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Abstract and Figures

Evidence from research and other sources is cited of orgasms elicited by imagery, stimulation of nipple, lips, mouth, anus, rectum, prostate and other body regions, in phantom limbs, during sleep, in response to brain and spinal cord stimulation, during childbirth, modulated by, and in response to, certain drugs and in relation to epileptic seizures. A concept of generalized neurological orgasmic processes involving recruitment, peak excitement and resolution is presented, of which genital orgasm is considered to be a special case.
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Non-genital orgasms
Barry R. Komisaruk
a
* and Beverly Whipple
b
a
Department of Psychology, Rutgers University, Newark, USA;
b
Professor Emerita, Rutgers
University, Newark, USA
(Received 6 December 2011; final version received 7 December 2011)
Evidence from research and other sources is cited of orgasms elicited by imagery,
stimulation of nipple, lips, mouth, anus, rectum, prostate and other body regions,
in phantom limbs, during sleep, in response to brain and spinal cord stimulation,
during childbirth, modulated by, and in response to, certain drugs and in relation
to epileptic seizures. A concept of generalized neurological orgasmic processes
involving recruitment, peak excitement and resolution is presented, of which
genital orgasm is considered to be a special case.
Keywords: brain; spinal cord; epilepsy; phantom limb; imagery; genital
Introduction
While orgasms characteristically result from genital stimulation, there are many
reports that other types of sensory stimulation non-genital also can generate
orgasms.
Types of sensory stimulation
Imagery orgasms
As one example, we have documented cases of women who claim they can experience
orgasms just by imagery without any physical stimulation. Their bodily reactions
of doubling of heart rate, blood pressure, pupil diameter and pain threshold,
responses that are comparable in magnitude to when the same women induced
orgasms by genital self-stimulation, bear out their claim (Whipple, Ogden, &
Komisaruk, 1992). This type of non-genitally-induced orgasm, as well as others
discussed below, may be typical for some individuals.
‘‘Zone’’ orgasms
According to Otto (1999) and Paget (2001), both men and women have reported that
they have experienced a ‘‘zone’’ orgasm. Otto (1999) says that a ‘‘zone orgasm occurs
when a sensitive spot or zone on the body of a person not usually used for erotic
stimulation is stimulated to a peak’’ (p. 110) and the person reports experiencing
an orgasm. He reports that of 216 persons who filled out a questionnaire con taining
*Corresponding author. Email: brk@psychology.rutgers.edu
Sexual and Relationship Therapy
2012, iFirst article, 1–17
ISSN 1468-1994 print/ISSN 1468-1749 online
Ó 2012 College of Sexual and Relationship Therapists
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the zone orgasm item, 31 women and 8 men stated that they had experienced a zone
orgasm. Paget gives examples of men and women who have experienced orgasm
from having their neck licked, their fing ers sucked or their thigh/groin area stroked.
The areas of the body identified by Otto whose stimulation could induce orgasm
were the neck, earlobes, underarm, side of the hip, inside the thighs and the toes and
fingers. Whipple and Ogden (1989) published an ‘‘extragenital matrix’’ designed to
help men and women map their bodies to discover areas of sensual and sexual
pleasure. They listed 36 parts of the body and 15 types of touch. They did not present
this as a goal toward orgasm, but rather as a means of discovering pleasure in
various parts of the body.
Mouth and anus orgasms
Paget (2001) described orgasms produced by stimulation of the mouth or anus in
women and men. Women with spinal cord injury (SCI) described experiencing
orgasm from stimulation of the ears, lips, breast s or nipples (Comarr & Vigue, 1978).
Both Otto (1999) and Paget (2001) discuss mouth orgasms in women and men.
According to Otto (1999) ‘‘the mouth orgasm happens at the peak of stimulation of
the mouth, may begin in the mouth and/or throat and may expand from there’’
(p. 61). He claimed that the mouth is the primary human sensory organ, starting with
suckling by infants. He stated that mouth orgasms appear to be triggered from the
lips, tongue, roof of mouth and throat. He interviewed women who said they
experience orgasm while kissing and others while performing oral sex on a man. The
women reported that the intense feelings of pleasure usually begin to build up in the
lips, and then at the point of release, they could experien ce a ‘‘whole body ’’ orgasm.
Some women said that their orgasm moved from their mouth to their clitoris; more
often they described that it spread though their body, generating vaginal a nd uterine
contractions. Otto reported that 41 of 205 (20%) women in his exploratory research
reported having mouth orgasms. Paget (2001) described mouth orgasms for women
similarly.
Otto (1999) described the occurrence of mouth orgasms also in men, both
homosexual and heterosexual. He claimed that the mouth is a primary erotic zone
and has the capacity of triggering its own unique orgasms. He reported that 26 of
the 130 (20%) men in his exploratory study reported exp eriencing mouth orgasms,
claiming that they seemed more reluctant than women to describe the orgasms.
Hand and shoulder orgasm
As another type of non-genital orgasm , Xaviera Hollander (1981) claimed that she
experienced an orgasm when a police officer placed his hand on her shoulder.
