The scope of the problem

Women's experiences with sexual pleasure and orgasm have been an area of ongoing interest for many years. In spite of many embattled advances, female sexuality remains mystified and downplayed in general. Male sexuality is more out in the open and accepted to a greater extent (though still being understood), while female sexuality remains in many respects taboo, and inter-related with gender-based bias in our culture. Individuals, couples and clinicians benefit from better information to enhance the sexual experience.

Greater understanding of female sexuality sets the stage for future research by determining what behaviors and techniques actually lead to the greatest pleasure for women. It's a profoundly important pursuit, one with implications for cultural change reaching beyond individual pleasure to challenge and destabilize norms. At the same time, fostering empowerment for individuals helps on a grassroots level by filling in missing information, sometimes surprisingly elementary. Take the basic anatomy of female erectile tissue, for example. Until only recently (O'Connell et al., 2005) the clitoris was construed by many to be exclusively a surface structure. 

As many people now know thanks to media coverage in the last several years - I'm willing to bet that this is still news to a number of readers in spite of the recent buzz - the clitoris is actually quite extensive, connecting with substantial erectile tissue which extends back into the pelvis in a wishbone shape, encircling the vagina (e.g. Encyclopaedia Britannica). These findings have important implications for sexuality as well as reproduction, and pondering why it took so long to discover the true form and functions of female erectile tissue leads one to speculate about gender politics in the field of medicine.

According to Herbenick and colleagues (2017), in spite of research and speculation, the question about what sexual activities and what kinds of behavior result in the greatest pleasure sexually has not been investigated among U.S. women using statistically representative samples ("probability" samples) from which generalizations about the whole population could be made. Instead, studies have relied on "convenience" samples, introducing a major area of potential error due to self-selection. 

In addition, research including probability samples has not addressed the specifics of sexual behaviors including genital touch, and instead has focused on basic questions of sexual satisfaction and dissatisfaction without elaborating important details. There is more and more known every day about the neuroscience of sexuality, and more information in mass-market materials including popular books and other sources about sexual needs and techniques, but empirical data investigating the finer details of women's sexual experiences is in short supply.

Therefore, Herbenick and colleagues set out to bridge the gap in our current understanding by designing a study using a probabilistic sample of women to find out what women's experiences are when it comes to sex, focusing on orgasm and a detailed inquiry into genital touch.

Basic study design

In June of 2015, study authors used the "KnowledgePanel® probability-based survey group panel (from a research company, GfK Research) to query a representative sample of 1055 U.S. women, representing 43% of the total group first contacted. It is standard practice to then correct for possible errors in bias due to who chooses to complete the survey using statistical corrections based on knowledge of the population sampled. Such panels are US Postal Service address-based sources of data developed to provide internet-based access to a representative sample of the population, and are developed to ensure accuracy as much a possible (e.g. homes without internet are provided with access and hardware to allow proper sampling), and are considered to be valid sources for probabilistic samples.

Questions regarding sexuality and touch were included in a larger set of 30 questions related to multiple aspects of sexuality and relationship. They used extensive prior work done by OMGYes (OMGYes.com) to help develop parts of the questionnaire related to various styles of genital touching, going into impressive and crucial detail.

Respondents were asked about where they liked to be touched in terms of specific anatomic sub-regions, what kind of touch they liked, what kinds of motions (e.g. circular, diagonal, different shaped ovals, flicking, squeezing, pinching, pulling, and other actions). They were asked in detail about clitoral stimulation preferences and sexual behaviors like delaying climax and how to best enjoy multiple orgasm. They were asked about general experience with orgasm, questions such as "Thinking about your entire life, would you say":

  1. "Some orgasms feel better than others"
  2. "All orgasms feel pretty much the same"
  3. "I don’t know/I haven’t had enough to know"

elaborating as necessary, e.g. "For you, what do you think helps some orgasms feel better than others,"  - and followed up with even more alternatives for further clarification. In short, in a way which hasn't been done before, the study authors and their collaborating partners have sought to really articulate a refined sense of female sexual behavior and experience based in empirical data.

What did they find?

Women sampled ranged in age from 18 to 94, with most identifying as heterosexual and more than half being married. Demographically, they were reflective of the U.S. population, after statistical weighting as noted above. Two-thirds reported sexual activity with partners in the last year, two-thirds of whom reported having vaginal intercourse, about half reporting receiving oral sex, and two-thirds reporting  genital touching by partners. 

