Vaginal orgasm 'doesn't exist', researchers argue

"There is no such thing as a vaginal orgasm," says the Mail Online, in a story that suggests some women have been diagnosed with sexual disorders based on the "myth" that they can orgasm through vaginal intercourse alone.
The news comes from a review of existing (not new) evidence, and its authors make some very bold assertions.
The researchers' main conclusion – that the vaginal orgasm does not exist – is based on their assertion that the vagina has no anatomical structure that can cause an orgasm.
In their opinion, this makes it impossible for a woman to achieve orgasm through penetrative sex alone.
However, they argue there are other effective methods for women to achieve orgasm, such as masturbation and oral sex.
If these arguments are true, it raises a couple of interesting related points. Foremost is the possibility that female sexual dysfunction, where a woman is unable to achieve an orgasm, may not be a "condition" at all if she is only experiencing the problem with penetrative sex.
Men who feel they have premature ejaculation problems because they are unable to "last" long enough to bring their partner to orgasm may in fact be unaware that their partner may not be able to orgasm through penetrative sex.
This is an interesting, if complex and unsupported, review of a subject of eternal fascination to the media – sexual arousal and orgasm in women.
Still, the main thrust of the researchers' argument – that penetrative sex is not the be all and end all of sexual activity – is a valid and reasonable one.
Where did the story come from?
The study was carried out by researchers from the Italian Centre of Sexology and the University of Florence. There is no information about any external funding.
It was published in the peer-reviewed journal Clinical Anatomy on an open-access basis, so it is free to read online.

The Mail Online went to town on the story, but its claim that, "for years women have often declared they can either orgasm through sex or foreplay" is not based on any evidence.
It also does not make it clear that this was an opinion piece summarising existing evidence and not research based on new evidence.
But, overall, the website made a fairly decent job of summarising some complex findings.
What kind of research was this?
This was a narrative review looking at the anatomical and physiological basis of female orgasm.
The authors say orgasm is a normal psychophysiological function and, in a statement of the rather obvious, women have the right to feel sexual pleasure.
For this reason, they say it is important that explanations of orgasm are based on female biology and not on hypotheses or personal opinion.
They also say some researchers have proposed a new "anatomical terminology" for the female sexual response, including an "inner clitoris" linked to the "G-spot". Their paper aims to clarify whether these new terms have a scientific basis.
A narrative review discusses and summarises the literature on a particular topic. As these reviews do not provide detailed information on the criteria for inclusion of the studies discussed, they are not considered as rigorous or reliable as systematic reviews.
With a narrative review, there is always the danger that "cherry-picking" of research may have taken place – where evidence that supports the authors' position is included, but contradictory evidence is ignored.

What does the review say?
The authors' main points were:
•The "inner clitoris" suggested by some researchers does not exist. The entire clitoris is an external organ, composed of the glans, body and root (or crura).
•There is no anatomical basis for a "clitoral-urethro-vaginal complex" (which others claim supports the idea of the "G-spot").
•The vagina has no anatomical relationship with the clitoris.
•There is no scientific basis for the existence of the G-spot, although it has become the centre of a "multimillion-dollar business" – for example, through surgical procedures that claim to help "enhance" the G-spot.
•The vaginal orgasm does not exist.
•The female erectile tissue responsible for orgasms is composed of the clitoris and its vestibular bulbs, the pars intermedia, labia minora and corpus spongiosum (of the female urethra). This, say the authors, corresponds to the penis in men and can be called the "female penis".
•"Female orgasm" is the scientific term that should be used for all orgasms in women.
How did the researchers interpret the results?
The authors say that, worldwide, the majority of women do not orgasm during intercourse: "Female sexual dysfunctions are popular because they are based on something that does not exist; the vaginal orgasm."
Yet they say female orgasm is possible in all women if the female erectile organs – as they put it, the "female penis" – are stimulated.
This can happen during a variety of sexual activity, including masturbation, cunnilingus (oral sex) and intercourse (using the hands to stimulate the "female penis" during penetrative or anal sex).
The researchers say many men think long intercourse is the key to female orgasm, but this is not necessarily helpful to women, some of whom "may be grateful to get it over with quickly".
Male ejaculation does not automatically mean the end of sex for women, they say, and they romantically conclude that touching and kissing can be continued almost indefinitely.
Conclusion
This is an interesting, if complex, review of a subject of eternal fascination for the media – sexual arousal and orgasm in women. However, despite the authors' claim to the contrary, it is hardly likely to be the last word on the topic.
Some of the points it makes are in line with scientific opinion, which holds that no distinction should be made between "types" of female orgasm.
The "vaginal orgasm" theory – first posited by Freud as the sexual response of "mature" women, achievable through intercourse and separate from the "clitoral orgasm" (for adolescents only) – was criticised by feminists as long ago as the 1970s and is considered an outmoded theory by most experts in sexual medicine.
However, the relationship between the clitoris and the sensitivity of the vagina continues to be the subject of debate.
Many women worry about achieving – or failure to achieve – orgasm. There are many reasons for orgasm problems. Your GP may be able to refer you to a specialist doctor or therapist, who can check for any physical reasons and help with any psychological barriers. Use the NHS Choices search facility to find sexual health services near you.
And, as the authors point out, if penetrative sex is not particularly stimulating, there are other techniques your partner can explore, such as mutual masturbation and oral sex. For more information on good sex tips, see Talking about sex.
Analysis by Bazian
Edited by NHS Website

Orgasm During Pregnancy: Why It’s Fine (and How It’s Different)

It can feel like pregnancy changes everything.
In some ways, it does. You’re skipping your favorite sushi place and reaching for well-done steak instead. The smallest odors seem to have you rushing to the toilet to throw up, and even sitcoms can leave you in an emotional puddle of tears. You’ve asked your OB everything under the sun, from whether you can have beef jerky to if your belly button will become an outie — and why.
But there’s one subject you’re wondering about that you’ve felt a little uncomfortable bringing up: the big O.
So is it OK to have an orgasm during pregnancy? (And if you’ve already had one, why did it felt really, really good — better than it ever has before?)
The short answer is yes, in most cases, it’s absolutely fine to have an orgasm while pregnant — in fact, it can also be a great for your emotional and mental well-being.
Let’s take a closer look at orgasm safety, sensations in the first, second, and third trimesters, and a big myth about orgasms bringing on labor — debunked.

