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Validation of a Self-Report Questionnaire Assessing the Bodily and Physiological Sensations of Orgasm
Abstract
Introduction:
Despite a plethora of research on sexual functioning during the past decades, the field is still lacking standardized measurements specifically characterizing orgasm. Although several validated tools are available to assess sexual function in healthy and clinical populations, items on orgasm are limited to frequency or dichotomous responses. A neurophysiologic model of orgasm developed from previous research in able-bodied and spinally injured populations offers a promising framework for the construction of a new questionnaire.
Aim:
To develop and validate a brief self-report measurement of orgasm by the assessment of bodily and physiologic sensations perceived during climax by able-bodied individuals. Although the currently available tool focuses on the phenomenological sensations associated with climax, the goal of this questionnaire was to capture the more specific genital and extragenital sensations associated with orgasm.
Main outcome measures:
The current Bodily Sensations of Orgasm questionnaire and the Orgasm Rating Scale.
Methods:
Data from previous research conducted on individuals with spinal cord injury and the available empirical literature provided a pool of 45 items organized into four categories, which were reviewed by an expert panel. Upon review, a 28-item questionnaire was created and administered to a community sample of 227 participants, including men and women, 18 to 73 years old.
Results:
Exploratory factor analyses supported the four-factor model, in which orgasm is comprised of extragenital sensations, genital sensations and spasms, nociceptive sensations, and sweating responses. Overall, a high degree of internal consistency was found for the final 22-item questionnaire (Cronbach α = 0.87), with individual reliability coefficients showing moderate to high internal consistency (r = 0.65-0.79) for each dimension. Overall temporal stability of the measurement was acceptable (r = 0.74). Using the Orgasm Rating Scale, satisfying convergent validity was confirmed, thereby indicating that the two measurements are complementary.
Conclusion:
The Bodily Sensations of Orgasm questionnaire allows for a brief evaluation of the physical and physiologic sensations associated with orgasm. Findings also suggest perceptual differences between men and women with regard to climax, with women reporting a larger repertoire of climactic sensations during orgasm.
... There is no universally accepted definition of orgasm (Mah & Binik, 2001;Dubray et al., 2017). Levin (1981) offered 13 different definitions. ...
... Twenty years later, Mah and Binik (2001) repeated the exercise and listed 25. Despite recent (and past) attempts, the field of sexual research has failed to reach a universally satisfying definition of orgasm (Dubray et al., 2017). Masters and Johnson (1966), who, over 12 years, studied in the laboratory the orgasms of 382 women and 312 males, described a three-stage process for the female orgasm. ...
... Two recent international consensuses on men's and women's orgasms departed from the previous focus on the characteristic muscular contractions (Dubray et al., 2017). organs." ...
Introduction
Up to 41% of women experience female orgasm disorder/difficulty (FOD), a statistic unchanged for 50 years. Despite this, there is a paucity of validated treatments. Research has suggested cannabis as a treatment for female sexual disorders for more than 50 years. Yet a literature review revealed no studies evaluating cannabis as a treatment specifically for FOD and no studies comparing women with and without FOD. This study is the first to evaluate cannabis as a treatment for FOD specifically in women with and without FOD.
Objective
Evaluate the effect of cannabis use before partnered sex on women with and without FOD.
Methods
This IRB-approved observational study conducted between March 24, 2022, and November 18, 2022, evaluated baseline demographics, sexual behavior, mental health, cannabis use, and the orgasm subscale questions of the Female Sexual Function Index (FSFI), evaluating orgasm frequency, orgasm satisfaction, and orgasm ease, with and without cannabis before partnered sex.
Results
Of 1,037 survey responses, the researchers received 410 valid, completed surveys; failure to meet the study’s criteria required excluding 23 (5.6%) surveys. Among the 387 valid survey participants, the majority of women, 52% (n = 202) reported orgasm difficulty, were between the ages of 25–34 (45%, n = 91), reported their race as white (75%, n = 152), and were married or in a relationship (82%, n = 165). Among respondents reporting orgasm difficulty (n = 202), cannabis use before partnered sex increased orgasm frequency (72.8%, n = 147/202, p < .001), improved orgasm satisfaction (67%, n = 136/202, p < .001) or made orgasm easier (71%, n = 143/202, p < .001). Frequency of cannabis use before partnered sex correlated with increased orgasm frequency for women with FOD (n = 202, p< .001). Orgasm response to cannabis depended on the reasons for use (n = 202, p = .022). Women with FOD reported 24% more mental health issues, 52.6% more PTSD, 29% more depressive disorders, 13% more anxiety disorders, and 22% more prescription drug use than women without FOD. Women with FOD were more likely to report sexual abuse history than women without FOD (38.6%, n=74/202).
Conclusions
Fifty years of sexuality research support use of cannabis for sexual difficulties. This is the first study to look at FOD specifically, demonstrating significant benefit. Randomized controlled studies are needed to evaluate cannabis’ efficacy on FOD sub-types, mental health and physical health conditions and other clinical implications; evaluating dosage, strain, timing, and method of intake. References Laumann et al., 2005 Kontula & Miettinen, 2016 Keiman & Meston, 1997 Dawley et al., 1979 Gorzalka et al., 2010 Klein et al., 2012 Lewis, 1970 Moser et al., 2023.
Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: inhaleMD.
... There is no universally accepted definition of orgasm (Mah & Binik, 2001;Dubray et al., 2017). Levin (1981) offered 13 different definitions. ...
... Twenty years later, Mah and Binik (2001) repeated the exercise and listed 25. Despite recent (and past) attempts, the field of sexual research has failed to reach a universally satisfying definition of orgasm (Dubray et al., 2017). Masters and Johnson (1966), who, over 12 years, studied in the laboratory the orgasms of 382 women and 312 males, described a three-stage process for the female orgasm. ...
... Two recent international consensuses on men's and women's orgasms departed from the previous focus on the characteristic muscular contractions (Dubray et al., 2017). organs." ...
This mixed-methods observational study, conducted between March 24, 2022, and February 28, 2023, is the first to evaluate cannabis use and female orgasmic disorder (FOD). Up to 41% of women experience FOD, a statistic unchanged for 50 years. A paucity of validated treatments exists. Researchers have suggested cannabis as a treatment for FOD for decades. This study’s statistically significant results align with and expand upon 50 years of cannabis research, revealing that cannabis helps women orgasm and increases orgasm frequency, satisfaction, and ease for women with and without FOD.
A survey collected data on demographics, sexual behavior, mental health, cannabis use, and the Female Sexual Function Index (FSFI) orgasm subscale questions with and without cannabis before partnered sex. The interviews evaluated cannabis-assisted orgasm, dosage, preferred strains, and timing of cannabis use before partnered sex.
Of the 1,037 survey responses, 387 were suitable for analysis. Among respondents reporting orgasm difficulty, 45% were between the ages of 25-34, 75% reported their race as white, and 82% were married or in a relationship. Cannabis use before partnered sex increased orgasm frequency (72%), improved orgasm satisfaction (67%), or made orgasm easier (71%). Frequency of cannabis use before partnered sex correlated with increased orgasm frequency. The reasons for cannabis use by women with FOD before partnered sex that created the most positive orgasm response was to manage pain or enhance sexual pleasure.
Not all women found cannabis helpful in orgasm. Moreover, the study’s findings may not be generalizable to women who rarely or do not use cannabis before sex or who have never experienced an orgasm. The researcher did not assess the cultivar of cannabis for effectiveness, nor were study participants asked about their cannabis chemotype of choice or the amount of cannabis used.
The study suggests that treatment for women with orgasm difficulty should incorporate cannabis and that U.S. states and countries with medical marijuana programs should make it a condition for use. At the same time, the researcher emphasizes the need for prioritizing further randomized controlled studies to assess cannabis dosage, timing, and other clinical implications for women experiencing orgasm difficulty.
... Literature is still unambiguous about gender differences: some authors emphasize the similarity of male and female orgasms [7-9], while others state a disparity from both a physiological and psychological point of view, considering them two separate phenomena. Gender differences have been demonstrated in the perception of psychological [10, 11] and physiological sensations of orgasm [12]. Despite less attention paid to male orgasm, literature found that orgasm experiences in men are influenced by psychosocial aspects [13,14] as well as in women, for whom orgasmic satisfaction and pleasure are related also to intrapersonal, interpersonal, and contextual factors [15][16][17]. ...
... The phenomenological adjectives used in the ORS do not capture completely the specific bodily sensations nor the specific feelings that are associated with climax. Dubray et al. [12] developed the Bodily Sensations of Orgasm questionnaire, a self-report questionnaire to assess the bodily and physiological sensations of orgasm meant to cover topics not enclosed by the ORS. It is limited to physical cues and it lacks a confirmatory factorial analysis to test the factorial model. ...
... (16) .90 (16) Contractions .91 (12) .90 (12) .92 ...
Orgasm is a phase of the human sexual response, and the possible discrepancies between male and female ways to experience it are still not clear in the literature. There is a lack of tools to adequately assess orgasm perception. This study aims to develop an instrument and verify possible differences between males and females. We constructed the Orgasmic Perception Questionnaire (OPQ) through different stages: first, 316 items selection was conducted on a sample of 96 people, where items came mainly from written descriptions of orgasm perception; second, an exploratory factor analysis was conducted on 674 Italian adults with a 63-item OPQ; finally, a confirmatory factor analysis was conducted on 1100 Italian adults with a 47-item OPQ. In the first study, 63 items fitted an equidistributional pattern and were to form the 63-item OPQ used for EFA. The EFA showed that five factors out of 47 explained 44.01% of the total variance and were named: Ecstasy, Contractions, Relaxation, Power, and Sensations. The confirmatory factor analyses run on the 47-item OPQ confirmed that the five-factor structure fits. Moreover, females scored higher than males with an adequate effect size in two factors: Contractions and Sensations. In conclusion, the OPQ could be a useful tool in both clinical settings and research studies to investigate the perception of orgasmic experience in its totality.
... There is no universally accepted definition of orgasm (Mah & Binik, 2001;Dubray et al., 2017). Levin (1981) offered 13 different definitions. ...
