What causes the orgasm gap, and how can couples close it?

Everyone, both men and women, deserves to experience an orgasm or the climax of sexual arousal. There are several disparities between men and women, including longevity between men and women, gender pay disparity, and orgasm disparity. The orgasm gap, or pleasure gap, is a social phenomenon referring to the general inequality between heterosexual men and women in terms of sexual satisfaction, more specifically, the unequal frequency in the achievement of orgasm during sexual encounters. Currently, across every demographic studied, women report the lowest frequency of reaching orgasm during sexual encounters with men. The size of the orgasm gap varies from 20 to 72 percent, to the disadvantage of women. In this article, we will discuss the definition and causes of orgasm disparity and suggestions for closing that gap.

Many changes occur throughout the entire body with orgasm. During arousal, blood flow to the genitals increases, causing them to be engorged and more sensitive, and the vagina lengthens and becomes lubricated. Vital signs also elevate as heart rate, blood pressure, and temperature increase and peak during orgasm. Some women also experience rhythmic muscle spasms in the uterus, vagina, and pelvic floor during orgasm, and the latter may be enhanced by regularly performing “Kegel” exercises. Other muscles in the body may also contract; for example, some women may curl their toes during climax. Unfortunately, studies have found that heterosexual women have the fewest orgasms during sex, which could come from a lack of understanding of female anatomy, the vulva, and certainly the clitoris.

The orgasm gap or pleasure gap is a term coined to describe the disparity in orgasms between couples. Also known as orgasm inequality, studies have used it to measure sexual satisfaction among different demographics. A good and healthy sex life can’t be measured purely by how many orgasms people have. However, studies have found a considerable difference between the number of orgasms men and women have in heterosexual relationships.

The orgasm gap doesn’t just exist between heterosexual women and men. It has been found that lesbian and bisexual women have more orgasms than heterosexual women. Similarly, there’s an orgasm gap between women when they’re alone and with partners. A study found that 39 percent of women said they always orgasm when they masturbate, compared to 6 percent experiencing an orgasm during sexual intimacy with a partner.

The International Society for the Study of Women’s Sexual Health (ISSWSH) calls the inability to have an orgasm “female orgasmic disorder” only if it produces personal distress and frustration. It is characterized by the persistent or recurrent compromise of orgasm frequency, intensity, timing, or pleasure associated with sexual activity for a minimum of six months.

We have come a long way since the sexual experiments of Masters and Johnson in 1966, which allowed these researchers to describe the human sexual response as a linear progression of excitement, plateau, orgasm, and resolution. Our current understanding of the sexual response is best described by the biopsychosocial model, which looks at how psychology, biology, sociocultural phenomenon, and interpersonal relationship all interact with each other. The model seems to explain why a woman is unable to achieve an orgasm, either for the first time ever (primary) or not able to experience orgasm again but has in the past (secondary). What makes things worse is that the most common female sexual dysfunction is not orgasmic disorder, but instead hypoactive sexual desire. If a woman does not desire to have sex, how can she have any chance of reaching an orgasm? Regardless of this fact, the majority of the reasons for low desire are also the same things that prevent orgasm in the first place.

Reasons for female anorgasmia include the following:

• Interpersonal: Quality of current or past relationships, unresolved conflicts, lack of emotional intimacy, poor communication with partner, infidelity, partner violence, partner’s sexual dysfunction
• Biology: Health conditions, medications (e.g., antidepressants), alcohol and substance use, age-related changes, recent treatments (e.g., hysterectomy)
• Psychology: Mental health disorder (e.g., depression), performance anxiety, life stressors and finances, body image
• Sociocultural: Upbringing, cultural norms and expectations, religious beliefs about sex, reproduction, and gender

Causes of the orgasm gap disparity

Although there are multiple factors that may contribute to the orgasm gap, sociocultural contributors have been overlooked. The fault for the orgasm gap doesn’t lie with penises, vaginas, or any individual man or woman. The fault lies primarily in cultural expectations and traditions.

From ancient times, sex has been surrounded by myths and misinformation. Since the beginning of recorded history, sexual intimacy was relegated primarily to procreative activity for conceiving children. Other forms of sexual intercourse, such as oral sex, anal sex, and oral clitoral stimulation, were considered immoral. We have now moved beyond antiquated values, and most people openly embrace sex for pleasure and procreation. However, while we’ve learned to embrace sex for pleasure, we still strongly emphasize penis-vaginal penetration.

Due to our culturally established ideas that sex is the insertion of a penis into the vagina, women are less likely to experience orgasms. Most people use the terms sex and intercourse interchangeably. Clitoral stimulation and oral sex are often classified as foreplay rather than sexual experiences. Unfortunately, vaginal penetration favors male orgasms, whereas clitoral stimulation favors female orgasms.

Another hangover from our puritanical past is the definition of the end of a sexual act. Traditionally, since sex was associated with procreation, the act was considered complete once the male deposited his semen into the vagina. Unfortunately, female orgasm wasn’t deemed necessary because it didn’t contribute to procreation. Unfortunately, even today, some men consider the sexual act complete after ejaculation, regardless of whether their female partners have achieved an orgasm.

