ArticlePDF Available

Coital positions and clitoral blood flow: A biomechanical and sonographic analysis

Authors:

Abstract and Figures

Objective. — To create biomechanical models of five common coital positions, and evaluate the degree of contact and forces against the clitoris. To evaluate clitoral blood flow before and after engaging in these positions. Methods. — Biomechanical models were rendered of a male and female pelvis in the following coital positions: face-to-face/female above, sitting/face-to-face, face-to-face/male above(with and without pillow), and kneeling/rear entry. The thrusting force and gravitational force were estimated for the pelvis(es) providing the main forces. The areas of contact between the pelvises were identified and highlighted. Sonography of the clitoris was performed before and after a healthy volunteer couple engaged in each position, using a Philips Lumify ultrasound (Koninklijke Philips N.V., Amsterdam, Netherlands) with a L12-4 linear array transducer(4—12 MHz). Results. — The biomechanical models for each position, with the exception of kneeling/rear entry, reveal a large amount of contact with the clitoris. Clitoral blood flow increased after engaging in each position except for kneeling/rear entry. Positions in which the gravitational force of the thrusting partner was in the same direction of (and thereby augmenting) the thrusting force resulted in intense clitoral blood flow (face-to-face/female above, and face-to-face/male above). Augmenting the face-to-face/male above position with a pillow generated a component of the male pelvic gravitational force in the direction of the clitoris; this resulted in more blood flow to all components of the cavernous body. Conclusion. — From a biomechanical perspective, different coital positions vary in their potential to stimulate the clitoris. These positions lead to variable increases in clitoral blood flow, concordant with our biomechanical models.
Content may be subject to copyright.
ARTICLE IN PRESS
+Model
SEXOL-858;
No.
of
Pages
7
Sexologies
xxx
(xxxx)
xxx.e1—xxx.e7
Disponible
en
ligne
sur
ScienceDirect
www.sciencedirect.com
RESEARCH
IN
ACTION
Coital
positions
and
clitoral
blood
flow:
A
biomechanical
and
sonographic
analysis
K.
Lovie ,
A.
Marashi
Department
of
medical
imaging
and
AI,
New
H
Medical,
PC,
176
Johnson
Street
#6H
Brooklyn,
11201
New
York,
United
States
KEYWORDS
Clitoris;
Biomechanics;
Sexual
positions;
Sonography
Summary
Objective.
To
create
biomechanical
models
of
five
common
coital
positions,
and
evaluate
the
degree
of
contact
and
forces
against
the
clitoris.
To
evaluate
clitoral
blood
flow
before
and
after
engaging
in
these
positions.
Methods.
Biomechanical
models
were
rendered
of
a
male
and
female
pelvis
in
the
follow-
ing
coital
positions:
face-to-face/female
above,
sitting/face-to-face,
face-to-face/male
above
(with
and
without
pillow),
and
kneeling/rear
entry.
The
thrusting
force
and
gravitational
force
were
estimated
for
the
pelvis(es)
providing
the
main
forces.
The
areas
of
contact
between
the
pelvises
were
identified
and
highlighted.
Sonography
of
the
clitoris
was
performed
before
and
after
a
healthy
volunteer
couple
engaged
in
each
position,
using
a
Philips
LumifyTM ultra-
sound
(Koninklijke
Philips
N.V.,
Amsterdam,
Netherlands)
with
a
L12-4
linear
array
transducer
(4—12
MHz).
Results.
The
biomechanical
models
for
each
position,
with
the
exception
of
kneeling/rear
entry,
reveal
a
large
amount
of
contact
with
the
clitoris.
Clitoral
blood
flow
increased
after
engaging
in
each
position
except
for
kneeling/rear
entry.
Positions
in
which
the
gravitational
force
of
the
thrusting
partner
was
in
the
same
direction
of
(and
thereby
augmenting)
the
thrusting
force
resulted
in
intense
clitoral
blood
flow
(face-to-face/female
above,
and
face-to-
face/male
above).
Augmenting
the
face-to-face/male
above
position
with
a
pillow
generated
a
component
of
the
male
pelvic
gravitational
force
in
the
direction
of
the
clitoris;
this
resulted
in
more
blood
flow
to
all
components
of
the
cavernous
body.
Conclusion.
From
a
biomechanical
perspective,
different
coital
positions
vary
in
their
poten-
tial
to
stimulate
the
clitoris.
These
positions
lead
to
variable
increases
in
clitoral
blood
flow,
concordant
with
our
biomechanical
models.
©
2022
Sexologies.
Published
by
Elsevier
Masson
SAS.
All
rights
reserved.
Corresponding
author
at:
469
West
57
Street,
#3C,
10019
New
York,
NY,
United
States.
E-mail
address:
kimberly.lovie@nycgyno.com
(K.
Lovie).
https://doi.org/10.1016/j.sexol.2022.04.007
1158-1360/©
2022
Sexologies.
Published
by
Elsevier
Masson
SAS.
All
rights
reserved.
Please
cite
this
article
as:
K.
Lovie
and
A.
Marashi,
Coital
positions
and
clitoral
blood
flow:
A
biomechanical
and
sono-
graphic
analysis,
Sexologies,
https://doi.org/10.1016/j.sexol.2022.04.007
ARTICLE IN PRESS
+Model
SEXOL-858;
No.
of
Pages
7
K.
Lovie
and
A.
Marashi
Introduction
The
purported
benefits
of
various
coital
positions
are
described
in
numerous
magazines,
books,
and
public
forums.
However,
there
is
little
scientific
research
that
evaluates
the
association
between
different
coital
positions
and
their
abil-
ity
to
produce
female
orgasm.
A
survey
of
Swedish
women
evaluated
the
tendency
of
various
sexual
techniques
(but
not
positions)
to
cause
climax.
In
this
study,
51—57%
of
women
achieved
orgasm
though
penile
penetration
alone,
and
50%
through
clitoral
stimulation
alone
(Fugl-Meyer
et
al.,
2006).
Swieczkowski
and
Walker
evaluated
the
ability
of
different
coital
positions
to
produce
orgasm
by
adminis-
tering
a
questionnaire
with
a
40-point
Likert
scale
(ranging
from
0/‘‘not
at
all’’
to
40/‘‘exclusively’’).