... Twenty years later, Mah and Binik (2001) repeated the exercise and listed 25. Despite recent (and past) attempts, the field of sexual research has failed to reach a universally satisfying definition of orgasm (Dubray et al., 2017). Masters and Johnson (1966), who, over 12 years, studied in the laboratory the orgasms of 382 women and 312 males, described a three-stage process for the female orgasm. ...
... Two recent international consensuses on men's and women's orgasms departed from the previous focus on the characteristic muscular contractions (Dubray et al., 2017). organs." ...
Introduction
Cannabis helps women orgasm who have difficulty orgasming and enhances the frequency and quality of women's orgasm. Studies have not yet shown if cannabis helps women orgasm who have female orgasmic disorder (FOD). Up to 41% of women worldwide suffer from FOD and the percentage of women suffering from FOD has not changed in 50 years.
Objective
The objective of this literature review is to present theories that support a hypothesis that cannabis may help women who have lifelong, acquired, or situational FOD. There is only one empirically validated treatment for lifelong FOD and no empirically validated treatments for acquired or situational FOD.
Method
Literature Review
Results
The dishabituation theory presents that Δ9-Tetrahydrocannabinol (THC), causes a dishabituating effect. Information processing of higher brain structures under the influence of THC reduces the routine represented by habits. Multiple studies have established the habits of cognitive distraction during sexual activity may distract a woman from her sensations and ability to orgasm. The theoretical rationale for the dishabituation theory proposes that THC could dishabituate the habit of being cognitively distracted and may explain why women who had never experienced an orgasm discovered they could orgasm when using cannabis before sex and why women who reported difficulty experiencing orgasm said it was easier to experience orgasm while using cannabis before sex. Neuroplasticity theory is a broad theory to describe how the human brain grows, changes, and rewires. Cannabis and endocannabinoids, the cannabinoids created by the human body, are increasingly recognized for their roles in neural development processes, including brain cell growth and neuroplasticity. The theoretical rationale for the neuroplasticity theory is that this theory may explain why some women learn to orgasm while using cannabis before sex and, once they learned to orgasm, found that they no longer required cannabis. The multi-modal treatment theory proposes that cannabis can treat multiple symptoms and conditions simultaneously. Multi-modal treatment is a broad area of study that involves combining two or more modalities targeting different aspects of a disease. The theoretical rationale for the multi-modal treatment theory is that this theory may explain why women who use cannabis for any reason may decrease their FOD. One researcher found that cannabis use decreased sexual dysfunction by up to 21% and that the reason women used cannabis had little to do with sexual functioning. The amygdala reduction theory proposes that cannabis can reduce the activity in the amygdala, a part of the brain associated with fear responses to threats. Hypervigilance, anxiety, and post-traumatic stress disorder (PTSD) are responses of the amygdala and commonly impair sexual response. The theoretical rationale for the amygdala reduction theory is that reduced amygdala activity can positively affect FOD. A reduction in anxiety associated with a sexual encounter could improve experiences and lead to improved orgasm and satisfaction.
Conclusion
Theories and anecdotal evidence from the existing body of cannabis, sex and women's orgasm research support that cannabis may be a treatment for FOD. Research needs to be conducted to evaluate cannabis as a treatment for FOD.
Disclosure
Work supported by industry: no. A consultant, employee (part time or full time) or shareholder is among the authors (Dr. Tishler is President and COO of inhaleMD, Inc. he is one of my dissertation advisors).
... Often during orgasm, the extreme pleasure causes a characteristic 'orgasm face' as well (Masters & Johnson, 1966;Levin, 2014). Most studies have focused on the genital physiologic changes that occur during orgasm, mainly studying the muscle contractions that occur (Mah & Binik, 2001;Dubray, Gérard, Beaulieu-Prévost, & Courtois, 2017). Researchers have tried to broaden the definition of orgasm by including the psychological effects that are associated with orgasm (Mah & Binik, 2001;Dubray et al., 2017). ...
... Most studies have focused on the genital physiologic changes that occur during orgasm, mainly studying the muscle contractions that occur (Mah & Binik, 2001;Dubray, Gérard, Beaulieu-Prévost, & Courtois, 2017). Researchers have tried to broaden the definition of orgasm by including the psychological effects that are associated with orgasm (Mah & Binik, 2001;Dubray et al., 2017). ...
... The current study is similar to the study conducted by King, Belsky, Mah, and Binik (2010), where it was concluded that women can achieve up to four differing types of orgasm. Unlike the 2011 study, however, this study helps to provide insight on the physiological sensations achieved during orgasm by utilizing the Bodily Sensations of Orgasm (BSO) questionnaire first published in 2017 (Dubray et al., 2017). ...
Previous research has shown that counselors feel uncomfortable addressing clients’ sexual concerns due to a lack of education on topics related to human sexuality. Various studies have attempted to identify the characteristics of vaginal orgasm, including whether women and other people with vaginas (PWV) can achieve different kinds of orgasms. The current study examines responses to participants surveyed across the United States on their orgasm response and compares responses of participants who achieved orgasm through masturbation and those who achieved orgasm through sex with a partner to determine whether PWV experience one kind of orgasm during masturbation and experience a different kind of orgasm during sex with a partner. Results from the current study suggest that there are two distinct orgasm experiences achieved by PWV which differ in physiological and psychological response. Counselors and counselor educators can use results from this study to help expand their knowledge on sexual response to feel more confident in their practice
... The general expectation is that female raters perform better than male raters when rating negative emotions [29,30,31,32]. In one study, female raters performed better in recognizing female expressions of pain [10]. ...
... Interestingly, for male expressers, we found that the low intensity affective states were signi cantly better rated by female raters and were not due to chance. Our nding supports the previously suggested female superiority regarding emotion detection and interpretation (females are faster and more accurate in the attribution of the displays; [29,30,31,32,42]). ...
Our study focused on the ability of humans to correctly rate the valence of human facial expressions and vocalizations of high (pain and pleasure) and low intensity (laugh and neutral expression/speech) affective states. The study was conducted online and used a large sample (n=902) of respondents. The task was to categorize whether the human vocalization and facial expression as positive, neutral, or negative. The stimuli were audio records and pictures of facial expressions extracted from freely downloadable online videos and can be considered semi-naturalistic. Each rating participant was presented simultaneously with the facial expression and the vocalization of the affective states. Two of these with high intensity (pain and pleasure) and two of low intensity (laugh/smile and neutral). Each affective state was expressed and rated by female and male expressers. Using a Bayesian statistical approach, we could test due-to-chance probabilities (guessing). The outcomes support the prediction that affective states with higher intensity are harder to correctly rate, even with a bimodal presentation. Furthermore, in comparison with previous unimodal studies using the same stimuli, the results provide novel insight into systematic perception. Adding the vocalizations to the facial expressions results in the participants being more convinced in their choices independently of the correctness of the assessment as previously shown in auditory stimuli perception.
... Barnett et al. [9] reported several gender differences related to orgasm. Other studies have shown differences regarding the perception of physiological sensations of orgasm and regarding orgasm frequency [10][11][12]. On the other hand, some studies have shown that men and women share similar psychological sensations of orgasm [13]. ...
... Accordingly, a previous study [17] has found differences across gender in mean scores from affectivity and physiological sensations of orgasm. Regarding the differences in the sensory dimension, according to Dubray et al. [10] perhaps women are better able to describe their sensations during the climax because they are more in tune with their internal sensations. Moreover, Mah and Binik [11] reported that the differences in the perception of physiological events of orgasm could be due to the different sensations of ejaculation. ...
The orgasm experience refers to the psychological self-evaluation of the orgasm. No previous research has compared the characteristics of the orgasm experience between men and women creating a ranking of the adjectives that better represent it. The main objective of this study was to analyze gender differences in the global orgasm experience, its dimensions, and its descriptive words to examine how do heterosexual people rate their orgasms. A sample of 1619 heterosexual adults (793 men, 826 women) completed a background questionnaire and the Orgasm Rating Scale. Results showed that there were significant gender differences in the global orgasm experience and three of its dimensions. Furthermore, fourteen of the 25 descriptive words showed differences between genders. In the ranking, the top five adjectives that better described the orgasm experience were the same in both genders. In conclusion, although differences across gender in the orgasm experience were observed, heterosexual men and women share similar adjectives to rate their orgasms.
... It has to be noted that the psychological characteristics of the orgasm experience have received little attention in the literature Mah & Binik, 2005) and that there is currently no universally accepted definition of this construct (Alwaal, Breyer, & Lue, 2015;Mah & Binik, 2001;Paterson, Amsel, & Binik, 2013;Safron, 2016). Regarding the comparisons across gender, it has been shown differences between men and women with regards to the perception of psychological Mah & Binik, 2002) and physiological feelings of orgasm (Dubrai, G erard, Beaulieu-Pr evost, & Courtois, 2017). Furthermore, previous literature also showed differences across gender in the physical and psychological changes experienced after orgasm (Paterson, Jin, Amsel, & Binik, 2014). ...
... (H6) There will be significant gender differences in both, predictive and mediation models Dubrai et al., 2017;Mah & Binik, 2002;Paterson et al., 2014). ...
The main objective of this study was to determine the predictive capacity of different variables, organized based on Ecological theory (i.e., personal, interpersonal, social, and ideological), in the intensity of the subjective orgasm experience within the context of heterosexual relationships. The sample was composed of 1,300 adults (547 men, 753 women). The proposed model for men showed that more intense subjective orgasm experience was predicted by age, sexual sensations seeking, sexual satisfaction, and partner-focused sexual desire. The model for women showed that more intense subjective orgasm experience was predicted by age, erotophilia, sexual sensation seeking, partner-focused sexual desire, and sexual satisfaction.
... In recent decades, research has moved beyond categorization to document greater diversity in women's experiences of orgasm, including orgasm occurring from both genital and nongenital stimulation (e.g., Herbenick & Fortenberry, 2011;Jannini et al., 2012;Komisaruk, Beyer-Flores, & Whipple, 2006;Komisaruk & Whipple, 2011). Additionally, there has been greater emphasis on understanding women's subjective experiences of sexual pleasure and orgasm (e.g., Dubray, Gerard, Beaulieu-Prevost, & Courtois, 2017;Opperman, Braun, Clarke, & Rogers, 2014;Pfaus et al., 2016). ...
