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Clitorally Stimulated Orgasms Are Associated With Better Control of Sexual Desire, and Not Associated With Depression or Anxiety, Compared With Vaginally Stimulated Orgasms

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Introduction: Most women report that clitoral stimulation is an integral aspect of their orgasm experience. Thus, recent claims that vaginal stimulation and vaginally generated orgasms are superior to clitoral stimulation and clitorally generated orgasms pathologize most women and maintain a clitoral vs vaginal dichotomy that might not accurately reflect the complexity of women's sexual experience. Aim: To have women report on their experienced source of orgasm, including combinations of vaginal and clitoral stimulation, the solo or partnered context of the stimulation, and the intensity of the orgasms from different sources and to predict indicators of mental health and sexual health using the orgasm source. Methods: Eighty-eight women 18 to 53 years old answered detailed questions about their usual and recent orgasm experiences, sexual history, depression, and anxiety. Then, they viewed a series of neutral and sexual films. They were instructed to increase or decrease their sexual arousal or respond "as usual" to the sexual films. They reported their sexual arousal after each film. Main outcome measures: Outcomes assessed included mental health (depression and anxiety) and sexual health (orgasm quality, ability to regulate sexual response to sex films). Reported sexual arousal was analyzed for the regulation task. Results: Most women (64%) reported that clitoral and vaginal stimulation contributed to their usual method of reaching orgasm. Women who reported that clitoral stimulation was primarily responsible for their orgasm reported a higher desire to self-stimulate and demonstrated greater control over their self-reported sexual arousal. The primary stimulation site for orgasm was unrelated to measurements of depression or anxiety despite sufficient statistical power. Conclusion: Most women reported that clitoral and vaginal stimulation is important in orgasm. Women experience orgasms in many varied patterns, a complexity that is often ignored by current methods of assessing orgasm source. The reported source of orgasm was unrelated to orgasm intensity, overall sex-life satisfaction, sexual distress, depression, or anxiety. Women who reported primarily stimulating their clitoris to reach orgasm reported higher trait sexual drive and higher sexual arousal to visual sexual stimulation and were better able to increase their sexual arousal to visual sexual stimulation when instructed than women who reported orgasms primarily from vaginal sources.
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Clitorally Stimulated Orgasms Are Associated With Better Control of
Sexual Desire, and Not Associated With Depression or Anxiety,
Compared With Vaginally Stimulated Orgasms
Nicole Prause, PhD,
1
Lambert Kuang, BS,
1
Peter Lee, BS,
1
and Geoffrey Miller, PhD
2
ABSTRACT
Introduction: Most women report that clitoral stimulation is an integral aspect of their orgasm experience. Thus,
recent claims that vaginal stimulation and vaginally generated orgasms are superior to clitoral stimulation and
clitorally generated orgasms pathologize most women and maintain a clitoral vs vaginal dichotomy that might not
accurately reect the complexity of womens sexual experience.
Aim: To have women report on their experienced source of orgasm, including combinations of vaginal and
clitoral stimulation, the solo or partnered context of the stimulation, and the intensity of the orgasms from
different sources and to predict indicators of mental health and sexual health using the orgasm source.
Methods: Eighty-eight women 18 to 53 years old answered detailed questions about their usual and recent
orgasm experiences, sexual history, depression, and anxiety. Then, they viewed a series of neutral and sexual lms.
They were instructed to increase or decrease their sexual arousal or respond as usualto the sexual lms. They
reported their sexual arousal after each lm.
Main Outcome Measures: Outcomes assessed included mental health (depression and anxiety) and sexual
health (orgasm quality, ability to regulate sexual response to sex lms). Reported sexual arousal was analyzed for
the regulation task.
Results: Most women (64%) reported that clitoral and vaginal stimulation contributed to their usual method of
reaching orgasm. Women who reported that clitoral stimulation was primarily responsible for their orgasm re-
ported a higher desire to self-stimulate and demonstrated greater control over their self-reported sexual arousal.
The primary stimulation site for orgasm was unrelated to measurements of depression or anxiety despite suf-
cient statistical power.
Conclusion: Most women reported that clitoral and vaginal stimulation is important in orgasm. Women
experience orgasms in many varied patterns, a complexity that is often ignored by current methods of assessing
orgasm source. The reported source of orgasm was unrelated to orgasm intensity, overall sex-life satisfaction,
sexual distress, depression, or anxiety. Women who reported primarily stimulating their clitoris to reach orgasm
reported higher trait sexual drive and higher sexual arousal to visual sexual stimulation and were better able to
increase their sexual arousal to visual sexual stimulation when instructed than women who reported orgasms
primarily from vaginal sources.
J Sex Med 2016;-:1e10. Copyright 2016, International Society for Sexual Medicine. Published by Elsevier Inc.
All rights reserved.
Key Words: Orgasm; Clitoris; Self-Regulation; Anorgasmia; Depression; Anxiety
INTRODUCTION
Debate exists as to whether female orgasms can be generated
separately by the vagina and by the clitoris and what advantages
might exist to one type or the other.
1e3
These include dif-
culties making clear physiologic distinctions between clitoral
and vaginal orgasm,
4e6
identication of better sexual health in
those reporting clitorally induced orgasm,
7
and failures to
replicate reported advantages of vaginal orgasms.
8
Specically,
it was hypothesized that psychological immaturity (psycho-
sexual immaturity, with its concomitant greater use of
Received October 31, 2014. Accepted August 23, 2016.
1
Department of Psychiatry, University of CaliforniaeLos Angeles, Los
Angeles, CA, USA;
2
Department of Psychology, University of New Mexico, Albuquerque, NM,
USA
Copyright ª2016, International Society for Sexual Medicine. Published by
Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.jsxm.2016.08.014
J Sex Med 2016;-:1e10 1
immature defense mechanisms) couldleadtoinhibitionof
frequency and appreciation (including vaginal orgasm) of
penile-vaginal intercourse (PVI) in favor of other or no sexual
behaviors, with noxious consequences for mental health
and intimate relationships.
9(p339)
Real vaginal orgasms
were distinguished from masturbatory clitoral orgasms,
including stimulation of the clitoris during coitus, and related
to avarietyofpsychiatricdisorderssupported by early
psychoanalytic theories.Such reports have proved iatrogenic,
because women who desire clitoral stimulation to reach orgasm
during partnered interactions report feeling such stimulation
with a partner is embarrassingand uncomfortableto
request.
10
The present study tested the psychometric properties
of womens self-reported orgasm and orgasm source. Then, the
relations between self-reported orgasm source and different
health indicators were tested. The hypothesis tested was that
women who stimulate their clitoris to reach orgasm during
coitus will exhibit poorer mental health than women who reach
orgasm through vaginal stimulation alone.
The importance of clitoral stimulation for female orgasm has
long been discussed.
11
When women are asked how they reach
orgasm, they overwhelmingly report stimulating their clitoris.
12
Clitoral stimulation results in more consistent orgasms during
solo masturbation, but the clitoral stimulation and orgasm
consistency decrease when a male partner is introduced.
13,14
The
investigators speculated that this was due to female reticence to
request clitoral stimulation. Women who continue to stimulate
their clitoris when with a partner are more likely to be orgasmic
with their partner.
15
When masturbating for a laboratory study,
all 26 women reported using clitoral stimulation as their primary
means of reaching orgasm.
16
Intersex surgeries in children that
involve the clitoris also increase their difculty reaching orgasm
as an adult.
17
Vaginal and clitoral orgasms have not been differentiated
physiologically. However, when the vaginal opening is extended
by a phallus, the surrounding tissues are stretched and respond
reexively.
18
In other words, it appears impossible for the penis
to enter the vagina without also moving structures of the
clitoris. Of course, other structures such as the periurethral
glans also are likely stimulated during vaginal penetration. The
reverse, that is, whether any clitoral stimulation necessarily
contributes to some vaginal stimulation, has not been investi-
gated to our knowledge. Because intravaginal reexive con-
tractions increase during sexual arousal,
19
one could speculate
that clitoral stimulation similarly promotes vaginal motility.
