The female orgasm continues to be the subject of intense scientific interest. Doctors puzzle over the different means by which women can achieve orgasm, and the things that can prevent orgasm in women.
Orgasm in Women: What Happens, Exactly?
When women do climax, "there are changes throughout the whole body, a head-to-toe kind of experience," says Michael Ingber, MD, a physician in urology and female pelvic medicine and reconstructive surgery at the Atlantic Health System in Morristown, New Jersey, and a fellow of the International Society for the Study of Women’s Sexual Health.
How Women Achieve Orgasm
One of the ways women can experience orgasm is through a goal-oriented four-step process first described by the sex researchers William Masters and Virginia Johnson decades ago.
1. Excitement In this state of desire or arousal, the woman initiates or agrees to sex, and as it commences she finds herself focusing mainly on sexual stimuli. Blood begins to engorge the clitoris, vagina, and nipples, and creates a full-body sexual blush. Heart rate and blood pressure increases. Testosterone and neurotransmitters such as dopamine and serotonin are involved in these processes, says Dr. Ingber.
2. Plateau Sexual tension builds as a precursor to orgasm. The outer one-third of the vagina becomes particularly engorged with blood, creating what researchers refer to as the "orgasmic platform." Focus on sexual stimuli drowns out all other sensations. Heart rate, blood pressure, and respiration continue to increase.
3. Orgasm A series of rhythmic contractions occur in the uterus, vagina, and pelvic floor muscles. The sexual tension caused by lovemaking or self-stimulation releases, and muscles throughout the body may contract. A feeling of warmth usually emanates from the pelvis and spreads throughout the entire body.
4. Resolution The body relaxes, with blood flowing away from the engorged sexual organs. Heart rate, blood pressure, and respiration return to normal.
Different Types of Stimulation, Different Types of Orgasm
Women are blessed with bodies that are capable of experiencing orgasm in more ways than one.
Some researchers believe that there are as many as 12 types of female orgasms. The most common type is a "clitoral" orgasm, says Ingber.
Clitoral stimulation has been proved the surest route to orgasm. "I think that clitoral stimulation [produces] probably the closest analogue to male orgasm, where you get erectile tissue, there is release, and after release it is uncomfortable to continue," says Steven R. Goldstein, MD, the director of gynecologic ultrasound and codirector of bone densitometry at New York University's Langone Medical Center and a professor of obstetrics and gynecology at the New York University School of Medicine.
Vaginal Stimulation, the G-Spot, and Intense Sexual Pleasure
But some women can also experience orgasm through vaginal stimulation. One group of researchers credit the G-spot, an area named and described by Beverly Whipple, PhD, RN, a professor emerita at Rutgers University in Newark, New Jersey, and a past president of the American Association of Sex Educators, Counselors and Therapists (AASECT).
The G-spot is an area felt through the wall of the vagina, an inch or two behind the back of the pubic bone near the junction of the bladder and the urethra and made up of tissues of the clitoris, urethra, and the female prostate gland, says Dr. Whipple. Some researchers believe that when stimulated, the G-spot causes intense sexual pleasure in some women; others question whether women can feel such pleasure at this location at all.
Sensory Pathways, Stimulation, and Orgasm Generation
Women also have been able to have orgasms through stimulation of the breasts or other parts of the body, or through the use of sexual imagery without any touch at all. Researchers have even found a nerve pathway outside the spinal cord, through the sensory vagus nerve, that will lead a woman to experience orgasm through sensations transmitted directly to the brain. "There are many nerve pathways that are responsible for the experience of orgasm in women," says Whipple.
The Female Orgasm: Problems Getting There
While there are physical problems that can keep a woman from experiencing orgasm, emotions can play a role, too. Some sex researchers say that anxiety and depression can prevent a woman from progressing along the sexual response cycle, says Ingber. Feelings of fear, guilt, distraction, or a loss of control can also affect orgasm. Similarly to men with erectile dysfunction, women can sometimes have problems achieving or maintaining adequate blood flow, says Ingber.
Treatments and Therapies to Help Women Reach Orgasm
It is estimated that as many as a quarter of American women have problems experiencing orgasm.
Doctors and sex therapists use several types of therapies to help women overcome these blocks to orgasm. Directed masturbation, sex education, and behavioral therapy are some of the means a woman might want to investigate if she cannot reach climax. Women may also want to try using a vibrator to provide increased clitoral stimulation, or a dildo crafted to provide better stimulation of the G-spot.
Interventions to Consider for Problems With Orgasm
If behavioral methods are not working and a woman is interested in other intervention, there are solutions better-researched for male erectile dysfunction that may help.
Ingber says that “for women having trouble with arousal, similar to men, Viagra (sildenafil) can be used,” he says. “Additionally, vacuum erection devices such as the Fiera can be used in order to improve libido and arousal. This applies gentle suction to the clitoris.”
Medical Treatments for Women With Low Sexual Desire
For women, particularly postmenopausal women, who have little sexual desire, an off-label use of topical testosterone can be prescribed. And an FDA-approved therapy called Addyi (flibanserin) may be effective for low libido in women with hypoactive sexual desire disorder (HSDD), says Ingber.