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Orgasm (from Greek ὀργασμός, orgasmos; "excitement, swelling"; also sexual climax) is the sudden discharge of accumulated sexual excitement during the sexual response cycle, resulting in rhythmic muscular contractions in the pelvic region characterized by sexual pleasure.[1][2] Experienced by males and females, orgasms are controlled by the involuntary or autonomic nervous system. They are usually associated with involuntary actions, including muscular spasms in multiple areas of the body, a general euphoric sensation and, frequently, body movements and vocalizations.[2] The period after orgasm (known as the refractory period) is typically a relaxing experience, attributed to the release of the neurohormones oxytocin and prolactin as well as endorphins (or "endogenous morphine").[3]
Human orgasms usually result from physical sexual stimulation of the penis in males (typically accompanying ejaculation) and of the clitoris in females.[2][4][5] Sexual stimulation can be by self-practice (masturbation) or with a sex partner (penetrative sex, non-penetrative sex, or other sexual activity).
The health effects surrounding the human orgasm are diverse. There are many physiological responses during sexual activity, including a relaxed state created by prolactin, as well as changes in the central nervous system such as a temporary decrease in the metabolic activity of large parts of the cerebral cortex while there is no change or increased metabolic activity in the limbic (i.e., "bordering") areas of the brain.[6] There is also a wide range of sexual dysfunctions, such as anorgasmia. These effects affect cultural views of orgasm, such as the beliefs that orgasm and the frequency or consistency of it are either important or irrelevant for satisfaction in a sexual relationship,[7] and theories about the biological and evolutionary functions of orgasm.[8][9]
In a clinical context, orgasm is usually defined strictly by the muscular contractions involved during sexual activity, along with the characteristic patterns of change in heart rate, blood pressure, and often respiration rate and depth.[10] This is categorized as the sudden discharge of accumulated sexual tension during the sexual response cycle, resulting in rhythmic muscular contractions in the pelvic region.[1][2] However, definitions of orgasm vary and there is sentiment that consensus on how to consistently classify it is absent.[11] At least twenty-six definitions of orgasm were listed in the journal Clinical Psychology Review.[12]
There is some debate whether certain types of sexual sensations should be accurately classified as orgasms, including female orgasms caused by G-spot stimulation alone, and the demonstration of extended or continuous orgasms lasting several minutes or even an hour.[13] The question centers around the clinical definition of orgasm, but this way of viewing orgasm is merely physiological, while there are also psychological, endocrinological, and neurological definitions of orgasm.[11][12][14] In these and similar cases, the sensations experienced are subjective and do not necessarily involve the involuntary contractions characteristic of orgasm. However, the sensations in both sexes are extremely pleasurable and are often felt throughout the body, causing a mental state that is often described as transcendental, and with vasocongestion and associated pleasure comparable to that of a full-contractionary orgasm. For example, modern findings support distinction between ejaculation and male orgasm.[2][12] For this reason, there are views on both sides as to whether these can be accurately defined as orgasms.[14]
Orgasms can be achieved during a variety of activities, including vaginal, anal or oral sex, non-penetrative sex or masturbation. They may also be achieved by the use of a sex toy, such as a sensual vibrator or an erotic electrostimulation. Achieving orgasm by stimulation of the nipples or other erogenous zones is rarer.[15][16] Multiple orgasms are also possible, especially in women, but they are also uncommon.[2][17] Multiple orgasms are orgasms that occur within a short period of one another.[17]
In addition to physical stimulation, orgasm can be achieved from psychological arousal alone, such as during dreaming (nocturnal emission for males or females)[12][14][18] or by forced orgasm. Orgasm by psychological stimulation alone was first reported among people who had spinal cord injury.[18] Although sexual function and sexuality after spinal cord injury is very often impacted, this injury does not deprive one of sexual feelings such as sexual arousal and erotic desires.[18]
A person may also experience an involuntary orgasm, such as in the case of rape or other sexual assault.