... Thus far, research focused on women's sexual pleasure has largely utilized convenience samples (e.g., Dubray et al., 2017;Hite, 1976), college samples (e.g., Levin & Meston, 2006;Waterman & Chiauzzi, 1982;Wood, McKay, Komarnicky, & Milhausen, 2016), or clinical samples (e.g., Read, King, & Watson, 1997;Rosen, Taylor, Leiblum, & Bachmann, 1993;Sipski, Alexander, & Rosen, 1999), and has often addressed broad aspects of sexual behavior, satisfaction, or dysfunction. The few nationally representative probability samples focused on sexual behavior in various parts of the world (e.g., Haavio-Mannila & Kontula, 1997;Herbenick et al., 2010a;Laumann, Gagnon, Michael, & Michaels, 1994;Mitchell et al., 2013;Smith, Rissel, Richters, Grulich, & de Visser, 2003) have not addressed specific details of sexual touch. ...
The study purpose was to assess, in a U.S. probability sample of women, experiences related to orgasm, sexual pleasure, and genital touching. In June 2015, 1,055 women ages 18 to 94 from the nationally representative GfK KnowledgePanel® completed a confidential, Internet-based survey. More than one-third of American women (37%) reported they needed clitoral stimulation in order to experience orgasm during intercourse and 18% said that vaginal penetration was sufficient for orgasm. Women reported diverse preferences for genital touch location, pressure, shape, and pattern. Clinical, therapeutic, and educational implications are discussed.
... The Spanish adaptation has 25 adjectives organized into four dimensions: Affective, Sensory, Intimacy, and Rewards [15]. Another approach to SOE is the one proposed by Dubray et al. [18], who developed the Bodily Sensations of Orgasm Questionnaire, which characterizes the orgasmic experience by attending only to specific genital and extragenital (bodily and physiological) sensations. Moreover, the Orgasmometer [19] also measures subjective orgasmic intensity using a graded visual color scale (from white to red) [19,20]. ...
The subjective orgasm experience (SOE) refers to its perception and/or assessment from a psychological viewpoint. Few works have approached this construct from a qualitative perspective and have never taken a consolidated theoretical model as a reference. This study aims to provide qualitative validity evidence to the Multidimensional Model of Subjective Orgasmic Experience, derived from the Orgasm Rating Scale (ORS), to qualitatively address SOE in the contexts of sexual relationships and solitary masturbation, analyzing the terms self-generated by individuals and examining the coincidence with the semantic descriptions of orgasm proposed by the ORS. Four hundred Spanish adults aged 18 to 64 years participated. The Technique of Free Association of Words was applied, and prototypical, frequency, and similitude analyses were performed. A similar description was observed concerning the terms generated in both contexts, with a higher frequency and intensity in the context of sexual relationships. In the context of solitary masturbation, negative orgasmic descriptions were evoked. Participants were able to elicit the vast majority of ORS adjectives, with Affective being the most notable dimension, followed closely by Rewards, especially in masturbation. Most of the adjectives were evoked simultaneously with those of the Affective, with “pleasurable” standing out as the most predominant one. This work provides qualitative evidence to the SOE study, ratifying the semantic composition of the ORS and thus endorsing the Multidimensional Model of Subjective Orgasmic Experience as a good theoretical model from which to continue studying the subjective orgasmic experience.
... There is no doubt, due to the camera perspective, about the occurrence of the climax in male expressers. In the female expressers, no such explicit method of judgment can be used, but all signals of the occurrence of climax were identified by the researchers (involving breathing, contraction of pelvic musculature, twitching of anal sphincter muscles, facial blushing, vocalization, etc.; Dubray et al., 2017), and further supported by expressers' self-reports after the videos had ended. ...
... Finally, on the differences in subjective orgasm experience, the results back the findings obtained in previous studies that systematically point out how women describe their subjective orgasm experience in both the sexual relationships [20,49,50] and masturbation [19,24,51] contexts more intensely than men. Evidence comparing orgasms in men and women is limited. ...
The tridimensional sexual desire proposal (i.e., dyadic to partner, dyadic to attractive other and solitary) has been empirically supported. However, solitary sexual desire and its relationship to other dimensions of sexual functioning has received less attention. Hence, we examined the capacity of solitary sexual desire to explain the subjective orgasm experience (Study 1) and sexual arousal (Study 2) in the context of solitary masturbation. Study 1, composed of 2406 heterosexual adults (M age = 39.72, SD = 11.81), assessed for solitary sexual desire, dyadic sexual desire, and the intensity of the subjective orgasm experience obtained through solitary masturbation, along with other associated parameters. Study 2, consisting of 41 heterosexual young people (M age = 22.49, SD = 3.17), evaluated the genital response (penile circumference/vaginal pulse amplitude) and subjective arousal to sexually explicit films related to solitary masturbation. In both men and women, solitary sexual desire accounted for a significant percentage of the subjective orgasm experience obtained through solitary masturbation. In addition, in women, the propensity for sexual arousal was explained by solitary sexual desire. It is concluded that solitary sexual desire -as opposed to dyadic- is important to explain sexual arousal and orgasm in the solitary masturbation context. These results highlight the importance of addressing sexual desire in the solitary context, given its implications with other dimensions of sexual functioning.
... There is no doubt, due to the camera perspective, about the occurrence of the climax in male expressers. In the female expressers, no such explicit method of judgment can be used, but all signals of the occurrence of climax were identified by the researchers (involving breathing, contraction of pelvic musculature, twitching of anal sphincter muscles, facial blushing, vocalization, etc.; Dubray et al., 2017), and further supported by expressers' self-reports after the videos had ended. ...
Our research consisted of two studies focusing on the probability of humans being able to perceive the difference between valence of human vocalizations of high (pain, pleasure and fear) and low intensity (laugh and neutral speech). The first study was conducted online and used a large sample (n=902) of respondents. The second study was conducted in a laboratory setting and involved a stress induction procedure. For both, the task was to categorize whether the human vocalization was rated positive, neutral or negative. Stimuli were audio records extracted from freely downloadable online videos and can be considered semi-naturalistic. Each rating participant (rater) was presented with five audio records (stimuli) of five females and of five males. All raters were presented with the stimuli twice (so as to statistically estimate the consistency of the ratings). Using a Bayesian statistical approach, we could test for consistencies and due-to-chance probabilities. The outcomes support the prediction that the results (ratings) are repeatable (not due to chance) but incorrectly attributed, decreasing the communication value of the expressions of fear, pain, and pleasure. Stress induction (in study two conducted on 28 participants) did have an impact on the ratings of male neutral and laugh – it caused decrease in correct attribution.
... There is no doubt, due to the camera perspective, about the occurrence of the climax in male expressers. In the female expressers no such explicit method of judgement can be used, but all signals of the occurrence of climax were identified by the researchers (involving breathing, contraction of pelvic and anal sphincter muscles, facial blushing, vocalization etc.; Dubray et al., 2017), supported by self-report at the end of the video in some cases. ...
... There is no doubt, due to the camera perspective, about the occurrence of the climax in male expressers. In the female expressers no such explicit method of judgement can be used, but all signals of the occurrence of climax were identified by the researchers (involving breathing, contraction of pelvic and anal sphincter muscles, facial blushing, vocalization etc.; Dubray et al., 2017), supported by self-report at the end of the video in some cases. ...
Our research consisted of two studies focusing on the probability of humans being able to perceive the difference between faces expressing pain versus pleasure. As controls, we included: smile, neutral facial expression, and expression of fear. The first study was online and was conducted using a large sample (n=902) of respondents. The second study was conducted in a laboratory setting and involved a stress induction procedure. For both, the task was to categorize whether the facial expression was rated positive, neutral or negative. Stimuli were faces extracted from freely downloadable online videos. Each rating participant (rater) was presented with five facial expressions (stimuli) of five females and five males. All raters were presented with the stimuli twice so as to evaluate the consistency of the ratings. Beforehand, we tested for stimuli differences using specialized software and found decisive differences. Using a Bayesian statistical approach, we could test for consistencies and due-to-chance probabilities. The results support the expectation that the results are not repeatable but indeed solely due to chance, diminishing the communication value of the expressions of pain and pleasure. The expression of fear was also rated due to chance, but not neutral and smile. Stress induction did have an impact on the perception of pleasure.
... When designing a page, read the HTML code carefully and make changes. We also need to learn a set of commonly used HTML coding standards [23]. Second, the system development process requires a very deep understanding of the basic principles and use of the database before proceeding with a rigorous database development program. ...
With the increasingly severe aging of the population, the difficult and expensive medical treatment problems are becoming more and more prominent; the salary level of domestic doctors is not high, but the cost of training doctors is high, coupled with doctors’ work pressure and mental pressure; the number of candidates for medical school is decreasing year by year; medical talent is rare; and the allocation of medical staff is scarce. Health care is the basic guarantee for people’s good life, and the shortage of medical staff will have many impacts on health care. Human-computer interaction (HCI) is the study of people, computers, and their interaction. HCI refers to the communication between the user and the computer system, which is the two-way information exchange of various symbols and actions between the human and the computer. The purpose of this paper is to study a healthcare system with human-computer interaction through the client, apply the system to the teaching of physiology and medicine, and analyze its effects and functions in combination with various evaluation indicators. This paper selects teaching content, ease of use of human-computer interaction design, technical services, and user subjective satisfaction as evaluation indicators, and constructs an evaluation model for this. And it builds the physiology and medicine teaching system framework and healthcare system, and conducts tests and statistics on the teaching system. This paper combines online questionnaires, in-app survey feedback, and field visits to collect feedback from users and administrators. The final data show that the teaching system meets the requirements in four evaluation indicators: teaching content, ease of use of human-computer interaction design, technical services, and user subjective satisfaction. User satisfaction with these four aspects reached 86.33%, 95.17%, 63.83%, and 81.87%, respectively. It shows that the system is more popular and can meet the needs of most users.