Scientists disagree on the criteria for identifying female
orgasm,
20
making it difcult to imagine any consensually
acceptable physiologic test to differentiate the source of orgasm
at this time.
The relation of the clitoris to the vaginal opening also differs
among women and within individual women depending on their
current state, which could affect womens ability to report on this
experience in a consistent way. Women whose clitoris is closer to
the vaginal opening are much more likely (moderate to large
effect sizes) to report consistent (67% of occasions) orgasms
from intercourse.
21
Also, anorgasmic women typically have a
smaller glans clitoris.
22
Clitoral body volume also grows largest
during the peri-ovulatory phase
23
of the cycle, probably reecting
higher estradiol levels. These individual anatomic differences
could be important if, for example, some women experience
orgasm during penetration from clitoral stimulation, whereas
others experience orgasm during penetration from vaginal
stimulation.
Women tend to agree that clitoral stimulation facilitates
orgasm experience. In a large sample (N ¼749) of women, 94%
indicated clitoral stimulation could result in orgasm and 70%
reported that deep vaginal stimulation could result in orgasm.
24
This is consistent with womens reports that stimulation of the
clitoris is the easiest method for generating an orgasm.
25
In fact,
vaginal intercourse ranks after manual clitoral stimulation or oral
sex for its ability to contribute to an orgasm from a partner.
26
These reports are supported by structural evidence, in which
the clitoral glans appears to be an analogous structure to the glans
penis as characterized by the density of difference types of
receptors (eg, mechanoreceptors).
27
In summary, most women
report that clitoral stimulation is important to generate an
orgasm.
Although there are objective tests for the presence of orgasm,
there are no objective tests of orgasm source. However, women
clearly are willing to answer questions about the source of their
orgasm. Orgasm sourceis complex and might refer to different
aspects of the sexual experience: the area of stimulation that
triggers orgasm, the area that feels most sensitized during sexual
arousal, the area in which orgasmic sensations are rst felt, the
area that feels like the epicenter of motor responses to orgasm, or
something else. Also, although vaginal and clitoral differences are
most commonly discussed, many areas of the body could be
sensitized to provoke orgasm.
6
(Table 1) Women are typically
asked to report what proportion of orgasms they have had after
stimulation of different genital areas.
28
Even without clear
physiologic correlates, these self-report data could reect
important subjective experiences of orgasm.
The present study had two goals. The rst goal was to test
some of the psychometric properties of questions that women are
commonly asked to characterize their orgasm source. This
included identifying the most common areas (if any) thought to
contribute mostand next mostto orgasm, how strongly the
most recent orgasm source corresponded with the most usual
orgasm source, and womens condence that they have had
orgasms. The second goal was to test whether women who report
experiencing orgasm primarily by clitoral stimulation, compared
with women who report experiencing orgasm primarily by
vaginal stimulation, exhibit superior mental health (anxiety,
depression), sexual health (sexual satisfaction, distress about sex,
ability to control sexual feelings), and/or subjective orgasm
quality.
J Sex Med 2016;-:1e10
2Prause et al
One part of the protocol tested womens ability to change
their own feelings of sexual arousal. In emotion research
broadly, the ability to exibly increase and decrease an emotion
is a positive skill that supports a person effectively managing her
affect
29,30
and is related to emotional intelligence.
31
Such
exibility also is related to better executive functions.
32
Relat-
edly, the ability to increase and decrease sexual arousal is
associated with lower trait sexual drive,
33
suggesting that those
with lower sex drive are better able to control their responses to
visual sexual stimulation. Taken together, the ability to regulate
ones own feelings of sexual arousal could be considered a
desirable skill. Thus, a common emotion regulation task using
sex lms was included in the present study to assess whether
orgasm source was related to better self-control of sexual
arousal.
AIMS
The study had two aims. The rstaimwastobetterchar-
acterize womens reports of their primary and secondary
sources of their orgasms. The second aim was to test whether
women who report mainly clitorally generated orgasms
differed in mental health, sexual functioning, or orgasm
occurrence from women who report mainly vaginally gener-
ated orgasms.
METHODS
Participants
Participants (N ¼88) were recruited through a condential
web service from psychology classes at the University of New
Mexico in Albuquerque. They were required to have normal
Table 1. Demographic characteristics of participants
Ethnicity, n (%)*
Hispanic 40 (45.5)
White (not Hispanic) 34 (38.6)
Other 13 (14.8)
African American 1 (1.1)
Sexual orientation (self-identied), n (%)*
Heterosexual 73 (83.0)
Bisexual 13 (14.8)
Asexual 2 (2.3)
Homosexual 0 (0)
No sexual intercourse partners to date, n (%)*6 (6.8)
Relationship status, n (%)*
Monogamous 31 (35.2)
Non-monogamous 11 (12.5)
No relationship 46 (52.3)
Orgasm recency, n (%)*
Earlier today 6 (6.8)
Yesterday 12 (13.6)
Day before yesterday 8 (9.1)
3 d to 1 mo previously 30 (34.1)
>1 mo previously 14 (15.9)
Condence experienced orgasm in lifetime, n (%)*
Very sure 49 (55.7)
Pretty sure 12 (13.6)
Not sure 13 (14.8)
Probably do not experience orgasms 9 (10.2)
Denitely do not experience orgasms 4 (4.5)
Experiences multiple orgasms, n (%)*25 (28.4)
Primary cause of most recent orgasm, n (%)*
,
Vaginal penetration alone 29 (33)
Clitoral stimulation
40 (45.5)
Do not have orgasms 15 (17.0)
Another method 3 (3.4)
Stimulation area that usually contributes most to
orgasm, n (%)*
Very tip (glans) of clitoris 29 (14.9)
Skin over or above clitoris 20 (10.3)
Side of the vagina toward my belly (might
include G-spot)
15 (7.7)
I dont know 6 (3.1)
Nipples 5 (2.6)
Labia 2 (1.0)
Side of the vagina toward my back 1 (0.5)
Opening of my vagina 2 (1.0)
Somewhere else 2 (1.0)
I dont experience orgasms 10 (5.2)
Age (y), mean (SD) 22 (7.3)
Sexual intercourse with partners (lifetime),
mean (SD)
7.3 (9.5)
Sexual intercourse 1 time only (lifetime),
mean (SD)
3.1 (6.9)
Sexual intercourse frequency, mean (SD)
§
2.9 (1.5)
Masturbation frequency,
mean (SD)
§
2.2 (1.2)
(continued)
Table 1. Continued
Frequency of viewing erotica (h/wk),
mean (SD)
1.7 (3.0)
Centers for Epidemiological StudieseDepression,
mean (SD)
k
15.6 (10.3)
Sexual Desire Inventory, mean (SD) 1.0 (1.8)
Desire for sex with partner
{
43.1 (13.6)
Desire for solitary sex
#
9.0 (6.0)
Female Sexual Function IndexeOrgasm,
mean (SD)**
3.1 (2.1)
*Values might not sum to total due to non-response.
Analyses included only those who reported their most recent orgasm as
caused primarily by clitoral or vaginal stimulation.
Includes clitoral stimulation alone or in combination with vaginal
stimulation.
§
2¼one to three times a month;3¼one time a week.
k
A suggested cutoff of 16 for depression has been suggested.
66
{
Range ¼8to70.
#
Range ¼3 to 26.
**Equivalent to a weighted score of 1.24, where 2.98 or lower was average in
a sample with orgasmic dysfunction.
67
J Sex Med 2016;-:1e10
Clitorally Versus Vaginally Stimulated Orgasms 3
(or corrected-to-normal) vision and hearing appropriate for
viewing lms. Most participants identied as heterosexual,
were sexually experienced, not currently in a relationship, and
reected the ethnic composition of the Albuquerque area, with
mostly Hispanic and white (not Hispanic) participants
(Table 1). No one declined to participate after reading the
informed consent statement. All procedures were approved
by the institutional review board at the University of New
Mexico.