Scientific literature focuses on the psychology of female orgasm significantly more than it does on the psychology of male orgasm, which "appears to reflect the assumption that female orgasm is psychologically more complex than male orgasm," but "the limited empirical evidence available suggests that male and female orgasm may bear more similarities than differences. In one controlled study by Vance and Wagner (1976), independent raters could not differentiate written descriptions of male versus female orgasm experiences".[14]
In men, the most common way of achieving orgasm is by physical sexual stimulation of the penis.[2] This is usually accompanied by ejaculation, but it is possible, though also rare, for men to orgasm without ejaculation (known as a "dry orgasm").[17] Prepubescent boys have dry orgasms.[19] Dry orgasms can also occur as a result of retrograde ejaculation,[20] or hypogonadism.[21] Men may also ejaculate without reaching orgasm,[21][22] which is known as anorgasmic ejaculation.[22] They may also achieve orgasm by stimulation of the prostate (see below).[2][23]
The traditional view of male orgasm is that there are two stages: emission following orgasm, almost instantly followed by a refractory period. The refractory period is the recovery phase after orgasm during which it is physiologically impossible for a man to have additional orgasms.[24][25] In 1966, Masters and Johnson published pivotal research about the phases of sexual stimulation.[10][26] Their work included women and men, and, unlike Alfred Kinsey in 1948 and 1953,[27] tried to determine the physiological stages before and after orgasm.
Masters and Johnson argued that, in the first stage, "accessory organs contract and the male can feel the ejaculation coming; two to three seconds later the ejaculation occurs, which the man cannot constrain, delay, or in any way control" and that, in the second stage, "the male feels pleasurable contractions during ejaculation, reporting greater pleasure tied to a greater volume of ejaculate".[28] They reported that, unlike females, "for the man the resolution phase includes a superimposed refractory period" and added that "many males below the age of 30, but relatively few thereafter, have the ability to ejaculate frequently and are subject to only very short refractory periods during the resolution phase". Masters and Johnson equated male orgasm and ejaculation and maintained the necessity for a refractory period between orgasms.[28]
There has been little scientific study of multiple orgasm in men.[23] Dunn and Trost defined male multiple orgasm as "two or more orgasms with or without ejaculation and without, or with only very limited, detumescence (loss of erection) during one and the same sexual encounter".[17] Although, due to the refractory period, it is rare for men to achieve multiple orgasms,[2][29] some men have reported having multiple, consecutive orgasms, particularly without ejaculation.[17] Multiple orgasms are more commonly reported in very young men than in older men.[17] In younger men, the refractory period may only last a few minutes, but last more than an hour in older men.[20]
An increased infusion of the hormone oxytocin during ejaculation is believed to be chiefly responsible for the refractory period, and the amount by which oxytocin is increased may affect the length of each refractory period.[30] A scientific study to successfully document natural, fully ejaculatory, multiple orgasms in an adult man was conducted at Rutgers University in 1995. During the study, six fully ejaculatory orgasms were experienced in 36 minutes, with no apparent refractory period.[2]
In women, the most common way to achieve orgasm is by direct sexual stimulation of the clitoris (meaning consistent manual, oral, or other concentrated friction against the external parts of the clitoris). General statistics indicate that 70–80% of women require direct clitoral stimulation to achieve orgasm,[2][31][32] although indirect clitoral stimulation (for example, via vaginal penetration) may also be sufficient.[5][33] The Mayo Clinic stated, "Orgasms vary in intensity, and women vary in the frequency of their orgasms and the amount of stimulation necessary to trigger an orgasm."[34] Clitoral orgasms are easier to achieve because the glans of the clitoris, or clitoris as a whole, has more than 8,000 sensory nerve endings, which is as many (or more in some cases) nerve endings present in the human penis or glans penis.[35][36][37] As the clitoris is homologous to the penis, it is the equivalent in its capacity to receive sexual stimulation.[38][39]