Is it ever not safe to have an orgasm during pregnancy?
When it comes to sex during pregnancy, there’s a lot that can cause hesitation: You may not feel “in the mood,” thanks to hormones and morning sickness; your partner may worry about “poking the baby” or otherwise hurting you; and you both may have concerns about orgasms and uterine contractions.
Always check with your doctor about whether you, specifically, are OK to have sex. But if your doctor hasn’t told you otherwise, and your pregnancy is low risk, it’s generally completely safe to get it on between the sheets.
In fact, when researchers looked at studies involving 1,483 pregnant women, they found that there were no significant differences between those who had sex during their pregnancy and those who didn’t when it came to inducing labor contractions.
Researchers also noted that in low risk pregnancies, sex wasn’t associated with “preterm birth, premature rupture of membranes, or low birth weight.”
However, if you have any of the following, your doctor may indeed tell you to abstain from sexual activity:

spotting or bleeding
incompetent cervix (when the cervix is shorter than about 22 millimeters and you’re at higher risk for preterm birth)
vasa previa (when the umbilical cord vessels run too close to the cervix)
placenta previa (when the placenta covers the cervix)
Also, don’t have sex if your water has already broken. Amniotic fluid forms a protective barrier between your baby and the outside world — without it, you’re more at risk for infection.
If your pregnancy is high risk for other reasons, like multiples, talk to your OB. One review of studies found that there simply isn’t enough research about sex during high risk pregnancies.
What a pregnancy orgasm feels like, by trimester
First trimester
Sex in the first trimester may be great, or it may suffer from many “false starts”: You’re in the mood one minute, and a wave of nausea hits you the next.
On the other hand, your body is already becoming more sensitive — your breasts, for example, may be more tender to the touch and therefore more easily stimulated by your partner or yourself. Your libido may increase, too. These things, along with more natural lubrication down there, may result in quicker and more satisfying orgasms.
Or, you may just need to wait for the discomfort of first trimester symptoms to pass. And some women’s libido actually decreases. And that’s OK, too. It’s all within the realm of normal.
Second trimester
This might be the sweet spot when it comes to reaching your, ahem, sweet spot.
With morning sickness (usually) a thing of the past and the discomforts of the third trimester yet to come, sex and orgasm during the second trimester may be the most enjoyable.
Here are a few things that you may experience:
Your orgasms may be more pleasurable. There are a few reasons for this, with perhaps the main one being increased blood flow during pregnancy. This means your uterus and vaginal area are more engorged, which can mean more sensitivity. This can go either way depending on the person, but for many, it means more pleasure — and easier orgasms.
You may feel post-orgasm uterine contractions or cramps. These are perfectly normal and even happen when you’re not pregnant — you just may not feel them unless you are. Don’t worry — these contractions aren’t labor, and they’re not going to bring on labor. Cramps will generally subside with rest.
Your stomach may feel very hard. This is another common occurrence during orgasm, pregnant or not. But with your stretched skin and more extended belly, chances are, you’ll notice this sensation more.
The release of hormones may be compounded. What we mean is this: Your body is already producing more oxytocin (the “love hormone”) during pregnancy. You’ll release even more when you orgasm. And that’s typically going to feel pretty darn good.
Third trimester
Sex in general may be more difficult during the home stretch that is the third trimester. For one thing, your adorable baby bump may feel more like an enormous sack of potatoes: awkward to carry and always in the way. (That’s where creative sex positions come in!)
But also, you may have a harder time reaching the big O. With baby taking up so much room in your uterus, the muscles may not be able to fully contract as they need to in order to climax.

How to Have an Anal Orgasm: 35 Tips for You and Your Partner

What is it?
An anal orgasm is exactly what it sounds like — orgasm that’s achieved through anal stimulation.
We’re talking touching, licking, fingering, penetration, and more. If it feels good, anything goes!
Curious? Read on to learn more about this backdoor wonder and how to bring your body to orgasm.


Who can do it?
Everyone! If you have a butt and you want it touched, butt play is for you.

Is an anal orgasm the same thing as a prostate orgasm?
Sometimes. Cisgender men and people assigned male at birth have a prostate, so in these cases a butt orgasm results from stimulating the prostate.
You can stimulate the P-spot through the perineum, which is the runway of skin between the balls and the anus.
If you prefer direct touch, you’ll need to head inside through the anus — about two inches.

What about the A-spot?
This is how anal orgasms work for cisgender women and people assigned female at birth. Anal penetration indirectly stimulates the A-spot in the vagina.
The A-spot, or anterior fornix if you want to get fancy, is located deep inside the vagina — around 5 or 6 inches in.
It’s an area filled with erotically charged nerve endings that have the ability to make you very wet, very fast.

What does it feel like?
It feels like intense waves of pleasure that begin deep inside your body and radiate through the rest of your body. In other words: Ah-mazing.
Minor discomfort the first couple of times is normal as you adjust to being penetrated back there. It shouldn’t cause severe pain.