Nearly 40 percent of women reported needing clitoral stimulation to orgasm during intercourse, and about the same percent reported that even if they did not need clitoral stimulation to orgasm, it made the experience more pleasurable. Almost 20 percent found vaginal penetration alone sufficient for orgasm. The remaining women reported not having orgasm during intercourse at all, or described alternative patterns such as stimulation before intercourse, orgasm after intercourse by oral sex, and so on. Additional response regarding orgasm during intercourse and clitoral stimulation support the finding that regardless of whether women could orgasm with penetration alone, clitoral stimulation resulted in significantly higher rates of orgasm during intercourse.

Most women reported that some orgasms feel better than others, about three-fourths of the sample. About 11% said that all orgasms feel pretty much the same, and about the same reported they didn't know or didn't have enough orgasms to know. Of those who felt not all orgasms are created equal, the average age when they realized this was at about 24.5 years old. What did women report enhanced orgasm? Many reported that orgasm was enhanced by spending more time to build arousal, having a partner who knows what they like, emotional intimacy, and clitoral stimulation during orgasm, lending support to our current understanding. Interestingly, less than 20 percent of women reported duration of sex as a factor contributing to better orgasm.

There was a great deal of detailed findings regarding the specifics of touch - far too much to report in full here. In general, women preferred clitoral touching around the clitoris, brushing over the clitoris without applying pressure, and labial stimulation. Less than 10% liked stimulation of the mons pubis, and very few (around five percent) did not want the clitoris touched. What shapes or styles of touch did women like? More than half reported liking vertical and circular movements, with about one third liking side-to-side motions. About 40 percent of women liked one kind of touch, 15 percent two kinds, 16 percent three, and a small fraction reported liking more styles. There were four patterns of stimulation respondents liked the most, reported by over 75 percent: rhythmic motion, circling around motion, switching between motions, and alternating between lighter and firmer touch. There was considerable detail about what exact anatomic approaches were preferred.

Further regarding orgasm, two-thirds of women reported liking delaying orgasm, using different techniques from stopping and starting again, to touching less sensitive areas, to shifting to less intense motions, and slowing down. Nearly half of women reported multiple orgasms, and they had different preferences about what to do after the first orgasm, about half saying returning to an earlier similar stimulation, a third reporting they liked continuing with the same motion and about a third reporting doing something completely different.

Additional considerations

This study provides rich and useful information for further research, individual consideration, and for advancing clinical approaches addressing sexual issues.

They found that there was a great deal of variation in genital touching preference, and suggested that women could benefit from particular consideration of location, pressure, shape/style and patterns of touch, to guide sexual exploration. Only 1 in 10 women reported liking firm pressure, an important finding to bear in mind. Furthermore, they found that fewer women report orgasm with only vaginal penetration than with vaginal penetration combined with clitoral stimulation, providing empirical support for something many already understand from personal experience.

Almost 75 percent of women found clitoral stimulation was either necessary for orgasm or made orgasms better. Adding clitoral stimulation during vaginal penetration improved both the frequency and the quality of orgasm - but quality of orgasm was associated even more strongly with building arousal, having a partner who knows them, and sharing emotional intimacy. Importantly, duration of intercourse was reported as a factor contributing to higher quality orgasm for only one in five women.

The study authors conclude:

"These findings also suggest that encouraging clients to develop a more specific vocabulary for discussing and labeling their preferences could empower them to better explore and convey to partners what feels good to them. Indeed, use of more specific and comfortable terms when talking about sex has implications for couples’ happiness and closeness."

References

Herbenick, D., Fu, T., Arter, J., Sanders, S.A. & Dodge, B. (2017). Women's experiences with genital touching, sexual pleasure, and orgasm: Results from a U.S. probability sample of women ages 18 to 94. Journal of Sex and Marital Therapy, July 5. DOI: 10.1080/0092623X.2017.1346530

O'Connell, H.E., Sanjeevan, K.V., Hutson, J.M. (2005). Anatomy of the clitoris. Journal of Urology, Oct.; 174(4 Pt 1):1189-95.

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Baby Come and Light My Fire... is a reply by Susan Heitler Ph.D.