The
average
ratings,
in
order
of
decreasing
orgasm
potential,
were:
face-to-face/male
above
(28),
face-to-face/female
above
(26.36),
manipulation
of
female
genitals
by
partner
(23.47),
cunnilingus
(17.94),
face-to-face/side
position
(16.73),
stimulation
of
breasts
and
other
non-genital
areas
(11.69),
sitting/face-to-face
(10.78),
prone/rear
entry
(8.23),
kneel-
ing/rear
entry
(5.85),
sitting/rear
entry
(3.81),
stimulation
by
vibrator
(2.26),
and
anal
intercourse
(0.89)
(Swieczkowski
and
Walker,
1978).
In
2018,
Krejcová
et
al.
investigated
coital
positions
in
a
group
of
Czech
volunteers.
Participants
were
shown
a
series
of
black
and
white
drawings
of
13
sexual
posi-
tions
and
were
asked
to
estimate
what
percentage
of
the
time
they
led
to
orgasm;
9
positions
were
coital:
face
to
face/male
above,
prone/rear
entry,
standing/face-to-face,
standing,
face-to-face/female
above,
supine/female
above,
kneeling/rear
entry,
sitting/face-to-face,
and
standing/rear
entry.
The
most
common
positions
(over
participants’
life-
times,
and
within
the
past
5
years)
were:
face
to
face/male
above
(median
80%
for
females),
face-to-face/female
above
(median
40%
for
females),
and
kneeling/rear
entry
(median
42%
for
women).
The
face
to
face/female
above
and
sitting/face-to-face
positions
were
most
likely
to
result
in
orgasm,
while
the
kneeling/rear
entry
position
was
least
likely
(Krejcová
et
al.,
2020).
Krejcová
et
al.
attribute
the
success
of
face-to-face
positions
to
their
ability
to
facilitate
communication,
both
verbal
and
physical
(Krejcová
et
al.,
2020).
Although
these
psychological
factors
are
involved
in
orgasm
(Meston
et
al.,
2004;
Brody,
2010;
Brody
and
Costa,
2017;
Adam
et
al.,
2020),
physical
stimulation
of
the
clitoris,
which
has
been
recognized
as
‘‘possibly
the
most
critical
organ
for
female
sexual
health,’’
likely
plays
a
dominant
role
(Mazloomdoost
and
Pauls,
2015).
Female
orgasm
is
hypothesized
to
be
regu-
lated
by
both
autonomic
and
somatic
nerves,
and
involves
a
complex
reflex
arc.
According
to
O’Connell
et
al.
(O’Connell
et
al.,
2005)
this
process
probably
involves:
Receptors
within
the
clitoris
and
vulva
detecting
stimulus
(i.e.
touch);
somatic
afferents
of
the
pudendal
nerve
(dorsal
clitoral
and
perineal
branches);
S2-4
spinal
cord
levels
transmitting
information
to
the
brain;
visceral
efferents
of
the
pelvic
splanchnic
nerves;
parasympathetic
stimulation
of
the
clitoris
resulting
in
dilation
of
the
of
the
clitoral
arteries;
erectile
tissue
of
the
clitoris
becoming
engorged
with
blood
(increased
inflow
and
decreased
outflow
of
blood);
secretions
from
the
Bartholin
and/or
Skene
glands
and
urethra;
sympathetic
stimulation
of
the
urovaginal
plexus
(through
the
hypogastric
nerves
and
inferior
hypogastric
plexus);
skeletal
muscle
contraction
of
the
vagina,
anus,
and
ure-
thra
(through
the
pudendal
nerve).
From
a
biomechanical
perspective,
pelvic
floor
mus-
cles
are
also
crucial
to
orgasm,
with
stronger
pelvic
floor
muscles
associated
with
improved
sexual
function
(Kanter
et
al.,
2015;
Kegel,
1952;
Graber
and
Kline-Graber,
1979;
Lowenstein
et
al.,
2010;
Martinez
et
al.,
2014).
Although
other
biomechanical
factors
(i.e.
forces
against
the
cli-
toris)
likely
play
a
major
role
in
this
process,
female
orgasm
has
yet
to
be
formally
studied
from
this
perspec-
tive.
Researchers
generally
agree
that
there
is
a
distinction
between
orgasms
resulting
from
clitoral
stimulation,
or
‘‘clitoral
orgasm’’
(CO),
and
those
resulting
from
vaginal
penetration
without
clitoral
stimulation,
or
‘‘vaginally
acti-
vated
orgasm’’
(VAO)
(Jannini
et
al.,
2012;
Buisson
and
Jannini,
2013).
A
VAO
is
hypothesized
to
involve
stimula-
tion
of
the
clitorourethrovaginal
(CUV)
complex
(Jannini
et
al.,
2012;
Buisson
and
Jannini,
2013).
Buisson
and
Jannini
performed
a
sonographic
study
to
evaluate
clitoral
blood
flow
after
external
and
internal
stimulation
(Buisson
and
Jannini,
2013).
Additional
sonographic
studies
have
evalu-
ated
the
CUV
complex
(Buisson
et
al.,
2008;
Gravina
et
al.,
2008;
Foldes
and
Buisson,
2009;
Battaglia
et
al.,
2009;
Battaglia
et
al.,
2010a;
Battaglia
et
al.,
2010b).
However,
no
sonographic
studies
have
been
performed
to
evaluate
the
efficacy
of
different
coital
positions.
Materials/Patients
We
evaluated
different
common
coital
positions
and
their
ability
to
stimulate
areas
in
the
female
pelvis
that
are
involved
in
orgasm,
with
attention
to
the
clitoris.
The
fol-
lowing
five
positions
were
assessed:
face-to-face/female
above,
sitting/face-to-face,
face-to-face/male
above
(with
and
without
pillow),
and
kneeling/rear
entry.
These
five
positions
were
chosen
because
they
were
among
the
most
or
least
likely
to
cause
orgasm,
or
were
the
most
com-
mon
based
on
the
results
of
Krejcová
et
al.
(Krejcová
et
al.,
2020)
In
their
study,
the
face-to-face/female
above
and
sitting/face-to-face
positions
were
most
likely
to
cause
orgasm.
The
kneeling/rear
entry
position
was
least
likely
to
cause
orgasm.
The
face-to-face/male
above
position
was
evaluated
because
it
was
the
most
common
(Krejcová
et
al.,
2020).
We
also
evaluated
the
face-to-face/male
above
posi-
tion
with
a
pillow
because
it
is
a
common
coital
practice.
The
five
positions
were
performed
by
a
healthy
medi-
cal
doctor
couple,
both
32-years-old,
at
home.