As another example, the heroine of the novel, Kinflicks, on realizing she just had
an orgasm when her lover held her hand, stat ed that she can experience orgasms
from stimulation anywhere on her body (Alther, 1975).
Hypersensitive skin (spinal cord injury) orgasms
Men and women with SCI have described that the skin near their injury is
hypersensitive to touch painful and intensely aversive to touch if accidentally
brushed but, when stimulated in the right way, by the right person, capable of
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producing pleasurable feelings that they describe as ‘‘orgasms’’. A woman with a
complete SCI at her upper thoracic level, whose area of hypersensitivity was the neck
and shoulder, claimed to have orgasms from stimulation of the skin of her neck.
In our laboratory, we measured her heart rate and blood pressure and found that it
increased markedly during self-application of a vibrator to her neck-shoulder
junction and she described experiencing an orgasm accompanied by a ‘‘tingling’’
sensation in her vagina (Sipski, Komisaruk, Whipple, & Alexander, 1993).
Breast and nipple orgasms
In reports by Kinsey, Pomeroy, Martin and Gebhard (1953), Masters and Johnson
(1966) and Paget (2001), women stated that they experienced orgasm s from breast or
nipple stimulation. Grafenberg (1950) claimed that ‘‘Kissing the nipples, touching
them with the penis, or inserting the penis between the two breasts lead [sic] to an
orgasm ...’’ (p. 146).
Possible neural basis
The orgasm-inducing effect of breast or nipple stimulation may be due to sensory
activity from the breast projecting to the same neurons that receive sensory activity
from the genitals specifically, the neurons of the paraventricular nucleus of the
hypothalamus (for a review, see Komisaruk & Whipple, 2000). These neurons
produce and secrete oxytocin into the bloodstream, brain and spinal cord in
response to breast or nipple stimulation as well as in response to vaginal, cervical or
uterine stimulation. The oxytocin released by suckling stimulates the contraction of
the myoepithelial cells that envelop the milk-secreting glands in the breast. When
these cells contract unde r the influence of oxytocin, they forcibly expel milk, in the
‘‘milk-ejection’’ or ‘‘milk-letdown’’ reflex. The oxytocin can concurrently stimulate
the uterine smooth muscle to contract. In a parallel process, during childbirth,
uterine contractions that push the fetus against the cervix stimulate sensory fibers
in the pelvic nerve that project via the spinal cord to the same paraventricular
nucleus of the hypothalamus, stimulating the neurons to release oxytocin into the
bloodstream the ‘‘Ferguson reflex’’ (Ferguson, 1941). This oxytocin released
during childbirth can also produce expulsion of milk from the breast in women who
are lactating.
Because the final common pathway for oxytocin secretion is mainly the
paraventricular nucleus of the hypothalamus (Cross & Wakerley, 1977), breast,
nipple, cervical and vaginal afferent activity evidently converges on this neuronal
cell group. There is normally a significant release of oxytocin into the bloodstream
within one minute after orgasm in healthy women and in some cases blood levels are
still elevated after five minutes (Carmichael et al., 1987, 1994; Cross & Wakerley,
1977). Activation of the paraventricular nucleus region of the anterior hypothalamus
has been reported during orgasm (Komisaruk et al., 2004), so it is likely that the
activity of these neurons, the neurons to whi ch they project and the neurons that
project to them is involved in the pleasurable sensation of orgasm (and the
description by some women of both nursing and childbirth as generating ‘‘orgasmic’’
feelings).
We recently reported a second site of convergence between nipple and genital
afferent activity the paracentral lobule of the postcentral gyrus, i.e., the sensory
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cortex (Komisaruk, Wise, Fr angos, Liu, et al., 2011). In mapping the distribution of
responses in the sensory cortex to clitoral, vaginal and cervical self-stimulation, we
included nipple self-stimulation and thumb and hallux stimulation for reference.
Stimulation of those three body parts activated the sensory cortex in precise
agreement with the ‘‘homunculus’’ map of Penfield and Rasmussen (1950), the finger
representation lateral, the toe stimulation in the media l hemisphere wall (paracentral
lobule) and the nipple self-stimulation in the thoracic region of the homunculus.
However, in response to nipple self-stimulation, we also observed activation that
partially overlapped the sites of activation produced by the clitoral, vaginal and
cervical self-stimulation in the paracentral lobule. In discussing this finding with our
neuroscience colleagues, we noticed a reliable sex difference: our male colleagues
commented that the finding is an exception to the Penfield homunculus; our female
colleagues commented, ‘‘of course’’!
This may represent either a direct or an indirect sensory convergence between
nipple and genital sti mulation. The possible i ndirect basis for this convergence is that
the nipple self-stimulation may activate the release of oxytocin into the systemic
circulation, generating uterine contractions, which would then stimulate a uterine/
cervical conventional sensory projection to the genital sensory cortex. We plan to
test this possibility by ascertaining whether total hysterectomy, which would
eliminate the uterine/cervical sensory input, will abolish the ability of nipple self-
stimulation to activate the genital sensory cortex. If it does, it would be consistent
with an indirect uterine/cervical sensory activation of the genital sensory cortex via
oxytocin. However, if nipple self-stimulation continues to activate the genital sensory
cortex after total hysterectomy, it would provide support for a convergent sensory
input directly from the genital and nipple sensory pathways. If the latter were found,
it would require a revision of the class ical concept of the body-regional specificity of
the homunculus.