... This study constitutes the largest available systematic selfreport study of multiple orgasm in men to date. Future selfreport studies should be able to remedy some of the memory and sampling limitations mentioned above and also address reliability and validity issues by using standardized measurement tools such as the Sexual Excitation/Sexual Inhibition Inventory for Women and Men (SESII-W/M) 27 the Orgasm Rating Scale (ORS) 28 and the Bodily Sensations of Orgasm (BSO) 29 questionnaire. In addition, future research should be carried out in the laboratory which will allow for adequate measurement of currently unclear timing parameters related to refractory periods and to time between orgasms and will also allow for the verification of ejaculation and dry orgasm. ...
Background
The scientific literature on multiple orgasm in males is small. There is little consensus on a definition, and significant controversy about whether multiple orgasm is a unitary experience.
Aims
This study has 2 goals: (i) describing the experience of male multiple orgasm; (ii) investigating whether there are different profiles of multiple orgasm in men.
Methods
Data from a culturally diverse online convenience sample of 122 men reporting multiple orgasm were collected. Data reduction analyses were conducted using principal components analysis (PCA) on 13 variables of interest derived from theory and the existing literature. A K-means cluster analysis followed, from which a 4-cluster solution was retained.
Results
While the range of reported orgasms varied from 2 to 30, the majority (79.5%, N = 97) of participants experienced between 2 and 4 orgasms separated by a specific time interval during which further stimulation was required to achieve another orgasm. Most participants reported maintaining their erections throughout and ejaculating with every orgasm. Age was not a significant correlate of the multiple orgasm experience which occurred more frequently in a dyadic context. Four different profiles of multiorgasmic men were described.
Strengths & Limitations
This study constitutes a rare attempt to collect systematic self-report data concerning the experience of multiple orgasm in a relatively large sample. Limitations include the lack of validated measures, memory bias associated with self-reported data and retrospective designs, the lack of a control group and of physiological measurement.
Conclusion
Our study suggests that multiple orgasm in men is not a unitary phenomenon and sets the stage for future self-report and laboratory study.
Griffin-Mathieu G, Berry M, Shtarkshall RA, Amsel R, Binik YM, Gérard M. Exploring Male Multiple Orgasm in a Large Online Sample: Refining Our Understanding. J Sex Med 2021;XX:XXX–XXX.
... Des travaux complémentaires sont à l'évidence nécessaires pour parfaire nos connaissances physiologiques et pathologiques, pour améliorer nos méthodes d'évaluation [44] et enfin pour optimiser les stratégies thérapeutiques. À noter que la survenue de troubles médullaires avant l'âge de 18 ans était un facteur prédictif d'absence de vie sexuelle. ...
Resume
Introduction: Les troubles sexuels chez la patiente neurologique ont peu été évalués en pratique quotidienne, en particulier, les troubles de l’orgasme. La prévalence semblait multipliée par deux chez les patientes médullaires comparativement à la population générale (1).
Objectifs: Analyser la prévalence, la typologie et l’impact des troubles de l’orgasme chez les patientes neurologiques (Accident vasculaire cérébral (AVC) (50%), sclérose en plaques (SEP) (>65%), maladie de Parkinson idiopathique (MPI), blessées médullaires (BM) (>50%) et neuropathies périphériques (NP)).
Méthode: Revue systématique de la littérature à partir de Medline via l’outil Pubmed et The Cochrane Database of Systematic Review (Cochrane library).
Résultats: Les dysorgasmies féminines ont peu été étudiées au cours des maladies neurologiques. Il s’agissait d’études pour la plupart rétrospectives, réalisées sur de petits effectifs. Elles s’appuaient sur des données cliniques à base de questionnaires généralistes étudiant la fonction sexuelle parfois associées à une exploration neuro-périnéale. SEP et BM ont été les deux populations les plus étudiées. La prévalence des troubles de l’orgasme était importante (plus de 1/3 des patientes), souvent associés à d’autres troubles sexuels (altération de la libido) et à des troubles urinaires et anorectaux. Les lésions médullaires complètes et l’atteinte de l’arc réflexe sacré avaient un impact négatif sur ces troubles et sur la qualité de vie sexuelle (p<0.05).
Conclusion: L’évaluation spécifique des troubles sexuels et en particulier des troubles de l’orgasme chez les patientes neurologiques semblait importante dans la prise en charge globale du handicap pelvi-périnéal afin d’améliorer la qualité de vie de ces patientes. L’éducation thérapeutique et des thérapies sexuelles ciblées paraissaient indiquées dans le traitement de ces troubles.
... Fifth, our nonvalidated outcome measures make it difficult to assess the validity of the data collected and to replicate our findings. Future research designs would benefit from well-validated instruments to measure constructs such as orgasm (Orgasm Rating Scale [ORS], Mah & Binik, 2002; Bodily Sensations of Orgasm questionnaire [BSO], Dubray et al., 2017), and sexual excitation/inhibition (Sexual Excitation/Sexual Inhibition Inventory for Women [SESII-W], Graham et al., 2006), to name a few. ...
Women’s multiorgasmic capacity has long been mentioned in the human sexuality literature. However, due in part to the conceptual vagueness surrounding this phenomenon, few empirical studies have focused on this topic, and our scientific knowledge is currently limited. This exploratory research is mainly aimed at providing a much-needed assessment of the profiles of women reporting multiorgasmic experiences. For this study, 419 sexually diverse women ages 18 through 69 who identified as multiorgasmic completed an online survey assessing variables pertaining to sociodemographic background, context and characteristics of a recent/typical multiorgasmic experience, relationships between multiple orgasm and sexual/nonsexual aspects of life, and sexual and orgasmic history. Data reduction analyses using principal component analysis pointed out that 15 variables of interest were distributed across six components, accounting for a large proportion of the sample’s variance. A k-means cluster analysis further revealed that four distinct groups of women could be parsed out. These four groups could be differentiated by three sets of variables—sexual motivation, sexual history, and multiple orgasm characteristics—suggesting that female multiple orgasm is not a unitary phenomenon. This research provides to date the most comprehensive picture of female multiple orgasm and helps refine our conceptual understanding.
... Only one of these items showed weak signs of DIF, but does not reflect significant differences in the scores between men and women. Never- theless, in accordance with previous studies (Arcos-Romero, Granados et al., 2018;Dubrai, Gérard, Beaulieu-Prévost, & Courtois, 2017;Mah & Binik, 2002), it has been shown the differences between sexes with regards to the per- ception of physiological feelings of orgasm. Some items from Sensory factor showed DIF and also significant dif- ferences between men and women. ...
Background/Objective: Orgasm Rating Scale (ORS) assess the subjective orgasm experience in context of sexual relationship. It is composed of four dimensions attributed to the orgasm (Affective, Sensory, Intimacy, and Rewards). The purpose is to analyse the factorial invariance of the ORS across groups, to examine the metric equivalence across sex, and to present the standard scores. Method: A total of 1,472 Spanish adults (715 men and 757 women) were evaluated. They were distributed across age groups (18-34, 35-49 and 50 years old and older). Factorial invariance across different groups and the differential functioning of the items across sex were analyzed, internal consistency was examined, and the standard scores were developed. Results: The structure of the ORS showed strict measurement invariance across sex, relationship status, sexual orientation and education level. It also reached a scalar measurement invariance across age range and duration of the relationship. Some items showed a differential functioning between sexes. Conclusions: The Spanish version of the ORS is invariant across different groups at a factorial level, and it shows equivalence across sex in most of its items at a metric level. The standard scores allow a more accurate assessment of the subjective orgasm experience in context of sexual relationship.
... According to these findings, Mah and Binik [18] also indicated that women value more subjectively than men the sensory aspects of orgasm experience. Similarly to previous research [30], it is suggested that women are better able to describe their sensations during orgasm or that they are more in tune with their internal sensations. Relationship between orgasm experience and sexual excitation: validation of the model of the subjective. . . ...
The aim of this study was to provide validity evidence of the Model of the Subjective Orgasm Experience (MSOE) associating its components with different types of sexual excitation. A total of 96 participants (48 men and 48 women) performed an experimental laboratory task, in which neutral and erotic content films were presented while the genital response was registered. After exposure to sexual stimulus presentation, participants reported their subjective sexual arousal. In addition, four dimensions (affective, sensory, intimacy, and rewards) of the subjective orgasm experience and the individual propensity for sexual excitation were assessed. Results showed that, in men, the affective, sensory, and rewards dimensions of the orgasm experience significantly correlated with the propensity for becoming sexually excited, and the intimacy dimension correlated with the genital response. In women, the sensory dimension of the orgasm experience positively correlated with the subjective sexual arousal. Types of sexual excitation which previously correlated with the orgasm experience were able to predict its four dimensions. The validation of the MSOE provides a more delimited explanation of the psychological experience of orgasm applicable to both sexes. It is an adequate model for both clinical and research purposes.
... Despite the current debate on female orgasm, the importance of orgasm itself in the couple's health and the possible impact of reduced or absent orgasmic experience in provoking or amplifying female SD, within the several psychosexological questionnaires mentioning the orgasmic function [28][29][30][31][32][33], none specifically measures the female orgasmic intensity. Previous attempts to assess female orgasm have been focused in assessing the phenomenological sensations (sensory and cognitive-affective), with a two-dimensional model, associated with orgasm (Orgasm Rating Scale) [20] or attempting to capture the specific bodily sensations that are associated with climax (Bodily Sensations of Orgasm questionnaire) [34]. Conversely, a well-validated Visual Analogue Scale (VAS) and named the "Orgasmometer", is currently available in the clinical andrology to assess, with excellent psychometric qualities, exclusively the intensity of orgasm in male [35]. ...
The female orgasm represents one of the most complex functions in the field of human sexuality.
