se, while
nonorgasmically distressed 25- to 34-year-old and
50- to 65-year-old women were more likely than
those with mild distress to be sexually satisfied.
Tab le 6 Prevalence of orgasmic dysfunction per se and distressing orgasmic dysfunction in women aged 18–74 years
Orgasmic function
18–24 years
25–34 years
35–49 years
50–65 years
66–74 years
18–74 years
Per se (N) 181 297 357 233 47 1,115
No dysfunction (NoD) (%) 23 21 19 12 32* 19
Mild dysfunction (MiD) (%) 50 56 64 66 49* 60
Manifest dysfunction (MaD) (%) 27 23 17 22 19* 21
Distressing (N) 179 290 350 230 46 1,095
No dysfunction (NoDD) (%) 56 59 51 42 44* 52
Mild dysfunction (MiDD) (%) 31 31 41 45 41* 37
Manifest dysfunction (MaDD) (%) 12 10 8 13 15* 11
*Denotes that N is lower than 50.
Proportions of sexually active the preceding year are given in bold.
64 Fugl-Meyer et al.
J Sex Med 2006;3:5668
Finally, to determine the relative importance of
orgasmic function/dysfunction on sexual well-
being as compared with other sexual functions/
dysfunctions a series of simple logistic regressions
were performed for the pooled sample of sexually
active women. In this group, sexual interest, lubri-
cation, orgasm, vaginism, and dyspareunia were
entered as independent variables. Sexual function/
dysfunction was for all these added items entered
using the same trichotomized six-graded scale (see
Methods) as for orgasmic function/dysfunction,
while sexual well-being was dichotomized as
above. The results are given in Table 9, which
shows that both manifest and mild orgasmic dys-
functions, with exception for manifest vs. no lubri-
cation dysfunction per se, are more likely than
other sexual functions/dysfunctions studied here
to co-occur with a relatively low level of overall
sexual well-being.
Orgasm and Sexual Well-Being
The results of this investigation thus indicate that
in sexually active women manifest orgasmic dys-
function, per se or distressful, generally are the
major sexual function components to take into
account when dealing with women’s sexual well-
being. This is, but to a clearly less extent, the
case for sporadically occurring (mild) orgasmic
Elsewhere [1] we have reported a relatively high
level of general sexual well-being among Swedish
women. It must be emphasized, however, that all
women’s sexual functions/dysfunctions studied in
this sample are significantly interrelated [3]. On
the other hand, when we recall the antique defini-
tion of orgasm as the summa voluptas, it appears
very reasonable that in sexually active women a
Tab le 7 Univariate logistic regressions, with computations of odds ratios (OR) and 99% confidence interval (brackets) for
associations between age at first activity, lifetime ability to reach orgasm at different sexual activities, and some erotic
perceptions and levels of orgasmic function per se or distressing
Independent variables Ref
Levels of function Levels of distress
Manifest vs. No Dysf. Mild vs. No Dysf. Manifest vs. No Dysf. Mild vs. No Dysf.
Median age
First masturbation >Median 1.6**** (0.70–2.8) 1.5**** (0.95–2.5) 1.4 (0.77–2.7) 1.4**** (0.92–2.0)
First orgasm >Median 3.6* (2.0–6.3) 1.9*** (1.1–3.1) 2.5* (1.4–4.5) 1.7* (1.2–2.5)
First vaginal coitus >Median 1.3 (0.77–2.2) 1.1 (0.72–1.8) 1.6**** (0.92–2.8) 1.4**** (0.96–2.0)
Coital techniques
Manual genital caressing Yes 5.4* (2.31–12.3) 1.7 (0.74–3.8) 4.5* (2.4–8.6) 1.2 (0.73–2.1)
Cunnilingus Yes 3.4* (1.8–6.2) 1.3 (0.74–2.2) 2.4* (1.9–6.2) 1.6*** (1.1–2.5)
Used vibrator, self Yes 2.9 (0.69–12.3) 0.87 (0.19–3.9) 3.3**** (0.95–11.8) 0.76 (0.22–3.3)
Partner used vibrator Yes 1.9 (0.59–6.5) 1.0 (0.35–2.9) 2.7 (0.72–10.0) 0.85 (0.41–2.8)
Anal sex Yes 0.81 (0.46–1.45) 0.82 (0.63–1.7) 1.0 (0.53–1.86) 1.1 (0.73–1.65)
Orgasm without clitoral stimulation Yes 1.6**** (0.95–2.6) 0.8 (0.54–1.2) 1.7**** (0.98–3.0) 1.1 (0.76–1.5)
Orgasm by penile motions Yes 2.6* (1.6–4.4) 1.1 (0.71–1.9) 1.9*** (1.1–3.3) 1.2 (0.84–1.7)
Erotic perceptions
More easily aroused than most Yes 2.9* (1.4–6.0) 2.4* (1.4–4.2) 1.4 (0.60–3.4) 1.3 (0.77–2.2)
Sexuality important Yes 2.7* (1.4–5.2) 1.1 (0.58–2.0) 2.8* (1.5–5.2) 1.2 (0.73–1.9)
More easily falling in love than most Yes 0.65 (0.33–1.3) 1.0 (0.54–1.8) 0.57**** (0.29–1.1) 0.70 (0.43-1-1)
Has sexual fantasies Yes 1.2 (0.63–2.2) 1.1 (0.62–1.8) 1.3 (0.66–2.4) 0.95 (0.61–1.5)
*P 0.000; **P < 0.001 > 0.000; ***P < 0.005 > 0.001; ****P > 0.010 < 0.05.