Regulation Task
Computerized training was provided on the regulation task
using non-sexual stimuli (lms of people eating, instructed to
regulate hunger). Participants were instructed to view each lm
the entire time (20 seconds) it was on the screen and to refrain
from stimulating themselves sexually. An instruction was given
for 2 seconds immediately before each sexual lm (Figure 1).
Participants saw a circle, an upward arrow, or a downward
arrow, which indicated that they should simply watch, increase
their sexual arousal, or decrease their sexual arousal to the
sexual lm, respectively. They were not restricted to the
cognitive or affective strategies they used to alter their
responses, because the interest was in examining usual abilities
to alter responses.
Films were shown on a 1,280 1,024 cathode ray tube
monitor with a 75-Hz refresh rate and 32-bit color depth at a
distance of 1 m using Presentation (Neurobehavioral Systems,
Berkeley, CA, USA). Participants were shown 30 different sexual
lms. Regulation instruction was pseudo-randomized to ensure
that preferences for certain lms would not interact with regulation
instruction. Furthermore, participants did not receive the same
instructions more than three times consecutively. After watching
every lm, participants rated the level of how sexually aroused
they felt on a seven-point Likert scale from not at allto very.
Self-rated sexual arousal was the primary dependent variable.
Film Stimuli
Two types of lms were used: neutral and sexual. The neutral
lm was previously standardized
34
not to evoke any particular
emotional state. It depicts neon lines appearing against a solid black
background at a slow rate of speed in random directions. Sexual
lms were selected to be sexually arousing to men and women. Two
lms were used from a previous study for scienticcontinuity.
35e37
Twenty-eight additional sexual lms were selected from the Adult
Video Network Award winners for Best Film and Best Scene
38
for a
total of 30 sexual lm clips. All sexual lms showed one man and
one woman having consensual, vaginal intercourse, included their
faces in the opening screen, and did not show kissing or oral sex.
Sexual lms did not include infrequent behaviors, such as bondage
and anal intercourse.
39
All lms were edited to 20 seconds in
length. Thisbrief presentation period was used to replicate previous
studies of self-regulation to emotional lms that ranged from 15
40
to 39
41
seconds. The same neutral lm appeared after every sexual
lm, for a total of 60 lm clips in the task.
Questionnaires
Questionnaires were included to assess mental health and
sexual functioning. Specic questionnaires were included to
assess the two most common Axis I problems, depression and
anxiety. Sexual health was assessed as the presence of sexual
problems and the level of sexual desire to characterize the sample.
Centers for Epidemiological StudyeDepression Scale
The Centers for Epidemiological StudyeDepression Scale
(CES-D)
42
is a 20-item questionnaire that assesses symptoms of
depression by asking participants to rate how often they had felt
or behaved certain ways (eg, I was bothered by things that
usually dont bother me.). Response options ranged from rarely
or none of the time (less than one a day)to most or all of the
time (5e7 days).The CES-D is a very widely used measure-
ment of depression in adolescents
43
to older adults.
44
Figure 1. Protocol and four trial types in the sexual regulation task.
J Sex Med 2016;-:1e10
4Prause et al
Beck Anxiety Inventory
The Beck Anxiety Inventory (BAI)
45
is a 21-item questionnaire
that assesses anxiety symptoms. Women were asked to rate how
much they were bothered by each symptom (eg, unable to relax,
fear of the worst happening) in the past month from not at all
to severelyit bothered me a lot.The BAI correlates with many
other measurements of anxiety.
46
The BAI appears less contami-
nated with depression symptoms than other common measure-
ments of anxiety
47
in non-symptomatic, college samples.
48
It is
moderately reliable (r ¼0.67) over an 11-day delay period.
34
Personal and Sexual History
This questionnaire included questions about a participants
background, sexual behaviors, and sexual feelings. Sexual history
questions (eg, number of lifetime sexual intercourse partners)
were from the National AIDS Behavior Survey.
49
Specically relevant for the present study, participants answered
many questions about their orgasm history and preferences. These
included, Which of these best describes what you were doing that
caused this last orgasm?Options included a list of sexual behaviors
(eg, with a partner during intercourse alone,”“with a partner
during intercourse while also stimulating myself with my hand,
another method not listed here,etc), which were recoded to
vaginal onlyif the participant reported that she experienced
orgasm through intercourse alone (Table 1). All other methods that
included clitoral stimulation, including stimulating the clitoris
during penetration, were coded as including clitoralstimulation.
To examine the relevance of questions sometimes used to
characterize orgasm source,
28
women were asked, When you
experience orgasm, please select the top two body areas that
contribute the most to your experiencing orgasm when they are
stimulated.A labeled photograph of the vulva was provided to
ensure that women were familiar with the available options
(Figure 2). All response options are listed in Table 1. For ana-
lyses, the clitoral hood and clitoral glans were coded as a clitoral
source, and any area of the vagina was coded as a vaginal
source. All other responses were excluded from these analyses
because they were too infrequent for analysis (Table 1). The
vaginal openingwas not coded as vaginalbecause of concerns
that the opening might cause more obnubilation and pareidolia
in contrast to the clitoris.
Women also were asked how sure they were that they expe-
rience orgasms. The language was, Some people get very sexu-
ally aroused, but are not sure that they have ever had an orgasm.
How sure are you that you experience orgasms?They could
respond very sure,”“pretty sure,”“not sure,”“probably do not
experience orgasms,and denitely do not experience orgasms.
This question assesses whether the women themselves have
condence in describing their own orgasm experiences.
Female Sexual Distress ScaleeRevised
The Female Sexual Distress ScaleeRevised (FSDS-R)
50
con-
sisted of 13 items and was used to compare the level of sexual
distress between women with vaginally stimulated orgasms and
women with clitorally stimulated orgasms (eg, How often did
you feel distressed about your sex life?with responses from
alwaysto never). The scale exhibited a high internal
consistency (a¼0.93) and test-retest reliability (r ¼0.80 for
frequency and 0.83 for intensity) over 4 weeks.
50
The scale was
used as a general measurement of satisfaction with sexual
functioning.
Sexual Desire Inventory
The Sexual Desire Inventory (SDI)
51
is a 14-item question-
naire that measures the strength and frequency of a persons
sexual desire. It is composed of two subscales: solitary (eg, How
strong is your desire to engage in sexual behavior by yourself?)
and dyadic (eg, When you rst see an attractive person, how
strong is your sexual desire?). They measure desire for mastur-
bation and partnered sexual activity, respectively. The scale has a
high internal consistency (a¼0.96) and test-retest reliability
(r ¼0.76) over a 1-month period. The SDI is included as an
indicator of the role of orgasm type in sexual motivation, where
different types of stimulation might be pursued based on, or as a
reection of, the strength of the sex drive.
Procedure
The study was conducted in a private, windowless testing
room at the Mind Research Network (Albuquerque, NM, USA).
After completing the informed consent process, participants
completed the questionnaires described earlier. At completion of
the questionnaires, they completed the sexual arousal regulation
Figure 2. Labeled photograph shown to women to ensure a
common understanding of genital anatomy (in color in study).
J Sex Med 2016;-:1e10
Clitorally Versus Vaginally Stimulated Orgasms 5
task. They wore headphones to listen to the videos and to
increase their sense of privacy during the task. The participants
received the instructions describing the task visually on the
computer screen and audibly in the recording to ensure the
participantsunderstanding. When the participants nished
receiving the instructions, the experimenter verbally answered
any other questions and then left the room. The participant was
given a standard keyboard to record her level of sexual arousal
and pleasantness during the tasks. After completing the regula-
tion task, instructions appeared on the screen instructing the
participant to alert the researcher. The researcher debriefed the
participants, answered any questions they had, and awarded
compensation in the form of participation credit for their
coursework.
