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Female hot spots: extragenital erogenous zones
Ihab Younis, Menhaabdel Fattah and Marwa Maamoun
Dermatology and Andrology Department, Faculty of
Medicine, Benha University, Benha, Egypt
Correspondence to Ihab Younis, MD, 6, Soria Street,
Mohandeseen, Guiza 12411, Egypt
Tel: + 20 333 775 767;
e-mail: ihabyounis@hotmail.com
Received 30 December 2015
Accepted 2 February 2016
Human Andrology 2016, 6:20–26
Purpose
Erogenous zones may be genital or extragenital. Women have a greater variety of
erogenous zones on the body compared with men. In the context of this article, it is
important to examine this issue in conjunction with problems of sexual dysfunctions.
Scientific research in the area of extragenital erogenous zones is scarce. Defining
extragenital erogenous zones with the most powerful excitatory effect and how to
stimulate them was the aim of this work.
Participants and methods
This work was a cross-sectional cohort study wherein a self-report questionnaire was
used. Usable questionnaires were obtained from 150 married women with regular
sexual activity. The questions covered epidemiological data, assessment of female
sexual functions, and information on extragenital erogenous zones.
Results
Extragenital erogenous zones were found in 95.3% of women. In a descending order,
the most powerful erogenous zones were breasts, lips, neck, ears, and buttocks. The
best method for stimulation differed according to the area – for example, the best
method for the lips was oral stimulation, whereas the best method for the breasts and
nipples was both manual and oral stimulation. Orgasm due to the stimulation of
extragenital areas was reported by 12% of participants.
Conclusion
Extragenital erogenous zones are present in a vast majority of women. An overall 12%
of women said that they can orgasm following stimulation of these zones. Female
patients complaining of difficulty in achieving orgasm may benefit from informing their
partners about the extragenital erogenous zones and methods to stimulate them.
Keywords:
erogenous zones, female, orgasm, women
Hum Androl 6:20–26
&2016 Human Andrology
2090-6048
Introduction
Erogenous zones are parts of the body that excite sexual
feelings when touched or stimulated. They may be
genital or extragenital (e.g. breasts, lips, and buttocks).
Extragenital erogenous zone stimulation during foreplay is
important for women to reach orgasm. A shorter than re-
quired foreplay is a common complaint from women. Among
5665 Japanese women, 43.5% desired a longer duration [1].
Similar findings were obtained by Hisasue et al. [2]. In
Egypt, Younis et al. [3] found that 20.7% of women fail to
reach orgasm because of the short duration of foreplay.
An intriguing neuroscientific explanation for the distribution
of erogenous zones was proposed in the 1990s, based on the
arrangement of body parts in primary somatosensory cortex
(S1). Ramachandran and Blakeslee [4] suggested that the
activation of body parts adjacent to genital zones in S1 may
produce partial activation of the areas for genital representa-
tion producing low-level erotic sensation. Notably, several
upper body areas (e.g. neck, ear, etc.) lie adjacent to the
breast in (lateral) S1, and Ramachandran and Blakeslee [4]
argued that lower body parts, especially the feet, lie close to
the cortical mapping for the genitals in (medial) S1.
In the introduction of their study, Turnbull et al. [5] stated
the following: ‘there is a striking absence of empirical
research in this area (distribution of erogenous zones in
normal persons based on somatic touch), and it appears that
no systematic survey of the magnitude of preferred erotic
sensations from various body parts has ever been published’.
The current study was conducted to identify which body
areas (other than the genitalia) are recognized by women
as the most sexually arousing, either by manual or oral
stimulation or both. Moreover, it was intended to
evaluate the effect of stimulating these identified areas
on sexual arousal and orgasm.
Participants and methods
Before proceeding with the present study, an approval
was obtained from the Department of Dermatology and
Andrology and the Ethics Committee, Benha University.
This work was a cross-sectional cohort study that was
carried out between November 2013 and July 2014 at the
Outpatient Clinic in Benha University Hospital and a
motherhood and childhood care center at Alexandria
20 Original article
2090-6048 &2016 Human Andrology DOI: 10.1097/01.XHA.0000481142.54302.08
Copyright r2016 Human Andrology. Unauthorized reproduction of this article is prohibited.
governorate. Questionnaires were distributed to 160
women; 10 of them refused to participate.
Inclusion criteria
(1) Married women with a regular sexual activity.
(2) Women able to read and write so that they can fill in
the questionnaire by themselves.