Anal orgasms
There are anecdotal reports of anal orgasm, in women and in men, in response to
insertion of a lubricated object, e.g., finger, penis, dildo or even fist and forearm into
the anus and rectum (those regions are not self-lubricating) (Haynes, 1994). Anal
stimulation is also practiced without penetration, by kissing, licking or sucking
(Morin, 1986).
According to Haynes (1994), anal sex is not an activity exclusive to male
homosexuals, nor is it the activity most often practiced by homosexual m ales.
Reinisch (1990) reported that about 33% of women have experienced anal
intercourse. Otto (1999) reported that 9% of the 205 women in his research
reported having anal orgasms. Of historical interest, Paget (2001) reports that
anal intercourse is the most popular sexual practice depicted in pre-Columbian
art.
In men, Otto (1999) differentiates prostate stimulation-induced orgasm from
anus stimulation-induced orgasm. Ladas, Whipple and Perry (1982, 2005) cite
anecdotal reports that the descriptions of the physiological responses during orgasm
from male prostate stimulation and the descriptions of orgasm from G spot
stimulation in women are similar. Otto (1999) reported that 34 of the 130 (26%) men
in his study claimed that they have prostate or anal orgasms. Of these 34 men, 12
stated that they were homosexual .
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The role of pelvic region genital an d non-genital innervation
An understanding of the sensory pathways that are most likely activated in genital
stimulation-induced orgasm can suggest the bases for the experiences of non-genital
orgasms. The pelvic nerve provides the afferent (sensory) nerve supply of the
vagina, cervix, rectum and urinary bladder (Berkley, Hotta, Robbins, & Sato, 1990;
Komisaruk, Adler, & Hutchison, 1972; Netter, 1986; Peters, Kristal, & Komisaruk,
1987). Activation of this nerve can generate orgasm when stimulated vaginally, so it
is not surprising that when activated non-genitally (e.g. rectally), the pelvic nerve can
also generate orgasm in both women and men. Stimulating the rectum in addition
to the penis, or clitoris, vagina and cervix could add to the quality complexity,
intensity and consequently pleasurableness of orgasm.
Genital-rectal ‘‘cross- talk’’
In an anecdotal report, one man described his 10-year history of feelings resembling
sexual orgasm and ejaculation after each defecation or forceful urination, followed
by a rise in pulse rate and a sense of relaxation that changed to extreme fatigue
(Van der Schoot & Ypma, 2002).
Conversely, in women, uterine, cervical and vaginal stimulation during childbirth
has been reported to induce feelings of the urge to defecate. Thus, ‘‘cross-talk’ or
‘‘referred sensation’’ or ‘‘equivalence’’ can exist between the feelings generated by
vaginal and by rectal stimulation, most likely because the same pelvic nerve
carries sensory information from both organs.
In men, sensory activity originating from the prostate (via the hypogastric nerve)
during ejaculation contributes to the pleasurable sensation of orgasm, as evidenced
by the finding that prostatectomy may diminish this feeling (Koeman, van Driel,
Weijmar Schultz, & Mensink, 1996). The contributory role of this afferent activity to
orgasm could help account for the experience of orgasm in men receiving mechanical
stimulation of the prostate during anal intercourse, which would add to the sensory
activity via the rectal component of the pelvic nerve.
‘‘Birthgasms’’
The hypogastric nerve also conveys sensory activity from the uterus and cervix
(Berkley et al., 1990; Bonica, 1967; Giuliano & Julia-Guilloteau, 2006; Hoyt, 2006;
Peters, Kristal, & Komisaruk, 1987). The orgasmic role of afferent activity via the
hypogastric nerve known to occur in men can help account for the parallel drawn in
women between the feelings generated during childbirth an d orgasm (Newton, 1955),
which has recently been termed ‘‘birthgasm’’ (Harel, 2007). Stimulation of the pelvic
nerve may also occur with stimulation of the area of the G spot (the area of the
female prostate gland) and may also account for the reports of orgasm and female
ejaculation from the urethra experienced by some women (Ladas, Whipple, & Perry,
1982, 2005; Perry & Whipple, 1982).
Anal versus prostatic orgasms
The described perceptual differences between orgasms elicited by anal versus
prostate stimulation is most likely due to their differential innervation the anus
via the pudendal and pelvic nerves and the prostate via the hypogastric nerves.
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In women, sensory activity from the clitoris (pudendal nerve), vagina (pelvic nerve)
and cervix (pelvic, hypogastric and vagus nerves) projects to different regions of the
sensory cortex, which could account for the different sensory and orgasmic qualities
of stimulation of each of these differentially innervated regions (Komisaruk et al.,
2006; Komisaruk, Wise, Frangos, Liu, et al., 2011). Similarly, the differential
innervation of the anus and prostate in men could account for the described different
qualities of orgasms elicited from these regions.