How to get started
Sex on the fly is fun, but when it comes to anal play, a little prep can help make the experience better for the receiver and the giver.
If you’re the receiving partner
Being relaxed and aroused are key, especially if this is your first foray into butt play.
Here are some ideas and other tips to get you started:
Indulge in something erotic. The more turned on you are, the easier and more enjoyable butt play will be. Watch porn, listen to an erotic story, or just close your eyes and fantasize.
Take a hot bath. A hot bath before anal play will help loosen tight muscles and increase blood flow to all your bits. Use bath time to give your erogenous zones a good rub-a-dub and show your anus some love while you wash up.
Practice with a butt plug. Sex toys can help you get a feel for anal play before experimenting with your partner. Take things slow and enjoy the feeling of the toy teasing your butt before inserting it.
Stock up on lube. There’s no such thing as too much lube when it comes to anal. It isn’t just about the delightful slip and slide, but also an important part of anal sex safety.
If you’re the giving partner
As the giver, you need to bring your A-game. A little prep can help you help them have that anal orgasm:
Groom those hands. Trim and file your nails to prevent tearing delicate skin. Short nails also mean less space for dirt and bacteria to hide. While we’re on the subject of bacteria, don’t forget to wash your hands thoroughly before going in. You could also wear latex gloves, and for extra comfort insert some cotton balls.
Use a condom. Condoms can be used on a butt toy and fingers, as well as a penis. If you want to use your tongue, a condom can also be cut open and used as an alternative to a dental dam. This isn’t just to prevent STIs, but also to nip the ick factor in the bud if you or your partner is nervous.
Get in the mood. Foreplay can help get you both ready for what’s to come and make entry into that special spot easier. Touching, kissing, and licking the buttocks and the area around the anus is a good way to get the party started.

Techniques to try
You’ll probably have to play with different techniques to find what works, but playing is half the fun anyway.
Here are some moves to try with whether you’re using your tongue, fingers, penis, toys, or a combo of them all.
With your tongue
Your tongue may not be able to directly stimulate the P-spot or A-spot, but it sure can work wonders on the rest of the perianal area and many other erogenous zones.
Use the tip of your tongue to tease the cheeks before working your way between them. Swirl your tongue around the anus for a moment and then push the tip into the opening, darting it in and out.
With your fingers
Come hither. Slowly insert your lubed finger into the anus and curl your finger upward in a “come hither” motion. Gradually increase the depth and speed — and, if desired, try inserting a second finger. Once you find a depth and pace that feels good, continue the motion and allow the pleasure to build.
Doorbell. From the inside or outside, find the spot that makes them go “oooh” with your finger and press your finger pad against it as if ringing a doorbell. Start with light pressure, gradually increasing the pressure and speed.
Circling. Rub the pad of your finger in a circular motion in the area of the A-spot or P-spot. Start circling the area slowly and gradually pick up the pace at your partner’s request — or based on their oohs and ahs. Play with pressure, as well as speed, to find the magic combo.
Simulated vibration. A little hard on the wrist, but if you speed up any move fast enough you can simulate vibration. Save this for when they’re close to the brink to avoid carpal tunnel.
With your penis, a strap-on, or other sex toy
Pressure. Applying more or less pressure can help you find the sweet spot.
Depth. No two butts are exactly alike, so play with depth to figure out how deep you need to go to hit the right spot. Take it slow and gentle —unless you get the OK to do more.
Vibrations. You can find vibrating massagers with different vibe and pulse settings. Try out the different combos to find what works best. Up the vibration when climax is near to take things over the edge.
Internal/external. Some sex toys work double duty thanks to an external vibe that stimulates the perineum or clitoris during penetration. You can also buy a dual penetrator vibrator to DP the anus and vag at the same time. Can we get a hallelujah!

How to incorporate other stimulation
An anal orgasm may be your goal, but don’t let that stop you from making use of all of the other hot spots a body has to offer!
Stimulate one or more to aim for a combo orgasm:
Clitoral. You can show the clit some love during anal play whether you’re the giver or the receiver. Use your hand, fingers, or a toy to slide up and down and side to side over the clit and hood.
Vaginal. A finger or toy can provide some DP action to penetrate the vagina while the butt’s receiving some love. Try the “come hither” move and you just might hit the elusive G-spot, too.
Penile. A good ol’ fashioned hand job is an easy add-on to anal play for the giver or receiver. Grasp the penis and stroke the entire length of the shaft, picking up the pace as climax approaches.
Erogenous zones. The body has dozens of potentially pleasurable zones craving some action. Use your hands or toy to explore the rest of your body, lingering on those that feel best. Try usual suspects like the neck, breasts, and scrotum or those less-explored like the backs of the knees, small of the back, and inner arms.

Positions to try
You can make any of the usual sex positions ass-friendly. Here’s how.
Facedown
To do this by yourself:
1.Lie facedown.
2.Reach your arm behind you and rest it on your back.
3.Reach your perineum or anus with your finger.
4.Tease and insert at your leisure.
To do this with a partner:
1.Lie facedown with your arms at your sides and legs slightly apart.
2.Have them sit next to you on the side most comfortable for them.
3.Have them gently massage your anus.
On your side, one leg to chest
To do this by yourself:
1.Lie on your side.
2.Bring your outer leg up toward your chest.
3.Reach your hand around to your anus.
4.Take your time to explore and stimulate as desired.
To do this with a partner:
1.Lie on your side.
2.Bring your outer leg toward your chest.
3.Have them sit behind you to reach your anus.
Doggy
To do this by yourself:
1.Get down on all fours.
2.Reach your arm between your legs or around your back to reach your anus.
3.Massage and penetrate as slowly or as urgently as you’d like.
To do this with a partner:
1.Get down on all fours.
2.Have them kneel behind you to reach your anus.
Cow
To do this by yourself:
1.Stabilize your dildo, vibrator, or other penetrative toy on the seat of a chair or other flat surface.
2.Straddle the chair or gently kneel down so that your butt is hovering just above the toy.
3.Slowly lower down and gradually insert the toy until you find the depth that feels best for you.
To do this with a partner:
1.Have them lie on their back.
2.Straddle them — or their well-positioned toy — with your knees on either side of their hips and your hands on the bed or floor.
3.Lower your butt and use your hips and hands to control the depth.