MAIN OUTCOME MEASURES
The data collected from the questionnaires and video tasks
were analyzed in relation to the participantsmost recent orgasm
by clitoral or vaginal stimulation. Recall (see earlier) of the most
recent orgasm was used, because state effects on the sexual
arousal task were of interest. The relation between the most
recent and the usualorgasm source is reported. A null-
hypothesis testing approach was used (a¼0.05). The exact
Pvalue is reported except when Pvalues were less than .001.
RESULTS
Questionnaires exhibited high internal consistency using the
Guttman l6,
52
a conservative estimate,
53
for the BAI (0.92),
CES-D (0.92), SDI (0.94), and FSDS-R (0.92). Women re-
ported signicantly higher sexual arousal after viewing the sexual
lm (mean ¼3.6 of 7, SD ¼1.6) than the neutral lm (mean ¼
1.8, SD ¼0.8, t
65
¼11.45, P<.001, d ¼1.4). This indicated
that the lm task worked as intended; thus, the planned analyses
for the lm test were conducted (see below).
Validity and Reliability of Self-Report Measurement
Three aspects of self-reported orgasm source were examined.
These included how often women indicated a primary and
secondary source that contributed to their orgasm, how sure
women were that they have orgasms, and reliability of the source
reports (most recent vs usual orgasm source). First, women who
reported that the primary area that usually caused their orgasms
was vaginal or clitoral were signicantly more likely to report that
the secondary area of stimulation that contributed to their
orgasm was the other (vaginal or clitoral) area (c
21
¼7.58,
P¼.007 by Fisher test, J¼0.42; Table 2). Second, womens
ratings of how sure they were that they had experienced orgasm
in their lifetimes differed signicantly from a rating of sure
(women were classied as being sureif they responded that
they were very surethey experience orgasms or denitely do
not experience orgasms;t
86
¼6.58, P<.001; Table 1), indi-
cating that women are frequently not sure that they are correctly
interpreting their orgasm experience (Table 1). Third, the area of
stimulation that women said caused their most recent orgasm
also was signicantly likely to be the same area of stimulation
that they reported contributed the most to their orgasms (c
21
¼
10.92, P¼.002 by Fisher test, J¼0.43; Table 3). However,
16 women (27%) indicated a difference between their most
recent and their usual orgasm source.
Differences in Functioning by Primary, Last Orgasm
Source Reported
Next, the relations of orgasm source with mental and sexual
health indicators were tested. First, general indicators of mental
health were examined. Neither depression (CES-D) nor anxiety
(BAI) scores were predicted by the womens source of their most
recent orgasm. Second, indicators of sexual health were exam-
ined. Women whose most recent orgasm was reached mainly by
clitoral stimulation reported more sexual arousal to the sexual
lms that they were told to just watch (t
52
¼2.11, P¼.04,
d¼0.59; clitoral mean ¼4.02, SD ¼1.5; vaginal mean ¼3.11
of 7, SD ¼1.6) than the women whose most recent orgasm was
reached mainly by vaginal stimulation. However, women
reporting primarily clitoral stimulation did report continued
sexual arousal that also was higher after the neutral lm that
followed the sexual lms (mean ¼2.75, SD ¼1.3) compared
with women who reported their latest orgasm was from vaginal
stimulation (mean ¼2.06, SD ¼1.0, t
53
¼2.19, P¼.03,
d¼0.59). For lms that elicited an increased sexual response,
the clitoral group also reported higher sexual arousal levels
(t
52
¼2.09, P¼.04, d ¼0.59; clitoral mean ¼4.28,
SD ¼1.5; vaginal mean ¼3.33, SD ¼1.7). The ability to
Table 2. Women who report usually experiencing clitoral or vaginal
areas as a primary source are likely to identify the other area as a
secondary source of their orgasm
Secondary source
Primary source
Clitoral Vaginal Total*
Clitoral 15 13 28
Vaginal 15 1 16
Total 30 14 44
*Missing data are due to women who report non-clitoral or non-vaginal
sources of orgasm (eg, nipple).
Table 3. Consistency of orgasm source comparing most recent
with usualorgasm source
Most recent source
Usual source
Clitoral Vaginal Total*
Clitoral 32 3 35
Vaginal 13 11 24
Total 45 14 59
*Missing data are due to women who report non-clitoral or non-vaginal
sources of orgasm.
J Sex Med 2016;-:1e10
6Prause et al
decrease sexual response did not vary as a function of orgasm
source. Women who reported that clitoral stimulation contrib-
uted more to their orgasm also reported a higher desire for
solitary sexual activity than women who reported that vaginal
stimulation contributed more to their orgasm (clitoral mean ¼
11.25, SD ¼6.4 vs vaginal mean ¼6.35, SD ¼3.4,
t
57
¼3.75, P<.001, d ¼0.96).
Characteristics of the orgasm that varied by their reported
source were compared. Orgasm source (clitoral vs vaginal) did
not predict self-reported orgasm intensity (clitoral mean ¼3.91,
SD ¼1.4; vaginal mean ¼3.18, SD ¼1.7; t
55
¼1.70,
P¼.1, d ¼0.48), overall sex-life satisfaction (clitoral mean ¼
3.56, SD ¼2.3; vaginal mean ¼2.96, SD ¼2.0; t
57
¼1.049,
P¼.3, d ¼0.28), or sexual distress scores (FSDS-R; vaginal
mean ¼11.05, SD ¼8.7 vs clitoral mean ¼10.85, SD ¼7.9,
t
53
¼0.085, P¼.933, d ¼0.02).
DISCUSSION
Some have suggested that orgasms generated by clitoral
stimulation are associated with inferior sexual, emotional, and
relationship functioning.
1
The results from the present study
suggest a more complex and nuanced picture of female orgasm
that goes beyond the clitoral vs vaginal dichotomy in two key
ways. First, these data clarify that the way in which orgasm
source has been assessed (clitoral or vaginal?) is misleading,
because most of our participants who reported a vaginal or
clitoral orgasm source as the primary site then reported the other
as the secondary site. Women experience orgasms in many varied
patterns, a complexity that is often missed by current methods of
assessing orgasm source. Second, women whose most recent
orgasm was caused primarily by clitoral stimulation indicated
better sexual functioning in several domains. Specically, these
women reported higher levels of sexual arousal when watching
sexual lms, were better able to increase their sexual arousal when
instructed, and reported a higher motivation to masturbate.
Higher sexual arousal reports to lms have been consistently
linked to better sexual function.
54
They also did not differ in
their general mental health (depression or anxiety).
Self-reported orgasm source data might be useful in women sure
of their orgasm experience who have experience with clitoral and
vaginal orgasms. However, these data suggest that women feel
compelled to report a source for their orgasm when asked,
including women who are unsure that they even experience
orgasms. No physiologic data have yet demonstrated differences to
support self-reported differences in orgasm source. However, most
women still selected an area of stimulation to describe the source
of their orgasm. In this rather complex picture, it is understandable
that signicant confusion could occur that would make attribution
of orgasms to a particular area of stimulation difcult.
Reframing the vaginal vs clitoral distinction might be useful in
future examinations of female sexual function. Most women in
this study reported that vaginal and clitoral stimulation
contributed to their orgasm(s). In fact, only one woman indi-
cated that her vagina was the primary and secondary area that
contributed to her orgasm. Put another way, asking women to
make a forced choice between clitoral and vaginal orgasm might
be similar to asking men to make a forced choice between a
penile glansor a penile shaftorgasm.
8
Many men report that
their shaft and glans are important in orgasm,
55
just as many
women in our study reported that the clitoris and the vagina are
important as primary or secondary sources of orgasm. Men also
were surveyed in this study (full results to be reported elsewhere).
Of those 99 men who reported having orgasms, the primary
stimulation site was reported as the very tip of my penisby 35,
just under the tip of the penisby 31, and the shaft of the
penisby 24 (others cited other sites of stimulation, such as
testicles). Also, the preference for the site of stimulation can
change with the partner and the sexual activity. Furthermore, the
preference might shift as perception changes with sexual arousal,
such as the shifts seen in pain thresholds
16
and sensitivity
56
with
increasing sexual arousal. Some have suggested shifting the
discussion to distinguish whether the external or internal clitoral
structures are involved, because evidence of uniquely vaginal
stimulation could not be identied by sonography.