The conjunction of the anatomical, physiological, psycho-relational and socio-cultural components contributes to make the female orgasm still partly unclear. The female orgasmic experience, its correlates and the relation with sexual desire, arousal and lubrication as predictors are highly debated in scientific community. In this context, little is known about the impact of female sexual dysfunction (SD) on sexual pleasure expressed by subjective orgasmic intensity, and there are no suitable psychometric tools suited to investigate this dimension. Thus, we validate, in female subjects, a Visual Analogue Scale (VAS) that we named Orgasmometer-F, to verify if SD is accompanied by a lower perceived orgasmic intensity. A total of 526 women, recruited through a web-based platform and from sexological outpatient clinic, were enrolled in the study. They were divided into, on the basis of the Female Sexual Function Index (FSFI) score in two groups: 1) 112women suffering from SD, (SD Group); and 2) 414 sexually healthy women (Control Group). The participants were requested to fill out the Orgasmometer-F, recording orgasmic intensity on a Likert scale from 0 (absence of orgasmic intensity) to 10 (maximum orgasmic intensity experienced). Women with SD experienced significantly lower orgasmic intensity than controls, as measured by the Orgasmometer-F (p < 0.0001). Interestingly, masturbatory frequency was positively correlated with orgasmic intensity, as were the lubrication, orgasm and sexual satisfaction domains of the FSFI. The Orgasmometer-F was well understood, had a good test-retest reliability (ICC = 0.93) and a high AUC in differentiating between women with and without sexual dysfunction (AUC = 0.9; p < 0.0001). The ROC curve analysis showed that a cut-off <5 had 86.5% sensitivity (95% CI 82,8–89,6), 80.4% specificity (95% CI 71.8–87.3), 75.4% positive predictive value (PPV) and 89.5% negative predictive value (NPV). In conclusion, the Orgasmometer-F, a new psychometrically sound tool for measuring orgasmic intensity in female population, demonstrated that SD impair orgasmic intensity.
... c 2 difference test ¼ 7.27). Then, we tested model 3, composed of 2 factors distributed as follows: factor 1 (cognitive-affective): pleasurable satisfaction (6, 27, 36), relaxation (28,29,30), emotional intimacy (12,16,20,23,25), and ecstasy (2, 18, 21, 33); and factor 2 (sensory): building (15,17), flooting (3,11), flushing (19, 38), shooting (7,14), throbbing (5,31), and general spasms (13,22,39). No good fit was obtained (RMSEA ¼ .113, ...
Background:
The Orgasm Rating Scale (ORS) is one of the few self-reported measures that evaluates the multidimensional subjective experience of orgasm.
Aim:
The objective of this study was to examine the psychometric properties of the ORS in context of sex-with-partner in a Spanish sample.
Methods:
We examined a sample of 842 adults from the general Spanish population (310 men, 532 women; mean age = 27.12 years, SD = 9.8). The sample was randomly divided into two, with a balanced proportion of men and women between each sub-sample. Sub-sample 1 consisted of 100 men and 200 women (33.3% and 66.6%) with a mean age of 27.77 years (SD = 10.05). Sub-sample 2 consisted of 210 men and 332 women (38.7% and 61.3%) with a mean age of 26.77 years (SD = 9.65). The ORS, together with the Sexual Opinion Survey-6 and the Massachusetts General Hospital-Sexual Functioning Questionnaire, was administered online. The survey included a consent form, in which confidentiality and anonymity were guaranteed.
Outcomes:
Based on exploratory factor analysis, we obtained a reduced 25-item version of the ORS, distributed along 4 dimensions (affective, sensory, intimacy, and rewards).
Results:
We performed both exploratory factor analysis and confirmatory factor analysis. The Spanish version of the ORS had adequate values of reliability that ranged from .78-.93. The 4 factors explained 59.78% of the variance. The factor structure was invariant across gender at a configural level. Scores from the ORS positively correlated with erotophilia and sexual satisfaction. The scale was useful to differentiate between individuals with orgasmic difficulties and individuals with no difficulties. We found that individuals with orgasmic difficulties showed a lower intensity in the affective, intimacy, and sensorial manifestations of orgasm.
Clinical translation:
This version of the ORS could provide an optimum measure for the clinical assessment to identify individuals with difficulties in their orgasmic capacity, thus, it could be used as screening device for orgasmic dysfunction.
Conclusions:
The ORS is an appropriate measure for its use for both research and clinical purposes. As limitations, quota sampling implies that the extent to which the results can be generalized is modest. Measurement invariance did not reach the level of weak invariance, and it was not tested across sexual orientation because most individuals identified themselves as heterosexual. The ORS is a multidimensional measure of the subjective experience of orgasm which has adequate psychometric properties; it is a reliable and valid scale. Arcos-Romero AI, Moyano N, Sierra JC. Psychometric Properties of the Orgasm Rating Scale in Context of Sexual Relationship in a Spanish Sample. J Sex Med 2018;XX:XXX-XXX.
... Somatic sensations may be diminished or absent after SCI, but diffuse autonomic sensations may be experienced and should be highlighted so the person can acknowledge the similarities with preinjury orgasm. Two questionnaires are available in the literature to assess the perceptual sensations of pleasure and orgasm: Courtois et al's 58,59 questionnaire on genital, cardiovascular, muscular, and autonomic sensations associated with sexual stimulation and climax in individuals with SCI (and recently validated on able-bodied controls), 60 and Mah and Binik's 61 questionnaire on sensoryemotional sensations characterizing orgasm in the able-bodied population. These questionnaires can be helpful in bringing the patients' attention to the range of sensations -genital, nongenital, or sensory-emotional -that can build up and characterize sexual pleasure and climax. ...
Sexuality is an important part of life, and it is necessary for clinicians to have a specific format in which to address sexual issues with their patients. A systematic approach to working with patients with spinal cord injury (SCI) to improve their sexual functioning and response is presented. Nonjudgmental communication about sexual concerns is followed by a detailed pre-and postinjury medical, psychosocial, and sexual history. If preexisting sexual issues are present, it is recommended that the patient be referred for assessment and treatment of these separate from the patient's SCI-related concerns. Physical examination, with special attention to issues that could impact the patient's sexuality, is followed by a detailed neurologic assessment with specific attention to the T11-L2 and S3-5 spinal segments. Education of the patient with regard to his or her sexual potential and the need to be flexible in his or her sexual repertoire is followed by self-exploration and practice. Routine follow-up is suggested after patient's initial sexual exploration. Treatment of confounding and iatrogenic factors related to SCI is followed by more sexual experience. Afterwards the clinician is encouraged to use simple techniques to treat sexual issues and follow-up with the patient to assess the outcome. A structured program utilizing vibratory stimulation with or without midodrine is described as a way to achieve ejaculation and potentially orgasm, and techniques for treating severe autonomic dysreflexia are discussed. If these interventions do not alleviate the patient's sexual concerns, the clinician should refer the patient for more specialized consultation.
... A questionnaire assessing the specific sensations of orgasm in individuals with SCI has been developed [84,85] to help patients identify the genital and extragenital sensations that can build up to or accompany climax. Initially developed for men with SCI, the 33item instrument was adapted to women with SCI [72] and recently validated in an able-bodied population [86]. ...
Background:
Although the rehabilitation of sexual function has been identified as a top priority among women presenting neurological conditions, sexual function is rarely assessed in this clinical group.
Objectives:
To review published assessment tools of sexual dysfunction in women with neurological conditions including multiple sclerosis (MS), spinal cord injury (SCI), Parkinson disease, stroke, traumatic brain injury.
Methods:
A systematic literature review was conducted with Medline via PubMed, PubMed Central, and Medline databases.
Results:
There are three reliable methods to assess sexual dysfunctions in women with neurological conditions: physiological assessments of reflexes and perineal sensitivity testing, self-reporting questionnaires on sexual function and sexual satisfaction, and electrophysiological assessments. Physiological assessments of sacral and thoracolumbar reflexes have mainly been conducted among women with SCI. When performed, they reveal the existence of a psychogenic and/or reflex sexual potential in those women. Other forms of physiological assessments include vulvar sensitivity testing in women with SCI, quantitative sensory testing and pudendal somatosensory evoked potentials in MS populations. A few validated self-reporting measures are also available to assess sexual potential and sexual satisfaction, although mostly in women with SCI and MS.
Conclusion:
Despite high prevalence rates and important clinical implications, sexual dysfunction is not systematically assessed in women presenting various neurological conditions. Several well-validated tools exist for such assessments, which could be used for sexual rehabilitation in these patients. The implementation of systematic assessments of sexual potential is feasible and renewed efforts should be made to do so in clinical practice.
... Therefore, almost all the data discussed in this review were collected using non-validated tools, thus potentially creating biases regarding the validity and generalizability of the findings. For the first time, Dubray et al [46] recently validated a brief self-report measurement of orgasm, assessing bodily and physiologic sensations perceived during climax; they developed a 22-item questionnaire analysing extragenital and genital sensations, spasms, nociceptive sensations, and sweating responses. Studies using this novel validated tool for the evaluation of post-RP OF are currently awaited. ...
In addition to urinary incontinence and erectile dysfunction, several other impairments of sexual function potentially occurring after radical prostatectomy (RP) have been described; as a whole, these less frequently assessed disorders are referred to as neglected side effects. In particular, orgasmic dysfunctions (ODs) have been reported in a non-negligible number of cases, with detrimental impacts on patients' overall sexual life. This review aimed to comprehensively discuss the prevalence and physiopathology of post-RP ODs, as well as potential treatment options. Orgasm-associated incontinence (climacturia) has been reported to occur in between 20% and 93% of patients after RP. Similarly, up to 19% of patients complain of postoperative orgasm-associated pain, mainly referred pain at the level of the penis. Moreover, impairment in the sensation of orgasm or even complete anorgasmia has been reported in 33% to 77% of patients after surgery. Clinical and surgical factors including age, the use of a nerve-sparing technique, and robotic surgery have been variably associated with the risk of ODs after RP, although robust and reliable data allowing for a proper estimation of the risk of postoperative orgasmic function impairment are still lacking. Likewise, little evidence regarding the management of postoperative ODs is currently available. In general, physicians should be aware of the prevalence of ODs after RP, in order to properly counsel all patients both preoperatively and immediately post-RP about the potential occurrence of bothersome and distressful changes in their overall sexual function.
Female Arousal and Orgasm: Anatomy, Physiology, Behaviour and Evolution is the first comprehensive and accessible work on all aspects of human female sexual desire, arousal and orgasm. The book attempts to answer basic questions about the female orgasm and questions contradictory information on the topic. The book starts with a summary of important early research on human sex before providing detailed descriptions of female sexual anatomy, histology and neuromuscular biology. It concludes with a discussion of the high heritability of female orgasmicity and evidence for and against female orgasm providing an evolutionary advantage.