Other things to consider
Here are a few other things to consider before heading to B-town for some butt play.
The anus doesn’t self-lubricate
It just doesn’t — at least not in the same the way as a vagina.
Your anus is located at the end of your rectum, which is part of your digestive tract. The mucus membrane that lines the rectum contains glands that produce mucus to protect your digestive tract.
Anal mucus is sometimes secreted when you have a bowel movement or during anal stimulation, but the amount of mucus secreted — if any — isn’t enough to help penetration.
Lube is a MUST
We can’t stress this enough. If you’re going to partake in anal play, you have to use lube.
Without it, getting anything into the butt won’t just be painful — it can also be dangerous.
Rough entry can lead to skin tears and increase your risk of sexually transmitted and other infections.
A silicone or water-based lube works just fine and is safe for use with condoms and sex toys.
Although pregnancy isn’t possible, STIs are
Anorectal STIs are on the rise, and the risk is higher for those on the receiving end.
Small tears in the delicate skin in and around the anus increase the risk of transmission of STIs, including:
chlamydia
gonorrhea
HIV
human papillomavirus (HPV)
Other bacteria can be spread, too
Butt play can expose you to more than just STIs.
Bacteria such as Shigella, E. coli, and Campylobacter are transmitted through feces, and contact with poop is a very real possibility even if you can’t see it.
Without a condom, one can also contract:
hepatitis A, B, and C
parasites, such as Giardia
intestinal amoebas
Never go back to front without cleaning and getting a fresh condom
Again, this is about the poop. The bacteria in feces can wreak havoc on the urinary tract, so if you decide to mix it up with oral or penis-in-vagina sex, you need to wash up and put on a new condom.

The bottom line
The bottom can be loads of fun, and an anal orgasm is worth pursuing. Even if you don’t have one, chances are you’ll have some type of orgasm along the way. Be prepared, go slow, and enjoy all the pleasure the butt has to offer.

G spot on the spot

Your piece about the ultrasound study of the “G spot” (23 February, p 6) failed to mention many of the scientific problems. First, the authors’ definition in their paper of vaginal orgasm as “the orgasm experienced after direct stimulation of the anterior vaginal wall by penetration, without concomitant stimulation of the external clitoris” is technical and impossible to confirm. Is this penile penetration or were fingers or dildo used?
In 25 years as a sex therapist, I have not met many women who knew which wall of their vagina received stimulation during penile intercourse – and how do you keep other walls from getting involved? We know a lot about the ultrasound technique, but we don’t know much about the sexual practices and experiences of the women in this study.
Secondly, the way you presented this research could encourage the dangerous wave of untested cosmetic surgeries and injections that claim to “thicken the G spot”. Commercialisation of this topic greatly exceeds its scientific basis. Media that should be scientific are promoting unsafe and untested practices.
Emmanuele Jannini writes:
• Some of our subjects were medical doctors and understood terms such as “anterior”. Though we used these terms in the paper, in real life we also used popular language to ensure all participants understood. Nothing we have published suggests the possibility of a surgical technique, so I disagree that this research could encourage cosmetic manipulation of the G spot.
New York, US

Why do women fake orgasms? Study suggests surprising answer

In one survey, 46% of headache sufferers said sex had triggered a headache. Usually, this is an overexertion headache (like joggers and weight-lifters sometimes get); you may feel a dull pain that builds during foreplay or get a sudden headache around orgasm (more likely in men). In rare cases, such an intense headache could be caused by a tumor or aneurysm. For most folks, though, sex headaches are harmless.More from Health.com: The 5 kinds of headaches istockphoto

(CBS) Do women fake orgasms to protect fragile men's egos?

 

A provocative new study suggests another reason women fake it: to keep a man faithful.
"One particular reason that emerges from a lot of studies is 'to keep my partner interested in this relationship,' or 'to prevent him from defecting [from] the relationship or leaving the relationship for another woman,'" study lead author Dr. Farnaz Kaighobadi, a postdoctoral research fellow at Columbia University in New York City, told Live Science.

For the study - published in the Nov. issue of Archives of Sexual Behavior - researchers surveyed 453 heterosexual women in the Southeastern U.S. who were in long-term relationships. The researchers found that 54 percent of the women admitted to faking an orgasm. A closer look showed women who thought their partner might stray were more likely to report faking. What's more, these women were more likely to engage in other "mate-retention" behaviors, like dressing to please or keeping tabs on their partners when they're apart.
"Pretending orgasm may be part of a broader strategy of mate retention available to women to maintain their intimate relationship," Kaighobadi told CBS News.
Kaighobadi suggests that faking an orgasm to keep a mate from straying may be an evolutionary adaptation. Previous research suggests when a woman has an orgasm, it may cause her body to retain sperm for child-bearing. The evolutionary theory suggests faking an orgasm unconsciously might help a woman retain the sperm of a man with "good genes," giving her the best chance to have a healthy child.
Essentially, women may use faked orgasms to signal to their partner that "I am selecting you," thus manipulating his commitment.