Orgasms during sleep and dreams
Nocturnal emissions usually involve an ejaculation during sleep for a male or
lubrication of the vagina for a female. Nocturnal emissions are also called wet
dreams and sometimes considered a type of spontaneous orgasm. Kinsey, Pomeroy,
& Martin (1948) reported that 83% of men in the USA experience nocturnal
emissions. It is not clear whether such orgasms are generated by the brain
independent of genital sensory activity in both men an d women or whether they are
dependent on genital stimulation resulting from contact with bedding.
Several lines of evidence demonstrate that the brain can generate an orgasm
independent of genital sensory activity in both men and women. Physiological
changes (vaginal blood flow, heart rate and respiration rate) were measured in a
sleeping woman while she had an orgasm in a dream, which she described when she
awoke (Fisher et al., 1983). During the orgasm, her heart rate increased from 50 to
100 beats per minute and her respiration from 12 to 22 breaths per minute and she
had a ‘‘very marked’ increase in vaginal blood flow. The vaginal blood flow showed
cyclic episodes of vascular engorgement (the equivalent of pen ile erections in men)
during REM (rapid eye movement) sleep periods.
In Fisher et al.’ s (1983) case study, the brain activity that generated the woman’s
experience of orgasm was not a response to genital stimulation, but the brain activity
generated output to the autonomic system that would normally be activated during
genitally stimulated orgasm. In other words, the physiological responses were not
‘‘reflexive’’ responses to genital stimulation but were generated intrinsically by the
brain. Orgasms during sleep are only one of multiple contexts in which orgasm can
occur apparently independent of genital sensory activity.
‘‘Phantom’’ orgasms
‘‘Phantom limb’’, or ‘‘phantom limb pain’’, is a phenomenon in which a person who
has suffered ampu tation of a limb feels that the limb is still present, often in severe
pain. John Money (1960) incorporated the concept of ‘‘phantom orgasm’’ in
characterizing men and women with SCI and no genital sensation who experienced
orgasm in their sleep. In this case, at least in the men, the ‘‘phantom’’ is the orgasm
experienced as genital. Of 14 men who had SCI between C5 and L1 (cervical 5 and
lumbar 1), all had experienced orgasm before their injury. Eight of the men reported
experiencing sexual intercourse in their dreams before injury and five of these men
reported orgasm imagery in dreams after their injury. In Money’s words, these men
with paraplegia ‘‘ . . . had no genitopelvic gratification (none ejaculated after their
injury). It is therefore all the more remarkable a phenomenon that some of them
had orgasm imagery in dreams almost as vividly as though it were the real thing. . . .
[This finding] offers conclusive evidence that cognitional eroticism can be a variable
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of sex entirely independent of genitopelvic sensation and action. The brain, in other
words, can work independently of the genitalia in the generation of erotic experience,
just as the genitalia of pa raplegics can work reflexly and independently of the
brain. . . . The occurrence of orgasm imagery in the sleep dreams of paraplegics may
be regarded as a special example of phantom imagery. It is of interest that this
phantom experience was restricted to sleep. Awake or asleep, there were no other
reported examples, from any of the patients, of phantom sensation or imagery
attributable to the genitalia’’ (p. 74/382).
Money (1960) also described the case of a 32-year-old woman who had been
injured in a fall three years earlier that produced a fracture dislocation at C6 and C7.
The injury left her incontinent and paralyzed except for minimal toe movements,
which disappeared following rhizotomy (surgical cutting of sensory nerve roots to
reduce leg spasms). The woman stated that ‘‘when I have had a sexy dream I have
always . . . reached a climax’’ (p. 70/378). The orgasm dreams were rare. The woman
estimated that she had had six orgasm dreams in the three years since her injury.
Orgasms in women with parapl egia
Women who are paraplegic as a result of ‘‘complete’’ SCI also experience orgasm s
(Cole, 1975; Whipple, 1990; Kettl et al., 1991; Sipski & Alexander, 1995; Sipski,
Alexander & Rosen, 1995). We found that women with ‘‘complete’’ SCI at T10 and
above were able to perceive vaginal and cervical self-stimulation, that they
responded to the self-stimulation with analgesia measured at the fingers and that
in our laboratory three out of five of these women experienced orgasms from the
self-stimulation (Komisaruk & Whipple, 1994). That they experienced orgasm was
surprising, because the known genital sensory pathways through the spinal cord
would be expected to be severed in the case of ‘‘complete’’ SCI.
A common spinothalamic pathway for orgasm and pain?
The traditional view of the pathway by which genital stimulation reaches the brain is
via the ventrolateral spinothalamic tract (Beric & Light, 1993). In cases of traumatic
SCI, it has been reported that if this tract is interrupted, genital stimulation-induced
orgasm is blocked in women and men (Beric & Light, 1993).
It is curious that this pathway also contains axons that convey pain impulses to
the brain. In cases of intractable pain of cancer, the spinothalamic tract may be
therapeutically transected by surgery. In such cases of bilateral interruption of the
spinothalamic tract, orgasm is abo lished in men (Monnier, 1968). In one case of
a man with intractable pain, surgical transection of the spinothalamic tract
blocked genitally stimulated orgasm along with blocking the pain (Elliott, 1969).