Given
the
sensitive
nature
of
the
research,
the
participants
were
cho-
sen
because
they
were
well-known
to
the
researchers,
and
willingly
volunteered
for
the
study.
The
participants
were
in
a
monogamous
relationship
with
each
other.
Both
partici-
pants
were
healthy
and
had
no
sexually
transmitted
illnesses
xxx.e2
ARTICLE IN PRESS
+Model
SEXOL-858;
No.
of
Pages
7
Sexologies
xxx
(xxxx)
xxx.e1—xxx.e7
or
significant
past
medical
history.
They
completed
the
Ari-
zona
Sexual
Experiences
Scale
(ASEX)
and
the
short
form
of
the
Female
Sexual
Function
Index
(FSFI-6),
two
validated
tools
for
evaluating
for
sexual
dysfunction;
neither
volunteer
had
sexual
dysfunction.
Informed
consent
was
obtained
for
both
participants.
This
study
was
carried
out
in
accordance
with
The
Code
of
Ethics
of
the
World
Medical
Association
(Declaration
of
Helsinki).
Methods
Biomechanical
anatomical
drawings
of
a
generic
male
and
female
pelvis
were
rendered
in
the
five
positions
using
Adobe
PhotoshopTM software.
The
male
pelvis
and
penis
were
depicted
with
decreased
opacification
to
better
visu-
alize
the
clitoris
and
vagina.
Areas
of
contact
between
the
female
vulva,
vagina,
and
her
partner’s
skin
and
penis
were
rendered
in
pink.
The
dominant
forces
involved
in
each
coital
position
were
depicted
with
vector
arrows.
Of
note,
the
magnitudes
of
the
vectors
were
chosen
arbitrarily,
as
they
depend
on
participant
mass
and
thrusting
forces
(which
are
partner-dependent).
The
gravitational
forceat
the
pelvic
center
of
mass
was
depicted
for
the
pelvis
that
provided
the
thrusting
force;
this
allowed
us
to
evaluate
whether
grav-
ity
(or
its
resolved
components)
added
to
the
overall
force
directed
against
the
clitoris.
The
location
of
the
center
of
gravity
was
estimated
based
on
data
from
the
Human
Per-
formance
Lab
(Cincinnati
Children’s
Hospital)
(Body
Center
of
Mass,
2022).
The
five
positions
were
evaluated
in
the
volunteer
cou-
ple.
The
duration
of
each
position
was
10
minutes.
The
objective
was
to
compare
clitoral
blood
flow
before
and
after
coitus
in
each
of
the
five
positions,
after
a
stan-
dardized
period
of
time.
Although
it
was
not
necessary
to
achieve
orgasm,
it
was
recorded
if
it
occurred.
Clitoral
ultrasound
was
performed,
with
grayscale
and
color
Doppler
ultrasound
images
obtained
before
and
after
coitus,
in
the
coronal
and
sagittal
planes.
Ultrasound
was
chosen
as
the
imaging
modality,
as
it
is
an
efficient,
low-cost
method
to
evaluate
the
clitoris,
and
can
be
performed
in
any
setting
(i.e.
at
home).
Greyscale
ultrasound
images
(not
evaluating
blood
flow)
were
acquired
to
assess
clitoral
anatomy.
Color
Doppler
ultrasound
images
were
obtained
to
evaluate
blood
flow
before
and
after
clitoral
stimulation.
The
ultrasound
images
were
obtained
with
a
Philips
LumifyTM ultrasound
machine
and
L12-4
linear
array
(4—12
MhHz)
transducer.
Cli-
toral
blood
flow
was
assessed
qualitatively
with
a
uniform
gain
setting
for
all
Doppler
acquisitions.
A
uniform
light
pres-
sure
was
applied
with
the
transducer,
acknowledging
that
heavier
pressure
could
skew
blood
flow.
Each
coital
position
was
evaluated
on
a
different
day
to
allow
the
clitoral
blood
flow
to
return
to
baseline.
This
ensured
that
the
order
in
which
the
coital
positions
was
evaluated
did
not
influence
the
results.
Results
The
ultrasound
acquisitions
in
the
transverse
plane
reveal
paired,
hypoechoic
cavernous
bodies
on
either
side
of
the
urethra.
In
the
sagittal
image,
the
glans,
raphe,
and
body
of
the
cavernous
body
are
visualized.
The
ischiopubic
ramus
is
adjacent
to
the
cavernous
body.
The
vestibular
bulbs
are
on
a
more
medial
plane
than
the
cavernous
bodies,
and
are
not
seen
in
the
sagittal
image
(Fig.
1).
The
biomechanical
models
for
each
position,
with
the
exception
of
the
kneeling/rear
entry
position,
reveal
a
large
amount
of
contact
between
the
female’s
clitoris
and
her
partner’s
skin.
In
the
biomechanical
model
for
the
face-to-face/female
above
position,
the
gravitational
force
at
the
female
pelvis
center
of
mass
is
in
the
same
direction
as
the
female
thrust-
ing
force
(Fig.
2a).
This
resulted
in
intense,
symmetric
blood
flow
to
all
three
parts
of
the
cavernous
bodies:
the
medial
aspect
of
the
body
and
raphe,
and
the
proximal
aspect
of
the
glans
(Fig.
2).
For
the
sitting/face-to-face
position,
both
partners
pro-
vide
a
thrusting
force
in
opposite
directions.
The
location
of
the
center
of
gravity
for
the
male
and
female
pelvis
are
approximately
in
the
same
location
between
the
partners.
This
gravitational
force
is
perpendicular
to
both
thrusting
force
vectors
(Fig.
3a).
This
position
led
to
a
relatively
small,
symmetric
increase
in
blood
flow,
localized
to
the
medial
aspect
of
the
cavernous
bodies
(Fig.
3).
In
the
face-to-face/male
above
position,
the
gravita-
tional
force
of
the
male
pelvis
is
almost
perpendicular
to
his
thrusting
force
(Fig.
4a).
This
led
to
an
intense,
diffuse
increase
in
blood
flow
to
all
aspects
of
the
cavernous
bodies,
and
to
the
surrounding
pelvic
tissues
(Fig.
4).
Modifying
the
face-to-face/male
above
position
with
a
pillow
can
be
mod-
eled
with
the
male
and
female
pelvises
on
an
inclined
plane.
