What’s an Orgasm? And What Does it Take to Have One?

The answers to the questions you've always wanted to ask.

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Published August 03, 2023
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Try to describe what chocolate tastes like to someone who has never eaten chocolate. Not so easy. Now try describing what an orgasm feels like to someone who has never had one. Exactly. So, I’m going to help you on this one.

Arousal (the lead-up to orgasm) results in lubrication, a racing heart and dilation of pelvic blood vessels, which increases blood flow to pelvic muscles and tissue. An orgasm is the physical phenomenon that follows sexual arousal and stimulation. Specifically, for a woman an orgasm consists of involuntary but coordinated rhythmic contractions of the pelvic floor muscles, uterus, vagina and anus, lasting 15 to 20 seconds. An intense feeling of pleasure is followed by muscle relaxation and contentment.

The ability to have an orgasm is about pelvic blood flow, but it is also about neurology and hormones and neurotransmitters and anatomy and arousal and relationship and genetics and experiences and expectations. If that sounds complicated, it is. But, as a sexual medicine physician who has treated hundreds of women, and the author of five books on sexual health, I’m going to break it down just as I do when talking to a patient. And since I am not a psychologist, I will put aside the psychosocial aspects of arousal and orgasm and focus on the biologic aspects of what your body needs to make it happen.

Arousal

Arousal is the physical manifestation of sexy thoughts and includes things like a racing heart, a slight elevation in blood pressure, increased genital blood flow and vaginal lubrication. While your body is most likely to become aroused if there is both physical and emotional stimulation, it is totally possible just by thinking about sex or as a response to sexual touching. It is virtually impossible to become aroused if you are experiencing pain or anticipating pain, which explains why women who experience pain with sexual activity are often unable to orgasm.

Clitoral stimulation

Most women need clitoral stimulation in the form of pressure, massage, vibration, licking or touching. Is orgasm possible with no clitoral stimulation? Absolutely. Orgasms can result from mental stimulation, anal stimulation, nipple/breast stimulation, cervix stimulation or vaginal stimulation … pretty much stimulation of any body par, including the brain! But for most women, clitoral stimulation is required.

Penile-vaginal intercourse is an extremely inefficient way to stimulate the clitoris, which explains why 70 to 80 percent women do not orgasm during intercourse without simultaneous clitoral stimulation. In other words, if you do not have an orgasm during intercourse but are able to have an orgasm with manual or oral stimulation, when you masturbate or use a toy, you are what sexual experts refer to as … normal.

Healthy nerves

Clitoral stimulation results in over 10,000 tiny nerve endings sending signals to the pleasure center in the brain via the spinal cord. The skin receptors that trigger clitoral nerves need to be responsive. This is one of the reasons that a skin condition, such as genitourinary syndrome of menopause (GSM) or lichen sclerosus, can get in the way of orgasm. The sensitivity of nerves, especially small nerves, can lessen with age or because of a medical illness such as diabetes. One of the most critical things that helps keep nerves healthy is …

Adequate blood flow

Those 10,000 clitoral nerves require adequate blood to function properly. This is why decreased blood flow due to aging, menopause, diabetes, cancer treatments, multiple sclerosis or vascular disease can all sabotage the ability of nerve endings to respond. But genital blood flow doesn’t just benefit the clitoris.

An adequate blood supply is also needed for arousal. Vaginal walls are dependent on capillaries (the smallest blood vessels) to produce lubrication. Pelvic floor muscles need blood flow for pre-orgasmic swelling, a phenomenon known as muscle congestion. If nerve endings are not as responsive as they used to be, there are several strategies to help kick your clitoris back into action.

What about those women who have no clitoral sensation because of a neurologic problem? Good news. There is a backup system for women with a spinal cord injury or other condition that blocks the primary neurologic pathway from the clitoris to the brain.

Stimulation of the cervix, which is located at the top of the vaginal canal, stimulates the pelvic branch of the vagus nerve, which travels to the brain but not via the spinal cord. Research shows that where an orgasm originates determines what part of the brain lights up on an MRI. Women who experience both clitoral and cervical orgasms experience two different types of sensation. This also explains why some women lose the ability to orgasm during intercourse following hysterectomy with removal of the cervix.

Vaginal orgasms?

I have just made a huge point of establishing that clitoral stimulation is generally required to have an orgasm. So, are those women who brag that they routinely have orgasms with vaginal penetration alone lying? There is always that possibility, but maybe not. There are four roads to orgasm via the vagina:

Clitoral stimulation. Clitoral stimulation can occur during intercourse, facilitated by a position that places the male pubic bone to put direct pressure on the clitoris. Strictly speaking, this is not a vaginal orgasm; it is a clitoral orgasm that occurs during vaginal penetration.

Stimulation of the G-spot. The G-spot is an internal bundle of nerve tissue on the roof of the vaginal canal, about one-third of the way back from the opening. Most experts agree that the G-spot is a highly sensitive (in some women) extension of litoral tissue as opposed to a separate structure that is sometimes stimulated during intercourse. The odds of orgasm increase if the penis has a greater girth and you are positioned to maximize stimulation of that area.

Cervical stimulation. This is another situation in which size matters. A longer penis, as opposed to a thicker penis, takes the prize since its tip poking the cervix during deep thrusting triggers the alternative pathway to the brain via the vagus nerve.

Arousal. Sexual excitement alone can trigger an orgasm in some women and, let’s face it, intercourse can be very arousing especially if the penis is attached to a human being whom you really like.

Do you talk to your doctor about sex? Let us know in the comments below.

Lauren Streicher, MD, is a Clinical Professor of Obstetrics and Gynecology at Northwestern University’s medical school, The Feinberg School of Medicine and is the medical director of the Northwestern Medicine Center for Sexual Medicine and the Northwestern Medicine Center for Menopause in Chicago. She is the host of the hit podcast, THE Menopause Podcast, and the author of Dr. Streicher’s Inside Information Series, which includes: Slip Sliding Away: Turning Back the Clock On Your Vagina-A gynecologist’s guide to eliminating post-menopause dryness and pain, and Hot Flash Hell: A Gynecologist’s Guide to Turning Down the Heat. She is also the author of Sex Rx: Hormones, Health and Your Best Sex Ever, and The Essential Guide to Hysterectomy. Dr. Streicher is a Fellow in the American College of Obstetricians and Gynecologists, a member of the Sexual Medicine Society of North America, Inc. and is a Certified Menopause Practitioner of The North American Menopause Society. She was the 2019 recipient of the North American Menopause Society Media Award.