The pain blockage persisted for several months, after which the pain reappeared.
Concurrently, his genital orgasmic response reappeared.
Female genital afference via the vagus nerves
To account for the phenomenon of genital sensory awareness in the women in our
study, and based upon a single, earlier study in rats showing that a tracer injected
into the cervi x labeled the sensory vagus nerves (Ortega-Villalobos et al., 1990), we
hypothesized that the vagus nerves (i.e., cranial nerves #10), conveyed sensory
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activity to the brain from the vagina and cervix in these women, bypassing the spinal
cord. We tested our hypothesis using functional magnetic resonance imaging (MRI),
ascertaining whether the sensory projection zone of the vagus nerves, i.e., the nucleus
of the solitary tract in the medulla oblongata, was activated by vaginal or cervical
self-stimulation in these women. Our positive findings confirmed the hypothesis
(Komisaruk, Gerdes & Whipple, 1997, Komisaruk et al., 2004). Thus, what at first
appeared to be cases of ‘‘non-genitally-elicited orgasms’’ were, in fact, respon ses to
genital self-stimulation, albeit by a previously unrecognized afferent pathway.
Non-clitoral genital sensation
An incidental implication of that study is that while the women in the study could
not feel their external body surface below the abdomen, including the clitoris, they
nevertheless could feel and respond with orgasm to the internal, vaginal and cervi cal,
stimulation. That observation provides evidence that vaginal and cervical stimula-
tion per se are perceived and can elicit orgasm in the absence of clitoral sensation.
That observation, combined with our recent report of unique sensory representation
of the vagina and the cervix on the sensory cortex, regionally distinct from the
projection of the clitoris (Komisaruk, Wise, Frangos, Liu, et al., 2011), provides
strong evidence against the persisting notion, promulgated by Kinsey et al. (1953),
that all genital sensation is med iated directly or indirectly by the clitoris.
Direct stimulation of the brain and spinal cord
Sem-Jacobsen (1968) applied electrical stimulation to the frontal cortex through a
chronically-implanted electrode. One patient, saying he liked the stimulation and
asking for more, responded wi th trembling, deep breathing, flushing, sudden
relaxation, smiling and ejaculation. Another patient was described by Sem-Jacobsen
as having ‘...a nonsexual type of orgastic sensat ion. The patient liked it and
wanted to be stimulated again, but when suddenly he became satisfied, he did not
want any more electrical stimulation ...he reported feeling ‘relaxed, pleasant ...its
like a sexual pleasure. No smell. No taste. I feel it in the whole body’’’ (p. 172). Then,
likely reflecting the contemporary scientific/cultural mores, Sem-Jacobsen stated,
‘‘Upon realizing that this was definitely a sexual response, no further stimulation was
made’’ (p. 172).
Heath (1964) implanted electrodes in several patients (preparatory to brain
surgery for treating epilepsy) and enabled them to self-stimulate via a wearable
control panel. One patient with an electrode implanted into the septum, ‘‘ . . . when
asked why he pressed the septal button with such (high) frequency, the patient said
the feeling was ‘good’ and made him feel as if he were building up to a sexual
orgasm. He was unable to achieve the orgastic end point, however, and explained
that his frequent, sometime s frantic, pushing of the septal button was an attempt to
reach a ‘climax’ although at times this was frustrating and produced a ‘nervous
feeling’’’ (p. 227). Valenstein (1973) report ed that in Parkinsonism patients, Dr. N.P.
Bechterewa of the Institute of Experimental Medicine in Leningrad ‘‘ . . . reports
several cases in whi ch stimulation of the ventrolateral thalamus or adjacent regions
evoked erotic and other pleasant sensations. In one case, that of a 37-year-old
woman with postencephalitic Parkinsonism, stimulation evoked very pleasant sexual
sensations that led to an orgasm’’ (p. 74).
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Heath also applied various neurochemicals via chronically implanted cannulas.
After injection of acetylcholine into the septum of a female epileptic patient when
she was ‘‘in a period of depression, anguish, and despair’’, these feelings ‘‘were
supplanted within minutes by pleasurable feelings. Consistently, strong pleasure
was associated with sexual feelings, and in most instances the patient experienced
spontaneous orgasm’’ (Heath, 1964, p. 236–237). In a subsequent report, ‘With
introduction of acetylcholine directly into the septal region . . . the [33-year-old
woman] patient became euphoric (often experiencing se xual orgasm) in association
with continuous bursts of high-amplitude [EEG] spindling focal in the septal
region, act ivity that gradually diminished over a thirty-minute pe riod’’ (Heath &
Fitzjarrell, 1984, p. 168).
Media reports described the studies of anesthesiologist and pain specialist Stuart
Meloy (2006), who reported that when he applied electrical stimulation through the
spine for the treatment of chronic back pain, 10 of 11 of his female patients, some of
whom claimed they did not experience genital stimulation-induced orgasms,
reported experiencing one or more orgasms during the electrical stimulation. It is
inevitable that many different spinal cord pathways were stimulated by this non-
specific method.