Tab le 8 Univariate logistic regressions, with computations by age cohorts of odds ratios (OR), and 99% confidence interval
(CI) for the associations between Manifest vs. No or Mild vs. No orgasmic dysfunction and distress and gross level of overall
sexual well-being (satisfied vs. not satisfied)
Orgasmic function
18–24 years
25–34 years
35–49 years
50–65 years
66–74 years
Manifest vs. No Dysf. 6.6* (1.8–24.5) 7.4* (2.6–20.7) 4.8* (1.8–12.9) 6.9* (1.8–27.2) 52.0*** (1.8–>1000)
Mild vs. No Dysf. 1.9 (0.56–6.4) 1.5 (0.61–3.7) 1.3 (0.59–2.8) 1.3 (0.40–4.1) 6.4**** (0.69–61.3)
Manifest Distressing 7.9* (2.0–31.0) 27.2* (5.3–139.4) 9.3* (2.6–33.0) 48.8* (6.7–356.0) 12.8 (0.000–>1000)
Dysf. vs. No Dysf.
Mildly Distressing 1.04 (0.56–3.7) 2.8* (1.4–5.8) 2.2** (1.2–4.1) 3.7* (1.6–8.3) 3.2 (0.48–20.6)
Dysf. vs. No Dysf.
*P 0.000; **P < 0.001 > 0.000; ***P < 0.005 > 0.001; ****P > 0.010 < 0.05.
Orgasm, Sexual Techniques, and Erotic Perceptions in Women 65
J Sex Med 2006;3:5668
perceived ability to reach orgasm is prerequisite
to feeling overall sexually satisfied. This is
particularly clear for no vs. manifest orgasmic
dysfunction, generally irrespective of age.
Furthermore, in this sample of sexually active
women, orgasmic function/dysfunction is not age
dependent. This is in consensus with most other
investigations [24]. In a recent literature survey
Hayes and Dennerstien [25] stated that cross-
sectional studies provide strong evidence that
women’s sexual functions decline with age. We [4]
have previously reported that in the sample stud-
ied here this is not the case for orgasmic function.
This is supported by the present finding that post-
menopausal sexually active women were as orgas-
mic as were (their younger) premenopausal peers.
Other biological/hormonal factors have definitely
been demonstrated to be influential on sexual
functions. However, in this investigation biologi-
cal correlates of women’s sexual dysfunctions were
not further explored. The relatively high preva-
lence of no orgasmic dysfunction per se in the
oldest cohort may tentatively be explained as a
result of a rewarding sexual life leading to a con-
tinuation of sexual activities into higher age, par-
ticularly if the aging woman has a steady partner
(see Table 4). However, the attrition rate was
clearly greater among respondents in the oldest
age cohort, which may affect conclusions con-
cerning age.