One misconception, particularly in older research publications, is that the vagina is completely insensitive.[40] However, there are areas in the anterior vaginal wall and between the top junction of the labia minora and the urethra that are especially sensitive.[41] With regard to specific density of nerve endings, while the area commonly described as the G-spot may produce an orgasm,[2][42] and the urethral sponge, an area in which the G-spot may be found, runs along the "roof" of the vagina and can create pleasurable sensations when stimulated, intense sexual pleasure (including orgasm) from vaginal stimulation is occasional or otherwise absent because the vagina has significantly fewer nerve endings than the clitoris.[4][43][44] The greatest concentration of vaginal nerve endings are at the lower third (near the entrance) of the vagina.[2][4][45][46]
Sex educator Rebecca Chalker states that only one part of the clitoris, the urethral sponge, is in contact with the penis, fingers, or a dildo in the vagina.[47] Hite and Chalker state that the tip of the clitoris and the inner lips, which are also very sensitive, are not receiving direct stimulation during penetrative intercourse.[47][48] Because of this, some couples may engage in the woman on top position or the coital alignment technique to maximize clitoral stimulation.[49][50] For some women, the clitoris is very sensitive after climax, making additional stimulation initially painful.[51]
Masters and Johnson argued that all women are potentially multiply orgasmic, but that multiply orgasmic men are rare, and stated that "the female is capable of rapid return to orgasm immediately following an orgasmic experience, if restimulated before tensions have dropped below plateau phase response levels".[28] Though generally reported that women do not experience a refractory period and thus can experience an additional orgasm, or multiple orgasms, soon after the first one,[2][52] some sources state that both men and women experience a refractory period because women may also experience a period after orgasm in which further sexual stimulation does not produce excitement.[53][54] After the initial orgasm, subsequent orgasms for women may be stronger or more pleasurable as the stimulation accumulates.[51]
Discussions of female orgasm are complicated by orgasms in women typically being divided into two categories: clitoral orgasm and vaginal (or G-spot) orgasm.[14][46] In 1973, Irving Singer theorized that there are three types of female orgasms; he categorized these as vulval, uterine, and blended, but because he was a philosopher, "these categories were generated from descriptions of orgasm in literature rather than laboratory studies".[2] In 1982, Ladas, Whipple and Perry also proposed three categories: the tenting type (derived from clitoral stimulation), the A-frame type (derived from G-spot stimulation), and the blended type (derived from clitoral and G-spot stimulation).[55] In 1999, Whipple and Komisaruk proposed cervix stimulation as being able to cause a fourth type of female orgasm.[55]
Female orgasms by means other than clitoral or vaginal/G-spot stimulation are less prevalent in scientific literature[14] and most scientists contend that no distinction should be made between "types" of female orgasm.[46] This distinction began with Sigmund Freud, who postulated the concept of "vaginal orgasm" as separate from clitoral orgasm. In 1905, Freud stated that clitoral orgasms are purely an adolescent phenomenon and that upon reaching puberty, the proper response of mature women is a change-over to vaginal orgasms, meaning orgasms without any clitoral stimulation. While Freud provided no evidence for this basic assumption, the consequences of this theory were considerable. Many women felt inadequate when they could not achieve orgasm via vaginal intercourse alone, involving little or no clitoral stimulation, as Freud's theory made penile-vaginal intercourse the central component to women's sexual satisfaction.[56][57][58][59]
The first major national surveys of sexual behavior were the Kinsey Reports.[27] Alfred Kinsey was the first researcher to harshly criticize Freud's ideas about female sexuality and orgasm when, through his interviews with thousands of women,[27] Kinsey found that most of the women he surveyed could not have vaginal orgasms.[57] He "criticized Freud and other theorists for projecting male constructs of sexuality onto women" and "viewed the clitoris as the main center of sexual response" and the vagina as "relatively unimportant" for sexual satisfaction, relaying that "few women inserted fingers or objects into their vaginas when they masturbated". He "concluded that satisfaction from penile penetration [is] mainly psychological or perhaps the result of referred sensation".[57]