The author has attempted to gather as much information on the subject as possible, including medical images, anonymized survey data and previously unreported trends. The groundbreaking book gives a scientific perspective on sexual arousal in women, and helps to uncover information gaps about this fascinating yet complex phenomenon.
The name “human-machine interface” (HMI) refers to a graphical user interface that enables human users to communicate with a system's machinery. HMIs are being used more frequently by consumers in regular chores as technology advances. Controls for using a machine, system, or instrument are provided by human-machine interface (HMI) systems. Every application of technology, including high-speed trains, CNC machining centers, semiconductor production machinery, and medical diagnostic and laboratory equipment, is made possible by sophisticated HMI systems. HMI systems include all the components a person will touch, see, hear, or employ to accomplish control functions and receive feedback on those actions. Today's HMI systems can transmit information to and receive information from other networked systems, such as materials handling or enterprise resource planning systems, as well as supervisory control and data acquisition (SCADA) and alarms (ERP). HMIs are used in self-service kiosks, ATMs, gas pumps, and checkout lanes to process user inputs, translate them into machine-readable code, and carry out activities without the assistance of an attendant, teller, or other staff members. An HMI offers a visual representation of the control system and real-time data acquisition in the context of industrial and process control systems. An HMI can boost productivity by offering a consolidated, exceptionally user-friendly representation of the control process. The use of HMIs in production lines allows users to update system processes without modifying any hardware since they may monitor and control processes that are not controlled by a central processing unit (CPU) and may include data recipes, event logging, video feeds, and event triggering. In an automated system, HMIs are frequently used in conjunction with a programmable logic controller (PLC) to monitor and control processes. In general, the HMI gives the user a graphical interface through which to interact with the PLC (typically a touchscreen). In addition to allowing orders to be issued, this interface also collects and translates feedback data from the PLC, which is subsequently understandably displayed on the screen. This gives the operator crucial flexibility and command over a particular system. A tablet or smartphone with an integrated touchscreen that enables people to interact with the machine's programming is a great illustration of a typical HMI.
The multidimensionality and interpersonal dimension of human sexuality make the study of female sexual dysfunction (FSD) a challenge. The aspiration to pursue a patient-centered, holistic approach collides with the need to establish commonly accepted diagnostic criteria for different disturbances in sexual functioning, involving one or multiple phases of the sexual response cycle and pain associated with sexual activity. According to recently proposed classifications, which are continuously evolving, the most relevant FSDs include hypoactive sexual desire disorder, female arousal disorder, persistent genital arousal disorder, and female orgasm disorder. The present chapter aims to provide a clinical perspective on these disorders by reviewing the most recent evidence on the pathophysiology, definitions, prevalence, leading etiologies, diagnostic tools, and key therapeutic approaches. Sexual pain-related conditions will be reviewed in another chapter.
It is evident that a gender bias still exists, with prominent biological etiologies of FSDs being neglected and understudied at the expense of psychodynamic and relational determinants. Moreover, classifications should serve to advocate the advancement of our knowledge of female sexual functioning. This process goes through the practical translation of the updated nosology in a language that is intelligible to primary healthcare providers all over the world, and ultimately, to women.
Background
Orgasm, particularly in older women, remains a poorly understood aspect of female sexual response partly because of a lack of validated self-report measures.
Aim
To evaluate the Orgasm Rating Scale (ORS) and Bodily Sensations of Orgasm Scale (BSOS) for use with pre, peri, and post-menopausal women and between solitary and partnered orgasm contexts.
Methods
Participants (solitary context, 252 pre, 139 peri, 190 post; partnered context, 229 pre, 136 peri, and 194 post-menopausal women, aged 18-82 years) were asked to complete an online questionnaire based on most recent solitary and partnered orgasm. Principal components analysis with Varimax rotation summarized the data into interpretable baseline models for all groups. Multi-Group Confirmatory Factor Analysis tested for multi-group measurement invariance. Adjustments to the models were made, and final model structures were presented.
Main Outcome Measures
ORS and BSOS measuring solitary and/or masturbation and partnered orgasm.
Results
For the ORS, 10 factor solutions were preferred, explaining 81% (pre), 80% (peri), and 81% (post) of the variance for the solitary and 83% (pre), 86% (peri), and 84% (post) of the variance for the partnered context. Factors included pleasurable satisfaction, ecstasy, emotional intimacy, relaxation, building sensations, flooding sensations, flushing sensations, shooting sensations, throbbing sensations, and general spasms. For the BSOS, 3 factor solutions were preferred, explaining 55% (pre), 60% (peri), and 56% (post) of the variance for the solitary and 56% (pre), 61% (peri), and 60% (post) of the variance for the partnered context. Factors included extragenital sensations, genital sensations and spasms, and nociceptive sensations and sweating responses. Divergent validity was observed (solitary r = -.04; partnered r = -.11) and configural, metric and scalar invariance for the solitary and partnered versions of the ORS and BSOS were found, suggesting the measures were interpreted similarly by all women.
Clinical Implications
With valid measurement tools, women's varying orgasm experiences can be investigated more systematically and compared to address gaps and conflicts in the existing literature. Ultimately, these additions may assist with improved interventions for women who are unsatisfied with their orgasm experiences.
Strengths and Limitations
Strengths include gaining the ability to compare age and menopausal status groups using empirically validated measures of orgasm experience. Limitations include cross-sectional design and lack of test-retest reliability measurement.
Conclusion
The ORS and BSOS are supported for use with women across adulthood in solitary and partnered orgasm contexts and can be used concurrently to provide a comprehensive assessment.
Webb AE, Reissing ED, Huta V. Orgasm Rating Scale and Bodily Sensations of Orgasm Scale: Validation for Use With Pre, Peri, and Post-Menopausal Women. J Sex Med 2022;XX:XXX–XXX.
This chapter aims to describe and evaluate the assessment tools for evaluating urological aspects for people with SCI through a systematic review of scientific literature. The systematic review was conducted in line with COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) on Pubmed, Scopus, CINAHL, and Web of Science. After removing duplicates, 3333 papers were screened. Of these, 476 were included in this systematic review. Among these, 33 papers were considered for this chapter. Results show 20 assessment tools that evaluate the urological area in persons with SCI. Among these, most scales evaluate the aspect of intermittent self-catheterization, neurogenic bladder, and sexuality. The most common assessment tools are the Qualiveen, which comprises 30 questions that assess general and urinary quality of life; the Intermittent Self-Catheterization Questionnaire (ISC-Q) which is a self-reported outcome measure that contains domains such as ease of use, convenience, discreetness, and psychological well-being; the Neurogenic Bladder Symptom Score (NBSS) which assesses lower urinary tract symptoms in patients with neurogenic lower urinary tract dysfunction; and, the Multiple Sclerosis Intimacy and Sexuality Questionnaire (MSISQ), which evaluates symptoms of sexual dysfunction (SD) such as impaired genital sensation, reduction of libido, or symptoms indirectly influencing sexual function, such as spasticity, pain, or discomfort in nongenital areas of the body or psychological, emotional, social, and cultural aspects that impact sexual function.
There exists little research on dream-related beliefs and their role in peoples' lives. Our aim was to develop a questionnaire (the Inventory of Dream Experiences & Attitudes [IDEA]) to assess dream-related beliefs and inves-tigate their relations to waking-state variables. Seven hundred twenty-five participants completed the IDEA, and 357 participants also completed ques-tionnaires on dreams, personality, and well-being and recorded their dreams for 2 or more consecutive weeks. A factor analysis of the IDEA revealed 7 dimensions: significance, positivity, recall, apprehension, entertainment, con-tinuity, and guidance. Using these dimensions, individuals were classified into three distinct profiles that showed differential relations to measures of per-sonality and well-being. The findings indicate that the IDEA is a useful instrument for researchers and that dream-related beliefs can play important psychological roles. Research on dream-related beliefs has been scarce, with the exception of peoples' attitude toward dreams, a global trait representing a general interest in dreams (e.g., Cernovsky, 1984; Robbins & Tanck, 1988; Rochlen, Ligiero, Hill, & Heaton, 1999; Schredl & Doll, 2001). Most studies show a moderate-sized relation between attitude toward dreams and dream recall frequency (e.g., Schredl & Montasser, 1996 –1997). However, a recent meta-analysis revealed that the size of the relation is probably overestimated because of methodological considerations regarding how dream recall is assessed (Beaulieu-Pré vost & Zadra, 2007).
The assessment of sexual arousal in men and women informs theoretical studies of human sexuality and provides a method to assess and evaluate the treatment of sexual dysfunctions and paraphilias. Understanding measures of arousal is, therefore, paramount to further theoretical and practical advances in the study of human sexuality. In this meta-analysis, we review research to quantify the extent of agreement between self-reported and genital measures of sexual arousal, to determine if there is a gender difference in this agreement, and to identify theoretical and methodological moderators of subjective-genital agreement. We identified 132 peer- or academically-reviewed laboratory studies published between 1969 and 2007 reporting a correlation between self-reported and genital measures of sexual arousal, with total sample sizes of 2,505 women and 1,918 men. There was a statistically significant gender difference in the agreement between self-reported and genital measures, with men (r = .66) showing a greater degree of agreement than women (r = .26). Two methodological moderators of the gender difference in subjective-genital agreement were identified: stimulus variability and timing of the assessment of self-reported sexual arousal. The results have implications for assessment of sexual arousal, the nature of gender differences in sexual arousal, and models of sexual response.
This article presents the development of a brief, self-report measure of female sexual function. Initial face validity testing of questionnaire items, identified by an expert panel, was followed by a study aimed at further refining the questionnaire. It was administered to 131 normal controls and 128 age-matched subjects with female sexual arousal disorder (FSAD) at five research centers. Based on clinical interpretations of a principal components analysis, a 6-domain structure was identified, which included desire, subjective arousal, lubrication, orgasm, satisfaction, and pain. Overall test-retest reliability coefficients were high for each of the individual domains (r = 0.79 to 0.86) and a high degree of internal consistency was observed (Cronbach's alpha values of 0.82 and higher) Good construct validity was demonstrated by highly significant mean difference scores between the FSAD and control groups for each of the domains (p < or = 0.001). Additionally, divergent validity with a scale of marital satisfaction was observed. These results support the reliability and psychometric (as well as clinical) validity of the Female Sexual Function Index (FSFI) in the assessment of key dimensions of female sexual function in clinical and nonclinical samples. Our findings also suggest important gender differences in the patterning of female sexual function in comparison with similar questionnaire studies in males.
