Orgasm

An orgasm is the peak of the sexual response: a feeling of intense pleasure with rhythmic, involuntary contractions of the genitals and pelvic floor, followed by relaxation. It is a nervous system response, not a test. You can enjoy sex with or without one.

What happens in the body

As arousal builds, heart rate, breathing, muscle tension and blood flow to the genitals all increase. At orgasm, the pelvic floor muscles contract several times within a few seconds. The brain releases chemicals such as dopamine, linked to pleasure, and oxytocin, linked to bonding. Then comes resolution: the body gradually returns to rest, and many people feel calm or sleepy.

Orgasm and ejaculation are not the same thing. In people with a penis they usually happen together, but they can occur separately. The refractory period, a time when another orgasm isn't possible, typically follows ejaculation. Many people with a vulva can have several orgasms in a row, but that is neither the norm nor a goal.

The phases of sexual response

In the 1960s, Masters and Johnson described four phases: excitement, plateau, orgasm and resolution. Helen Singer Kaplan later added desire at the start. We now know the process doesn't always follow that order. Rosemary Basson proposed a circular model in which desire often comes after intimacy begins, not before. We explain this in our article on spontaneous and responsive desire.

What the research shows

A study of 52,588 US adults (Frederick et al., Archives of Sexual Behavior, DOI 10.1007/s10508-017-0939-z) asked how often people orgasmed during sexual intimacy. "Usually or always" was the answer for 95% of heterosexual men, 89% of gay men, 86% of lesbian women and 65% of heterosexual women. This difference is known as the "orgasm gap". Women who orgasmed more often tended to receive more oral sex, have longer encounters and communicate more.

Another study of 1,055 women aged 18 to 94 (Herbenick et al., Journal of Sex & Marital Therapy, DOI 10.1080/0092623X.2017.1346530) found that only 18.4% could orgasm from penetration alone. 36.6% needed clitoral stimulation, and another 36% said it made orgasm better. In other words, needing clitoral stimulation is the norm.

A wide range of experiences

• Intensity and length vary from person to person and from one time to the next.
• Orgasm can come from stimulating different erogenous zones, not just the genitals.
• Age, hormones, tiredness and mood all play a part. During menopause, dryness or pain can affect pleasure; there are options that help, as we explain in sexuality during menopause.
• Trust and context matter as much as physical touch.

Common difficulties and their causes

Finding it hard to orgasm is very common. It is only considered a clinical problem (anorgasmia or orgasmic disorder) when it is persistent and causes distress. The NHS (for ejaculation problems) and MedlinePlus, from the US National Library of Medicine (for orgasm difficulties in women), list possible causes:

• Physical: long-term illness, diabetes, nerve damage (for example from multiple sclerosis or a spinal cord injury), hormonal changes such as the menopause, vaginal dryness, chronic pelvic pain, prostate or bladder surgery, and alcohol or recreational drugs.
• Psychological: stress, tiredness, performance anxiety, depression, relationship problems, shame or negative ideas about sex, lack of information and experiences of abuse.
• Specific medicines: SSRI antidepressants, some blood pressure medicines such as beta-blockers, and antipsychotics can delay orgasm or ejaculation.

Premature ejaculation is also common and often improves with simple techniques and, if needed, treatment.

What can help

• Get to know your own body; our stimulation and self-discovery guide can help.
• Take time over foreplay and clitoral stimulation.
• Say what feels good, in words or by guiding your partner's hand. If that's hard, see how to talk to your partner.
• Take the pressure off: focus on sensations rather than "getting there".
• Exercise your pelvic floor, which can increase sensation.

Common myths

• "No orgasm means bad sex": pleasure is much broader than that.
• "Women should orgasm from penetration": for most women, that isn't the case.
• "Partners should come at the same time": that's a cultural idea, not a rule.
• "If it doesn't happen, someone is to blame": it usually depends on stimulation, context and communication.

When to see a doctor

See your GP if the change is recent with no clear reason, if it started with a new medicine, if you have diabetes or a neurological condition, or if sex is painful (see pain during sex). Don't stop a medicine on your own: ask whether there are alternatives. If the cause is emotional or relationship-related, psychosexual or couples therapy helps many people improve communication and stimulation.