Wednesday October 8 2014
Do you have problems with orgasm during penetrative sex?
"There is no such thing as a vaginal orgasm," says the Mail Online, in a story that suggests some women have been diagnosed with sexual disorders based on the "myth" that they can orgasm through vaginal intercourse alone.
The news comes from a review of existing (not new) evidence, and its authors make some very bold assertions.
The researchers' main conclusion – that the vaginal orgasm does not exist – is based on their assertion that the vagina has no anatomical structure that can cause an orgasm.
In their opinion, this makes it impossible for a woman to achieve orgasm through penetrative sex alone.
However, they argue there are other effective methods for women to achieve orgasm, such as masturbation and oral sex.
If these arguments are true, it raises a couple of interesting related points. Foremost is the possibility that female sexual dysfunction, where a woman is unable to achieve an orgasm, may not be a "condition" at all if she is only experiencing the problem with penetrative sex.
Men who feel they have premature ejaculation problems because they are unable to "last" long enough to bring their partner to orgasm may in fact be unaware that their partner may not be able to orgasm through penetrative sex.
This is an interesting, if complex and unsupported, review of a subject of eternal fascination to the media – sexual arousal and orgasm in women.
Still, the main thrust of the researchers' argument – that penetrative sex is not the be all and end all of sexual activity – is a valid and reasonable one.
Where did the story come from?
The study was carried out by researchers from the Italian Centre of Sexology and the University of Florence. There is no information about any external funding.
It was published in the peer-reviewed journal Clinical Anatomy on an open-access basis, so it is free to read online.
The Mail Online went to town on the story, but its claim that, "for years women have often declared they can either orgasm through sex or foreplay" is not based on any evidence.
It also does not make it clear that this was an opinion piece summarising existing evidence and not research based on new evidence.
But, overall, the website made a fairly decent job of summarising some complex findings.
What kind of research was this?
This was a narrative review looking at the anatomical and physiological basis of female orgasm.
The authors say orgasm is a normal psychophysiological function and, in a statement of the rather obvious, women have the right to feel sexual pleasure.
For this reason, they say it is important that explanations of orgasm are based on female biology and not on hypotheses or personal opinion.
They also say some researchers have proposed a new "anatomical terminology" for the female sexual response, including an "inner clitoris" linked to the "G-spot". Their paper aims to clarify whether these new terms have a scientific basis.
A narrative review discusses and summarises the literature on a particular topic. As these reviews do not provide detailed information on the criteria for inclusion of the studies discussed, they are not considered as rigorous or reliable as systematic reviews.
With a narrative review, there is always the danger that "cherry-picking" of research may have taken place – where evidence that supports the authors' position is included, but contradictory evidence is ignored.
What does the review say?
The authors' main points were:
- The "inner clitoris" suggested by some researchers does not exist. The entire clitoris is an external organ, composed of the glans, body and root (or crura).
- There is no anatomical basis for a "clitoral-urethro-vaginal complex" (which others claim supports the idea of the "G-spot").
- The vagina has no anatomical relationship with the clitoris.
- There is no scientific basis for the existence of the G-spot, although it has become the centre of a "multimillion-dollar business" – for example, through surgical procedures that claim to help "enhance" the G-spot.
- The vaginal orgasm does not exist.
- The female erectile tissue responsible for orgasms is composed of the clitoris and its vestibular bulbs, the pars intermedia, labia minora and corpus spongiosum (of the female urethra). This, say the authors, corresponds to the penis in men and can be called the "female penis".
- "Female orgasm" is the scientific term that should be used for all orgasms in women.
How did the researchers interpret the results?
The authors say that, worldwide, the majority of women do not orgasm during intercourse: "Female sexual dysfunctions are popular because they are based on something that does not exist; the vaginal orgasm."
Yet they say female orgasm is possible in all women if the female erectile organs – as they put it, the "female penis" – are stimulated.
This can happen during a variety of sexual activity, including masturbation, cunnilingus (oral sex) and intercourse (using the hands to stimulate the "female penis" during penetrative or anal sex).
The researchers say many men think long intercourse is the key to female orgasm, but this is not necessarily helpful to women, some of whom "may be grateful to get it over with quickly".
Male ejaculation does not automatically mean the end of sex for women, they say, and they romantically conclude that touching and kissing can be continued almost indefinitely.
This is an interesting, if complex, review of a subject of eternal fascination for the media – sexual arousal and orgasm in women. However, despite the authors' claim to the contrary, it is hardly likely to be the last word on the topic.
Some of the points it makes are in line with scientific opinion, which holds that no distinction should be made between "types" of female orgasm.
The "vaginal orgasm" theory – first posited by Freud as the sexual response of "mature" women, achievable through intercourse and separate from the "clitoral orgasm" (for adolescents only) – was criticised by feminists as long ago as the 1970s and is considered an outmoded theory by most experts in sexual medicine.
However, the relationship between the clitoris and the sensitivity of the vagina continues to be the subject of debate.
Many women worry about achieving – or failure to achieve – orgasm. There are many reasons for orgasm problems. Your GP may be able to refer you to a specialist doctor or therapist, who can check for any physical reasons and help with any psychological barriers. Use the NHS Choices search facility to find sexual health services near you.
And, as the authors point out, if penetrative sex is not particularly stimulating, there are other techniques your partner can explore, such as mutual masturbation and oral sex. For more information on good sex tips, see Talking about sex.
Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter. Join the Healthy Evidence forum.