Hey BBC - The Female Orgasm Is Actually Not A Mystery!

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Those of you that have been reading this blog or have seen our movie, Science, Sex and the Ladies, could probably guess where my gripes with the BBC article, "The Mystery of the Female Orgasm." begin - THE FEMALE ORGASM IS NOT A MYSTERY.

Reading that article would lead one to believe that the lady-gasm is incredibly complicated to figure out in the ol' bedroom, that it revolves around the vagina, that science doesn't have a clue what it even is, and that only quite recently have scientists really begun to find any answers. All of that is utterly incorrect. The female orgasm is no more complicated than the male orgasm. It revolves around the external clitoral glans. Science has had this shit pretty solidly figured out since about 1966 - about as long as it's had the male orgasm figured out, and all of the exciting new studies in this article that are supposedly cracking this female-orgasm thing wide open: Well, actually they're better categorized as studies that focus on fringe ideas about female orgasm - speculating about ways of coming that have never been verified in scientific literature.

The 'orgasms' this article focuses on are G-spot orgasms, vaginal orgasm, and orgasm from inner clitoral leg or cervical stimulation. These are just things people talk about. There is no scientific proof that they exist. Seriously, an orgasm caused this way has never been observed or recorded in science, not even in the scientific research this BBC article references. In the same way, for men, spiritual orgasms, orgasms from anal sex, prostate stimulated orgasms, and mental orgasms are just things that people talk about. They are not actual orgasms well documented in scientific literature. The big difference here is that an article about male orgasm would treat these things as the  fringe hearsay that they are, and an article about the female orgasm treats these as what female orgasm is.

I honestly don't want to blame the author of this article or the BBC for this. It's bigger than them. This article flies because it is the status quo. It is what people understand about female orgasm. I will put a touch of blame on the scientists interviewed for this article. I know they have to at least be aware that vaginally induced orgasms have never been physically verified in science, and I know they know that their research does not prove this orgasm exists, but only speculates about how this orgasm might happen if it exists. And if they are not aware of this, may I be so bold as to say that they should probably become a bit more thoughtful about what exactly they are researching?

So, let me re-write this article for you:

Hi Everyone! BBC Future presents: The Female Orgasm - It Ain't Such a Mystery (my re-write)

Lady-gasms?!? What Are Them Things?
Orgasm is the rhythmic release of the pelvic muscle tension created during arousal, and it is caused by sufficient stimulation of the penis or the clitoral glans/vulva area. It's the same for all sexes, all genders, trans people, gay people, straight people, intersex people - you name em' if they got something that is like a penis or a clitoral glans, then it can be stimulated to orgasm. Males generally trigger ejaculation at orgasm, but orgasms and ejaculation are 2 different things and can be experienced separately. It is possible for men to have multiple orgasms if they are able to hold off ejaculation until they orgasm a couple times, although it doesn't seem to be common. They are also able to ejaculate w/o orgasm, sometimes due to prostate (G-spot) stimulation through the anus. It seems some women can ejaculate through direct stimulation of their G-spot, which is the sorta female version of the male prostate that surrounds the urethra that can be felt through the vaginal wall. Although this doesn't seem to be super common either - and it has never been shown to cause an orgasm. Add in some clitoral stimulation, though, with the G-spot stimulation and a woman might be able to orgasm and ejaculate at the same time. Although it is possible for both men and women to ejaculate, it is the orgasm that is that release of muscle tension pent up through arousal.

Now, let's go back a bit. A person first needs to be aroused before he or she can orgasm. Any ol' stimulus can arouse; smell, touch, sound, sight. It's incredibly individual and has everything to do with a person's culture, past experiences, and state of mind (I'd argue our culture creates a lot more barriers to female arousal than to male), but once the arousal happens, our bodies all react quite similarly. An increase of blood flow begins to makes the penis hard and lubrication seep through the walls of the vagina and for the inner clitoral legs swell. Ladies and gentlemen both have a similar amount of blood pooling in the groin. We just see men's more easily. Then if arousal is continued and if there is appropriate stimulation to either the penis or the clitoral glans, an orgasm will occur. The pelvic muscle of men and women alike will rhythmically release that tension. It is recordable, predictable, and no knowledgeable researcher out there would deny that this can be described as an orgasm.