The
force
of
gravity
from
the
male
pelvis
(Fg)
is
resolved
into
two
components:
the
gravitational
force
perpendicular
to
the
inclined
plane
(F),
and
the
gravitational
force
parallel
to
the
plane
(F//)
(Fig.
5a).
This
led
to
an
intense,
symmet-
ric
blood
flow
to
the
body
and
raphe
of
the
cavernous
body
(Fig.
5).
The
biomechanical
model
for
the
kneeling/rear
entry
position
reveals
minimal
contact
between
the
female’s
clitoris
and
her
partner’s
skin.
The
male
thrusting
force
is
perpendicular
to
the
gravitational
force
at
the
female
pelvis’
center
of
gravity
(Fig.
6a).
This
resulted
in
a
neg-
ligible
increase
in
blood
flow
(Fig.
6).
The
male
and
female
volunteers
achieved
orgasm
during
all
five
sessions.
Discussion
The
biomechanical
models
of
the
face-to-face
positions
(including
face-to-face/female
above,
face-to-face/male
above
with
and
without
pillow,
and
sitting/face-to-face)
demonstrate
a
considerable
amount
of
contact
between
the
female
pelvis
and
her
partner’s
skin.
Although
Krejcová
et
al.
attribute
the
success
of
the
face-to-face
positions
to
their
ability
to
facilitate
verbal
and
physical
commu-
nication
(Krejcová
et
al.,
2020),
our
models
support
our
hypothesis
that
face-to-face
positions
also
maximize
cli-
toral
stimulation
and
increase
blood
flow.
The
kneeling/rear
entry
position
produces
the
least
amount
of
direct
clitoral
contact,
and
resulted
in
a
negligible
increase
in
blood
flow
compared
to
the
face-to-face
positions.
According
to
Krejcová
et
al.,
the
face-to-face/female
above
position
was
among
the
most
likely
to
lead
to
xxx.e3
ARTICLE IN PRESS
+Model
SEXOL-858;
No.
of
Pages
7
K.
Lovie
and
A.
Marashi
Figure
1
Transverse
(a)
and
sagittal
(b)
views
of
the
clitoris
depicting
the
paired
cavernous
bodies
(CB)
urethra
(Ure),
glans
(GL),
raphe
(RA),
ischiopubic
ramus
(IR),
and
vagina
(VA).
Figure
2
Biomechanical
model
of
the
face-to-face/female
above
position.
The
thrusting
force
(FT)
is
provided
by
the
female
pelvis,
and
is
in
the
same
direction
as
the
gravitational
force
(Fg)
at
the
female
pelvis
center
of
mass
(a).
Transverse
and
sagittal
views
of
the
clitoris
before
(b
and
c)
and
after
(d
and
e)
engaging
in
the
face-to-face/female
above
position,
with
color
Doppler
flow.
Figure
3
Biomechanical
model
of
the
sitting/face-to-face
position
(a).
Both
partners
apply
a
thrusting
force
(FT)
in
opposite
directions,
which
are
both
perpendicular
to
the
female
and
male
pelvis
gravitational
force
(Fg).
Transverse
and
sagittal
views
of
the
clitoris
before
(b
and
c)
and
after
(d
and
e)
engaging
in
the
sitting/face-to-face
position,
with
color
Doppler
flow.
orgasm
(Krejcová
et
al.,
2020).
Based
on
the
biomechanical
model,
with
the
female
positioned
above,
the
downward
force
of
gravity
maximizes
the
pressure
on
the
clitoris.
This
gravitational
force
is
also
in
the
same
direction
as
the
female
thrusting
force,
which
can
help
facilitate
this
motion.
Additionally,
compared
to
when
she
is
below
her
partner,
she
has
more
control
over
the
pressure
exerted
against
the
clitoris.
Although
this
position
did
not
lead
to
the
largest
increase
in
blood
flow,
it
was
the
only
posi-
tion
in
which
all
aspects
of
the
cavernous
body
were
involved.
Krejcová
et
al.
found
that
the
sitting/face-to-face
posi-
tion
had
a
high
likelihood
of
causing
orgasm
(Krejcová
et
al.,
2020),
which
is
supported
by
our
model.
This
position
allows
each
partner
equal
opportunity
to
exert
a
thrusting
force
against
the
other,
which
can
increase
the
pressure
against
the
clitoris.
Of
note,
the
gravitational
force
is
perpendicular
to
both
partners’
thrusting
forces,
and
does
not
contribute
to
the
total
force
(and
therefore
pressure)
exerted
against
the
clitoris.
These
biomechanical
factors
might
explain
why
the
sitting/face-to-face
position
has
a
high
likelihood
of
causing
climax,
but
is
not
the
most
likely.
These
findings
are
xxx.e4
ARTICLE IN PRESS
+Model
SEXOL-858;
No.
of
Pages
7
Sexologies
xxx
(xxxx)
xxx.e1—xxx.e7
Figure
4
Biomechanical
model
of
the
face-to-face/male
above
position
(a).
The
thrusting
force
(FT)
is
provided
by
the
male
pelvis,
and
is
approximately
perpendicular
to
the
gravitational
force
of
the
male
pelvis
(Fg).
Transverse
and
sagittal
views
of
the
clitoris
before
(b
and
c)
and
after
(d
and
e)
engaging
in
the
face-to-face/male
above
position,
with
color
Doppler
flow.
Figure
5
Biomechanical
model
of
the
face-to-face/male
above
with
a
pillow
(a).
The
thrusting
force
(FT)
is
provided
by
the
male
pelvis.
The
force
of
gravity
from
the
male
pelvis
(Fg)
is
resolved
into
two
components:
the
gravitational
force
perpendicular
to
the
inclined
plane
(F),
and
the
gravitational
force
parallel
to
the
plane
(F//).
Transverse
and
sagittal
views
of
the
clitoris
before
(b
and
c)
and
after
(d
and
e)
engaging
in
the
face-to-face/male
above
position
with
pillow,
with
color
Doppler
flow.
Figure
6
Biomechanical
model
of
the
kneeling/rear
entry
position
(a).
The
thrusting
force
(FT)
is
provided
by
the
male
pelvis,
and
is
approximately
perpendicular
to
the
gravitational
force
of
the
male
pelvis
(Fg).
Transverse
and
sagittal
views
of
the
clitoris
before
(b
and
c)
and
after
(d
and
e)
engaging
in
the
kneeling/rear
entry
position.
corroborated
by
ultrasound:
the
sitting/face-to-face
posi-
tion
resulted
in
increased
blood
flow
compared
to
baseline,
but
less
than
the
positions
in
which
pelvic
gravitational
force
is
exerted
against
the
clitoris.