The characteristics common to all human orgasm experiences and potential gender and contextual factors affecting these experiences were investigated in two studies. A two-dimensional descriptive model of the orgasm experience was evaluated by testing hypotheses concerning (a) fit of the model to adjective-ratings data describing male and female orgasm experiences, and (b) sexual context effects on the importance of model components. In the first model-evaluation study, 888 university students (523 women) provided adjective ratings to convey orgasm experiences attained through both solitary masturbation and sex with a partner. In a cross-validation study, 798 university students (503 women) provided similar ratings to convey orgasm experiences attained either through solitary masturbation or through sex with a partner. Overall, findings supported the utility of a two-dimensional model of the orgasm experience, an adjective-rating approach in comparing male and female orgasm, and the importance of examining sexual context effects on the orgasm experience.
Ejaculatory/orgasmic disorders, common male sexual dysfunctions, include premature ejaculation, inhibited ejaculation, anejaculation, retrograde ejaculation and anorgasmia.
To provide recommendations/guidelines concerning state-of-the-art knowledge for management of ejaculation/orgasmic disorders in men.
An International Consultation in collaboration with the major urology and sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 17 committees. Committee members established specific objectives and scopes for various male and female sexual medicine topics. The recommendations concerning state-of-the-art knowledge in the respective sexual medicine topic represent the opinion of experts from five continents developed in a process over a 2-year period. Concerning the Disorders of Ejaculation/Orgasm in Men Committee, there were nine experts from six countries.
Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation and debate.
Premature ejaculation management is dependent upon etiology. When secondary to ED, etiology-specific treatment is employed. When lifelong, initial pharmacotherapy (SSRI, topical anesthesia, PDE5 inhibitors) is appropriate. When associated with psychogenic/relationship factors, behavioral therapy is indicated. When acquired, pharmacotherapy and/or behavioral therapies are preferred. Retrograde ejaculation, diagnosed with spermatozoa and fructose in centrifuged post-ejaculatory voided urine, is managed by education, patient reassurance, pharmacotherapy or bladder neck reconstruction. Men with anejaculation or anorgasmia have a biologic failure of emission and/or psychogenic inhibited ejaculation. Men with age-related penile hypoanesthesia should be educated, reassured and be instructed in revised sexual techniques which maximize arousal.
More research is needed in understanding management of men with ejaculation/orgasmic dysfunction.
An orgasm in the human female is a variable, transient peak sensation of intense pleasure, creating an altered state of consciousness, usually with an initiation accompanied by involuntary, rhythmic contractions of the pelvic striated circumvaginal musculature, often with concomitant uterine and anal contractions, and myotonia that resolves the sexually induced vasocongestion and myotonia, generally with an induction of well-being and contentment. Women's orgasms can be induced by erotic stimulation of a variety of genital and nongenital sites. As of yet, no definitive explanations for what triggers orgasm have emerged. Studies of brain imaging indicate increased activation at orgasm, compared to pre-orgasm, in the paraventricular nucleus of the hypothalamus, periaqueductal gray of the midbrain, hippocampus, and the cerebellum. Psychosocial factors commonly discussed in relation to female orgasmic ability include age, education, social class, religion, personality, and relationship issues. Findings from surveys and clinical reports suggest that orgasm problems are the second most frequently reported sexual problems in women. Cognitive-behavioral therapy for anorgasmia focuses on promoting changes in attitudes and sexually relevant thoughts, decreasing anxiety, and increasing orgasmic ability and satisfaction. To date there are no pharmacological agents proven to be beneficial beyond placebo in enhancing orgasmic function in women.
The controversy about clitoral versus vaginal orgasms was discussed in Chapter 10. In this article, the Singers offer a new typology of orgasm, which tries to integrate recent physiological research with women’s subjective experience of orgasm. While the authors’ typology has not gained widespread acceptance, this article is valuable for its careful description of the various subjective and physiological components of orgasm. The authors also make the point that description of what orgasm is can cause distress in women who discover that their orgasm does not meet some criteria. Orgasms are indeed different for different women, and for the same women on different occasions.
Despite decades of research, the neurophysiology of orgasm remains unknown. Animal models with the urethrogenital reflex in rats and facial expressions of orgasm in macaques have provided remarkable contributions, but the models can only explain a part of the overall perceptual experience of orgasm in humans. Human studies on the other hand have mostly focused on subjective reports, and while a few instruments have been developed (but seldom used), the distinction between orgasm and intense sexual pleasure has not always been demonstrated. Recent advances in functional imagery have further contributed to our understanding of orgasm, but a final comprehensive model bringing together all the findings and explaining the neurophysiology of orgasm is still lacking. This paper reviews the literature on orgasm, from animal studies to human data, including those from men and women with spinal cord lesions who offer a natural experimental model to study climax. The data lead us to propose a model of orgasm as a non-pathological analog of autonomic hyperreflexia (AHR), involving a sympathetic storm arising from genital stimulation and triggering genital, autonomic, and muscular responses that are normally submitted to immediate and massive supraspinal inhibition (thereby leaving only the pleasurable experience of orgasm). The model is consistent with the physiological recordings of orgasm in men and women, the neurophysiology of ejaculation in men, and data from functional imagery and from clinical conditions involving unexplained reports of orgasm, in particular from prostatectomized men, prepuberal boys, women in labor, women who suffered sexual abuse, and individuals complaining of orgasmic cephalgia.
Determining the number of factors to extract is a critical decision in exploratory factor analysis. Simulation studies have found the Parallel Analysis criterion to be accurate, but it is computationally intensive. Two freeware programs that implement Parallel Analysis on Macintosh and Windows operating systems are presented.
To provide a questionnaire for assessing the sensations characterizing orgasm. To test the hypothesis that orgasm is related to autonomic hyperreflexia (AHR) in individuals with a spinal cord injury (SCI).
A total of 97 men with SCI, of whom 50 showed AHR at ejaculation and 39 showed no AHR, were compared. Ejaculation was obtained through natural stimulation, vibrostimulation or vibrostimulation combined with midodrine (5-25 mg). Cardiovascular measures were recorded before, at, and after each test. Responses to the questionnaire were divided into four categories: cardiovascular, muscular, autonomic and dysreflexic sensations.
Significantly more sensations were described at ejaculation than with sexual stimulation alone. Men with SCI who experienced AHR at ejaculation reported significantly more cardiovascular, muscular, autonomic and dysreflexic responses than those who did not. There was no difference between men with complete and those with incomplete lesions.
The findings show that the questionnaire is a useful tool to assess orgasm and to guide patients in identifying the bodily sensations that accompany or build up to orgasm. The findings also support the hypothesis that orgasm may be related to the presence of AHR in individuals with SCI. Data from able-bodied men also suggest that AHR could be related to orgasm, as increases in blood pressure are observed at ejaculation along with cardiovascular, autonomic and muscular sensations.
Self-report instruments concerning personality and subjective responses to sexual orgasm were filled out by 281 female university undergraduates. Exploratory and confirmatory factor analyses were used to evaluate the dimensionality of women's subjective responsiveness to orgasm. The results did not support the concept of a unidimensional orgasm process; separate coital and masturbatory factors of orgasmic experience were obtained. Highly internally consistent scales were developed to assess the two factors, and both scales were found to be significantly correlated with indices of extraversion, attitudes toward masturbation, and sexual experience. A path-analytic model was developed which is consistent with the hypothesis that heterosexual and monosexual behaviors act as mediators between extraversion, neuroticism, and attitudes toward masturbation, on the one hand, and subjective coital or masturbatory orgasmic responsiveness, on the other. It appears that attitudes toward masturbation may also have a direct influence on masturbatory responsiveness. Various therapeutic implications of the path model are described. Replications and extensions of the study with older, more experienced populations are necessary.
A random sample of 100 undergraduate women were interviewed about their subjective sexual experience. Sexual sensations during masturbation, oral sex, intercourse, and intercourse with concurrent clitoral massage were summarized and differentiated. Sensations labeled "orgasm" by a majority of the subjects were identified, and the suggestion was made that experiences other than that outlined by Masters and Johnson may be considered orgasmic by women in a more general population. Some support was found for Singer and Singer's typology of orgasm at a subjective level. Most subjects who experienced multiple orgasms found them no more satisfying than single ones. Clitoral and vaginal orgasms may be distinguished subjectively, but no clear preference for one or the other emerged from a consensus of the subjects. Orgasm rate was significantly related (p less than 0.001) to satisfaction during intercourse and oral sex, but not during masturbation. Some evidence was found supporting the role of social learning in developing sensitivity in the clitoris and vagina and possibly the breasts.
It has generally been assumed that a male's experience of orgasm is different from a female's experience of orgasm. In this study, a questionnaire consisting of 48 description of orgasm (24 male and 24 female) was submitted to 70 judges. These professionals (obstetrician-gynecologists, psychologists and medical students) were to sex-identify the description to discover whether sex differences could be detected. The judges could not correctly identify the sex of the person describing an orgasm. Furthermore, none of the three professional groups represented in the sample of judges did better than any of the other groups. Male judges did no better than female judges and vice versa. These findings suggest that the experience of orgasm for males and females is essentially the same.
Vaginal eroticism was investigated in a group of 27 coitally experienced volunteers by means of systematic digital stimulation of both vaginal walls. Erogenous zones were found in all subjects, mainly located on the upper anterior wall and the lower posterior one. An orgasmic response was elicited by stimulation of these zones in 89% of the subjects.
This study supports previous findings regarding vaginal eroticism. It does not support the existence of the discrete anatomical structure called the Grafenberg spot. It supports the contention that there are two distinct types of female orgasm, vaginally evoked and clitorally evoked. It also supports the finding that some women expel a fluid through the urethra at the time of orgasm. In this particular case the fluid was chemically indistinguishable from urine.