The orgasm gap and what sex-ed did not teach you

There is a clear disparity between men and women when it comes to achieving orgasm; a phenomenon scientists call the orgasm gap.
Studying orgasms is no easy task. We work as psychology of sexual behaviour researchers in the lab of Dr. James Pfaus at Concordia University and were interested to explore the “controversy” of clitoral versus vaginal orgasms.
We conducted a literature review on the current state of the evidence and different perspectives on how this phenomenon occurs in women. Particularly, the nature of a woman’s orgasm has been a source of scientific, political and cultural debate for over a century. Although science has an idea of what orgasms are, we are still quite uncertain as to how they occur.
Orgasms are one of the few phenomena that occur as a result of a highly complex interaction of several physiological and psychological systems all at once. While there may be evolutionary reasons why men are more likely to orgasm during sex, we shouldn’t doom ourselves to this idea. Indeed, part of the problem lies in what happens in the bedroom.
We all have different preferences when it comes to what we like in bed. But one commonality we share is that we know when we orgasm and when we do not. We don’t always orgasm every time we have sex, and that can be just fine, because we may have sex for many different reasons. However, studies repeatedly show that women reach climax less often than men do during sexual encounters together.
For example, a national survey conducted in the United States showed that women reported one orgasm for every three from men. Heterosexual males said they achieved orgasm usually or always during sexual intimacy, 95 per cent of the time.
The gap appears to become narrower among homosexual and bisexual people, where 89 per cent of gay males, 88 per cent bisexual males, 86 per cent lesbian women, and 66 per cent of bisexual women orgasm during sexual interactions.

When we take a closer look at what might explain the orgasm gap, we can see the type of relationship we have with our partner matters. If you are in an established committed relationship, the gap tends to close, but it widens during casual sex.
That is, women in a committed relationship report reaching an orgasm as often as 86 per cent of the time, whereas women in casual sex encounters report they orgasm only 39 per cent of the time. Furthermore, heterosexual women achieve orgasm easily and regularly through masturbation.
Likewise, the more knowledge about the female genitalia (especially about the clitoris) the partner has, the higher the likelihood is for women to orgasm more frequently. Finally, and most importantly, the respondents reported the most reliable practice to achieve an orgasm for women is oral sex.
We don’t know why this gap occurs in casual sex versus sex in a committed relationship, but part of it might be how we communicate what we want sexually, what we expect sexually and attitudes toward sexual pleasure.
What sex-ed did not teach you
Formal education teaches us a vast amount of relevant topics in school, yet sexual education has been and is still a matter of (moral) debate. For many of us, sexual education covered reproductive biology and how not to get pregnant or contract sexually transmitted infections.
Sex-ed has been focused on preventing kids from having sex. “Always use condoms” was sometimes the most progressive sex-ed message. Education is now progressing into teaching what sex is about and how to engage in ethical and respectful sex, but that is still not the whole picture. How about pleasure or how to have fun and to explore what we like, how to communicate to our partners and many other crucial aspects of intimate life?
The key to the ultimate goal of enjoying ourselves is to know what you and your partner want and how to satisfy each other. Consequently, incomplete and biased sex education fails both men and women, omitting the fact sex is not only for reproduction but also for enjoyment.
Maybe the first thing we should learn about sex is that it is one of the favourite pastimes of adults. Preventing it from happening will only increase the likelihood of future generations engaging in it more, only with less knowledge about to how get the most out of it.
Some advice for sexual partners
Our first reaction to the orgasm gap may be to point fingers and find someone to blame: Cultural attitudes, religion, society, the educational system, your ex. Certainly, anyone would agree that the gap is a multifactorial phenomenon.
Statistics do not count when it comes to your own intimacy. In bed, it’s you and your partner(s), and that is what matters. We cannot create nor do we trigger orgasms in our partners. We can only help to make them easier, more fun and more enjoyable for them.
Even if you may have a good idea of what your partner may want in bed, what people like varies a great deal. Thus, understanding what a partner wants, how, when, where, or for how long, requires openness, trust and, most importantly, communication.
These key ingredients may be what’s missing in both casual and long-term encounters. We could all be more open and humble, and acknowledge that with a good attitude and a good teacher, everyone gets better at it.
Your sexual prowess and ability to satisfy grows with practice; it goes without saying that our sexual lives should improve beyond previous negative experiences.
There may be very few things in this world that perhaps all people in this world enjoy, and orgasms are among them. But the enjoyment of sex is not the race to climb to the top of the mountain. Instead, it is the enjoyment of getting there.
So what can you do? Talk, be confident and pay attention to your partner.
Satisfaction means very different things for different people. What really matters is what you and your partner(s) want. Shattering the climax glass ceiling is a team effort. Sex is fun — and everyone has something to learn about it.