18
Others
have suggested shifting to a description of genitalorgasms,
possibly distinguished from clitoral, given the many structures
stimulated by intercourse.
6
The present data appear consistent
with these views.
Although self-report data of orgasm were analyzed in this
study, they appear of limited utility. In this study, a substantial
number of women were unsure of whether they were experi-
encing orgasm. Physiologic studies of orgasm in women rarely
verify the presence of orgasm through any objective means,
57
despite the availability of such physiologic methods as anal or
vaginal pressure monitors,
58
or through the use of direct obser-
vation as in studies of men.
59
Surprisingly, even very invasive
spinal surgery interventions to improve anorgasmia continue to
rely on self-reported orgasm events alone as an outcome.
60
Studies claiming to analyze the locus of orgasm in women
might not be tapping into real physiologic distinctions among
orgasm types. In this study, self-reported orgasm source data
were collected to attempt to replicate, extend, or challenge
existing publications. Future studies should begin to verify the
presence of other orgasm markers (eg, physiologic, behavioral)
to ensure convergence between self-report and physiologic
measurement of orgasm.
This study has limitations. The sample was a convenience
sample of relatively young students who might differ from the
general population of women. Also, Hispanic and non-Hispanic
women were well-represented by chance, and they might have
different experiences of orgasm that are unknown. Perhaps the
most difcult limitation to address is that many of the differences
in self-reported orgasm source can be attributable to the presence
of a partner. For example, vaginal stimulation is more likely to
occur in a partnered context, in which a male partner would
J Sex Med 2016;-:1e10
Clitorally Versus Vaginally Stimulated Orgasms 7
promote vaginal penetration where he receives direct physical
pleasure. Ideally, analyses should be conducted in four cells:
partner present with vaginal source, partner absent with vaginal
source, partner present with clitoral source, and partner absent
with clitoral source. Very few women reported that they expe-
rienced a vaginal orgasm source without having an intercourse
partner (eg, using an inserted toy during solo masturbation).
This suggests it might be difcult to identify women who
masturbate using penetration alone, limiting even experimental
options for testing the importance of the presence of the partner.
The approach itself represents a challenge, because a self-report
approach was used to demonstrate the limitations of a self-
report approach. For example, these reports still cannot be
linked to specic physiologic events that might distinguish them.
Also, the study was conducted in a laboratory setting. Although
research attempting to link laboratory responses to real-world
sexual behaviors is increasing,
61e63
it is unclear how closely
self-reports resemble behaviors and experiences at home. Further,
institutional review boards have prevented the study of orgasms
in the United States. Specically, a protocol submitted to the
Institutional Review Board of the University of New Mexico in
Albuquerque was rejected after months of review when we
refused to remove just the orgasm component of the study,
although no safety, condentiality, science, or similar concerns
were identied as a problem.
CONCLUSION
Many women report feeling sexually inadequate, because they
cannot experience orgasms by penile penetration alone (eg, all real
women do,”“I am sure [clitoral stimulation during intercourse]
doesnt look nice).
64
This dissatisfaction is so signicant that
methods purported to surgically enhance vaginal sensitivity are
peddled.
65e67
This second failure to replicate previous reports of
the superiority of women who experience vaginal orgasms
8
and
contrary data patterns suggest that data suggesting the problems
with clitoral stimulation to reach orgasm are not replicable. Some
women already have shifted away from prioritizing orgasm as a
neurophysiologic response to clitoral or vaginal stimulation
essential to sexual satisfaction, such as this focus group participant:
Idont think that the act of sex is to have an orgasm. Itsnotthe
goal. The goal of sex is to be intimate with your partner and show
them you care and that you love them.
10(p621)
The goal of sexual
interactions is likely to shift with the social context, individual
preferences, and the state of the individual. These data suggest
that, when orgasm is a part of the sexual interaction, the superi-
ority of one stimulation area or another is likely to change with the
context and the desired outcome. Women who experience orgasm
regularly during masturbation with good knowledge of their
clitoris often cannot experience orgasm when they want to with a
partner.
12
Such partnered anorgasmia can worsen if a womans
preferred method of stimulation is pathologized (for review, see
Levin
5
). The study of orgasm will remain in its infancy stage until
scientists successfully overcome scienticandmoralchallengesto
strong empirical methods.
Corresponding Author: Nicole Prause, PhD, Department of
Psychiatry, University of CaliforniaeLos Angeles, 730 West-
wood Boulevard, Los Angeles, CA 90024, USA; E-mail: nicole.
prause@gmail.com
Conicts of Interest: The authors report no conicts of interest.
Funding: None.
STATEMENT OF AUTHORSHIP
Category 1
(a) Conception and Design
Nicole Prause; Lambert Kuang; Peter Lee; Geoffrey Miller
(b) Acquisition of Data
Nicole Prause
(c) Analysis and Interpretation of Data
Nicole Prause; Lambert Kuang; Peter Lee
Category 2
(a) Drafting the Article
Nicole Prause; Lambert Kuang; Peter Lee; Geoffrey Miller
(b) Revising It for Intellectual Content
Nicole Prause; Geoffrey Miller
Category 3
(a) Final Approval of the Completed Article
Nicole Prause; Lambert Kuang; Peter Lee; Geoffrey Miller
REFERENCES
1. Brody S. The relative health benets of different sexual
activities. J Sex Med 2010;7:1336-1361.
2. Suschinsky KD, Lalumiere ML. Sex differences in sexual
concordance: a reply to Brody (2012). Arch Sex Behav 2013;
42:1107-1109.
3. Levin RJ. Should the clitoris become a vestigial organ by
personal psychological clitoridectomy? A critical examination
of the literature. J Womens Health Issues Care 2014;3:1-14.
4. Levin RJ. The human female orgasm: a critical evaluation of its
proposed reproductive functions. Sex Relatsh Ther 2011;
26:301-314.
5. Levin RJ. The deadly pleasures of the clitoris and the con-
doma rebuttal of Brody, Costa and Hess (2012). Sex Relatsh
Ther 2012;27:272-295.
6. Levin RJ. Recreation and procreation: a critical view of sex in
the human female. Clin Anat 2015;28:339-354.
7. Prause N. The human female orgasm: critical evaluations of
proposed psychological sequelae. Sex Relatsh Ther 2011;
26:315-328.
8. Laan E, Rellini AH. Can we treat anorgasmia in women? The
challenge to experiencing pleasure. Sex Relatsh Ther 2011;
26:329-341.
J Sex Med 2016;-:1e10
8Prause et al
9. Brody S, Costa RM. Vaginal orgasm is associated with less use
of immature psychological defense mechanisms. J Sex Med
2008;5:1167-1176.
10. Salisbury CMA, Fisher WA. Did you come?A qualitative
exploration of gender differences in beliefs, experiences, and
concerns regarding female orgasm occurrence during hetero-
sexual sexual interactions. J Sex Res 2013;51:616-631.
11. Marmor M. Some considerations concerning orgasm in the
female. Psychosom Med 1954;3:240-245.
12. Darling CA, Davidson JK, Cox RP. Female sexual response
and the timing of partner orgasm. J Sex Marital Ther 1991;
17:3-21.
13. Wade LD, Kremer EC, Brown J. The incidental orgasm: the
presence of clitoral knowledge and the absence of orgasm for
women. J Womens Health 2005;42:117-138.
14. Garcia JR, Lloyd EA, Wallen K, et al. Variation in orgasm
occurrence by sexual orientation in a sample of U.S. singles.
J Sex Med 2015;11:2645-2652.
15. de Sutter P, Day J, Adam F. Who are the orgasmic women?
Exploratory study among a community sample of French-
speaking women. Sexologies 2014;23:e51-e57.