Exclusion criteria
(1) Presence of medical conditions affecting female
sexuality (e.g. neuropsychiatric diseases).
(2) Refusal to participate.
A clear informed consent was obtained from all women
after discussing the aim of the study.
Tools
The tool used was a self-administered questionnaire
written in English and translated into a simple Arabic
language to ensure it is understood by all participants
regardless of their level of education. Face-to-face
questionnaire was not used to avoid any embarrassment
and to give the participants a wide range of privacy and
freedom to express themselves without any disturbance
or fear.
Each participant was handed an open envelope containing
a copy of the questionnaire. After filling the question-
naire, the participant put it in the envelope and sealed it
and placed it in a basket containing other sealed
envelopes to ensure anonymity.
The questionnaire included the following items:
(1) Epidemiological data: age, educational level (reads
and writes, finished secondary school and university
degree), occupation, and residence.
(2) Assessment of female sexual functions, including the
frequency of intercourse, desire to have sex, arousal
(lubrication), orgasm, pain, and sexual satisfaction.
(3) Partner sexual dysfunction and its type.
(4) Presence of extragenital erogenous zones, degree of
arousal that they give, and best method for their
stimulation.
A copy of the English questionnaire is given in Appendix I.
Statistical analysis
The clinical data were recorded on a report form. These
data were tabulated and analyzed using the computer
program SPSS (SPSS for Windows, version 16.0; SPSS
Inc., Chicago, Illinois, USA).
Descriptive data
Descriptive statistics were calculated in the form of
frequency and distribution for qualitative data.
Analytical statistics
In the statistical comparison between the different
groups, the significance of difference was tested using
one of the following tests:
(1) The w
2
-test, which was used for intergroup compar-
ison of categorical data.
Table 1 Demographic data (n=150)
N(%)
Age (years)
o20 7 (4.7)
20–29 19 (12.7)
30–39 85 (56.7)
440 39 (26.0)
Educational level
Can only read and write 5 (3.3)
Secondary school 58 (38.7)
University degree 87 (58.0)
Duration of marriage (years)
o5 46 (30.7)
5–10 44 (29.3)
10–15 36 (24.0)
15–20 17 (11.3)
420 7 (4.7)
Table 2 Sexual activity of participants (n= 150)
N(%)
Coital frequency (n= 150)
Daily 19 (12.7)
2–3 times/week 59 (39.3)
Once/week 46 (30.7)
Once/month 17 (11.3)
oOnce/month 9 (6.0)
Unprovoked desire (n= 150)
Several times/day 34 (22.7)
Once/day 31 (20.7)
Once/week 64 (42.7)
Once/month 11 (7.3)
Almost never 10 (6.7)
Vaginal lubrication (n= 150)
Almost all times 111 (74.0)
4½ times 14 (9.3)
o½ times 16 (10.7)
Almost never 9 (6.0)
Ability to reach orgasm (n= 150)
Almost all times 72 (48.0)
4½ times 25 (16.7)
o½ times 41 (27.3)
Dyspareunia (n= 150)
Yes 22 (14.7)
No 128 (85.3)
Husband sexual dysfunction (n= 150)
Yes 39 (26.0)
No 111 (74.0)
If yes, what type of sexual dysfunction (n=39)
Erectile dysfunction 23 (57.5)
Premature ejaculation 21 (52.5)
Masturbation (n= 150)
Yes, before marriage 25 (16.7)
Yes, before and after marriage 37 (24.7)
No, but I have a friend who does 28 (18.7)
No 60 (40.0)
Overall satisfaction with sexual life (n= 150)
Outstanding 49 (32.7)
Satisfactory 72 (48.0)
Unsatisfactory 29 (19.4)
Do you feel that there are certain areas in your body
that give you high sexual arousal? (n= 150)
Yes 143 (95.3)
No 7 (4.7)
Female extragenital erogenous zones Younis et al.21
Copyright r2016 Human Andrology. Unauthorized reproduction of this article is prohibited.
(2) The Fisher exact test, which was used when one of
the cells of a table was 5 or less.
APvalue of 0.05 or greater was considered statistically
significant, a Pvalue greater than 0.05 statistically
insignificant, and a Pvalue of 0.001 or greater was
considered highly significant in all analyses.
Results
Demographic data of participants indicate that the most
common age group (56.7%) was 30–39 years. Fifty-eight
percent of participants had a university degree and most
of them (30.7%) were married for less than 5 years
(Table 1).