All female mammals have a clitoris – we’re starting to work out what that means for their sex lives

Female enjoyment of sex is typically associated with the human species.
But actually all female mammals have a clitoris, the highly sensitive organ that is linked with pleasure and orgasm in women.
And research is now starting to slowly unpack how the clitoris might be involved in sexual encounters in mammals. For example, a research paper presented at a biology conference this week showed that the clitoris in dolphins is very large, and more complex than we previously thought.
Let’s take a look at the biology and evolution of the clitoris – for science.
It starts in the uterus
All babies, regardless of whether they are destined to become a boy or a girl, begin development in the womb with a small bulge called a genital tubercle.
If the developing fetus is destined to become male, the fetal testes will produce the male hormone testosterone and the genital tubercle will develop into a penis. If, on the other hand, the fetus is destined to become a female, the fetal ovary will not produce any hormones and instead the genital tubercle will develop into the clitoris.
Both structures look very similar in the early days of pregnancy.
Since the penis and the clitoris both develop from the same structure, they share many similarities.
The clitoris has a hood in humans: this is the same as the foreskin in males. The clitoris has a glans, which is the same structure as the head of the penis in men. Both the penis and clitoris become engorged with blood when stimulated. And both structures are full of nerves which, at least in humans, provide a pleasurable sensation when stimulated.
A very recent science

But compared to the penis, the clitoris is not well studied even in humans.
Amazingly, it was not until the late 1990s that the complete anatomy of the human clitoris was accurately described by Australia’s first female urologist, Helen O’Connell. Her work to understand the detailed form and function of the clitoris provides answers to some basic biological questions about sex.
Such research also has implications in pelvic area surgery, where doctors can use this knowledge to avoid any loss of sexual function.
Female hyenas are special
Because the penis and clitoris develop from the same tissue in the fetus, anything that affects the hormone balance in the embryo can impact its development. A great example of this is seen in the female spotted hyena.
In this mammal, the female rules the pack. She is larger and more muscular than the males because she is exposed to high levels of male hormones during embryonic development.
But this more muscled physique comes at a cost. The male hormones also affect the clitoris, turning it into a structure that looks like the male penis.
Unfortunately for the female hyena this 20cm clitoris contains the birth canal. So, the female needs to both mate and give birth through her clitoris, which often splits in the process, causing a high death rate in first time mothers.
There are other known differences in clitoris anatomy across species too.
The urethra is the tube through which urine passes to the outside of the body. Many animals have the urethra running through the clitoris (as it does in the penis) while in humans, the urethra opens at the base of the clitoris.Most mammals also have a small bone in the clitoris to help it become rigid during intercourse. This is known as the os clitoris and again shares a counterpart in the penis, the os penis. Os clitoris and os penis bones are present in most mammals, and humans are unusual in not having one in either organ.
Getting lost in the moment
The jury is still out on whether all mammals experience orgasm.
Non-human primates almost certainly do, but it is difficult to measure pleasure in animals.
What is certain is that females who stick around for longer during the act of mating are much more likely to become pregnant and produce more offspring. So if a clitoris does enhance enjoyment, then it would be strongly selected for in nature through increasing the females chance of having offspring.
Although the clitoris is not well studied, there is evidence of larger clitorides – yes, this is the plural of clitoris – in animals in which sex plays an important part in relationship building. Examples include the matriarchal hyena, bonobo chimps, humans and most recently in the dolphin.
Lots of surprises
A paper released this week reveals that female bottlenose dolphins have clitorides similar to humans, and that female dolphins may experience sexual pleasure.
Researchers used a combination of dissections and 3D scans to explore the female genitalia of dolphins in detail.
The shape and structure of the dolphin clitoris is very similar to that of the human. Both animals have extensive areas of erectile tissue that are larger than the clitoral hood. The skin under the clitoral hood also contains bundles of nerves that may increase sensitivity, raising the possibility that sexual experiences can be pleasurable for female dolphins.
However, there are also some differences in the location of the clitoris with respect to the vaginal opening and how it would be stimulated during copulation.
These comparative studies help us learn about the function of genitalia, and the evolution of sexual bonding across species.
Science has revealed a bizarre array of penis shapes found in mammals, from a four-headed penis in the echidna to two-headed penises in many marsupials.
It remains to be seen what surprises the clitoris has in store for us.

What are the differences among birth control pills?

Dear Alice,
What are the differences in birth control pills? I switched from Ortho-Tri cyclen to Alesse after asking my doctor for a lighter dose of estrogen, but have been told by friends that Nordette has the least amount and is the most effective. With all the news of hormones negatively affecting women's health, I'm very concerned.

Dear Reader,

No wonder you're confused — there are a variety of birth control pills on the market, and between the messages from advertisements, your friends, and your health care provider it can be difficult to distinguish what's best for you. Many people experience some sort of side effect related to birth control pills. In terms of long-term risk, research suggests that higher doses of estrogen increase the risk of breast and cervical cancers. That being said, its use can also lower the risk of getting ovarian, endometrial, and colon cancers. Learning more about the benefits and risks of different kinds of birth control pills can help you make the decision that is best for you!
Generally speaking, two different types of pills are being prescribed today:

• Combination pill: This is the most commonly prescribed type of pill, and it contains small doses of both estrogen and progestin in synthetic forms. Within this type there are monophasic pills, which has the same amount of each hormone throughout the whole cycle; and multiphasic pills, which contains varying amounts of the hormones in one cycle. These two subcategories are further segmented based on whether it contains more estrogen or progestin. Ortho Tri-Cyclen is a common brand of combination pills; the two others you mentioned, Alesse and Nordette, have since been discontinued and are no longer available on the market.
• Progestin-only pill: Also called the minipill, this is usually prescribed to decrease some of the side effects associated with estrogen or if there are health conditions or life changes, such as needing to breastfeed, that no longer allow for synthetic estrogen as an option. Progestin-only pills may initially cause more irregular menstruation, decreasing the number of periods for the first year. Other progestin-only contraceptive options include the contraceptive shot and some intrauterine devices (IUDs).