Sexual Techniques and Orgasm
The prevalence of the different sexual practices
and the ability to obtain orgasm by them in rela-
tion to age largely appear to support previous epi-
demiological reports. Thus, in Sweden Zetterberg
[26] in 1967 found that among 18- to 60-year-old
women those younger than 30 (now 47–59 years
old) had their first coital experience at a median
age of 17, while the corresponding age for those
31–60 (now 60–80 years old) was 19. For compar-
ison, at recalculation of our sample the 18- to 30-
year-olds had their first coitus at a median age at
16 and the 31- to 60-year-olds at a median age of
17 years. The present results therefore indicate a
Swedish generational shift toward having first coi-
tus at a younger age than nearly three decades
earlier. This generational effect, previously dis-
cussed by Lewin ([6], pp. 84–103), is reasonably
similar to that reported from the United States
[27,28] and from the United Kingdom [29]. There
is, moreover, a strong similarity between our find-
ings about (lifetime) penetrative coital prevalence
and that reported from the United Kingdom [29]
and from France [30].
In France [30], Denmark [31], and the United
States [28] lifetime prevalence of cunnilingus and
fellatio (as registered in the 1990s) was quite near
the prevalence we found, 72–80% for cunnilingus
and 63–68% for fellatio. Wellings et al. [29]
reported the combined cunnilingus/fellatio life-
time use in 18- to 44-year-old British women to
be about 80%. The lifetime prevalence of this
combination was in our sample—arranged in
order of increasing age (cohorts)—76%, 91%,
82%, 53% with a meagre 14% for the 66- to 74-
year-old women. For the 18- to 49-year-olds, rea-
sonably close to the British findings, and quite
evidently underlining the generation effect. It
deserves particular emphasis that genital manual
caressing had been a common source of orgasm
for all but the oldest cohort. This was also true for
Half a century ago Kinsey et al. [32] reported
that the source of first orgasm, in a selected female
population in the United States, was masturbation
for 40%, petting for 24%, and penetrative inter-
course for 27%. These proportions are roughly
Tab le 9 Univariate logistic regressions with computation
of odds ratios (OR) and 99% confidence interval for the
associations of level of overall sexual well-being (satisfied
vs. not satisfied) with levels of different female sexual
OR Confidence interval
MaD vs. NoD/MaDD
vs. NoDD
5.5*/10.6* 3.2–9.4/6.2–18.3
MiD vs. NoD/MiDD
vs. NoDD
1.0/1.8* 0.60–1.6/1.3–2.5
MaD vs. NoD/MaDD
vs. NoDD
8.5*/10.0* 4.8–14.9/4.9–20.3
MiD vs. NoD/MiDD
vs. NoDD
1.3****/2.1* 0.93–1.9/1.5–3.0
MaD vs. NoD/MaDD
vs. NoDD
6.7*/17.2* 3.9–11.7/8.4–35.4
MiD vs. NoD/MiDD
vs. NoDD
1.6**/2.5* 1.0–2.5/1.8–3.6
MaD vs. NoD/MaDD
vs. NoDD
4.9****/8.2** 0.87–27.4/1.1–60.7
MiD vs. NoD/MiDD
vs. NoDD
1.6/1.8 0.81–3.3/0.81–4.0
MaD vs. NoD/MaDD
vs. NoDD
5.2*/10.0* 2.4–9.0/2.5–10.8
MiD vs. NoD/MiDD
vs. NoDD
1.4**/2.1* 1.0–2.0/1.5–3.0
*P 0.000; **P < 0.001 > 0.000; ****P > 0.010 < 0.050.
MaD = manifest; MiD = mild; NoD = no dysfunction per se;
MaDD = manifestly; MiDD = mildly; NoDD = no distressing dysfunction.
66 Fugl-Meyer et al.
J Sex Med 2006;3:5668
those we found, with the exception of the oldest
cohort. In 1976/77, 40-year-old Danish women
[33] reported that their first orgasm resulted from
penetrative intercourse with or without clitoral
stimulation in 59%. These authors reported that
Danish 40-year-old women had a slightly lower
prevalence of masturbation (25%) and a clearly
lower prevalence of manual genital caressing
(11%) as first source of orgasm than the 33% and
27% found here for the 35- to 49-year-old cohort.
One major finding of this exploratory analysis
is that several generational differences character-
ize the sexual life of Swedish women; as the rela-
tively younger among them have their first vaginal
intercourse and reached orgasm at an earlier age
than did their older peers. The younger women
also have had a greater repertoire by which to
reach orgasm. In this context one of the most
important deductions to us appears to be that hav-
ing had first orgasm and coitus at a relatively early
age appears to be a protector against orgasmic
dysfunction, whether manifest or mild. Other sig-
nificant protectors against manifest, but not mild,
orgasmic dysfunction are clearly partner-related
having been genitally stimulated by partner’s hand
and mouth.