What About Vaginal Orgasms?!?
There is a minority of women who claim to orgasm from vaginal stimulation alone. Although women's claims should never be disregarded, it is important to realize that this type of orgasm has never actually been observed and recorded in scientific literature, and it's possible that at least some of these claims involve the use of the word 'orgasm' to mean something other than the physical orgasm that can be identified through rhythmic pelvic muscular activity. It's actually possible that an orgasm caused only by stimulation inside the vagina is merely a myth made up by Freud. As some Italian researchers pointed out just this year as part of their criticism of the re-naming of female genitals and female sexual response happening in a lot of recent research on female sexual response, "(Komisaruk) ignores the fact that 'vaginal orgasm' has no scientific basis; the term was invented by Freud in 1905, and medical authorities writing in French, German, and English during Freud's time were unanimous in holding that female pleasure originated in the structures of the vulva generally and in the clitoris specifically. No alternative sites were proposed."  (Puppo 291)

In fact, in 1966 researchers Masters and Johnson released Human Sexual Response, a large, groundbreaking study that described arousal and orgasm in both men and women. Their findings are still important and relevant, and they unequivocally said that all female orgasms resulted from stimulation of the clitoral glans, laying to rest Freud's vaginal orgasm. Since the time Masters and Johnson released their work, there have been over 40 year of studies investigating what might cause a vaginal orgasm, but not a one of those studies has actually documented a vaginal orgasm. That's a lot of years that have gone by with absolutely no proof, and it's not particularly hard to get the proof. Recording the rhythmic pelvic muscle activity during orgasm is completely possible to do. It's probably even easier to do now than it was in M&J's time. Studies have done it plenty of times, further corroborating Master and Johnson's findings. Strange that this has not happened for vaginally stimulated orgasm. If these orgasms do exist, they are yet undocumented, and likely even less common than we now believe them to be - certainly a fringe situation.

My Critique From The Beginning of the BBC Article to End

The article begins with anecdotes and metaphors creating a sentiment that can basically be summed up by the picture below.

Then, the article tells us "It's a stark contrast to a man's experience; so long as they can get an erection, a few minutes of vigorous stimulation generally results in ejaculation."

Okay,
1. An erection means a man is aroused, and similarly, as long a woman can get aroused, she too needs only a few minutes of vigorous stimulation in order to come. (Seriously, women can masturbate to orgasm about as fast as men do.)
 2. Ejaculation and orgasm are different things, remember. Since this is an article about orgasm, I think the author probably should have used the word orgasm instead of ejaculation.

So, clearly the article is coming from the premise that lady-gasms are confusing, but it tells us, "recent years have seen a flurry of studies by these real-life Masters of Sex, and they are finally getting some answers."

This is particularly funny to me because these 'real-life Masters of Sex' the article refers to are the scientists interviewed for this article, and they are all working on fringe ideas of female orgasm. The article completely ignores the work of the actual real-life Masters of Sex, Masters and Johnson. These are the people who did the work to actually understand female (and male) orgasm. These are the researchers who lifted the mystery from lady-gasms, but clearly, even with a Showtime series about them, their contribution has gotten overshadowed, skewed, and ignored over the years. It absolutely boggles my mind that an article about the female orgasm from a revered news site like the BBC doesn't even mention Masters and Johnson or their discoveries. It is an appalling oversight, but it is also completely unsurprising and indicative of how far from reality the cultural discussion of female orgasm is, and how few people seem to notice.

After informing us that scientists are just now doing studies that begin to answer these long held secrets of the female orgasm and that fMRI studies basically show that male and female brains are similar during orgasm. (Here's a good 2011 overview of the fMRI research on arousal and orgasm to date btw. It's the full text article - not just the abstract!)
Then things get a little dicey again. We are told that pinning down the anatomy of an orgasm is hard because, "the penis has just one route for carrying sensations to the brain, the female genital tract has three or four."