Orgasms from epileptic seizures
There are numerous reports of men and women who describe orgasmic feelings just
before the onset of an epileptic seizure, termed ‘‘orgasmic aura’’ (Calleja, Carpizo, &
Berciano, 1988; Janszky et al., 2002, 2004; Reading & Will, 1997). The most common
brain region from which these orgasmic auras originate is the right temporal lobe.
The aura may have a spontaneous onset or may be triggered by some specific
stimulus for example, orgasmic aura was triggered in a woman when she brushed
her teeth (Chuang, Lin, Lui, Chen, & Chang, 2004).
While seizure-related orgasms may be described as ‘‘unwelc ome’’ (e.g. Reading &
Will, 1997), in other cases they have been described as pleasurable. One woman was
reported to have refused antiepileptic medication or brain surgery because she
enjoyed her orgasmic auras and did not want to have them eliminated (Janszky et al.,
2004).
Orgasmic auras are not necessarily experienced as involving genital sensation.
However, when epileptic seizures origi nate in the genital projection zone of the
sensory cortex, individuals report that they experience genital sensation that
develops into an orgasm and the orgasm feels as if it were generated by genital
stimulation (e.g. Calleja, Carpizo, & Berciano, 1988).
Blumer (1970), a neurosurgeon, described a condition of ‘‘global hyposexuality’’
in 29 of 50 temporal pole epilepsy patients, male and female, a condition that was
alleviated by temporal lobectomy. However, in some cases, the seizures recurred,
which would inhibit sexual activity but have a rebound effect shortly after the
seizures. In one such case , Blumer describe d that about 20 minutes after the
attacks, his pa tient ‘‘. . . would seek sexual relations with his wife . . . His wife had
started to look forward to this happening. Normally he would not seek sexual
relations more than onc e a week. However, if a seizure occurred following sexual
relations even only one hour later he would desire sexual relations again’’
(p. 1103). Another patient rejected surgical intervention for his seizures: ‘‘At that
time his wife told the neurosurgeon that he was regularly demanding intercourse
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immediately after his attacks. At times when he was having several attacks a day,
his impatient demands were difficult for his wi fe, but she always acquiesced. By
contrast, in the absence of seizures several weeks might pass without his
experiencing sexual arousal’’ (p. 1103). Blumer also reported that one of his
patients with temporal pole epilepsy ‘‘. . . experienced the feeling of sexual climax
with e ach of his seizures ’’ (p. 1105).
Fadul, Stommel, Dragne v, Eskey an d Dalmau (2005) described a ‘‘focal
paraneoplastic limbic enceph alitis presenting as orgasmic epilepsy’’ in a 57-year-
old woman with a two-month history of daily episodes that consisted of a sudden
pleasure-provoking feeling that was described as ‘‘like an orgasm’’. The feeling lasted
for 30 seconds to 1 minute. An MRI revealed a tumor in the left anterior medial
temporal lobe and the EEG showed a focal left midtemporal abnormality. After
antitumor medication with carbamazepine, the tumor regressed and the episodes
subsided.
Neurological similarities between orgasms and seizures
The reports that epileptic seizures can generate orgasm-like feelings suggest a basic
commonality between the two phenomena. Epileptic seizures are characterized by
abnormal synchronous activation of a large number of neurons, followed by their
synchronous inactivation, then shortly thereafter by their synchronous reactivation.
It is likely that the rhythmical and voluntary movement-generated timing of genital
stimulation that ultimately generates orgasm also produces synchronous activation
of large numbers of brain neurons, although in a more precisely regulated pattern.
A conseq uence (and probably a function) of this regulated synchronous activity in
orgasm is the activation of high-threshold systems, such as the system that controls
ejaculation. The evidence that the ejacul atory system has a relatively high threshold
is that under normal conditions, rhythmical and timed genital stimulation is
necessary to recruit neural elem ents to a higher and higher state of excitation, which
climaxes with ejaculation. The ejaculation cannot be elicited at lower levels of
excitation and, thus, it is characterized as a high-threshold system. In the case of
ejaculatory orgasm, the genital stimulation is channeled into relatively specific and
coordinated systems, such as coordinating vigorous thrusting movements with the
ejaculatory event. By contrast, in an epileptic seizure, the mass synchronous neural
activation becomes abnormally diffuse and can ‘‘spill over’’ into motor systems
that are not normally activated simultaneously, resulting in unc oordinated limb
movements, loss of balance and uncoordinated facial and tongue movements, as in
a grand mal seizure.
Thus, the mass neuronal activation that characterizes an epileptic seizure bears
a resemblance to the mass neuronal activation that characterizes orgasm. Using
functional MRI, we recently reported widespread brain activation during orgasm
(Komisaruk, Wise, Frangos, Liu, et al., 2011) (Figure 1). It is perhaps this similarity
that can generate the orgasm-like feelings during epileptic seizures.