The present findings that a relatively greater
variety of sexual behaviors—such as being geni-
tally stimulated by a partner’s hand and mouth and
(although marginally significant) performing fell-
atio—is most likely to occur in orgasmic women
may indicate that women who take a multifaceted
part in mutual sexual activities have a relatively
greater capacity to release control and therefore to
reach orgasm.
Our previous findings that the ability to reach
orgasm is closely associated with partner’s sexual
function and with overall satisfaction with sexual
life, a good partner relationship, and (men) part-
ner’s absence of sexual dysfunctions gains further
support when we here can ascertain that the
majority of the women’s experienced orgasm is
best with the penis in the vagina. During mastur-
bation, however, seven out of 10 solely stimulated
the clitoris, and more women had an orgasm with
manual genital stimulation than during penetra-
tive intercourse. It should here be noted that man-
ual genital caressings were not defined in further
detail and answers can therefore imply stimulation
of the vaginal wall, in particular the G-spot. Our
findings on the preferred source of orgasm during
intercourse can nevertheless be at least partly
interpreted as a “technique” for achieving multiple
Erotic Perceptions and Orgasm
In the literature we have located no epidemiolog-
ically anchored report to compare our findings
that women who perceive themselves to be rela-
tively easily sexually aroused were less likely
(admittedly at what we have termed the borderline
meaningfulness level) to have manifest or even
sporadically occurring orgasmic dysfunction (per
se). Nor have we located epidemiological reports
to compare the present deduction that women who
attach relatively great importance to sexuality are
rather likely not to have manifest orgasmic dys-
function. The fact that considerably fewer among
the oldest two cohorts (in particular the oldest one)
had a steady partner may at least to some extent
explain why relatively positive levels of the differ-
ent erotic perceptions explored here were clearly
less prevalent in these oldest cohorts. In this con-
text one should bear in mind that level of sexual
satisfaction is very much lower in women without
than in those with a steady partner (see also [23]).
Moreover, only minorities among women in
the two oldest cohorts who did not have a steady
partner perceived sexuality as important. Hence,
having or not having a steady partner must be
considered when interpreting the present results.
We, unfortunately, did not control—with a follow-
up question—if the women, in particular the rel-
atively older ones, thought that the question on
the importance of sexuality referred to partnered
sexual activities, possibly confounding our results.
Many different aspects, mostly generational and
partner-related, of sexual techniques are corre-
lated with Swedish women’s orgasmic experience.
Moreover, among the different components of
female sexual dysfunction orgasmic function—
as broadly and idiosyncratically defined by the
women themselves—is the major one likely to
influence, or be influenced by, level of sexual well-
being. These findings and those of previous
reports on this sample (see Introduction) imply
that quite regardless of a woman’s age when she
seeks professional help for orgasmic dysfunction,
a reasonable survey of her sexual experience and
techniques over time and of her current erotic
perceptions, partner relationship, and partner’s
sexual abilities should be established. In sexual
medicine a meticulous case history in order to
understand the background of the symptoms is as
etiologically important as it is in other fields of
medicine and psychology. Only if this is accepted
Orgasm, Sexual Techniques, and Erotic Perceptions in Women 67
J Sex Med 2006;3:5668
can (hopefully) adequate treatment strategies be
established, ultimately leading to increasing level
of sexual well-being, for the woman as well as for
society at large.
This article was supported by the Swedish National
Institute of Public Health. In particular we acknowledge
the support of Kristina Ramstedt of that institute.
We also acknowledge the contribution to the “Sex in
Sweden” investigation of Gisela Helmius, Ann Lalos
and Sven-Axel Månsson.
Corresponding Author: Kerstin Fugl-Meyer, PhD,
Andrology Center, Karolinska University Hospital,
Stockholm, Sweden, SE 171 76. Tel: (+46) 8-51770155;
Fax: (+46) 8-313691; E-mail: kerstin.fugl-meyer@
Conflict of Interest: None.
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... 31 Moreover, side positions and further variations of the missionary position should be included in future research because earlier research indicates these are frequently used. 11,12 Moreover, we did not map the use of multiple positions during one sexual encounter. Ideally, future research should explore a trajectory of positions used during usual sexual intercourse. ...