The
face-to-face/male
above
position
(without
a
pillow)
was
the
most
common
position
reported
by
Krejcová
et
al.
(median
80%
for
females).
However,
it
was
not
among
the
positions
most
likely
to
lead
to
orgasm
(Krejcová
et
al.,
2020).
This
finding
might
be
explained
by
the
woman
hav-
ing
less
control
over
the
pressure
exerted
against
the
vulva.
Interestingly,
this
position
led
to
the
largest
increase
in
blood
flow
to
the
clitoris
and
surrounding
tissues,
which
was
diffuse.
A
variation
of
this
position
involves
the
woman
tilting
her
pelvis
upwards,
sometimes
with
the
aid
of
a
pil-
low.
Pillows
marketed
for
this
intention,
often
referred
to
as
‘‘sex
pillows,’’
or
‘‘positioning
pillows’’
are
usually
firm
and
wedged
shaped,
providing
more
precise
and
consistent
pelvic
angulation
than
conventional
bed
pillows.
Although
Krejcová
et
al.
did
not
evaluate
the
frequency
of
orgasm
when
a
pillow
was
used
in
this
position,
the
biomechanical
models
suggest
that
a
pillow
would
increase
the
likelihood
of
orgasm:
a
female
can
adjust
herself
on
the
pillow
to
increase
xxx.e5
ARTICLE IN PRESS
+Model
SEXOL-858;
No.
of
Pages
7
K.
Lovie
and
A.
Marashi
the
amount
of
contact
between
the
clitoris
and
her
partner’s
skin.
The
F//component
of
gravity
created
by
the
‘‘inclined
plane’’
of
the
pillow
allows
more
force
(and
therefore
pres-
sure)
to
be
directed
from
the
male
pelvis
to
the
clitoris.
In
addition
to
increasing
the
amount
of
contact
and
pressure
on
the
clitoris,
pillows
can
increase
the
depth
of
penetra-
tion.
Of
note,
the
participants
studied
by
Krejcová
et
al.
rated
positions
with
deep
vaginal
penetration
as
more
plea-
surable
(Krejcová
et
al.,
2020).
In
our
volunteer
couple,
this
position
resulted
in
an
intense,
symmetric
increase
in
blood
flow
to
the
clitoris,
less
diffuse
than
when
a
pillow
was
not
used.
Krejcová
et
al.
found
that
the
median
frequency
of
the
kneeling/rear
entry
position
was
among
the
least
likely
to
result
in
orgasm
(Krejcová
et
al.,
2020).
Because
the
penis
spans
the
posterior
aspect
of
the
perineum
to
enter
the
vagina,
this
position
might
result
in
decreased
contact
with
the
clitoral
bulbs,
therefore
making
orgasm
less
likely.
This
was
supported
by
our
biomechanical
model,
which
demon-
strates
the
least
clitoral
contact
compared
to
the
other
positions
studied.
This
led
to
a
minimal
increase
in
clitoral
blood
flow.
Our
study
was
limited
to
creating
biomechanical
models
for
five
coital
positions,
and
evaluating
changes
in
clitoral
blood
flow
in
one
female
volunteer
after
engaging
in
these
positions.
Individual
women
might
have
different
respon-
siveness
to
stimulation
from
these
positions.
Additionally,
different
partners
might
exert
varying
degrees
of
thrusting
forces,
which
would
impact
the
predictions
of
the
biome-
chanical
models.
Psychological
factors
also
play
a
role
in
clitoral
blood
flow
and
orgasm,
and
are
not
accounted
for
in
this
investigation
(Meston
et
al.,
2004;
Brody,
2010;
Brody
and
Costa,
2017).
Since
this
is
a
pilot
study,
it
is
important
that
it
be
replicated
with
a
larger
number
of
subjects.
Conclusions
Our
findings
suggest
that,
from
a
biomechanical
perspective,
different
coital
positions
vary
in
their
potential
to
stimu-
late
the
clitoris.
These
positions
lead
to
variable
increases
in
clitoral
blood
flow,
concordant
with
our
biomechani-
cal
models.
According
to
our
results,
face-to-face
positions
are
more
likely
to
lead
to
orgasm
because
they
maximize
clitoral
stimulation
and
blood
flow.
In
addition,
positions
in
which
the
female
partner
has
more
control
over
the
pressure
exerted
on
the
clitoris
(i.e.
female
above)
pro-
duce
more
uniform
increases
in
clitoral
blood
flow.
These
results
can
help
clinicians
inform
patients
with
sexual
dys-
function.
Difficulty
achieving
orgasm,
the
causes
of
which
are
multifactorial,
is
one
component
of
sexual
dysfunc-
tion.
Clinicians
can
use
these
findings
to
counsel
patients
about
which
coital
positions
might
help
them
achieve
climax.
Disclosure
of
interest
The
authors
declare
that
they
have
no
competing
interest.
Acknowledgements
We
thank
Dr.
Nima
Nouri
Naini
for
his
support
and
help-
ful
radiology
discussions
from
the
beginning
of
our
research
endeavors.
We
thank
Claire
Chanu
for
assistance
with
French
translation.
References
Fugl-Meyer
KS,
Öberg
K,
Lundberg
PO,
Lewin
B,
Fugl-Meyer
A.
Origi-
nal
Research
-
Epidemiology:
On
Orgasm,
Sexual
Techniques,
and
Erotic
Perceptions
in
18-
to
74-Year-Old
Swedish
Women.
J
Sex
Med
2006;1:56—68.
Swieczkowski
JB,
Walker
CE.
Sexual
behavior
correlates
of
female
orgasm
and
marital
happiness.
J
Nerv
Ment
Dis
1978;166:335—42.
Krejcová
L,
Kuba
R,
Flegr
J,
et
al.
Kamasutra
in
Practice:
The
Use
of
Sexual
Positions
in
the
Czech
Population
and
Their
Association
With
Female
Coital
Orgasm
Potential.
Sex
Med
2020;8:767e776.
Meston
CM,
Levin
RJ,
Sipski
ML,
et
al.
Women’s
orgasm.
Annu
Rev
Sex
Res
2004;15:173—257.
Brody
S.
The
relative
health
benefits
of
different
sexual
activities.