Phantom limb orgasm
The case of a man who described orgasms in his amputated phantom foot was
described by Ramachandran and Blakeslee (1999). They reported the following
conversation:
10 B.R. Komisaruk and B. Whipple
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Patient: Doctor, every time I have sexual intercourse, I experience sensations
in my phantom foot. How do you explain that? My doctor said it
doesn’t make sense.
Ramachandran: Look [I said] . . . One possibility is that the genitals are right next to the foot
in the body’s brain maps. Don’t worry about it. [He laughed nervously]
Patient: All that’s fine, doctor. But you still don’t understand. You see, I
actually experience my orgasm in my foot. And therefore it’s much
bigger than it used to be because it’s no longer just confined to my
genitals. (p. 36)
Maps of the sensory cortex show that sensation from the foot projects to the
cortex immediately adjacent to the region receiving sensation from the genitals
(Komisaruk, Wise, Frangos, Liu, et al., 2011) (Figure 2). It is likely that after
amputation of the foot, fibers of the neurons in the genital sensory cortex ‘‘invade’’
or ‘‘sprout’’ into the adjacent region, vacated by the neuron fibers that originally
came from the foot. This neural reorganization is similar to another phenomenon
reported by Ramachandran and Blakeslee (1999) in which a man with an amputated
hand felt his phantom hand when his face was touched. The hand and face sensory
regions are immediately adjacent to each other in the sensory cortex.
Drug-induced orgasms
Another type of orgasm-like experience that is independent of the genital system is
the claim by cocaine users that the rush they feel just after injecting the drug feels
Figure 1. ‘Tapestry representation of the fMRI activity of 80 Brodmann and other brain regions
(columns) taken every 2 seconds (rows, starting at the top) prior to, during and after one woman’s
orgasm. The shade of gray represents the relative fMRI activity level of each region (darkest:lowest
to lightest:highest). Inspection of the pattern reveals: (1) non-uniform sequen ce of activation of
different brain regions leading up to orgasm, (2) greater activation in the right hemisphere than the
left, (3) widespread activation of the brain at orgasm and (4) substantial reduction in brain activity
after orgasm (adapted from Komisaruk, Wise, Frangos, Birbano, et al., 2011).
Sexual and Relationship Therapy 11
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orgasmic (Seecof & Tennant, 1986). This effect may be due at least in part to the
dopamine-releasing action of cocaine in the nucleus accumbens (Komisaruk, Wise,
Frangos, Birbano, et al., 2011), a telencephalic region that we have found to be
activated during genital stimulation-induced orgasm s in women (Komisaruk et al.,
2004).
Orgasm of specific non-genital body parts
A different type of ‘‘non-genital orgasm’’ was described by a young male colleague of
Komisaruk and Whipple (1998). He experienced these orgasm s under the influence
of marijuana during self-stimulation of different parts of the body.
Nose orgasm
Stimulation was applied using an electric vibrator held in place against the tip of the
nose. A buildup of intensity of irritating sensation was described. The imagery
evoked was described as starting as a small point of light then approaching closer
and closer, getting brighter and larger, as if flying directly into the face. At the
moment when the irritating sensation was unbearably intense, which was just before
Figure 2. fMRI data showing (arrows) the region of the sensory cortex (paracentral lobule)
activated by stimulation of specific body regions, in relation to the classical Penfield sensory
homunculus. Note that self-stimulation of clitoris, vagina and cervix (group data from 11
women) activate slightly different regions, but all in the ‘‘male genital’’ region of Penfield’s
map. Hallux (great toe) stimulation by the investigator activated the foot region of the
homunculus (individual data). Note that nipple self-stimulation in this individual also
activated the medial paracentral lobule in the genital region. Activity in the lateral cortex is
related to hand activity (adapted from Komisaruk, Wise, Frangos, & Liu, 2009).
12 B.R. Komisaruk and B. Whipple
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‘‘collision’’ of the bright light against the face, a sneeze occurred, ‘‘blowing away’’
the light.
Knee orgasm
With the vibrator stimulating the knee, the quadriceps (extensor) muscle of the thigh
increased in tension, while simultaneously, the image observed was of an increasingly
immense panoramic scene of thousands of troops and artillery. At the reported
orgasmic moment, the leg gave an extensor kick, every single element in the
panorama made a simultaneous forward move and a simultaneous forceful grunt
was emitted. As a basis for claiming that these experiences were ‘‘orgasms’’, the
colleague described the nature of an actual genital orgasm in the same terms. Thus:
Penile orgasm. When the vibrator was applied to the tip of the penis, an image of
an ocean liner appeared in the distance, being raised from the depths of the ocean
by an uplifted hand. A great effort, perceived as a growing tension in the postural
muscles of the trunk and limbs, was mobilized in which the hand was raising the
increasingly massive ocean liner. The ocean liner then burst forth into the
sunlight in a fountain of spray at which moment, peak muscle contrac tion, actual
ejaculation and laughter all erupted simultaneously. This last orgasm was a
genital orgasm, but stated in the same context as the respiratory and knee
orgasms. It had the same qualities of imagery and muscle tension appropriate to
the imagery, as did the other types of orgasms, except it was in the genital system
and included the visceromot or response of ejaculation. Stated alternatively, it was
similar in form to the non-genital orgasms, but it was a genital orgasm. This
description indicates that there was coherence among somatic, visceral and
cognitive activity leading up to the orgasmic moment.