The most common coital frequency was 2–3 times/week
(39.3%). Once/week was the most reported time of
feeling a sexual desire without direct stimulation
(42.7%). Vaginal lubrication was obtained in almost every
sexual encounter in most women (74%). Most women
(48%) were able to reach orgasm. When asked ‘Do you
feel that there are certain areas in your body that give you
high sexual arousal (other than the genitalia) when
stimulated?’, 143 (95.3%) women gave an affirmative
answer (Table 2).
Areas that gave the highest exciting effect when
stimulated were the breasts and nipples, followed by
the lips, the neck and the nape of the neck, the ears, and
the buttocks (84.6, 83.9, 75.5, 55.2, and 36.4%, respec-
tively). The areas producing the least erotic effect when
stimulated were the wrists, behind the knees, and feet
(3.5, 3.5, and 4.9%, respectively) (Table 3).
The best method for stimulation differed according to
the area – for example, the best method for the lips was
oral stimulation (57.5%). For the breasts and nipples,
both manual and oral stimulation (74.6%) and for the
neck/the nape of the neck both manual and oral
stimulation (66.1%) was the best method (Table 4).
Orgasm occurring due to stimulation of extragenital areas
was reported by 12% of participants. The most common
areas reported among those women were breasts and
nipples (100%), lips (66.7%), and the neck/the nape of
the neck (33.3%). In 50% of participants, this orgasm was
weaker than the orgasm produced by stimulating genital
areas (Table 5).
Advance in age decreased the excitatory effect of
stimulating the neck/the nape of the neck. The decrease
was statistically significant. There was a tendency of
aging to decrease the excitatory effect of stimulating the
breasts/nipples and the lips but the difference was
statistically insignificant (Table 6).
Discussion
Of our participants, 84.6% reported high arousal from
breast/nipple stimulation. A similar figure (81.5%) was
reported in the study of Levin and Meston [6], who used
a short questionnaire to examine the effect of nipple/
breast stimulation during sexual activity in sexually
experienced 148 men and 153 women (age range: 17–29
years).
A study by Komisaruk et al. [7] used functional MRI to
map sensory cortical responses to clitoral, vaginal,
cervical, and nipple self-stimulation. They found that,
unexpectedly, nipple/breast self-stimulation activated not
only the ‘expected’ thoracic sensory homuncular region
Table 3 The strongest areas producing extragenital sexual
excitation (n= 143)
a
Sites Highly stimulating [N(%)]
Breast/nipples 121 (84.6)
Lips 120 (83.9)
Neck/nape of the neck 108 (75.5)
Ears 79 (55.2)
Buttocks 52 (36.4)
Inner thigh 50 (35)
Lower abdomen/pubis 49 (34.3)
Scalp 28 (19.6)
Feet 7 (4.9)
Behind the knees 5 (3.5)
Wrist 5 (3.5)
a
There is overlap because more than one answer is allowed.
Table 4 Method of getting the best stimulation
N(%)
Manual Oral Both
Scalp (n= 46) 42 (91.3) 0 (0) 4 (8.7)
Underarm/inner arm (n= 24) 17 (70.8) 1 (4.2) 6 (25)
Behind the knees (n= 22) 15 (68.2) 1 (4.5) 6 (27.3)
Feet (n= 24) 16 (66.7) 0 (0) 8 (33.3)
Wrist (n=18) 11 (61.1) 1 (5.6) 6 (33.3)
Inner thigh (n= 68) 11 (16.2) 3 (4.4) 54 (79.4)
Buttocks (n= 69) 11 (15.9) 2 (2.9) 56 (81.2)
Lower abdomen/pubis (n= 73) 8 (11) 6 (8.2) 59 (80.8)
Breast/nipples (n= 130) 6 (4.6) 27 (20.8) 97 (74.6)
Neck/nape of the neck (n= 118) 4 (3.4) 36 (30.5) 78 (66.1)
Ears (n= 87) 2 (2.3) 25 (28.7) 60 (69)
Lips (n= 134) 2 (1.5) 77 (57.5) 55 (41)
Table 5 Extravaginal orgasm
N(%)
Have you ever experienced an extravaginal orgasm (n= 150)
Yes 18 (12.0)
No 132 (88.0)
If yes, what was the site (n= 18)
Scalp 0 (0.0)
Neck/nape of the neck 6 (33.3)
Ears 3 (16.7)
Lips 12 (66.7)
Breast/nipples 18 (100.0)
Lower abdomen/pubis 3 (16.7)
Buttocks 4 (22.2)
Inner thigh 4 (22.2)
Behind the knees 0 (0.0)
Feet 0 (0.0)
Wrist 0 (0.0)
Underarm/inner arm 0 (0.0)
If yes, it was (n= 18)
Weaker than vaginal orgasm 9 (50.0)
Stronger than vaginal orgasm 3 (16.7)
Equal to vaginal orgasm 6 (33.3)
22 Human Andrology
Copyright r2016 Human Andrology. Unauthorized reproduction of this article is prohibited.