A point about female orgasmic pathways being more complicated than male orgasmic pathways is being made here, but it's comparing apples to oranges. The penis is the male organ of sexual pleasure and the 'female genital tract' is the clitoris (the female organ of sexual pleasure), plus the vagina, the cervix and uterus, hell they're probably throwing the urethra in too. So, yeah, obviously the female genital tract will have more routes for carrying sensation to the brain than just the penis. However, if we compare the two organs that are able to be stimulated to orgasm, the clitoris/vuvla area and the penis, they both have one route, the pudendal nerve. The pelvic nerve, for instance, does involve itself with inside the vagina and cervix, but for men it is involved with erection and the rectum, so the male genital tracts has more than one route too, but that doesn't mean there are more ways for males to orgasm.

Here's the 1 external clitoral glans portion of the article. Although it is introduced as the "seat of female pleasure," it is only really discussed as one of many instead of the organ of sexual pleasure (the way an article might discuss the penis and male orgasm). There is no discussion about the scientific research that cemented its place, alongside the penis, as where orgasms arise. There is just a brief discussion of when the clit was acknowledged through history, ending with Freud's assessment that orgasm from clitoral stimulation is inferior to vaginal orgasm. The article then tells us, "Between thirty and forty percent of women claim never to have experienced an orgasm through vaginal penetration alone - though many more can have orgasms through clitoral stimulation. The suggestion that the vaginal orgasm is somehow superior has irked feminists. It sounds as if women who don't experience vaginal orgasm just aren't trying hard enough. So should vaginal orgasms be a rite of passage for all women, or just a privileged few? Is it even possible to have an orgasm in the absence of the clitoris?"After that, the article moves directly into discussing orgasm in relation to vaginal penetration. 

There's a few things about this section that bother me. I understand that there was an attempt here to give a nod to the clit and to question the idea that vaginal orgasms are more mature, but I think as a whole, it fails to do that, and possibly gives even more credibility to Freud's backward ideas about vaginal orgasm.

1. The stat here put the amount of women who have vaginally orgasmed at around 60-70%. I don't know where in particular that stat's from, but it's high. I understand how stats can range on this topic because depending on how specific the survey question is about whether additional clitoral stimulation is used during intercourse, the numbers vary (The Case of the Female Orgasm: Bias in the Science of Evolution has a fantastic overview of lots of surveys on this), but the numbers I normally see are only about 30% of women claim to orgasm with only vaginal stimulation.

2. This might be just me being obsessive, but contrasting the stats for vaginal orgasm versus the "many more" that can have orgasms through clitoral stimulation makes it seem like an either/or situation, as if there are some women who are 'wired differently' and have the ability to orgasm through vaginal stimulation but not clitoral and vice versa (and some who can do both). The truth is that there is every indication that all healthy women can orgasm from clitoral glans stimulation, and there is no indication that there are other women who are 'wired' to orgasm vaginally.

3. Why are we still even approaching Freud and his ideas on lady-gasms as worthwhile? He literally just made up that shit. Asking if vaginal orgasms should be a rite of passage or for only a privileged few validates not only that vaginal orgasms are a thing, but that they are something special that should be envied.

4. Saying feminists were 'irked' by the idea of vaginal orgasms being superior sounds trivial, minimizing the egregious nature of Freud's assertions and how ridiculous and harmful they were. The inability to have vaginal orgasms classified women as psychologically damaged by the established medical community up into the 1970's. Feminists in the 70's and 80's were outspoken about this, not just because it 'irked' their feminist sensibilities, but because they were on the side of science. The first actual large scale studies about female orgasm had come out and shown quite clearly that vaginal orgasm was not even a thing, much less some kind of superior thing. They were looking at female orgasm from the perspective of scientific knowledge and what they saw was women being punished for the inability to do something that their bodies actually couldn't do.

The article goes right into research by Barry Komisaruk. He and Beverly Whipple did a study in which women with spinal cord injuries that severed the ability for clit stimulation to get to the brain, were still able to orgasm through vaginal stimulation - likely due to the Vagus nerves that carry sensation from the cervix to the brain without using the spinal cord. Komisaruk thinks maybe this is why women describe clitoral orgasms as more localized and external and vaginal orgasms as more whole-body and internal. He also says of this study, "Women with spinal cord injury who could not feel their clitoris, nevertheless had orgasms from vaginal stimulation. That's probably the best evidence that vaginal orgasms exist."