The effects of the marijuana may have been to break down the inhibitory
pathways that normally separate waking from dream imagery, thereby revealing
associations that may otherwise occur only in dreams, hallucinations, synesthesia
(the [con]fusing of two different senses, e.g. ‘‘tasting shapes’’ [Cytowic, 1998]),
psychosis and other altered states of consciousness. The orgasms, while markedly
different from each other, were all described as manifesting dreamlike imagery that
was related in an understandable way to the function of the specific body part that
was stimulated and expressed the orgasm. In each of the three types of orgasms
described above, each component skeletal motor, respiratory and cognitive while
unique in its own ‘‘currency’’, was coherent with each of the others. Invariably,
explosive respiratory activity (sneeze, grunt, laugh) accompanied each orgasm.
Each orgasm built in a coherent, comprehensible (though dreamlike) crescendo of
excitation, culminating in a synchronous climax that was described as pleasur able.
Conclusion
Apparently, just as pain is not restricted to any one part of the body, neither is
pleasure. A characteristic of orgasmic pleasure, the perception of the body’s
explosive muscular expression, can be perceived not only in the genital system but
also in the respiratory system and other body systems (Komisaruk & Whipple, 1998).
Thus, it seems that while the genital system is particularly well-organized to mediate
the orgasmic process, other body systems evidently manifest at least some of the
Sexual and Relationship Therapy 13
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same prope rties and, consequently, under appropriate stimulus conditions and
sensitization may exhibi t comparable activity.
The mental state that occurs during orgasm has been described as an ‘‘altered
state of consciousness’’ (Davidson, 1980, p. 282) that may lead to a state of
tranquility and deep unconsciousness, to which the French have attributed the name
la petite mort the little death. The altered state of consciousness that may occur
during orgasm has characteristics that are similar to epileptic aura and seizure.
Indeed, as described above, there are reports of men and women with epilepsy
experiencing feelings of orgasm during epileptic attacks. It is of interest that the part
of the brain involved in epileptic attacks may include the specifically genital sensory
projection sites, but more often it does not involve these sites. When it does,
individuals rep ort genital sensations during orgasm, but when it does not,
individuals say they have had orgasms but no particular genital sensations.
Evidently, ‘‘non-genital orgasm’’ is not an oxymoron.
Notes on contributors
Barry R. Komisaruk, PhD, a behavioral neuroscientist, is Distinguished Professor in the
Psychology Department / Associate Dean of the Graduate School, Rutgers University, and
Adjunct Professor in the Radiology Department, University of Medicine and Dentistry of
New Jersey, campuses in Newark. Some of his major research contributions include the
first reports in the literature of: the pain-blocking action of vaginal stimulation and its
neurological mechanisms, the role of the vagus nerves as a spinal cord bypass pathway in
conveying vaginal sensation in women, the sensory cortical representation of the clitoris,
vagina and cervix in women, and the brain regions activated during orgasm in women.
Komisaruk has published more than 155 peer-reviewed research papers, an equal number
of conference presentations, four books including The science of orgasm, has received more
than $11m in research and training grant awards from the NIH, NSF, NJ State and
private foundations, multiple research recognition awards, has served on grant review
committees of the NIH and NSF, as a program director in the NIH-NIGMS, and on
multiple journal editorial boards.
Dr Beverly Whipple, a certified sexuality educator, sexuality counselor, and sex researcher,
is the co-author of seven books and over 170 research articles and book chapters. She is
the recipient of many awards, including the Gold Medal from the World Association for
Sexual Health (WAS) for outstanding contributions and lifetime achievements. For their
50th anniversary, the New Scientist named her one of the 50 most influential scientists in
the world (2006). Dr Whipple was the President of AASECT (1998–2000), was the Vice
President of the World Association for Sexology (2001–2005), the Secretary General/
Treasurer of the World Association for Sexual Health (2005–2009), was on the board of
the International Society for the Study of Women’s Sexual Health (2002–2004), and was
the President of SSSS (2002–2003).
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... files/FGMC_2016_brochure_final_UNICEF_SPREAD.pdf). Alexander and Rosen [51] and Komisaruk and Whipple [52] provided other evidence of a different focus on the sexuality of women with SCI compared to men. Women are oriented to giving rather than receiving pleasure. ...
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A rich and complexly interwoven matrix of psychosocial and physiological variables influence those transformations of consciousness that we label sexual. Much more than for other “instinctive” behaviors, sexual activity manifestly involves a set of unique physiological correlates, interacting with a highly prized array of subjective experiences. The physiological, behavioral, and experiential events undergo slow shifts of intensity and quality as well as sharp transformations from one “state” to another. Furthermore, this is a realm of human experience directly accessible to all and obviously essential to the preservation of the species. For these reasons, sexual phenomena are of great potential interest to students of psychophysiology and can provide unique and important models for psychobiological research.