16. Paterson LQP, Amsel R, Binik YM. Pleasure and pain: the
effect of (almost) having an orgasm on genital and nongenital
sensitivity. J Sex Med 2013;10:1531-1544.
17. Minto CL, Liao LM, Woodhouse CR, et al. The effect of clitoral
surgery on sexual outcome in individuals who have intersex
conditions with ambiguous genitalia: a cross-sectional study.
Lancet 2003;361:1252-1257.
18. Buisson O, Jannini EA. Pilot echographic study of the differ-
ences in clitoral involvement following clitoral or vaginal sexual
stimulation. J Sex Med 2013;10:2734-2740.
19. Carmichael MS, Warburton VL, Dixen J, et al. Relationships
among cardiovascular, muscular, and oxytocin responses
during human sexual activity. Arch Sex Behav 1994;
23:59-79.
20. Mah K, Binik YM. The nature of human orgasm: a critical
review of major trends. Clin Psychol Rev 2001;21:823-856.
21. Wallen K, Lloyd EA. Female sexual arousal: genital anatomy
and orgasm in intercourse. Horm Behav 2011;59:780-792.
22. Oakley SH, Vaccaro CM, Crisp CC, et al. Clitoral size and
location in relation to sexual function using pelvic MRI. J Sex
Med 2014;11:1013-1022.
23. Morotti E, Battaglia B, Persico N, et al. Clitoral changes,
sexuality, and body image during the menstrual cycle: a pilot
study. J Sex Med 2013;10:1320-1327.
24. Bronselaer G, Callens N, De Sutter P, et al. Self-assessment of
genital anatomy and sexual function within a Belgian, Dutch-
speaking female population: a validation study. J Sex Med
2013;10:3006-3018.
25. Schober JM, Meyer-Bahlburg HFL, Ransley PG. Self-assessment
of genital anatomy, sexual sensitivity and function in women:
implications for genitoplasty. BJU Int 2004;94:589-594.
26. Brewer G, Hendrie CA. Evidence to suggest that copulatory
vocalizations in women are not a reexive consequence of
orgasm. Arch Sex Behav 2011;40:559-564.
27. Shih C, Cold CJ, Yang CC. Cutaneous corpuscular receptors of
the human glans clitoris: descriptive characteristics and
comparison with the glans penis. J Sex Med 2013;10:1783-
1789.
28. Prause N. A response to Brody, Costa and Hess (2012):
theoretical, statistical and construct problems perpetuated
in the study of female orgasm. Sex Relatsh Ther 2012;
27:260-271.
29. Bonanno GA, Papa A, Lalande K, et al. The importance of
being exible: the ability to both enhance and suppress
emotional expression predicts long-term adjustment. Psychol
Sci 2004;15:482-487.
30. Kashdan TB, Rottenberg J. Psychological exibility as a
fundamental aspect of health. Clin Psych Rev 2010;
30:865-878.
31. Geher G, Miller G. Mating intelligence: sex, relationships, and
the minds reproductive system. New York: Taylor & Francis
Group; 2007.
32. Gyurak A, Goodkind MS, Kramer JH, et al. Executive functions
and the down-regulation and up-regulation of emotion. Cogn
Emot 2011;26:103-118.
33. Moholy M, Prause N, Proudt GH, et al. Sexual desire, not
hypersexuality, predicts self-regulation of sexual arousal. Cogn
Emot 2014;29:1505-1516.
34. Rotternberg J, Ray RD, Gross JJ. Emotion elicitation using
lms. In: Coan JA, Allen JJ, eds. Handbook of emotion elici-
tation and assessment. Oxford: Oxford University Press;
2007. p. 9-28.
35. Janssen E, Carpenter D, Graham CA. Selecting lms for sex
research: gender differences in erotic lm preference. Arch
Sex Behav 2003;32:243-251.
36. Pinowski N. Outdoor ecstasy. Chatsworth, CA: Adam & Eve;
1994.
37. Thompson B. Outdoor ecstasy. Los Angeles: Ultimate Stu-
dios; 1994.
38. Steele N. Bonny & Clide. Kildare, Ireland: Bluebird Films; 2010.
39. Woodard TL, Collins K, Perez M, et al. What kind of erotic lm
clips should we use in female sex research? An exploratory
study. J Sex Med 2008;5:146-154.
40. Goldin PR, McRae K, Ramel W, et al. The neural bases of
emotion regulation: reappraisal and suppression of negative
emotion. Biol Psychiatry 2008;63:577-586.
41. Beauregard M, Levesque J, Bourgouin P. Neural correlates of
conscious self-regulation of emotion. J Neurosci 2001;
21:6993-7000.
42. Radloff LS. The CES-D scale: a self-report depression scale for
research in the general population. Appl Psychol Meas 1977;
1:385-401.
43. Radloff LS. The use of the Center for Epidemiologic Studies
Depression Scale in adolescents and young adults. J Youth
Adolesc 1991;20:149-166.
44. Beekman AT, Deeg DJ, Van Limbeek J, et al. Criterion validity
of the Center for Epidemiologic Studies Depression scale
(CES-D): results from a community-based sample of older
subjects in the Netherlands. Psychol Med 1997;27:231-235.
J Sex Med 2016;-:1e10
Clitorally Versus Vaginally Stimulated Orgasms 9
45. Beck AT, Epstein N, Brown G, et al. An inventory for
measuring clinical anxiety: psychometric properties. J Consult
Clin Psychol 1988;56:893-897.
46. Gillis MM, Haaga DAF, Ford GT. Normative values for the Beck
Anxiety Inventory, Fear Questionnaire, Penn State Worry
Questionnaire, and Social Phobia and Anxiety Inventory.
Psychol Assess 1995;7:450-455.
47. Fydrich T, Dowdall D, Chambless DL. Reliability and validity
of the Beck Anxiety Inventory. J Anxiety Disord 1992;
6:55-61.
48. Creamer M, Foran J, Bell R. The Beck Anxiety Inventory in a
non-clinical sample. Behav Res Ther 1995;33:477-485.
49. Binson D, Catania JA. Respondentsunderstanding of the
words used in sexual behavior questions. Public Opin Q 1998;
62:190-208.
50. Derogatis L, Clayton A, Lewis-DAgostino D, et al. Validation of
the Female Sexual Distress ScaleeRevised for assessing
distress in women with hypoactive sexual desire disorder.
J Sex Med 2008;5:357-364.
51. Spector IP, Carey MP, Steinberg L. The sexual desire inventory:
development, factor structure, and evidence of reliability.
J Sex Marital Ther 1996;22:175-190.
52. Guttman L. A basis for analyzing test-retest reliability.
Psychometrika 1945;10:255-282.
53. Callender JC, Osburn HG. An empirical comparison of coef-
cient alpha, Guttmans lambda-2, and MSPLIT maximized
split-half reliability. J Educ Meas 1979;16:89-99.
54. Sarin S, Amsel R, Binik YM. A Streetcar named derousal?A
psychophysiological examination of the desire-arousal
distinction in sexually functional and dysfunctional women.
J Sex Res 2016;53:711-729.
55. Schober JM, Meyer-Bahlburg HF, Dolezal C. Self-ratings of
genital anatomy, sexual sensitivity and function in men using
the Self-Assessment of Genital Anatomy and Sexual Func-
tion, Malequestionnaire. BJU Int 2009;103:1096-1103.
56. Payne KA, Binik YM, Pukall CF, et al. Effects of sexual arousal
on genital and non-genital sensation: a comparison of women
with vulvar vestibulitis syndrome and healthy controls. Arch
Sex Behav 2007;36:289-300.
57. Whipple B, Ogden G, Komisaruk BR. Physiological correlates
of imagery-induced orgasm in women. Arch Sex Behav 1992;
21:121-133.
58. Bohlen JG, Held JP, Sanderson MO, et al. The female orgasm:
pelvic contractions. Arch Sex Behav 1982;11:367-386.