If this is the best evidence for vaginal orgasm, then things don't look good for the vaginal orgasm. First off, as with all vag-gasm studies, the women merely said they had an orgasm. It was not physically verified. It's just that 3 of the 5 women in this study claimed to orgasm and were taken at their word. Maybe they did, maybe they didn't, but since this is a scientific investigations, and as of yet no orgasm like the one they are claiming to have has ever been observed, it really does need to be verified.
Secondly, nonchalantly calling the stimulation these 5 women were receiving 'vaginal stimulation' is rather misleading. That makes it sound like it was just some in-out of the vagina with a dildo or something, but in fact it was a very specific type of cervical stimulation that involves a pessary, which is kinda like a hard cervical ring that had to be professionally fitted to each woman individually. The pessary has Velcro on it, and a device that ends with a modified tampon with Velcro on the end is inserted in and attached to the Velcro on the pessary. It is controlled by the patient and sort of puts suction-y pressure on the cervix (without really touching the cervix - cause that can hurt like a bitch, right?). It’s not your average vaginal stimulation, so even if this contraption did cause a verifiable physical orgasm in these 3 women with spinal cord injuries, it's not exactly the kind of stimulation that's easily replicated at home.
I go into more detail about this study HERE.

Never the less, that study, which certainly does not prove women can orgasm from vaginal stimulation is deemed sufficient enough for the article to state the following. "So if different nerves can carry sensation from different regions of the female genitalia - and both can trigger orgasm - are some regions of the vagina more sensitive than others? Where should couples go hunting for the elusive vaginal orgasm?"

And the article is still stuck on the false premise that vaginal orgasms are a proven reality.

I described above that stimulation of the G-spot, or more clearly stated - the female prostate, has been shown to cause ejaculation, but not orgasm, in women. However, that distinction is often lost, and the 'G-spot' becomes a way to describe something that doesn't exist - a button in the vagina that causes orgasm. That is where this article ends up in the section on the G-spot. It first describes that studies have shown the G-spot is a bundles of nerves, blood vessels, and remnants of the prostate gland, and then it goes on to say that a minority of women could stimulate it to trigger, "powerful orgasms and the release of a small amount of fluid from the urethra that was not urine," but admits that actual evidence to support or refute the G-spot is patchy.

Of course the evidence for the G-spot is spotty because the word 'G-spot' is sometimes used to mean the female prostate area and sometimes used to mean a mystical orgasm button in your vag. Although there is plenty more research that should go into ejaculation and the female prostate, it's largely evident that there is a prostate-like area around the urethra in women that can be felt through the vaginal wall and that some women can ejaculate when it's stimulated. There is no evidence, however, that stimulation to anything in the vagina, much less the prostate-like area, can cause orgasm. One way of speaking about the G-spot is backed by evidence and the other is not, but in both research and common language it's confused, and so yeah, it makes the research look spotty.

The article next moves to a study with 20 women by a researcher named Jannini that showed there does,"seem to be physical differences between women who claim to experience vaginal orgasm and those who don't." A thicker area of tissue between the vagina and the urethra correlates with women who orgasm vaginally.

It's true. That is what the study finds, but it must be noted that per usual there is no proof that the women who say they can orgasm vaginally can actually do that. I know I harp on this, but the word orgasm, when it comes to women, is used so loosely, and the cultural assumptions about it are so confusing that it is not unreasonable to think that there may be a woman or two out there who says, and maybe even believes, that she orgasms from vaginal stimulation only, but she actually does not. Maybe she just has a psychological or spiritual 'climax.' Maybe she ejaculated. These things might feel pleasurable or satisfying but if she does not exhibit the release of pelvic muscle tension known to indicate orgasm, then scientifically, it should not be categorized as an orgasm. If even 1 of the women in this study were using the word orgasm incorrectly, then that would make a huge difference to the results of a 20 person study like this. Also, even if it were verified that the claims of vaginal orgasm were true, there is no proof that the thickness differences have anything to do with the ability to orgasm this way. It's merely a correlation. In the end this study says nothing about if or how women orgasm vaginally. It is at best merely a starting point for further investigation. I go into more detail about this study HERE.