Masters and Johnson's research into the female sexual response cycle, as well as Shere Hite's, generally supported Kinsey's findings about female orgasm.[48][57][60][61] Masters and Johnson's research on the topic came at the time of the second-wave feminist movement, and inspired feminists such as Anne Koedt, author of The Myth of the Vaginal Orgasm, to speak about the "false distinction" made between clitoral and vaginal orgasms and women's biology not being properly analyzed.[62]
Accounts that the vagina is capable of producing orgasms continue to be subject to debate because, in addition to the vagina's low concentration of nerve endings, reports of the G-spot's location are inconsistent—it appears to be nonexistent in some women and may be an extension of another structure, such as the Skene's gland or the clitoris, which is a part of the Skene's gland.[5][40][44][63] In a January 2012 The Journal of Sexual Medicine review examining years of research into the existence of the G-spot, scholars stated that "[r]eports in the public media would lead one to believe the G-spot is a well-characterized entity capable of providing extreme sexual stimulation, yet this is far from the truth".[44]
Possible explanations for the G-spot were examined by Masters and Johnson, who were the first researchers to determine that the clitoral structures surround and extend along and within the labia. In addition to observing that the majority of their female subjects could only have clitoral orgasms, they found that both clitoral and vaginal orgasms had the same stages of physical response. On this basis, they argued that clitoral stimulation is the source of both kinds of orgasms,[60][61] reasoning that the clitoris is stimulated during penetration by friction against its hood; their notion that this provides the clitoris with sufficient sexual stimulation has been criticized by researchers such as Elisabeth Lloyd.[33]
Australian urologist Helen O'Connell's 2005 research additionally indicates a connection between orgasms experienced vaginally and the clitoris, suggesting that clitoral tissue extends into the anterior wall of the vagina and that therefore clitoral and vaginal orgasms are of the same origin.[5] Some studies, using ultrasound, have found physiological evidence of the G-spot in women who report having orgasms during vaginal intercourse,[42][64] but O'Connell suggests that the clitoris's interconnected relationship with the vagina is the physiological explanation for the conjectured G-spot. Having used MRI technology which enabled her to note a direct relationship between the legs or roots of the clitoris and the erectile tissue of the "clitoral bulbs" and corpora, and the distal urethra and vagina, she stated that the vaginal wall is the clitoris; that lifting the skin off the vagina on the side walls reveals the bulbs of the clitoris—triangular, crescental masses of erectile tissue.[5] O'Connell et al., who performed dissections on the female genitals of cadavers and used photography to map the structure of nerves in the clitoris, were already aware that the clitoris is more than just its glans and asserted in 1998 that there is more erectile tissue associated with the clitoris than is generally described in anatomical textbooks.[43][60] They concluded that some females have more extensive clitoral tissues and nerves than others, especially having observed this in young cadavers as compared to elderly ones,[43][60] and therefore whereas the majority of females can only achieve orgasm by direct stimulation of the external parts of the clitoris, the stimulation of the more generalized tissues of the clitoris via intercourse may be sufficient for others.[5]
French researchers Odile Buisson and Pierre Foldès reported similar findings to that of O'Connell's. In 2008, they published the first complete 3D sonography of the stimulated clitoris, and republished it in 2009 with new research, demonstrating the ways in which erectile tissue of the clitoris engorges and surrounds the vagina, arguing that women may be able to achieve vaginal orgasm via stimulation of the G-spot because the highly innervated clitoris is pulled closely to the anterior wall of the vagina when the woman is sexually aroused and during vaginal penetration. They assert that since the front wall of the vagina is inextricably linked with the internal parts of the clitoris, stimulating the vagina without activating the clitoris may be next to impossible.[40][42][65][66] In their 2009 published study, the "coronal planes during perineal contraction and finger penetration demonstrated a close relationship between the root of the clitoris and the anterior vaginal wall". Buisson and Foldès suggested "that the special
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