... For instance, we did not explore the differences in the use of particular sexual positions across age groups, although existing studies suggest that differences in sexual behavior between various age groups do exist. 4,7,12 Various studies suggest that the presence of pain with vaginal penetration, 32 body mass index, 33 physical disability, 34 and pregnancy 35 influence the choice of sexual positions in couples and should be controlled for. Moreover, it is possible that the use of sexual positions varies between cultures, a subject which should be investigated by cross-cultural studies. ...
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Introduction: A limited number of scientific studies explore the frequency with which various sexual positions are used in human populations and the potential of particular sexual position to facilitate female coital orgasm. Aim: The aim of this study was to provide data about the prevalence and frequency of various sexual positions, their rated pleasurability, and their association with female coital orgasm consistency (COC). Methods: A sample of Czech heterosexual population (11,225 men/9,813 women) were presented with a list of 13 sexual positions in black-and-white silhouettes. For each position, they indicated frequency and pleasurability. COC was assessed as the proportion of penile-vaginal intercourse with a current partner which led to orgasm. Main outcome measure: Participants reported the frequency of use of sexual positions and rated their pleasurability. Using ordinal logistic regression, association between the COC and frequency of use of coital positions was tested. Results: In both men and women, the most commonly used sexual positions were face to face/male above, face to face/female above, and kneeling/rear entry. Nonetheless, there emerged some gender differences in the rating of pleasurability of various positions (all P < .001). We found that a higher proportion of female coital orgasms are positively associated with the frequency of use of face to face/female above (odds ratio [OR] = 1.005, P < .001) and sitting/face-to-face positions (OR = 1.003, P < .001) and negatively associated with the frequency of kneeling/rear entry position (OR = 0.996, P < .001). Conclusions: Our findings suggest that there are no gender differences in the frequency of use of sexual positions, but their rated pleasurability differs between men and women, and higher frequency of use of face-to-face positions with female above increases the likelihood of achieving coital orgasm during penile-vaginal intercourse. Most results, however, were of small effect sizes, and more research is needed to further explore this issue. Krejčová L, Kuba R, Flegr J, et al. Kamasutra in Practice: The Use of Sexual Positions in the Czech Population and Their Association With Female Coital Orgasm Potential. Sex Med 2020;8:767-776.
... Magnificent sex is conceptualized as optimal sexual experiences that are better than goodenough sex, good sex, and very good sex, that facilitate extraordinary erotic intimacy (Kleinplatz and Ménard, 2020). Definitions of sexual pleasure have ranged from being measured by orgasm frequency (Barrientos & Páez, 2006;Fugl-Meyer et al., 2006) and intensity (Opperman et al., 2014), to ratings of how pleasurable people found their last sexual encounters (Hargons et al., 2018;Townes et al., 2021), whereas sexual satisfaction ...
Existing conceptualizations and measures of good sex are varied and inconclusive. Additionally, few studies have defined good sex from the margins, thus definitions are primarily informed from privileged perspectives. People with marginalized racial, gender, and sexual identities can offer culturally informed definitions of good sex that may expand current definitions. This study fills that gap by identifying factors that constitute good sex among Black people with diverse sexual and gender identities. Data were collected from 448 Black individuals who participated in an online Qualtrics survey with demographic, open-ended, and scaled questions. Results indicate a range of descriptors that align with existing sexual wellness literature and include the top 20 words to describe good sex as well as the top 10 words for demographics of interest. Differences in most frequent descriptors based on gender and sexual identities are reported. These results provide a foundation for sexual health practitioners, educators, and therapists to improve societal knowledge about what constitutes good sex among Black people.
... Female orgasm is therefore a complex and extremely variable neuromuscular phenomenon, modulated by localization [65][66][67] and modalities [68] of sexual stimuli, individual characteristics such as personality [69] and self-image [70] and quality of romantic relationship [71], which lead to different degrees of orgasmic intensity and pleasure [72]. ...