Jannini conducted another study on 3 women where ultrasound was used to find that moving a lubricated tampon in and out of the vagina shifted both the internal parts of the clit and the tissue around the urethra. When the women just rubbed their external clit, just the external parts of the clit shifted. The article uses this to back up the idea that the inner clitoral legs, stimulated through the vaginal wall, might be the way vaginally stimulated orgasms happen.

Maybe. Or maybe not. No orgasms were observed in this study. This, like the last study, can only really be viewed as a starting point. If vaginal orgasms happen, then this article might be a starting point for investigating the mechanism for how they happen. That's about as much as can be taken from it. I go into more detail about this study HERE.

Pauls, another researcher, did a case study about a woman with incredibly unique genital structure that included a clit positioned closer to the vaginal opening than normal. She claimed to vaginally orgasm every time she had sex (although it was never physically verified that she was able to do this). (I go into detail about that study HERE). The article wondered if this indicated that vaginal penetration may be "stimulating both the external and internal parts of the clitoris." Pauls and her colleagues wondered about this too, and created a study to see if the size and location of the clit made a difference in ability to orgasm. With MRI measurements, the researchers found that for the 30 subjects, "the smaller the pea-shaped glans, and the further from the vagina, the harder they found it to achieve orgasm."

That was the conclusion that came from the study, but I don't think that conclusion is reasonably supported by this study. Out of the ~ 23 measurements of the clit size and distance, only 5 actually show significant differences between the groups. In fact, the clitoral glans area that the authors put forth as a significant difference between the two groups of women is only significant when they measured it from the coronal, but not the sagittal view. Unfortunately, this study also failed at asking the participants the proper questions so that they could be grouped in a way that would create meaning when compared to the clitoral measurements. Statistics are only as good as the understanding that exists of the population it is describing, and I don't think the understanding was good at all. I go into more detail on this study HERE.

"Taken together, these studies imply that there are multiple routes by which women can experience an orgasm, be it through vaginal stimulation, clitoral stimulation, or both at once. "

Or not. These studies taken together show that the vaginally stimulated orgasm has still not been observed, and although there are lots of theories, just as there has been for the past 40 years, as to how this type of orgasm might occur, none are conclusive...particularly because it's awful hard to prove the mechanism that causes vaginally stimulated orgasms, when a vaginally stimulated orgasm has never been observed. Maybe, just maybe, these types of 'orgasms' are so mysterious because they don't really exist, and so investigating them would naturally be tricky.

Komisaruk chimes in a final time in reference to a study he did revealing that, "projections from different regions of the female genitals - and indeed the nipples - all converge on the same general region of the brain, albeit in slightly different areas." (I go into more detail about that study HERE). He says, "There's a good neuroanatomical basis for different types of orgasms and different types of sensations." He goes on to say, "This could account for why combining clitoral, vaginal, and cervical stimulation seems to produce these more intense, complex and pleasurable orgasms that women describe." 

I'll just leave it at this. No, there is actually not good evidence for different types of orgasms. Different types of sensations? Sure. Moving a penis in and out of the vagina feels different than lightly touching the vulva, feels different that sucking on the nipple, and feels different than kissing the back of the neck. I personally like them all, but that doesn't mean they all can cause orgasm. Also, I'd like to know more about these more intense, complex and pleasurable orgasms that women describe. When do they describe them? How are they more complex, intense and pleasurable? And how exactly did he find that these amazing orgasms were specifically related to a combination of cervical, vaginal, and clitoral stimulation?

The article ends with some advice from Pauls and Jannini. I particularly appreciate that Pauls tells us if we don't have orgasms through straight out vaginal penetration, then that's normal. She's absolutely right, but her one statement within an article that focuses almost entirely on vaginally stimulated orgasms is a beautifully perfect microcosm of our sexual culture. Sure we hear now and then that lots of women need clitoral stimulation to orgasm, but as a whole our culture obsesses on the completely un-verified vaginally stimulated orgasm to a point, I would argue, of absurdity.

