Female Orgasm: 3 Myths Debunked by an ObGyn
Female Orgasm Facts
Amongst friends, the conversation about sex always seems to go to “The Big O.” We want to talk about sex, with our girlfriends, with our hairdressers, but not with our doctors. Why are we hesitant to discuss our sexual health with our providers, when nearly 43% of all women struggle with sexual dysfunction?
Yet, as a sexual health physician, these are all things I have heard in my office, behind closed doors in a safe space.
“It takes forever to have an orgasm. What is wrong?”
“I have never had an orgasm. Why?”
“Ever since I started my Zoloft, I cannot have an orgasm.”
“My orgasm feels so different; it’s almost not there.”
“My partner does not know how to touch me - I can only orgasm by myself.”
“I am broken;I have never had an orgasm during sex.”
Female Orgasmic Disoder and Other Sexual Dysfuntion
Sexual dysfunction can include problems with desire, arousal, pain or orgasm. The topic we talk most about, within the media and with our girlfriends: orgasms. However, there are many myths about the female orgasm. We have all heard these myths or seen them on full display in the movies as characters are ripping off their clothes and instantaneously aroused, almost immediately orgasming on screen. Without any safe places to discuss sexuality, this leads to a conundrum of misinformation. So, I am here to set the record straight.
First, let’s talk about why these myths about the female orgasm spread like wildfire. Up until now, there have been so many healthcare barriers women have had to face, specifically for sexual dysfunction. There is a profound lack of research, funding, female leadership, and trained sexual health providers. Women often live in the shadows as invisible patients, often dismissed even if they have had the courage to come forward to discuss these very personal issues.
Female Sexual Arousal Disorder
Currently there are no FDA approved treatment options for the millions of women who suffer from orgasm dysfunction. ISSWSH( International Society for the Study of Women’s Sexual health) describes orgasm dysfunction as:
Problem with orgasm lasting 6 months or greater, that is distressing to the patient, and may be a problem with frequency, timing, frequency and pleasure. A woman may describe an orgasm that has muted intensity, never occurs, is devoid of pleasure or is delayed.
Myth #1 - Most women can orgasm from penetrative sex.
False. I see women on a weekly basis in my office who genuinely think there is something wrong with them because they require some type of clitoral stimulation to have an orgasm. A comprehensive analysis of 33 studies over 80 years found that during vaginal intercourse just 25% of women consistently experience an orgasm, about half of women sometimes have an orgasm, 20% seldom or ever have orgasms, and about 5% never have orgasms.
Let’s review some basic anatomy to understand why most women require some clitoral stimulation to orgasm.
Only a small portion of the clitoris is visible or external, the hood and the body. The bulbs (erectile tissue) and the crura (wings) of the clitoris which wrap around the vaginal opening are internal. The glans of the clitoris - the external visible portion is the most responsive to sexual stimulation and is the most densely innervated part of the human body.
With all of those nerve endings, the clitoris is crucial to sensation, pleasure and orgasm. Most women will require stimulation of the clitoris to achieve orgasm; this can be attained with digital or oral stimulation or clever positioning during intercourse.
A study that examined the size and location of the clitoris and its effect on the ease of ability to achieve orgasm was performed. They found that a woman with a smaller clitoris that was located further from the vaginal opening struggled more with achieving orgasm with intercourse. 
Another study found that women who reported that orgasm was a goal were more likely to report success in achieving orgasm during their most recent sexual encounter.
Why Can't I Orgasm?
Myth #2 I CANNOT ORGASM BECAUSE IT’S ALL IN MY HEAD AND THERE IS NOTHING I CAN DO ABOUT IT
FALSE. There are a multitude of reasons that may cause a woman to have problems with orgasm. The most important piece of the puzzle is to determine why there is an issue with orgasm. A visit to a provider that specializes in sexual health will often help.
A thorough medical exam and history with review of medications is part of the work up. Problems with hormones, a side effect of a medication, menopause, problems with nerves, blood flow, the spinal cord, neurotransmitters, a brain injury or dermatologic or anatomic problems can render problems with orgasm. A provider can check hormonal levels and order imaging as needed.
Once a determination is made as to the etiology, or cause, of the orgasm dysfunction, a treatment option can be offered. Currently, there are no FDA approved treatment options for orgasm dysfunction, but there are many treatment options. Treatment options can include hormones or off-label medications (an off -label medication is one that is FDA approved for a different reason, but has evidence that it can help with orgasm dysfunction). Sometimes surgery or a procedure is required to help with orgasm dysfunction.
How do providers measure the level of orgasm dysfunction or response to medications? There is a survey that women can fill out that measures all the domains of sexuality, including orgasm. This survey is called the Female Sexual Function Index, or FSFI. The survey is scored and responses to medications/treatments are measured and compared to pre-treatment levels.
MYTH #3 ALL WOMEN CAN HAVE MULTIPLE ORGASMS
False. To understand this, we must explore the typical phases of an orgasm.
- Excitement - blood flow increases to the genitalia, the vagina lengthens and heart rate (HR) and blood pressure (BP) increase
- Plateau - the vagina firms, the clitoris retracts
- Orgasm - the external and internal genitalia contract, lasting 13-51 seconds
- Resolution - swelling resolves, heart rate and blood pressure return to normal
In studies, about 15 - 42% percent of women report having experienced multiple orgasms.
Let’s examine the data that exists; women that report multiple orgasms experience more than 1 orgasm in a single session in succession; timing between orgasms may be a few seconds to a few minutes.
Masters and Johnson’s model further broke this down into women that experienced either repeated (multiple) or sequential orgasms. Repeated orgasms are described as orgasms separated by a rest period that does not fall below plateau; sequential orgasms are repeated orgasms without a plateau.
In a large data review of multiple orgasm the working definition was of 2 or more orgasms in a single sex session.
What were the findings in women that report multiple orgasms?
- Shorter orgasm latency (or, the time it takes us to get to orgasm, women who are on the shorter end of the norm are more likely to have multiple orgasms)
- Sexually motivated
- Sexual interest
So, yes, while it is possible for women to have multiple orgasms, this does not hold true for the majority of women. The ability to have multiple orgasms is determined by both biology, brain chemistry, anatomy and circumstance. If achieving multiple orgasms is something you desire, there are ways to to increase your chance of multiple orgasms through exploration and play with your partner.
JD Salinger once wrote that “a woman’s body is like a violin; it takes a terrific musician to play it right.”
With knowledge of our bodies and anatomy we can gain a better understanding of what we respond to and what will help us achieve orgasm. Self exploration can help in this - and, as we discover, we can guide our partners to be that terrific musician and help us reach orgasm.