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In the field of female sexuality, the existence of the so-called “G-spot” represents a topic still anchored to anecdotes and opinions and explained using non-scientific points, as well as being overused for commercial and mediatic purposes. Purpose of Review The scope of this review is to give an update on the current state of information regarding the G-spot and suggesting potential future directions in the research field of this interesting, albeit controversial, aspect of human sexual physiology. Recent Findings From evolutionary, anatomical, and functional points of view, new evidence has rebutted the original conceptualization of the G-spot, abandoning the idea of a specific anatomical point able to produce exceptional orgasmic experiences through the stimulation of the anterior vaginal wall, the site where the G-spot is assumed to be. From a psychological perspective, only few findings to date are able to describe the psychological, behavioral, and social correlates of the pleasure experience by G-spot-induced or, better, vaginally induced orgasm (VAO). Summary Recent literature suggests the existence of a G-spot but specifies that, since it is not a spot, neither anatomically nor functionally, it cannot be called G, nor spot, anymore. It is indeed a functional, dynamic, and hormone-dependent area (called clitorourethrovaginal, CUV, complex), extremely individual in its development and action due to the combined influence of biological and psychological aspects, which may trigger VAO and in some particular cases also female ejaculation (FE).
... K vyšší frekvenci orgasmu také přispívá aktivnější role ženy během sexuální aktivity s partnerem (Frederick a kol., 2018). Mnohé studie potvrdily, že širší repertoár sexuálního chování vede k vyšší pravděpodobnosti ženského orgasmu (Anthony, 2012;Haavio-Mannila and Kontula 1997;Frederick a kol., 2018;Fugl-Meyer et al. 2006), nicméně přímá souvislost mezi frekvencí používání různých sexuálních pozic a frekvencí výskytu orgasmu nebyla prakticky zkoumána. Studie Krejčové a kolektivu (aktuálně v recenzním řízení) ukázala, že výskyt vaginálního orgasmu u žen byl predikován starším věkem ženy a častějším užíváním pozic, kdy je žena na muži a nižší frekvencí pozice penetrace zezadu v kleče. ...
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Ženský orgasmus je komplexní psychosomatický proces. Přestože existuje celá řada definic ženského orgasmu, většina z nich se shoduje, že se skládá ze dvou komponent: z tělesné složky, kdy dochází k uvolnění neuromuskulárního napětí v těle ženy v reakci na tělesné dráždění, a z psychologické složky, kdy ženy pociťují sexuální naplnění a uspokojení. Výskyt ženského orgasmu je velmi variabilní a závisí na mnoha faktorech. V rámci tohoto textu představujeme některé z těchto faktorů, které ovlivňují orgastickou schopnost žen a to s důrazem na partnerskou a sexuální perspektivu.
The “orgasm gap” refers to the finding that cisgender men, on average, have more orgasms than cisgender women during heterosexual partnered sex. In the current research, we replicated evidence for several orgasm discrepancies across sexual contexts and assessed men’s and women’s perceptions of the orgasm gap. Our sample consisted of 276 heterosexual, cisgender, sexually active undergraduate students (56.52% women; M age = 18.84). We assessed participants’ self-reported orgasm frequencies with a familiar partner, with a new partner, and during masturbation, as well as participants’ perceptions of their partners’ orgasm frequencies. We found evidence for orgasm discrepancies between young men and women within contexts and for women across contexts. Additionally, men perceived the size of the orgasm gap to be smaller than women perceived it to be. We used qualitative analyses to assess participants’ perceptions of driving forces behind the orgasm gap and their responses could be grouped into five overarching themes: Sociocultural Influence, Women’s Orgasm Difficulty, Biology, Men’s Fault, and Interpersonal Communication. This qualitative data can inform education and advocacy efforts focused on improving orgasm outcomes for young women, particularly by disproving prominent biological justifications for orgasm difference and addressing relevant sociocultural concerns. Additional online materials for this article are available on PWQ’s website at .