Human female orgasm was studied by collecting and analyzing the subjective orgasmic histories of 30 women, ages 18 to 59 years. Virtually all of the 93% who reported they had experienced orgasm also reported some level of conscious control over whether or not they reached orgasm. Women differed widely as to preferred types of physical stimulation and/or mental activities to facilitate orgasm. Orgasms were experienced as centered in the clitoral and/or vaginal areas. Women over 40 were more likely to have experienced orgasm in more than one anatomic site than were women aged 18 to 29. Marital status, religion, occupation, educational level, experiences of pregnancy and childbirth, various reported characteristics of relationships with partners, and early sexual experience were not associated with where orgasm is experienced within the body or with other variables of adult orgasmic experience. The variation among women as to how orgasm is best reached, differences in where it is experienced within the body, and the reasons why an individual woman experiences orgasms differently over time remain poorly understood phenomena.
Pelvic muscle contractions during sexual response can be monitored conveniently by the anal probe method described. Eleven young adult male subjects were each recorded for three sessions of masturbation to orgasm. Electrical signals from an anal pressure probe were automatically digitized by computer. Orgasmic contractions were easily distinguished from voluntary contractions by the steadily increasing intervals and complete muscle relaxation between orgasmic contractions. At orgasm each subject produced a characteristic series of contractions starting abruptly at an intercontraction interval of about 0.6 seconds, and continued for 10 to 15 contractions at an increasing increment of about 0.1 second per contraction. Pressure amplitude, representing the force of contractions, increased from the beginning of the regular series to a maximum at the seventh or eighth contraction. Area under the pressure curve, reflecting muscular exertion during contraction, generally increased throughout the regular series. Each man's pattern of contractions was very similar from one session to the next and distinguished his records from others'. Individuals' patterns could be grouped into three types, based chiefly on the location of the regular contraction series within the subjective span of orgasm. The most common type was a simple series of regular contractions. It had the shortest duration and fewest contractions. The next most common pattern began with the regular series, followed by a number of irregular contractions. This type was longest in duration. One man with a third type of intermediate duration, had a number of preliminary contractions before the series of regular contractions began in midorgasm.
To develop a brief, reliable, self-administered measure of erectile function that is cross-culturally valid and psychometrically sound, with the sensitivity and specificity for detecting treatment-related changes in patients with erectile dysfunction.
Relevant domains of sexual function across various cultures were identified via a literature search of existing questionnaires and interviews of male patients with erectile dysfunction and of their partners. An initial questionnaire was administered to patients with erectile dysfunction, with results reviewed by an international panel of experts. Following linguistic validation in 10 languages, the final 15-item questionnaire, the international index of Erectile Function (IIEF), was examined for sensitivity, specificity, reliability (internal consistency and test-retest repeatability), and construct (concurrent, convergent, and discriminant) validity.
A principal components analysis identified five factors (that is, erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction) with eigenvalues greater than 1.0. A high degree of internal consistency was observed for each of the five domains and for the total scale (Cronbach's alpha values of 0.73 and higher and 0.91 and higher, respectively) in the populations studied. Test-retest repeatability correlation coefficients for the five domain scores were highly significant. The IIEF demonstrated adequate construct validity, and all five domains showed a high degree of sensitivity and specificity to the effects of treatment. Significant (P values = 0.0001) changes between baseline and post-treatment scores were observed across all five domains in the treatment responder cohort, but not in the treatment nonresponder cohort.
The IIEF addresses the relevant domains of male sexual function (that is, erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction), is psychometrically sound, and has been linguistically validated in 10 languages. This questionnaire is readily self-administered in research or clinical settings. The IIEF demonstrates the sensitivity and specificity for detecting treatment-related changes in patients with erectile dysfunction.
The present study investigated the cardiovascular, genital, and endocrine changes in women after masturbation-induced orgasm because the neuroendocrine response to sexual arousal in humans is equivocal.
Healthy women (N = 10) completed an experimental session, in which a documentary film was observed for 20 minutes, followed by a pornographic film for 20 minutes, and another documentary for an additional 20 minutes. Subjects also participated in a control session, in which participants watched a documentary film for 60 minutes. After subjects had watched the pornographic film for 10 minutes in the experimental session, they were asked to masturbate until orgasm. Cardiovascular (heart rate and blood pressure) and genital (vaginal pulse amplitude) parameters were monitored continuously throughout testing. Furthermore, blood was drawn continuously for analysis of plasma concentrations of adrenaline, noradrenaline, cortisol, prolactin, luteinizing hormone (LH), beta-endorphin, follicle-stimulating hormone (FSH), testosterone, progesterone, and estradiol.
Orgasm induced elevations in cardiovascular parameters and levels of plasma adrenaline and noradrenaline. Plasma prolactin substantially increased after orgasm, remained elevated over the remainder of the session, and was still raised 60 minutes after sexual arousal. In addition, sexual arousal also produced small increases in plasma LH and testosterone concentrations. In contrast, plasma concentrations of cortisol, FSH, beta-endorphin, progesterone, and estradiol were unaffected by orgasm.
Sexual arousal and orgasm produce a distinct pattern of neuroendocrine alterations in women, primarily inducing a long-lasting elevation in plasma prolactin concentrations. These results concur with those observed in men, suggesting that prolactin is an endocrine marker of sexual arousal and orgasm.
This critical review presents a synthesis of the available theoretical and empirical literatures on human orgasm. Findings from both normal and clinical human populations are included. Two major trends in the literature, the dichotomization of biological and psychological perspectives and the assumption of gender differences, are highlighted. A new multidimensional model of the psychological experience of orgasm is described with a view to futhering a biopsychological approach applicable to both sexes. Clinical applications of this new model are discussed.
A model of female sexual arousal shows the composite emotion of subjective sexual arousal, which results from conscious appraisal of sexual stimuli and their context in the presence of positive affective and cognitive feedback. Genital feedback augments the subjective arousal to a variable degree. Genital congestion can be triggered by sexual stimuli in the absence of subjective arousal. Then the congestion either is ignored or not interpreted as sexual. An anhedonic or even a dysphoric response to the sensations of genital congestion are further possibilities. This model allows for various subtypes of arousal disorder and thus facilitates a choice of therapeutic intervention.
To explore the effectiveness of various sources of self-stimulation, including oral midodrine, in triggering ejaculation in men with spinal cord injury (SCI), and to document the systematic variations in blood pressure at ejaculation and consider a revised definition of autonomic dysreflexia.
The study included 62 men with SCI lesions from C2 to L2. Ejaculation potential was assessed with various sources of stimulation, beginning with natural stimulation, followed, if the test was negative, by penile vibrator stimulation (PVS) followed, if the test was again negative, by PVS combined with oral midodrine, started at 5 mg and increased in 5 mg steps up to 25 mg. The success rate of ejaculation was recorded, as were blood pressure (BP) changes measured at baseline and at ejaculation (or on the last trial if the test was negative). Reported sensations were also recorded and compared during positive and negative tests.
Overall, 89% of the patients reached ejaculation with one mode or another of stimulation. When patients had a negative result with natural stimulation, 56% were salvaged by PVS, and when PVS was negative, another 22% were salvaged by midodrine combined with PVS. The mean systolic BP increased by 35 mmHg at ejaculation during PVS and by 11 mmHg after midodrine, and a subsequent 29 mmHg at ejaculation during PVS combined with midodrine. By contrast, negative tests showed a relatively stable BP; the difference in changes in BP during positive and negative tests was significant (P < 0.01). Increases in BP during positive tests declined significantly more often within the limits of autonomic dysreflexia than negative tests (P < 0.01).
These results support the view that most men with SCI can obtain an ejaculation when a wide spectrum of stimulation is used, including natural stimulation, PVS, and PVS combined with oral midodrine. Positive tests were associated with significant increases in BP, in contrast to negative tests, where BP was relatively stable. This suggests that significant changes in BP are required for ejaculation and that insignificant changes are predictive of future failure. As most changes in BP during positive tests also fall within the criterion of autonomic dysreflexia, a revised definition of autonomic dysreflexia should be considered to encourage safe experiences with ejaculation and safe use of midodrine.
With the advances in penile vibrator stimulation (PVS), most spinal cord injured (SCI) men can self-ejaculate. Oral midodrine may further increase ejaculation success, while maintaining autonomy. Since most SCI men attempt ejaculation for sexual rather than reproductive purposes, self-ejaculation should be emphasized and sensations explored.
Explore (i) self-ejaculation success rate in SCI men; (ii) vascular parameters indicative of autonomic dysreflexia (AD) during sexual stimulation and ejaculation; and (iii) sensations associated with ejaculation.
Ejaculation was assessed on 81 SCI men with complete ASIA A (49%) and incomplete B to D lesions (51%), subdivided into tetraplegics (C2-T2), paraplegics sensitive to AD (T3-T6), paraplegics not sensitive to AD (T7-T10), paraplegics with lesions to the emission pathway (T11-L2), and paraplegics with lesions interrupting the emission-ejaculation pathways (L3-below). Natural stimulation was attempted first followed, if negative, by PVS followed, if again negative, by PVS combined with oral midodrine (5-25 mg).
Ejaculation success, systolic and diastolic blood pressure, and perceived physiological and orgasmic sensations.
Overall 91% reached ejaculation, 30% with natural stimulation, 49% with PVS and 12% with midodrine plus PVS. Midodrine salvaged up to 27% depending upon the lesion. Physiological and orgasmic sensations were perceived significantly more at ejaculation than sexual stimulation. Tetraplegics did not differ from paraplegics sensitive to AD on perceived cardiovascular and muscular sensations, but perceived significantly more autonomic sensations, and generally more physiological sensations than lower lesions unsensitive to AD.
Most SCI men can self-ejaculate and perceive physiological and orgasmic sensations. The climactic experience of ejaculation seems related to AD, few sensations being reported when AD is not reached, pleasurable climactic sensations being reported when mild to moderate AD is reached, and unpleasant or painful sensations reported with severe AD. Sexual rehabilitation should emphasize self-ejaculation and self-exploration and consider cognitive reframing to maximize sexual perceptions.
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