but also the region of the paracentral lobule that overlaps
with the region activated by clitoral, vaginal, or cervical
self-stimulation. They stated that ‘this finding is
consistent with many women’s reports that nipple/breast
stimulation is erotogenic and can elicit orgasms’. Obtain-
ing orgasm due to extragenital stimulation only was
reported by 18 (12%) participants; all of them reported
breast stimulation as the source of obtaining orgasm.
However, half of those women reported that this orgasm
was equal or even stronger compared with genital orgasm.
Cordeau et al. [8] compared the sensitivities of several
sexual areas on the female body, including the parts in the
perineum area (clitoris, labia minora, vaginal, and anal
margin), breasts and nipples as well as control body
locations (neck, forearm, and abdomen). The researchers
used light touch, pressure, and vibration to assess how
sensitive these body parts were in 30 healthy women
between the ages of 18 and 35 years. With regard to
pressure, the clitoris and nipple were the most sensitive,
and the lateral breast and abdomen were the least
sensitive. Average detection thresholds for vibration
suggest that the clitoris and nipple are equally sensitive.
If the female breast is the most sensitive extragenital area
then what is the most sensitive area of it? Terzis et al. [9],
using tuning forks, found that the highest sensitivity is in
the nipple, followed by the areola and then the lateral
surface.
Following the breasts/nipples, the lips were the second
most erotogenic zone in our participants, followed by the
neck, the ears, the buttocks, and then the inner thigh.
The only study that can be compared with our work is the
study by Turnbull et al. [5], who detected the erogenous
zones in 304 men and 489 women using an online
questionnaire. Participants rated the ability of 41
different body areas to facilitate sexual arousal. Outside
the genital area, the most important erogenous body
zones were the mouth, followed by the nape of the neck,
the nipple/breast, the inner thigh, the back of the neck,
and then the ears. The shin of the tibia, the nose, and
elbow were the least erogenous body areas. After
reporting erogenous zones found in women compared
with those found in men, Turnbull et al. [5] concluded
that the basis for the claim that women have a greater
diversity of erogenous zones seems in part unjustified.
Women clearly experience higher erotic intensity for
some body parts, but this effect appears to have been
exaggerated in the popular media.
Our finding that the feet were among the least ergogenic
areas supports the finding of Turnbull et al. [5], who
suggested that the primary somatosensory (S1) theory of
erogenous zones does not appear to be accurate.
According to this theory, the feet lie adjacent to the
genitals in the ‘map’ of the body found in the S1, which is
where touch sensation is first processed in the brain.
Thus, S1 does not appear to be the likely site that would
support Ramachandran’s neural body map proposal [4].
Turnbull et al. [5] suggested that the origins of erogenous
zone distribution may derive from a map located
elsewhere in the brain. Speculating on the location of
this map, they stated that ‘perhaps the most likely
possibility is the insula, increasingly well-known as a site
for both emotional and multisensory integration as
indicated by Craig [10]’. Notably, there is clear evidence
that the insula is especially activated [11] by unmyeli-
nated low-threshold mechanoreceptors, which are selec-
tively tuned for slow-paced light touch, of the sort found
in affiliative and erotic settings.
As shown in Table 4, the method of stimulating
extragenital erogenous zone is important. Our partici-
pants preferred oral over manual stimulation of the
breast, neck, and ears. Conversely, they preferred manual
stimulation on the inner thighs and buttocks. This can be
of clinical importance when counseling couples having
sexual dysfunctions. It goes without saying that the male
partner should be advised on finding the extragenital
erogenous zones in the body of his partner as they vary
from one woman to another, as well as on applying
the appropriate amount of pressure to each area – that is,
not a very light touch (that could be ineffective) or
applying strong touch (that could be painful). The
different aspects of foreplay are currently studied in our
department.