Background Orgasm occurrence plays an important role in general sexual satisfaction for women. Until now, only few studies have focused on examining a broad spectrum of sexuality- and relationship-specific factors associated with orgasm in heterosexual women currently in a long-term relationship or on differences between the overall experience of orgasm and multiple orgasms. Aim The present study aims to understand how various sexuality- and relationship-associated factors are related to experiencing partnered orgasm among heterosexual women having stable relationships in Germany. Moreover, the study aims to differentiate between the overall experience of orgasm and the experience of multiple orgasms and shed light on their impact on general sexual satisfaction. Methods Within the nationwide representative survey GeSiD (German Health and Sexuality Survey), n = 1,641 sexually active women aged between 18 and 75 years in heterosexual relationships reported their experience of orgasm during the latest sexual encounter. Data on the type of sexual practices, frequency of sexual activity and of masturbation, relationship satisfaction, feelings of love, closeness, and general sexual satisfaction were analyzed. Outcomes The overall experience of orgasm, the experience of multiple orgasms, and associations between experiencing orgasm and sexual satisfaction. Results Frequency of sexual activity, relationship satisfaction, feelings of love and closeness were moderately to strongly positively correlated with each other and each showed positive associations with the likelihood of orgasm. Greater number of sexual practices and frequency of sexual activity were associated with an increased likelihood of experiencing multiple orgasms, which in turn was correlated with higher sexual satisfaction. Clinical Implications In clinical and therapeutic work with women who have difficulty achieving orgasm, central issues should be the perceived relationship quality as well as regular sexual activity with the partner. Strengths & Limitations The present population-representative study is the first in Germany to identify significant factors associated with the experience of orgasm among heterosexual women in relationships. Further studies ought to include the frequency of orgasms in partnered sex over a longer period of time as well as the experience of orgasm during masturbation. Conclusion The experience of orgasm for women is related to a variety of complex interpersonal mechanisms and to be associated with sexual satisfaction. Cerwenka S, Dekker A, Pietras L, et al. Single and Multiple Orgasm Experience Among Women in Heterosexual Partnerships. Results of the German Health and Sexuality Survey (GeSiD). J Sex Med 2021;XX:XXX–XXX.
About one eighth of people are exposed to adversities such as abuse and neglect. Life history theory suggests that early experiences of adversity are strongly associated with later engagement in risky sexual behaviors. Specifically, those exposed to early adversity tend to engage in sex at an earlier age, have casual sex, and have high numbers of partners. Interestingly, it is also known that individuals exposed to early adversity are more likely to engage in more same-gender behavior. Existing research clearly outlines the association between early adversity and sexual behaviors that are considered risky. However, we have yet to identify a potential mediating mechanism that explains the full range of sexual behaviors seen in those who experience early adversity including adult sexual risk taking and same gender behavior. Outlining the specific mechanisms that influence later sexual risk taking is critically important in understanding the unique developmental experiences of those who experience early adversity. Here we propose and support one mediator important in the association between early adversity and later sexual behavior. We hypothesize that an increased sensitivity to the potential for sexual rewards mediates the association between early experiences of adversity and later sexual behavior, both risk behavior and female same-gender behavior. In the present manuscript we review relevant theoretical and empirical research in support of our claims.
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The study purpose was to assess, in a U.S. probability sample of women, the specific ways women have discovered to make vaginal penetration more pleasurable. Through qualitative pilot research with women that informed the development of the survey instrument used in this study, we identified four previously unnamed, but distinct, techniques women use to make vaginal penetration more pleasurable: Angling, Rocking, Shallowing and Pairing. This study defines each technique and describes its prevalence among U.S. adult women. Weighted frequencies were drawn from the Second OMGYES Pleasure Report—a cross-sectional, online, national probability survey of 3017 American women’s (age 18–93) sexual experiences and discoveries. Participants were recruited via the Ipsos KnowledgePanel®. Data suggest that 87.5% of women make vaginal penetration more pleasurable using ‘Angling’: rotating, raising, or lowering the pelvis/hips during penetration to adjust where inside the vagina the toy or penis rubs and what it feels like. Approximately 76% of women make vaginal penetration more pleasurable using ‘Rocking’: the base of a penis or sex toy rubbing against the clitoris constantly during penetration, by staying all the way inside the vagina rather than thrusting in and out. About 84% of women make vaginal penetration more pleasurable using ‘Shallowing’: penetrative touch just inside of the entrance of the vagina—not on the outside, but also not deep inside—with a fingertip, sex toy, penis tip, tongue, or lips. Finally, 69.7% of women orgasm more often or make vaginal penetration more pleasurable using ‘Pairing’: when a woman herself (Solo Pairing) or her partner (Partner Pairing) reaches down to stimulate her clitoris with a finger or sex toy at the same time as her vagina is being penetrated. These data provide techniques that are at women’s disposal to make penetration more pleasurable—which can enable women to better identify their own preferences, communicate about them and advocate for their sexual pleasure.