59. Georgiadis JR, Farrell MJ, Boessen R, et al. Dynamic subcortical
blood ow during male sexual activity with ecological validity: a
perfusion fMRI study. Neuroimage 2010;50:208-216.
60. Meloy TS, Southern JP. Neurally augmented sexual function in
human females: a preliminary investigation. Neuromodulation
2006;9:34-40.
61. Both S, Spiering M, Everaerd W, et al. Sexual behavior and
responsiveness to sexual stimuli following laboratory-induced
sexual arousal. J Sex Med 2004;41:242-259.
62. Prause N, Steele VR, Staley C, et al. Late positive potential
to explicit sexual images associated with the number of
sexual intercourse partners. Soc Cogn Affect Neurosci
2015;10:93-100.
63. Bloemers J, Gerritsen J, Bults R, et al. Induction of sexual
arousal in women under conditions of institutional and
ambulatory laboratory circumstances: a comparative study.
J Sex Med 2010;7:1160-1176.
64. Lavie-Ajayi M, Joffe H. Social representations of female
orgasm. J Health Psychol 2009;14:98-107.
65. Meadows LD, Avellanet YR, English J. Fat augmentation of the
anterior vaginal wall: a novel use of fat augmentation in
enhancing the female sexual experience. Am J Cosmet Surg
2011;28:171-176.
66. Boyd JH, Weissman MM, Thompson W, et al. Screening for
depression in a community sample: understanding the
discrepancies between depression symptom and diagnostic
scales. Arch Gen Psychol 1982;39:1195-1200.
67. Wiegel M, Meston C, Rosen R. The Female Sexual Function
Index (FSFI): cross-validation and development of clinical
cutoff scores. J Sex Marital Ther 2005;31:1-20.
J Sex Med 2016;-:1e10
10 Prause et al
... Direct stimulation of the clitoris improves the regularity of experienced orgasms, called orgasm consistency and orgasm quality (Herbenick et al., 2018). During sexual intercourse without direct clitoral stimulation, only about one-third of all females experience an orgasm (Prause et al., 2016). In contrast, during masturbation, 59% of women usually experienced an orgasm (Dunn et al., 2005). ...
... In contrast, during masturbation, 59% of women usually experienced an orgasm (Dunn et al., 2005). Approximately 14% of female participants have never had an orgasm or are unsure if they had one (Dunn et al., 2005;Prause et al., 2016). Moreover, there is a negative trend for young women (under the age of 35) to experience orgasms during intercourse. ...
... So, during vaginal penetration, underlying parts of the clitoris are stimulated. Most women report that they use clitoral and vaginal stimulation to experience orgasm (Prause et al., 2016). The subjective perception of an orgasm can differ depending on whether an orgasm is reached by vaginal or clitoral stimulation. ...
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Introduction Societal assumptions and individual myths that define vaginal penetration as normal sexuality can affect the sexual pleasure of varied sexual activities. Although women orgasm much more easily through direct clitoral stimulation than through vaginal intercourse, many couples desire the latter. The purpose of this study is to investigate how orgasms from different types of stimulation with a partner affect sexual satisfaction and orgasm satisfaction in cisgender women. Also, the attitude of women to stimulate their clitoris themselves to reach orgasm during sex with their partner will be included. Methods Two independent surveys (N = 388 and N = 555) were conducted online in 2016 and 2020. Results Regression analyses showed that orgasm consistency through sexual intercourse had a stronger influence on orgasm satisfaction and sexual satisfaction than orgasm consistency through oral sex, stimulation by the partner’s hand, or self-stimulation. Positive thoughts and feelings about self-stimulation of the clitoris during sex with the partner showed only little effect, but in some cases, they were even negatively related to the reported satisfaction. Conclusions The results indicate that the common misconception about sexuality, that it is normal for women to experience orgasms during penile-vaginal intercourse, influences the subjective evaluation of one’s own sexuality. Orgasms from clitoral stimulation seem to have a second-class quality for some women, although there is no evidence that these orgasms feel like less pleasureable. Policy Implication Rigid assumptions about what normal sexuality should look like should be publicly addressed and discussed in sex education classes.
... In recent years, some researches have associated both the subjective and physiological orgasm experience with other sexual response components, for example, sexual desire [14][15][16][17][18][19], sexual excitation [13,16,18,[20][21][22], or sexual satisfaction [16,18,[23][24][25]. Sexual desire refers to the interest in engaging in sexual activity, solitary or with another person, and can be measured by the amount of thought with sexual content [26]. ...
... Except for the study by Prause et al. [15], which associates the orgasm experience with partner-focused dyadic sexual desire, no previous research exclusively relates the three dimensions of sexual desire proposed by Moyano et al. [28] with the four dimensions of subjective orgasm experience proposed by Arcos-Romero et al. [13]. Thus, the main objective of this study is to examine the relationship between dimensions of sexual desire and dimensions of subjective orgasm experience. ...
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... The second focuses on sexual behavior and clitoral stimulation. Research consistently shows that engaging in a variety of sexual practices that stimulate the clitoris significantly increases women's likelihood of having an orgasm (Darling, Davidson, and Cox 1991;herbenick et al. 2018;Laumann et al. 1994;Prause et al. 2016;Richters et al. 2006). Given that the clitoris is the pleasure center for female sexuality, it makes a great deal of sense that sexual behaviors that stimulate it will produce more orgasms. ...
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Gender scholars have addressed a variety of gender gaps between men and women, including a gender gap in orgasms. In this mixed-methods study of heterosexual Canadians, we examine how men and women engage in gender labor that limits women’s orgasms relative to men. With representative survey data, we test existing hypotheses that sexual behaviors and relationship contexts contribute to the gender gap in orgasms. We confirm previous research that sexual practices focusing on clitoral stimulation are associated with women’s orgasms. With in-depth interview data from a subsample of 40 survey participants, we extend this research to show that both men and women engage in gender labor to explain and justify the gender gap in orgasms. Relying on an essentialist view of gender, a narrow understanding of what counts as sex, and moralistic language that recalls the sexual double standard, our participants craft a narrative of women’s orgasms as work and men’s orgasms as natural. The work to produce this gendered narrative of sexuality mirrors the gender labor that takes place in the bedroom, where both women and men engage in sexual behaviors that emphasize men’s pleasure to a greater extent than women’s.
... The relevance of the subjective experience of orgasm in the context of sexual relationships with a partner lies in its association with sexual satisfaction [5,6], as well as being related to other indicators of sexual health, such as erotophilia, sexual desire, or sexual arousal [3,7,8]. In this context, it has been observed that people who report difficulties related to orgasm experience it with less intensity at a subjective level [5]. ...
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Currently, no validated instrument exists for assessing the subjective experience of orgasm in the gay population. The Orgasm Rating Scale (ORS), previously validated in the heterosexual population, comprises four dimensions: Affective, Sensory, Intimacy, and Rewards. This study validated it for sexual relationships in the gay population by obtaining its factorial invariance by sexual orientation and sex, its internal consistency reliability, and evidence of validity in its relationship with other variables. We assessed 1600 cisgender Spanish adults–heterosexuals, gays, and lesbians–divided into 4, sex-based groups of 400 each, according to the Kinsey scale scores. Participants reported recent experiences of orgasm in the context of sexual relationships and responded to the ORS and other scales assessing attitude toward sexual fantasies and sexual functioning. The ORS structure showed a strict multigroup-level invariance by sexual orientation and sex, confirming its four-dimensional structure. The subjective orgasm intensity was associated with a positive attitude toward sexual fantasies and sexual functioning. Scores obtained on the Affective, Intimacy, and Rewards dimensions confirmed the ability to discriminate between gay people with and without orgasmic difficulties. The ORS’s Spanish version presents good psychometric properties as a validated scale to evaluate the subjective experience of orgasm in the gay population.