Because each of these has a different amount and type of synthetic estrogen and progestin, it makes comparing pills complicated. However, most birth control pills nowadays contain less estrogen than previous versions, with current formulas containing about 20 to 30 micrograms, compared to pills of the past which may have had more than 50 micrograms. Additionally, some pills are taken in 21-day or 28-day cycles, while others, called extended-cycle birth control pills, are taken in 84-day cycles. This increases the amount of time between each period of withdrawal bleeding, occurring only every three months, compared to every month. Just as pills can have different amounts of hormones, the number of days the pill is taken in a cycle may also affect comparisons.

Most pills have some reported side effects — changes in acne, weight, or mood, to name a few. People who take the pill may experience some side effects to different degrees. Many of these effects may be mitigated by a change in dosage. For instance, an increase in acne might be countered by a higher dose of estrogen and less progestin, while persistent headaches might be mollified by lower doses of both. Because of the many factors that come into play when choosing a pill, it's wise to take note of any symptoms you’re experiencing that are related to the pills. That way, you can work with your health care provider to determine the best contraception option for you. It's not uncommon for people to try out several different formulations of the contraceptive pill or other hormonal methods to determine which works best for them or has the least amount of disruptive side effects.
Synthetic hormones are a much debated topic, especially as it relates to estrogen and breast cancer. Some studies have indicated a 20 percent increase in the risk of breast cancer for those who use birth control pills. The risk of cervical cancer also increases after using oral contraceptives for five years or more, but the risk can decline when they aren't used anymore. However, just as the risk for breast and cervical cancers can increase from oral contraceptive use, it can also reduce the risk of other cancers. Endometrial cancer is reduced by about 30 percent, and the protective factors continue even after it's no longer being used. Additionally, the risk of ovarian cancer can be reduced about 30 to 50 percent, and like endometrial cancer, lasts long after it's no longer used. Finally, they can reduce the risk of colorectal cancer by 15 to 20 percent. Given its ability to both increase and reduce different types of cancers, it's ultimately about finding what works for you and based on you and your health care provider's evaluation of the pros and cons associated with oral contraceptives.
All in all, kudos to you for taking control of your health and seeking more information about what you are putting in your body.

How do birth control pills work?

Alice,
How do birth control pills work?
— Woman

Dear Woman,
Despite being small in size, birth control pills pack a punch in preventing pregnancy! This occurs through several mechanisms, mainly by stopping ovulation; when ovaries don't release eggs, sperm can't find and fertilize them to result in a pregnancy. Most birth control pills contain synthetic forms of one or more hormones: estrogen and progestin. These hormones stabilize natural hormone levels and prevent estrogen from peaking in the middle of the menstrual cycle. Without the estrogen bump, the pituitary gland doesn't release other hormones that normally cause the ovaries to release mature eggs. Specifically, synthetic estrogen works to stop the pituitary gland from producing follicle stimulating hormone (FSH) and luteinizing hormone (LH) in order to prevent ovulation. It also supports the uterine lining (endometrium) to prevent breakthrough bleeding mid-cycle. Meanwhile, synthetic progestin works to stop the pituitary gland from producing LH in order to prevent an egg from being released, make the uterine lining inhospitable to a fertilized egg, partially limit the sperm's ability to fertilize the egg, and thicken the cervical mucus to hinder sperm movement (although this effect may not be key to preventing pregnancy). Want to know more? Keep on reading!
There are two kinds of hormonal birth control pills. Different types of pills contain different amounts of progestin and estrogen. The first is called a combination pill, which contains both estrogen and progestin. One added benefit of combination pills is that users experience less breakthrough bleeding. Combination pills can be broken down into two categories, which differ in how frequently users have withdrawal bleeding (which mimics a menstrual period). Conventional pills generally have 21 or 24 active pills and seven or four inactive pills, respectively, creating packs of 28 pills. For continuous dosing or extended cycles pills, the packs can have 84 active pills with seven inactive pills or contain only active pills. With either form of pill, the inactive pills can trigger the withdrawal bleeding, and if the active pills were taken correctly and consistently, pregnancy protection will still exist during this time. If using a formulation with only active pills, the bleeding may stop completely. On top of being separated into conventional and continuous, combination pills are also categorized by hormone dosage. The monophasic active pills contain the same amount of estrogen and progestin during the cycle. However, in multiphasic active pills, the amounts of estrogen and progestin change during the cycle. Of the multiphasic pills, biphasic pills have two different progesterone doses, one of which is increased halfway through the cycle, while triphasic pills gradually increase the dose of estrogen (and in some cases, progesterone) two times during the cycle.

The second kind of hormonal birth control pill is the progestin-only pill (also known as the minipill). The amount of progestin in the minipill is less than in the combined pill. It works by thickening the cervical mucus and thinning the endometrium. Sometimes it will suppress ovulation. The progestin-only pills come in 28 day pill packs. Each day is an active pill and doesn't contain any inactive pills. The progestin-only pills may cause some people to experiencing breakthrough bleeding between periods.
Both combination and progestin-only pills are available in several brands, and each has a slightly different blend of hormones. All birth control pills work most effectively when daily, but the consequences of not taking the pill at the same time every day differ based on pill type. Combination pills need to be taken every day but not necessarily at the same exact time every day. Minipills must be taken at the same time every day within a three hour window. Regardless of the kind, when you forget your pill (or take it three to four hours late or more), this causes a dip in your body's levels of the birth control hormones. To maximize pregnancy prevention potential and to minimize side effects, consider picking a time you're likely to remember – maybe first thing in the morning or right before bed – to take your pills every day. If you're concerned that you have missed a dose, it's wise to consult with a health care provider, as the correct course of action depends on the type and brand of birth control.
As if there aren’t already enough options to consider, hormonal birth control is also available in more than just pill form! The combination formula is available as a patch and a vaginal ring, while the progestin-only formula is available in intramuscular shots, an implant, and in intrauterine devices. Some may prefer these other forms of hormonal birth control because they can be taken less often (and consequently are easier to remember). However, for some people, hormonal birth control may not be an option due to various medical conditions or undesirable side effects. Figuring out what works best for a person may take some trial and error to determine what side effects are manageable and which aren't. Some folks need to try several out over time to find one that is agreeable to them, beyond just being effective.
For more information on how birth control pills work, check out the Go Ask Alice! Sexual and Reproductive Health archives. You can also read more in the Contraception section to learn more about different types of contraceptives. Your health care provider can also offer more information about different kinds of birth control, including which method might be best for your lifestyle and needs.
Take care,

Bled from rough sex — Should I see a doctor?