Substantial evidence has demonstrated that sexual dysfunction is negatively associated with the sexual satisfaction of individuals in a committed heterosexual relationship. However, little is known about their relationship based on couple data, especially in non-Western societies. We extended this study to examine the extent to which men’s and women’s sexual dysfunction were associated with their own as well as their partners’ sexual satisfaction. Participants were 1,014 heterosexual couples who participated in a community-based survey in Hong Kong in 2017. Using the actor–partner interdependence model and structural equation modeling, our results indicated that the dyadic model fit the data better than the individual model. Women’s orgasm and men’s sexual desire functioning were significant predictors of both own and partner’s sexual satisfaction, and these two domains had similar effects on the sexual satisfaction of both men and women. These findings are discussed in terms of the importance of taking a dyadic approach to research and enhance sexual health and well-being of heterosexual couples.
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In this epidemiological report the aim was to describe the prevalence of sexual abuse—defined situationally by the woman as being forced by another person into a situation or act that she perceives as sexual—in a national representative sample of 1335 Swedish women aged 18-74, and to relate occurrence of sexual abuse to level of sexual function and to sexual satisfaction. Data were gathered using a combination of strictly structured questionnaires/check-lists filled in by respondents during a face-to-face interview. The main results are that at least 12% of Swedish women have been sexually abused at least once in their lifetime, the most common types of abuse being vaginal penetration and genital manipulation by the perpetrator. Fifty percent of the abused women had been abused more than once. Nearly all reported types of sexual abuse were significantly associated with a relatively low level of orgasm, and also, but less systematically, with other sexual dysfunctions. The sexually abused women and in particular those abused more than once, reported a significantly lower level of sexual well-being than did non-abused women. It is concluded that sexually abused Swedish women are at high risk of future sexual maladaptation concerning sexual functions and sexual well-being.
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Introduction: Accurate estimates of prevalence/incidence are important in understanding the true burden of male and female sexual dysfunction and in identifying risk factors for prevention efforts. Aim: To provide recommendations/guidelines concerning state-of-the-art knowledge for the epidemiology/risk factors of sexual dysfunctions in men and women. Methods: An International Consultation in collaboration with the major urology and sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 17 committees. Committee members established specific objectives and scopes for various male and female sexual medicine topics. The recommendations concerning state-of-the-art knowledge in the respective sexual medicine topic represent the opinion of experts from five continents developed in a process over a 2-year period. Concerning the Epidemiology/Risk Factors Committee, there were seven experts from four countries. Main outcome measure: Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation and debate. Results: Standard definitions of male and female sexual dysfunctions are needed. The incidence rate for erectile dysfunction is 25-30 cases per thousand person years and increases with age. There are no parallel data for women's sexual dysfunctions. The prevalence of sexual dysfunction increases as men and women age; about 40-45% of adult women and 20-30% of adult men have at least one manifest sexual dysfunction. Common risk factor categories associated with sexual dysfunction exist for men and women including: individual general health status, diabetes mellitus, cardiovascular disease, other genitourinary disease, psychiatric/psychological disorders, other chronic diseases, and socio-demographic conditions. Endothelial dysfunction is a condition present in many cases of erectile dysfunction and there are common etiological pathways for other vascular disease states. Increasing physical activity lowers incidence of ED in males who initiate follow-up in their middle ages. Conclusions: There is a need for more epidemiologic research in male and female sexual dysfunction.
In this review anatomical and physiological data concerning the peripheral innervation of the female genital organs are described and clinical implications discussed. Both the somatic and the autonomic nervous system are involved in the regulation of female genital functions. The spinal cord segments S 2-4 are the most important. Most of the innervation to the internal genitalia goes through the pelvic plexus. This is localized in the cervico-vaginal region and is a combined sympathetic and parasympathetic structure also containing many nerve cells. The main somatic nerve innervating the external genitalia is the pudendal nerve. This nerve has a protective course and is mainly localized under or within the pelvic floor and is ending in the dorsal clitoridal nerve. There are also a number of somatic sensory nerves of other origin and somatic motor nerves direct from the spinal cord going above the pelvic floor. The clitoris is one of the most sensitive areas of the human body as regards exteroceptive stimuli. There are a number of sensory receptors for different qualities both in the clitoris and in the vulvar area. In the anterior part of the vaginal wall, corresponding to the G spot area, there are many more nerve fibers than in other parts of the vaginal walls. However, at the introitus there is a rich innervation of intraepitelial free nerve endings working as pain receptors. The cavernosal nerves to the clitoris are passing through the pelvic floor just beneath the urethra.
This article examines how the different investigators (physiologists, endocrinologists, brain imagers, psychologists) who examine, study and characterise the criteria for accepting that an orgasms has occurred in women and men during a specific sexual scenario.