J
Sex
Med
2010;7:1336—461.
Brody
S,
Costa
RM.
Vaginal
orgasm
is
associated
with
indicesof
women’s
better
psychological,
intimate
relationship,
and
psy-
chophysiological
function.
Can
J
Hum
Sex
2017;26:1—4.
Adam
F,
De
Sutter
P,
Day
J,
et
al.
A
Randomized
Study
Com-
paring
Video-Based
Mindfulness-Based
Cognitive
Therapy
With
Video-Based
Traditional
Cognitive
Behavioral
Treatment
in
a
Sample
of
Women
Struggling
to
Achieve
Orgasm.
J
Sex
Med
2020;17:312—24.
Mazloomdoost
D,
Pauls
RN.
A
Comprehensive
Review
of
the
Cli-
toris
and
Its
Role
in
Female
Sexual
Function.
Sex
Med
Rev
2015;3:245—63.
O’Connell
HE,
Sanjeevan
KV,
Hutson
JM.
Anatomy
of
the
clitoris.
J
Urol
2005;174(4
Pt
1):1189—95.
Kanter
G,
et
al.
A
strong
pelvic
floor
is
associated
with
higher
rates
of
sexual
activity
in
women
with
pelvic
floor
disorders.
Int
Urog-
ynecol
J
2015;26(7):991—6.
Kegel
AH.
Sexual
functions
of
the
pubococcygeus
muscle.
West
J
Surg
Obstet
Gynecol
1952;60(10):521—4.
Graber
B,
Kline-Graber
G.
Female
orgasm:
role
of
pubococcygeus
muscle.
J
Clin
Psychiatry
1979;40(8):348—51.
Lowenstein
L,
et
al.
Can
stronger
pelvic
muscle
floor
improve
sexual
function?
Int
Urogynecol
J
2010;21(5):553—6.
Martinez
CS,
Ferreira
FV,
Castro
AAM,
Gomide
LB.
Wome n
with
greater
pelvic
floor
muscle
strength
have
better
sexual
function.
Acta
Obstet
Gynecol
Scand
2014;93:497—502.
Jannini
EA,
Rubio-Casillas
A,
Whipple
B,
Buisson
O,
Komisaruk
BR,
Brody
S.
Female
orgasm(s):
one,
two,
several.
J
Sex
Med
2012;9(4):956—65.
Buisson
O,
Jannini
EA.
Pilot
echographic
study
of
the
differences
in
clitoral
involvement
following
clitoral
or
vaginal
sexual
stimula-
tion.
J
Sex
Med
2013;10(11):2734—40.
Buisson
O,
Foldes
P,
Paniel
BJ.
Sonography
of
the
clitoris.
J
Sex
Med
2008;5(2):413—7.
Gravina
GL,
Brandetti
F,
Martini
P,
Carosa
E,
Di
Stasi
SM,
Morano
S,
et
al.
Measurement
of
the
thickness
of
the
urethrovaginal
space
in
women
with
or
without
vaginal
orgasm.
J
Sex
Med
2008;5:610—8.
Foldes
P,
Buisson
O.
The
clitoral
complex:
a
dynamic
sonographic
study.
J
Sex
Med
2009;6:1223—31.
Battaglia
C,
Nappi
RE,
Sisti
G,
Persico
N,
Busacchi
P,
Venturoli
S.
The
role
of
3-D
ultrasonography
in
the
evaluation
of
menstrual
cycle-
related
vascular
modifications
of
the
clitoris.
A
prospective
pilot
study.
J
Sex
Med
2009;6:2715—21.
xxx.e6
ARTICLE IN PRESS
+Model
SEXOL-858;
No.
of
Pages
7
Sexologies
xxx
(xxxx)
xxx.e1—xxx.e7
Battaglia
C,
Nappi
RE,
Mancini
F,
Alvisi
S,
Del
Forno
S,
Battaglia
B,
et
al.
3-D
volumetric
and
vascular
analysis
of
the
urethrovaginal
space
in
young
women
with
or
without
vaginal
orgasm.
J
Sex
Med
2010a;7:1445—53.
Battaglia
C,
Nappi
RE,
Mancini
F,
Alvisi
S,
Del
Forno
S,
Battaglia
B,
et
al.
PCOS
and
urethrovaginal
space:
3-D
volumetric
and
vascular
analysis.
J
Sex
Med
2010b;7:2755—64.
Body
Center
of
Mass
Example
-
Motion
Analysis.
Available
from:
h
ttp://w
ww.youtube.com/watch?v=HSW8gXmOazs
[Last
accessed
21
March
2022].
xxx.e7
ResearchGate has not been able to resolve any citations for this publication.
Article
Full-text available
Introduction: A limited number of scientific studies explore the frequency with which various sexual positions are used in human populations and the potential of particular sexual position to facilitate female coital orgasm. Aim: The aim of this study was to provide data about the prevalence and frequency of various sexual positions, their rated pleasurability, and their association with female coital orgasm consistency (COC). Methods: A sample of Czech heterosexual population (11,225 men/9,813 women) were presented with a list of 13 sexual positions in black-and-white silhouettes. For each position, they indicated frequency and pleasurability. COC was assessed as the proportion of penile-vaginal intercourse with a current partner which led to orgasm. Main outcome measure: Participants reported the frequency of use of sexual positions and rated their pleasurability. Using ordinal logistic regression, association between the COC and frequency of use of coital positions was tested. Results: In both men and women, the most commonly used sexual positions were face to face/male above, face to face/female above, and kneeling/rear entry. Nonetheless, there emerged some gender differences in the rating of pleasurability of various positions (all P < .001). We found that a higher proportion of female coital orgasms are positively associated with the frequency of use of face to face/female above (odds ratio [OR] = 1.005, P < .001) and sitting/face-to-face positions (OR = 1.003, P < .001) and negatively associated with the frequency of kneeling/rear entry position (OR = 0.996, P < .001). Conclusions: Our findings suggest that there are no gender differences in the frequency of use of sexual positions, but their rated pleasurability differs between men and women, and higher frequency of use of face-to-face positions with female above increases the likelihood of achieving coital orgasm during penile-vaginal intercourse. Most results, however, were of small effect sizes, and more research is needed to further explore this issue. Krejčová L, Kuba R, Flegr J, et al. Kamasutra in Practice: The Use of Sexual Positions in the Czech Population and Their Association With Female Coital Orgasm Potential. Sex Med 2020;8:767-776.