I honestly don't want to hate on the author of this article. It was certainly not that she was ignorant or terrible at her job. The sources she used and the people she spoke to are top studies and top researchers in female orgasm. What she said in her article is not off-base from things other reporters and sexperts say. I critique this article, but it is more a critique of the sexual culture that stimulates this type of discussion around female orgasm and that allows this type of article to be published by the BBC and that makes audiences accept the misinformation so easily.

What I do want is to open eyes and start tough conversations, and I hope this critique helps to do that.

Extra Info
If you are unsure about my assertions that orgasm can be defined with the rhythmic pelvic muscle activity, or that the clitoris needs to be stimulated to cause orgasm, or that Masters and Johnson really did create important, fundamental and still relevant work in regards to human sexual response, then please check out a debate I had with Edward Clint at Skeptic Ink HERE. I address all those things in detail.

If you want to understand more clearly what I mean when I say vaginal stimulation has never been shown to cause orgasms. I detail that out HERE.

If you want to see more about the affects and reasons for this cultural misunderstanding of female orgasm - Watch Science, Sex and the Ladies HERE.

If you want to see an artist doing bold, important work on the ignorance about and cultural erasing of the clitoris (which goes hand in hand with the ignorance about and cultural erasing of a realistic female orgasm), check out 101 Laws of Cliteracy by Sophia Wallace.

Cited
"Relationships Among Cardiovascular, Muscular, and Oxytocin Responses During Human Sexual Activity" Carmichael, et al. Archives of Sexual Behavior Vol. 23, No. 1 1994

Response to the letter to the editor by Barry K. Komisaruk "re: Puppo V, Puppo G. 2014. Anatomy of sex: Revision of the new anatomical terms used for the clitoris and the female orgasm by sexologists". Puppo V1, Puppo G. Clin Anat. 2015 Apr;28(3):291-2. doi: 10.1002/ca.22500. Epub 2014 Dec 22.

"Relationships Among Cardiovascular, Muscular, and Oxytocin Responses During Human Sexual Activity" Carmichael, et al. Archives of Sexual Behavior Vol. 23, No. 1 1994

The Case of the Female Orgasm: Bias in the Science of Evolution. LLoyd, Elisabeth A.  Cambridge: Harvard University Press. 2005.

Women's clitoris, vagina, and cervix mapped on the sensory cortex: fMRI evidence. Komisaruk BR1, Wise N, Frangos E, Liu WC, Allen K, Brody S. J Sex Med. 2011 Oct;8(10):2822-30. doi: 10.1111/j.1743-6109.2011.02388.x. Epub 2011 Jul 28.

Clitoral size and location in relation to sexual function using pelvic MRI. Oakley SH1, Vaccaro CM, Crisp CC, Estanol MV, Fellner AN, Kleeman SD, Pauls RN. J Sex Med. 2014 Apr;11(4):1013-22. doi: 10.1111/jsm.12450. Epub 2014 Feb 13.

Sexual function in a woman with congenital bladder exstrophy and multiple pelvic reconstructive surgeries: a case report. Vaccaro CM1, Herfel C, Karram MM, Pauls RN. J Sex Med. 2011 Feb;8(2):617-21.

Pilot echographic study of the differences in clitoral involvement following clitoral or vaginal sexual stimulation. Buisson O1, Jannini EA. J Sex Med. 2013 Nov;10(11):2734-40.

"Measurement of the thickness of the urethrovaginal space in women with or without vaginal orgasm." Gravina GL, Brandetti F, Martini P, Carosa E, Di Stasi SM, Morano S, Lenzi A, Jannini EA. J Sex Med. 2008 Mar;5(3):610-8.

Female ejaculation orgasm vs. coital incontinence: a systematic review. Pastor Z. J Sex Med.2013 Jul;10(7):1682-91. 2013 May 1.

Brain activation during vaginocervical self-stimulation and orgasm in women with complete spinal cord injury: fMRI evidence of mediation by the vagus nerves. Komisaruk BR1, Whipple B, Crawford A, Liu WC, Kalnin A, Mosier K. Brain Res. 2004 Oct 22;1024(1-2):77-88.

Human Sexual Response. Masters, W. and V. Johnson. Little, Brown & Co. 1966.