“How can I have an orgasm?” “How can I have a more pleasurable orgasm?” As a patient educator in our PRISM clinic, I have heard a number of women walk into our clinic walls with these questions. Some women come to our clinic upset because they have been able to orgasm before and now cannot. In other cases, women come to our clinic upset because they have never been able to reach orgasm. When I first had the idea to write a post about orgasm function, I thought, “What a home-run blog topic!” I could see it practically writing itself: “The Basics of The Orgasm and What Might Be Stopping Yours.” I began to compile my research, confident that I was taking on a task that would be easily tied into a bow after three simple steps: 1) Find the most current definition of an orgasm 2) Summarize exactly what an orgasm is 3) Write about how it can go wrong… Ha. Ha. Ha.
What’s in an orgasm?
In some magical, alternate universe, scientists know exactly how to make an orgasm. They understand what is going on in the mind and body during an orgasm, they are able to bottle that reaction in a pill, and hand them out like candy for anyone facing orgasm difficulty. That, however, is not the universe we live in. In my research, I realized that while science has revealed a lot about the human orgasm (information that, spoiler alert, can be helpful for those having orgasm difficulty) there is still so much we do not know. Let me guide you through the world of what scientists know about the human orgasm and—my personal favorite part—how what we don’t know might be even more exciting.
Orgasm as a step in the sexual process
One of the most basic ways of thinking about the orgasm is as one step of “the sexual response cycle.” Now, there is not one “cycle” that researchers agree on, but two researchers in the 1970s, William Masters and Virginia Johnson, developed a basic model that has served as a foundation for many more complex models.
Masters and Johnson (I’ll call them M&J) described a woman’s typical sexual response cycle as consisting of excitement, plateau, orgasm, and resolution. Unlike in the male model, M&J highlighted that women did not require a “refractory phase,” meaning they were physically able have multiple orgasms in a row. Like I said, this model has since been built upon in numerous ways and criticized for its simplicity, but it still serves a helpful starting point for thinking about a really common way of understanding an orgasm: as a pleasurable release following a buildup of sexual tension.
This model also helps us begin to understand why someone might have trouble having an orgasm. Look at all those steps! If an orgasm is the product of a buildup of sexual tension, you have you have to be able to actually get through all the steps. So if you are anxious and thinking about work instead of getting aroused and excited? Or if you are feeling more “sleepy” than “aroused”? If you’re worried that the kids are going to hear you or come barreling through your bedroom door at a moment’s notice? It might be hard to build up all the sexual tension and excitement that is thought to lead to orgasm.
Where does this leave us? Well, models like this one are simplified ways of understand something really complex. M&J watched people having orgasms and described what happened in general. These kinds of descriptions are interesting and teach us a lot about sexuality, but they do not dig into the body to try and access what is happening underneath the skin (aka biologically).
Orgasm in the body
Researchers know most about orgasm in terms of the changes that happen in the body that we can see and feel. We have M&J to thank for a lot of this knowledge! When observing couples coming to orgasm in a research setting, M&J measured things like their heart rate, blood pressure, breathing during an orgasm, and muscle tension.
We now understand many things about how the body changes before and during orgasm. The vagina widens and lengthens. There are contractions in the muscles of the pelvis, in the uterus, and in the rectum. Blood flows to the tissues in the vagina and to the clitoris. These organs actually fill with blood when we are aroused, which explains why our genitals swell and redden. In the vagina, the blood rushing in also helps to create additional moisture on the surface of the skin of the vagina. This partially explains the sensation of “wetness.” These are the expected signs of arousal for most people, but there are also expected variations, like in the context of menopause, which can make achieving orgasm more difficult.
Based on our experience working in our sexual function clinic, we know that when the physical elements of arousal are not functioning as expected, it can be harder to achieve orgasm. For example, while limited research is available in the scientific literature, we often see that women with very tense pelvic floor muscles may have trouble achieving an orgasm. This may be because the blood flow to the small vessels in the pelvis is restricted and cannot build up to create that “pressure” that is expected right before orgasm. There is also some evidence that clitoral size and shape can affect a woman’s orgasm. So the physical body really does matter—which goes against anyone saying to a woman who cannot have an orgasm that “it’s all in her head.” That being said, the experience of an orgasm often goes beyond the physical. Even if we can “fix” certain mechanisms like the ones I have described (for example blood flow or moisture), this does not exactly result in guaranteed, mind-blowing orgasms every time. So, what does?
Orgasm in the brain
Understanding the brain during orgasm and how it, along with the rest of our nervous system, regulates orgasm is one of the most complicated and controversial aspects of the orgasm literature. Instead of turning this blog into a neuroscience course, I will say this: the exact ways in which the central nervous system (i.e. the brain and spinal cord) plays a role in creating the female orgasm is a code that has not been cracked. We know that blood flow changes in the brain before and during orgasm, but scientists don’t agree on where exactly blood flows or if there is one pattern that all brains follow. Most scientists agree that neurotransmitters in the brain play a role in “accelerating” the body towards orgasm and pumping the “brakes.” Many also agree that dopamine (the gas) and serotonin (the brakes) are the main chemicals involved in this process. Other scientists, however, say there may be more chemicals involved than we think.
Why does this matter? Well, if we knew the brain’s secret code for making an orgasm (in other words, the exact science behind what is happening then the brain), we could 1) define an orgasm chemically 2) test women with orgasm difficulty for low levels of those key chemicals and 3) try to “fix” their orgasms with drugs that behaved liked those chemicals. While there is ongoing work in these directions, the science is nowhere near that far along. And, perhaps, we don’t need it to be.
So what have we learned?
If you are experiencing orgasm difficulty, there is no perfect science to clearly point to what is “wrong.” According to the American College of Obstetricians and Gynecologists (ACOG), the only way a doctor or nurse should be telling you that something is “wrong” with your sexual function in the first place is by taking an extensive sexual history interview. This interview should ask questions that get to the root of your sex life as a whole, your relationships, traumas, hopes and fears for your sexual function, orgasm function and more. And even if something about this interview is “abnormal” according to most of the population, it should never be called a problem unless it causes you personal distress or worry.
How your orgasm works (or doesn’t) is just one part of your sexual story. It is that whole story (the hopes, the fears, the pain, the pleasure) that creates your personal measure of “right” and “wrong.” Addressing your orgasm “dysfunction,” then, requires getting to know your own body, your own orgasm, and your own desires. That leaves the defining in the hands of every person, which I find pretty exciting.
Excited about embarking on your own orgasm-defining journey? To get started, you could explore some self-care resources to find ways to increase your pleasure, embark on a more intensive at-home program for orgasm growth (here is one example), or talk to your doctor (especially in the face of orgasm difficulty). None of these resources will contain all of the answers, but they will likely offer some tools for helping you along. Have fun.
This piece draws heavily on clinical experience from the PRISM clinic, Levin 2014 Pharmacology, Biochemistry, and Behavior and the textbook Praeger Perspectives Sexual Health Volume 2: Physical Foundations. These sources listed below.
Photo credit: Jayson Hinrichsen on Unsplash
1. Levin RJ. The pharmacology of the human female orgasm — Its biological and physiological backgrounds. Pharmacology Biochemistry and Behavior. 2014 Jun;121:62–70.
2. Tepper M, Owens AF, editors. Sexual health. Westport, Conn: Praeger; 2007.
Edited by Kelsey Paradise.