Article
Full-text available
Objectives: To explore, in an age perspective, women's lifetime sexual techniques and the extent to which they had led to orgasm. To relate these techniques and current erotic perceptions to orgasmic function in women sexually active during the last 12 months and to describe the relative impact of orgasmic function/dysfunction on their sexual well-being. Methods: A nationally representative sample of 18- to 74-year-old women (N = 1,335) participated. Nearly all were heterosexual. Current orgasmic capacity was broadly and subjectively classified into: no, mild, or manifest dysfunction. Sexual techniques and erotic perceptions were recorded together with level of sexual satisfaction. Results: Generational differences characterized age at first orgasm and intercourse, types and width of sexual repertoire, and also current erotic perceptions, while orgasmic dysfunction and distress caused by it were less age dependent. Likely protectors of good orgasmic function, mainly against manifest dysfunction, were: a relatively early age at first orgasm, a relatively greater repertoire of techniques used--in particular having been caressed manually or orally by partner(s), achievement of orgasm by penile intravaginal movements, attaching importance to sexuality and being relatively easily sexually aroused. In turn, among other aspects of female sexual function women who did not have orgasmic dysfunction or distress were particularly likely to be satisfied with their sexual life. Conclusion: Besides providing data on matters frequently said to be sensitive this investigation shows that women's generation and with it several long-ranging aspects of women's sexual history and their feelings of being sexual are important indicators of their orgasmic and thereby their overall sexual well-being. When (in clinical practice) establishing treatment strategy for women with orgasmic dysfunction due respect should be given to these factors.
Article
Full-text available
There is general agreement that it is possible to have an orgasm thru the direct simulation of the external clitoris. In contrast, the possibility of achieving climax during penetration has been controversial. Six scientists with different experimental evidence debate the existence of the vaginally activated orgasm (VAO). To give reader of The Journal of Sexual Medicine sufficient data to form her/his own opinion on an important topic of female sexuality. Expert #1, the Controversy's section Editor, together with Expert #2, reviewed data from the literature demonstrating the anatomical possibility for the VAO. Expert #3 presents validating women's reports of pleasurable sexual responses and adaptive significance of the VAO. Echographic dynamic evidence induced Expert # 4 to describe one single orgasm, obtained from stimulation of either the external or internal clitoris, during penetration. Expert #5 reviewed his elegant experiments showing the uniquely different sensory responses to clitoral, vaginal, and cervical stimulation. Finally, the last Expert presented findings on the psychological scenario behind VAO. The assumption that women may experience only the clitoral, external orgasm is not based on the best available scientific evidence.
Article
Full-text available
Although many studies examine purported risks associated with sexual activities, few examine potential physical and mental health benefits, and even fewer incorporate the scientifically essential differentiation of specific sexual behaviors. This review provides an overview of studies examining potential health benefits of various sexual activities, with a focus on the effects of different sexual activities. Review of peer-reviewed literature. Findings on the associations between distinct sexual activities and various indices of psychological and physical function. A wide range of better psychological and physiological health indices are associated specifically with penile-vaginal intercourse. Other sexual activities have weaker, no, or (in the cases of masturbation and anal intercourse) inverse associations with health indices. Condom use appears to impair some benefits of penile-vaginal intercourse. Only a few of the research designs allow for causal inferences. The health benefits associated with specifically penile-vaginal intercourse should inform a new evidence-based approach to sexual medicine, sex education, and a broad range of medical and psychological consultations.
Article
Introduction: This study examines the effectiveness of integrating mindfulness-based techniques within therapy for women suffering to achieve orgasm. Although widely applied in psychotherapy, this approach has only recently been introduced in the treatment of female sexual dysfunction. Aim: To compare the effectiveness of a video-based self-administered treatment, rooted within the cognitive behavioral treatment (CBT) framework, with a video-based self-administered mindfulness treatment applying cognitive behavioral sexual therapy (mindfulness-based cognitive therapy), the latter of which was specifically created to increase women's ability to achieve orgasm. Methods: A convenience sample of 65 women suffering from difficulties to achieve orgasm, aged 18 to 58 years (mean = 32.66, standard deviation = 9.48), were randomly allocated using a randomization procedure to either a mindfulness-based cognitive therapy (N = 35) or CBT (N = 30) group. Each participant completed questionnaires before and after the start of treatment and 2 months after its completion. Main outcome measure: We applied repeated-measure general linear models to compare the 2 groups (ie, between participant factor) on each dependent variable across time (ie, the within-participant factor). Compare mean analyses for paired samples were only conducted when the interaction effect between condition and time was significant (ie, P <.05). Results: Statistical analyses show that women in both groups presented increased sexual functioning (P = .001) and decreased sexual distress (P < .001), as well as improved desire, arousal, orgasm, and sexual satisfaction (P < .05) after their respective treatments. Contrary to our hypothesis, significant reductions in sexual pain were only observed in CBT participants. Clinical implications: To the best of our knowledge, this is the first study to apply a randomized allocation procedure to evaluate the effectiveness of a video-based mindfulness intervention for women struggling to achieve orgasm. These results should guide clinicians' decisions with respect to evaluating the relevance and the real added value of proposing mindfulness exercises to their patients with such difficulties. Conclusion: When women suffering from difficulties to achieve orgasm are randomly assigned to a mindfulness group or an active control, improvements in sexual functioning and reductions in sexual distress can be observed after both treatments. Adam F, De Sutter P, Day J, et al. A Randomized Study Comparing Video-Based Mindfulness-Based Cognitive Therapy With Video-Based Traditional Cognitive Behavioral Treatment in a Sample of Women Struggling to Achieve Orgasm. J Sex Med 2019;XX:XXX-XXX.
Article
A recent study by Therrien and Brotto (2016) examined the associations of orgasm during intercourse, concordance of laboratory genital and subjective arousal, and demographic variables in a group of sexually dysfunctional women. The authors claimed that their results cast doubt on the large body of multi-method multi-national research demonstrating that women's orgasm from penile-vaginal intercourse, and specifically vaginal orgasm are associated with a broad range of indices of women's better psychological, intimate relationship, and psychophysiological health. The problems with Therrien and Brotto's (2016) conclusions are discussed, and include that they did not even measure vaginal orgasm (they measured orgasm during intercourse, which can in some cases consist of orgasm elicited by clitoral masturbation during intercourse), and the non-generalisability of their findings from a sexually dysfunctional sample to the general population of women. Evidence is also presented against their claims that findings regarding orgasm during intercourse have not been investigated by other researchers, and their denial of differences between vaginal orgasm and clitoral orgasm. Denial of the myriad benefits of vaginal orgasm undermines women's sexual and general health potential, and serves only the demands of political correctness.