... It has never been revealed why this clitoral stimulation does not cause the "noxious outcomes" that clitoral stimulation (digitally or vibrationally) is claimed to create even when occurring during coitus. In this context, neither Prause et al., (2016) nor Therrien and Brotto (2016) found negative mental health in women who used clitoral stimulation. ...
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Objectives: The present body of work presents a case study addressing the development of sexual behaviors in a patient with primary anorgasmia in order to reduce emotional distress manifested by guilt, embarrassment and performance anxiety, as well as learning new sexual patterns to increase pleasure and sexual satisfaction. Specifically, we sought to create a positive attitude toward sexuality as part of mental health and increase self-confidence in expressing one's sexuality. Reaching orgasm by the patient was not a stated goal, not to accentuate the distress, but the development of sexual behaviors aimed to increase the duration and intensity of arousal and more frequent manifestation of sexual desire, designed to create the conditions for its occurrence. Method: This is a case study on a 44-year-old patient, during 20 sex therapy sessions of 1 hour each, for 22 weeks, May-September 2021. Assessment methods for Axis I and Axis II, anamnesis and clinical observation, structured, semi-structured and unstructured clinical interviews (Delcea C., 2021) and investigation of medical, family, sexual, socio-cultural, and psycho-social history (individual completion)-MCMI III psychometric tests (Millon in sex therapy intervention (face to face): to identify stimuli of pleasure, arousal and sexual relaxation, having as source the partner's body we used the Genogram of excitatory stimuli, the technique of anticipating excitatory stimuli and the technique of defocusing irrelevant stimuli. (Delcea C., 2021). Sensate focus and directed masturbation to identify individual arousal stimuli, and self-monitoring through journals. 3. Cognitive restructuring of dysfunctional cognitions. 4. Progressive desensitization, in the construction and practice of new exciting sexual behaviors. 6. Psychoeducation. 7. Relaxation techniques (eg breathing, mindfulness). Results: Following the standard psychological assessment, the patient has no Axis I and II emotional disorders, and no history of sexual abuse. The MCMI profile shows a person without clinical personality disorders, but a very high level of Distress (PDA), present cognitive schemas, Negativism and Need for approval that outlines a possible anxious predisposition, as well as present dysfunctional attitudes of medium level, considered as predispositions for depression. Sexual testing with the score sc = 19 FSDS scale, (Derogatis, LR 2002) The sexual distress scale in women shows that the patient has
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Objectives: The present body of work presents a case study addressing the development of sexual behaviors in a patient with primary anorgasmia in order to reduce emotional distress manifested by guilt, embarrassment and performance anxiety, as well as learning new sexual patterns to increase pleasure and sexual satisfaction. Specifically, we sought to create a positive attitude toward sexuality as part of mental health and increase self-confidence in expressing one's sexuality. Reaching orgasm by the patient was not a stated goal, not to accentuate the distress, but the development of sexual behaviors aimed to increase the duration and intensity of arousal and more frequent manifestation of sexual desire, designed to create the conditions for its occurrence. Method: This is a case study on a 44-year-old patient, during 20 sex therapy sessions of 1 hour each, for 22 weeks, May-September 2021. Assessment methods for Axis I and Axis II, anamnesis and clinical observation, structured, semi-structured and unstructured clinical interviews (Delcea C., 2021) and investigation of medical, family, sexual, socio-cultural, and psycho-social history (individual completion) - MCMI III psychometric tests (Millon), Scale of Anxiety Hamilton, HRSA (SEC), PDA Affective Distress Profile, Opris D., Macavei B. (SEC), YSQ-S3 Short Form Cognitive Questionnaire (SEC), DAS Dysfunctional Attitude Scale Beck A., Weissman A. ( SEC); For sexual testing: Genogram of excitatory stimuli, (Delcea C., 2021), FSFI Female Sexual Function Index, Rosen M. 2000, FSDS Female Sexual Distress Scale, Derogatis, 2019, FOS Female Orgasm Scale, McIntyre, Smith, 2019, ORS The Orgasm Rating Scale, Mah K., Binik, 2019, MISSA Multiple Indicators of Subjective Sexual Arousal, Mosher DL, 2019- SISES Sexual Inhibition / Excitation Scale, (Milhausen RR 2019). Methods used in sex therapy intervention (face to face): to identify stimuli of pleasure, arousal and sexual relaxation, having as source the partner's body we used the Genogram of excitatory stimuli, the technique of anticipating excitatory stimuli and the technique of defocusing irrelevant stimuli. (Delcea C., 2021). Sensate focus and directed masturbation to identify individual arousal stimuli, and self-monitoring through journals. 3. Cognitive restructuring of dysfunctional cognitions. 4. Progressive desensitization, in the construction and practice of new exciting sexual behaviors. 6. Psychoeducation. 7. Relaxation techniques (eg breathing, mindfulness). Results: Following the standard psychological assessment, the patient has no Axis I and II emotional disorders, and no history of sexual abuse. The MCMI profile shows a person without clinical personality disorders, but a very high level of Distress (PDA), present cognitive schemas, Negativism and Need for approval that outlines a possible anxious predisposition, as well as present dysfunctional attitudes of medium level, considered as predispositions for depression. Sexual testing with the score sc = 19 FSDS scale, (Derogatis, LR 2002) The sexual distress scale in women shows that the patient has a high level of stress that positively correlates with the existence of sexual dysfunction, manifested by feelings of shame, guilt , inadequacy, and average sexual satisfaction. From the 2 orgasm measurement scales, FOS (McIntyre - Smith, 2019) and ORS (Mah K., Binik, Y., 2019) there is a lack of experience of orgasm by the subject, throughout life and an increased dissatisfaction. The FSFI Scale Index of sexual functioning in women (Rosen R., 2000) shows the same difficulty in experiencing orgasm in the context in which sexual desire exists and the level of arousal is high, from the subjective assessment of the patient. Sexual desire - 4.2; Excitation - 5.1; Lubrication - 4.2; Orgasm - 1.2; Sexual satisfaction - 4.4; Disappearance - 0.9 (maximum = 6.0). The genogram of excitatory stimuli shows an insufficient register of excitatory stimuli on the partner's body, 4 out of 8 (face, chest and arms) and an absent register of excitatory physical stimuli having as source its own body, absent fantasies, unique, poor and repetitive scenarios. Conclusions: This is a patient without mental disorders with clinical significance, with predispositions for the installation of anxiety and depression, high level of distress. There is a poor sexual history and reduced and inadequate arousal. Absent fantasies, absent masturbation, dysfunctional cognitions about sex, "sex is unknown, forbidden, dangerous", register of excitatory stimuli on one's own absent body, and reduced for the partner's body, sexual pattern during predominantly passive sexual intercourse, on receiving pleasure, focused on the partner's body. There is a lack of development of arousal stimuli and consequently sexual behaviors maintain orgasm dysfunction.
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An extensive series of papers by Brody and co-workers using questionnaires have correlated penile vaginal intercourse (PVI) and clitoral stimulation with various female functions and malfunctions. A major claim is that only PVI 'competently performed and sensitively experienced' leading to orgasm is 'associated with. and in some cases, causes processes associated with better psychological and physical functioning'. Clitoral stimulation to orgasm per se or to facilitate orgasm even during PVI, however, is not beneficial to women's psychological, interpersonal or behavioural health and can lead to 'noxious consequences'. Recently , as correlations are no guarantee of causation, independent studies have not confirmed some of their claims. The present review examines critically and rejects :- the demonising of the clitoris as an organ inducing 'deadly pleasures' or that it should become vestigeal by self-creating a 'psychological clitoridectomy', that evolution 'rewards' PVI but punishes clitoral stimulation, that cervical buffeting is normally involved in PVI-orgasms or that a longer penis facilitates these, that orgasm is involved in sperm transport and thus reproductive fitness, that prolactin released at orgasm is an instigator of sexual satiation, that the coital alignment technique does not involve clitoral and periurethral glans stimulation by the penis and that women who cannot have orgasms induced by PVI alone are sexually dysfunctional and that their male partners are sexually inadequate.