Table 6 Effect of age on extragenital erogenous zones with high stimulation
Age (years) [N(%)]
o20 (n= 7) 20–29 (n= 19) 30–39 (n= 82) 440 (n= 35) w
2MC
P
Breast/nipples 7 (100) 17 (89.5) 70 (85.4) 27 (77.1) 3.154 0.463
Neck/nape of the neck 6 (85.7) 17 (89.5) 66 (80.5) 19 (54.3) 12.027*0.011*
Lips 6 (85.7) 17 (89.5) 66 (80.5) 31 (88.6) 1.728 0.718
Ears 5 (71.4) 14 (73.7) 51 (62.2) 9 (25.7) 17.301*0.001*
Inner thigh 4 (57.1) 8 (42.1) 31 (37.8) 7 (20) 5.678 0.111
Lower abdomen/pubis 2 (28.6) 11 (57.9) 30 (36.6) 6 (17.1) 9.562*0.019*
Buttocks 2 (28.6) 8 (42.1) 35 (42.7) 7 (20) 5.919 0.104
Scalp 0 (0) 5 (26.3) 23 (28) 0 (0) 14.508*0.001*
Behind the knees 0 (0) 1 (5.3) 4 (4.9) 0 (0) 2.161 0.545
Feet 0 (0) 0 (0) 6 (7.3) 1 (2.9) 2.684 0.748
Wrist 0 (0) 0 (0) 5 (6.1) 0 (0) 3.854 0.48
Underarm/inner arm 0 (0) 1 (5.3) 4 (4.9) 0 (0) 2.161 0.545
MC, Monte Carlo test.
*Statistically significant at Pr0.05.
Female extragenital erogenous zones Younis et al.23
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Limitations
The number of women who participated in the research
is small due to the sensitivity of the topic of erogenous
zones for many women. Second, the majority of women
were highly educated and that limits the diversity of
participants.
Conclusion
Most participating women (95.3%) said that they are
aware of the extragenital erogenous zones in their bodies.
The most powerful extragenital erogenous zones were
the breasts and nipples, followed by the lips and the neck
and the nape of the neck (84.6, 83.9, and 75.5%,
respectively). The best method for stimulating extra-
genital erogenous zones differed between manual and
oral stimulation. Twelve percent of women said that they
can orgasm by the sole stimulation of extragenital
erogenous zones. Teaching sexual dysfunction patients
about the extragenital erogenous zones and the methods
of their stimulation can be of help to these patients.
Acknowledgements
Conflicts of interest
There are no conflicts of interest.
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24 Human Andrology
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Case No. ( )
1.
2.
degree
3. Duration of marriage: ---- years
4.
5.
6. How many times do you feel vaginal lubrication during the sexual act ?
7.
8.
9.
10. If [Yes], what type of that sexual dysfunction?
once/month Less than once/month
Coital frequency: Daily 2-3 times/week once/week
How many times you feel a sexual desire? Several times/day
Once/day Once/week Once/month Almost never
Erectile dysfunction Premature ejaculation
than half the times More than half the times Almost never
Does your partner suffer from any sexual dysfunction? Yes No
Do you experience pain during the sexual act? Yes No
Almost all times > ½ times < ½ times Almost never
How many times do you reach orgasm? Almost all times Less
Educational level: Read & write Secondary school University
Age: <20 years 20-29 years 30-39 years >40 years
Appendix
Appendix I: Questionnaire
Female extragenital erogenous zones Younis et al.25
Copyright r2016 Human Andrology. Unauthorized reproduction of this article is prohibited.
11. Do you feel that there are certain areas in your body that give you high
sexual arousal? Yes No
12. If [Yes], where are they?
Site High
stimulation
Low
stimulation
No stimulation
Scalp
Neck/Nape of neck
Ears
Lip
Breast/Nipples
Lower
abdomen/Pubis
Buttock
Inner thigh
Behind the knees
Feet
Wrist
Under arm/Inner arm
13. If [Yes], how are they maximally stimulated?
Site Manually Orally Both
Scalp
Neck/Nape of neck
Ears
Lips
Breast/Nipples
Lower
abdomen/Pubis
Buttock
Inner thigh
Behind the knees
Feet
Wrist
Under arm/Inner arm
14. Have you ever experienced an extra-genital orgasm? Yes No
15. If [Yes], what was the site? Scalp Neck/nape of the neck
Ears Lips Breast/Nipples Lower
abdomen/Pubis Buttocks Inner thigh Behind the knees Feet
Wrist Under arm/Inner arm
16. If [Yes], it was : Less intense than vaginal orgasm More intense than
vaginal orgasm Equal to vaginal orgasm
26 Human Andrology
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