Article
IntroductionThe clitoris is often considered the female version of the penis and less studied compared to its male counterpart. Nonetheless, it carries the same importance in sexual functioning. While it has more recently been allocated the appreciation it deserves, the clitoris should be examined as a separate and unique entity.AimTo review clitoral anatomy, its role in sexual functioning, the controversies of vaginal eroticism and the female prostate, as well as address potential impacts of pelvic surgery on its function.Methods We examined available evidence (from 1950 until 2015) relating to clitoral anatomy, the clitoral role in sexual functioning, vaginal eroticism, female prostate, female genital mutilation/cutting, and surgical implications for the clitoris.Main Outcome MeasuresMain outcomes included an historical review of the clitoral anatomy and its role in sexual functioning, the controversies regarding vaginal sources of sexual function, and the impact of both reconstructive and nonmedical procedures on the clitoris.ResultsThe intricate neurovasculature and multiplanar design of the clitoris contribute to its role in female sexual pleasure. Debate still remains over the exclusive role of the clitoris in orgasmic functioning. Normal sexual function may remain intact, however, after surgical procedures involving the clitoris and surrounding structures.Conclusions The clitoris is possibly the most critical organ for female sexual health. Its importance is highlighted by the fact that the practice of female genital cutting is often used to attenuate the female sexual response. While its significance may have been overshadowed in reports supporting vaginal eroticism, it remains pivotal to orgasmic functioning of most women. Donna Mazloomdoost and Rachel N. Pauls. A comprehensive review of the clitoris and its role in female sexual function. Sex Med Rev **;**:**–**.
Article
We evaluated the associations between pelvic floor muscle strength and tone with sexual activity and sexual function in women with pelvic floor disorders. This was a secondary analysis of a multicenter study of women with pelvic floor disorders from the USA and UK performed to validate the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR). Participants were surveyed about whether they were sexually active and completed the PISQ-IR and the Female Sexual Function Index (FSFI) questionnaires to assess sexual function. Physical examinations included assessment of pelvic floor strength by the Oxford Grading Scale, and assessment of pelvic floor tone as per ICS guidelines. The cohort of 585 women was middle-aged (mean age 54.9 ± 12.1) with 395 (67.5 %) reporting sexual activity. Women with a strong pelvic floor (n = 275) were more likely to report sexual activity than women with weak strength (n = 280; 75.3 vs 61.8 %, p < 0.001), but normal or hypoactive pelvic floor tone was not associated with sexual activity (68.8 vs 60.2 %, normal vs hypoactive, p = 0.08). After multivariable analysis, a strong pelvic floor remained predictive of sexual activity (OR 1.89, CI 1.18-3.03, p < 0.01). Among sexually active women (n = 370), a strong pelvic floor was associated with higher scores on the PISQ-IR domain of condition impact (parameter estimate 0.20± 0.09, p = 0.04), and the FSFI orgasm domain (PE 0.51 ± 0.17, p = 0.004). A strong pelvic floor is associated with higher rates of sexual activity as well as higher sexual function scores on the condition impact domain of the PISQ-IR and the orgasm domain of the FSFI.
Article
Objective To investigate the relation between pelvic floor muscle strength and sexual function among women with higher and lower pelvic floor muscle strength.DesignA cross-sectional study was performed among employees and students of the University.SettingUrogynecology department, Federal University of Pampa, Brazil, carried out between January and July of 2012.PopulationForty women, aged 20–28 years.Methods Forty-nine women were screened and nine were excluded. Baseline information of the participants was obtained. The Female Sexual Function Index questionnaire was applied and pelvic floor muscle strength randomly measured by transvaginal palpation according to the Ortiz scale, and by perineometry. Women were allocated into two groups according to muscle strength.Main Outcome MeasuresIndex of sexual function and pelvic floor muscle strength.ResultsWomen with stronger pelvic floor muscles scored higher in the following domains: desire, excitement, orgasm and general score of the questionnaire (4.9 ± 0.73 vs.3.8 ± 0.58; 5.0 ± 0.35 vs. 4.3 ± 0.82; 5.8 ± 0.21 vs. 4.0 ± 1.00 and 32.4 ± 0.77 vs. 27.6 ± 3.29, p < 0.001). There was a moderate correlation between pelvic floor muscle pressure and both sexual satisfaction (r=0.47, p = 0.03) and lubrication (r=-0.69, p = 0.001) as well as the manual evaluation of pelvic floor muscle strength, graded by the Ortiz and perineometry, which were interrelated (r=0.65, p = 0.001).Conclusion Our findings suggest that women with stronger pelvic floor muscles have better sexual function.This article is protected by copyright. All rights reserved.
Article
Introduction: Women describe at least two types of orgasms: clitoral and vaginal. However, the differences, if any, are a matter of controversy. In order to clarify the functional anatomy of this sexual pleasure, most frequently achieved through clitoral stimulation, we used sonography with the aim of visualizing the movements of the clitorourethrovaginal (CUV) complex both during external, direct stimulation of the clitoris and during vaginal stimulation. Method: The ultrasounds were performed in three healthy volunteers with the General Electric® Voluson® sonography system (General Electric Healthcare, Vélizy, France), using a 12-MHz flat probe and a vaginal probe. We used functional sonography of the stimulated clitoris either during manual self-stimulation of the external clitoris or during vaginal penetration with a wet tampon. Main outcome measures: Functional and anatomic description, based on bidimensional ultrasounds, of the clitoris and CUV complex, as well as color Doppler signal indicating speed of venous blood flow, during arousal obtained by external or internal stimulation. Results: The sagittal scans obtained during external stimulation and vaginal penetration demonstrated that the root of the clitoris is not involved with external clitoral stimulation. In contrast, during vaginal stimulation, because of the movements and displacements, the whole CUV complex and the clitoral roots in particular are involved, showing functional differences depending on the type of stimulation. The color signal indicating flow speed in the veins mirrored the anatomical changes. Conclusions: Despite a common assumption that there is only one type of female orgasm, we may infer, on the basis of our findings, that the different reported perceptions from these two types of stimulation can be explained by the different parts of the clitoris (external and internal) and CUV complex that are involved.