Dear Rammed,
From your question, it’s not clear whether you’re experiencing vaginal or anal bleeding. While it may be common to bleed after your first time having vaginal sex, subsequent instances may be due to a number of causes. No matter the source of your bleeding, it's best to see a health care provider as they can help diagnose the specific cause and recommend an appropriate treatment and prevention strategies. Beyond getting this checked out, a dose of communication may also be in order.
Anal bleeding often involves tearing in the lining of the rectum. If you’re experiencing anal bleeding, it’s critical to abstain from sex as it can increase the risk for sexually transmitted infections (STIs) and further damage. Vaginal bleeding after sex, on the other hand, may be due to concerns such as:
•Vaginal dryness
•Friction during sex
•Inadequate lubrication during sex or foreplay
•Menstruation
•Pelvic inflammatory disease (PID)
•Genital sores from sexually transmitted infections (STIs)
•Cervical polyps (benign, noncancerous growths on the cervix)
•Cervicitis (inflammation of the cervix)
•Cervical ectropion (the lining of the cervix protrudes out and grows on the outside of the cervix)
•Cervical or vaginal cancer
List adapted from Mayo Clinic.
This list isn't comprehensive so it’s best to have your health care provider take a look and recommend a treatment plan.

Rammed, it may also be a good idea to reflect on whether you enjoy engaging in this type of sexual activity. Was this something you and your partner both agreed upon? If so, consider steps for reducing the chance of this happening in the future — for instance, you may ask your partner to go slower, communicate clearly if you're experiencing pain, and use lubrication to minimize any uncomfortable friction during sex. It’s also worth noting that if you ever feel discomfort or pain during sex, you have the right to stop your partner. You can say something like, "No, this is too rough;" or, "Stop, you're hurting me!" If this isn’t something you agreed to, it will be good to have a conversation with your partner about the type of activities you’re comfortable with to ensure experiences that are pleasurable to you both. You can say something like, "The last time we had sex, you were a little too rough. It caused bleeding and I had to get it checked out. I don't want that to happen again, so I will let you know when to stop or ease up, okay?" It could also be good to ask your partner if there are other ways to have sex that are pleasurable to you both that don't result in bleeding or are less rough.
Talking with a health care provider to address and treat this bleeding, talking with your partner, and taking steps to prevent this in the future are good ways to get you back to pleasurable action.

Coitus interruptus

Dear Unfulfilled sex,
Kudos to you for coming forward to figure out how to navigate this sometimes uncomfortable situation. Coitus interruptus, sometimes referred to as withdrawal, is often used as a way to prevent pregnancy. However, some may use this method because they find orgasming from masturbation to be more fulfilling. It’s worth noting that withdrawal has a lower effectiveness rate than other forms of contraception because for some people, pre-ejaculate may contain viable sperm that can lead to conception. Additionally, the point of ejaculation may not always be clear or easy to control. As such, it’s recommended that other forms of contraception, such as condoms or other barrier methods be used to protect against pregnancy and sexually transmitted infections (STIs). Regardless of your partner’s reason, it sounds like talking you’re your partner about both of your sexual needs is a good idea. Read on for tips for how you might approach this conversation.
In any relationship, communication is critical for ensuring all partners are on the same page. Not all conversations are easy, but by approaching your partner in a nonjudgmental and open way, it might open up the door to deeper discussions about what you both want sexually or otherwise. Before having this conversation, think about where and when you might broach the subject. It’s probably best to do this at a neutral time when you both aren’t preoccupied with other things and not right before or right after you’ve had sex. You might also choose to have this conversation after you’ve had a chance to process your emotions so you’re able to better able to communicate your thoughts and feelings.

One way to start the conversation is to tell your partner how much you care about him and this relationship. Then you can explain what you’ve been noticing with your sexual interactions. At this point, if you feel comfortable doing so, you can tell him how it makes you feel — that it feels like you’re not getting the full sexual experience when he pulls out early. This might also be a good time to ask him why he pulls out early, whether it’s to prevent pregnancy or whether he finds it more pleasurable. If he says he’s been doing it as a way to prevent pregnancy, consider sharing some other, more effective contraceptive options that will allow you both to finish together. You can read more about different forms of contraceptives in the Contraception category of the Go Ask Alice! Sexual and Reproductive Health archives. If he shares that he finds masturbation more pleasurable because it’s what he’s used to as feeling good, then maybe you can ask him if he’d be willing to try staying in a few times, to see if he discovers any new pleasurable sensations. However you choose to go about this conversation, be yourself and use your own language to express your desires. And, because it takes two to convo — make sure to be present, listen to your partner, and be open to new ideas that prioritize shared pleasure (even beyond orgasms).
Though this conversation may seem intimidating, it can offer an opportunity to understand what's going on and how you can work it out together. If both of you are able to hold this conversation successfully, your pillow talk may turn into some potentially tantalizing play time in the future. Good luck!