There has been abundant information on the role of the penis and very little on the anatomy and physiology of the clitoris. The penis serves multiple purposes: urination, procreation, and pleasure. However, in female bodies, all these purposes are distributed among different organs. The clitoris is the seat of ultimate female pleasure, making it key to female orgasms. Less than 10 percent of women can orgasm with vaginal penetration alone. Most women need clitoral stimulation to achieve an orgasm. As such, women should teach themselves (and their partners) about clitoral stimulation.

Additional causes for the existence of the orgasm gap include:

• Women are judged more harshly for wanting casual sex than men.
• Sex education generally focuses on abstinence or procreation, not female sexual pleasure.
• The lack of awareness of the clitoris’s crucial role in female orgasms.
• Little-to-no training in sexual communication, which is essential for female orgasms.
• Body consciousness and lack of self-esteem can get in the way of experiencing sexual pleasure.

Closing the orgasm gap

Most men and women have little training in sexual communication, yet good sexual communication is key when it comes to female orgasms. This is because there are differences between women regarding what they need to orgasm, and what one woman needs to orgasm can vary from one encounter to another. Many women are plagued by body-image self-consciousness during sex, and it’s impossible to have an orgasm while worrying about feeling fat or holding the lower abdomen in.

Foreplay is important because it takes a woman a longer time to increase the level of arousal to have an orgasm compared to a man. Caressing, spooning, kissing, and touching erogenous areas are usually thought of as foreplay, but there are also other things you and your partner can do before the bedroom. Communicate with your partner throughout the day so that both of you think of each other in a positive light. For example, you can send each other short love notes and loving emojis by text message, or attach sexual images or 3-second videos on your cell phone in anticipation of the bedroom later that evening.

In recent years, numerous clitoral-focused sex toys, especially clitoral vacuum-suction vibrators, have arisen to help women achieve orgasms. Clitoral sex toys focus on clitoral stimulation to help women achieve regular orgasms and bridge the orgasm gap. Clitoral vibrators are effective in delivering sonic pulses into the clitoris. These sonic pulses vibrate the entire clitoral structure, helping women achieve orgasms within minutes. Women should teach themselves (and their partners) about clitoral stimulation. Closing the orgasm gap requires knowledge and enhanced communication. To close the orgasm gap, both women and men must understand that the clitoris is key to women’s orgasms. A very small percentage of women (about 3 to 10 percent) reliably orgasm from penetration alone. Most women require clitoral stimulation to reach orgasm.

The following are some tips to help women experience orgasms more frequently:

• Expect and request more oral sex and clitoral stimulation.
• Increase the duration of the sexual experience (greater than 15 minutes).
• Focus on methods to improve the overall quality of the relationship.
• Discuss what you expect in bed.
• Praise the sexual partner when they do something correctly.
• Tactfully give instructions to the partner: dos and don’ts.
• Explore new sex positions.
• Slow down or change the type of stimulation.
• Incorporate different types of sexual stimulation (e.g., anal stimulation).
• Discuss sexual fantasies.
• Use sex toys.
• Express love during the sexual experience.

Developing a theoretical understanding of the clitoris isn’t enough to achieve consistent orgasms. Once you understand your body, you can more accurately guide your partner to help you achieve better orgasms. Women must explore their bodies to discover their non-genital erogenous zones, which may include nipples/breasts, lips, inner thigh, anus, buttocks, back of neck, ears, mons pubis, armpits, and bottoms of the feet. It’s important for women to discover their own bodies and then to accurately instruct their sexual partners on what they enjoy and what areas of their bodies require stimulation.

What about the G-spot? There has been debate among the scientific community as to the existence of the G-spot. Histologically, there is nothing special about the anterior vaginal wall tissue about 4-5 cm inside from the opening of the urethra. However, stimulation of this area can stimulate the crus and fork of the clitoris and help to bring a woman to orgasm. In some women, double or triple stimulation of erogenous zones can facilitate escalation to orgasm. For example, her partner may give oral clitoral stimulation while finger-penetrating the anterior vaginal wall and stimulating her nipples at the same time.

In most men, after an orgasm there is a refractory period of greater than ten minutes when a man is incapable of having another orgasm. On the other hand, women have the capability of having multiple orgasms as there is no refractory period. A woman can have an orgasm and then have another within seconds, while some women have one orgasm then decline in arousal, and then again can be aroused and have another climax a few minutes later. Unfortunately, few women experience multiple orgasms. The exact number is difficult to know as designing and conducting a well-controlled study on orgasm is very difficult.

Women’s orgasms are an area where knowledge is insufficient. In one study, knowledge of the clitoris wasn’t related to women’s rates of orgasm. These authors concluded that knowledgeable women, or their partners, do not give priority to orgasm for women. Again, when penetration is involved, it’s often considered the main event and mistakenly assumed that both partners should orgasm. So, to close the orgasm gap, we must hold clitoral stimulation and vaginal penetration as equal.

Currently, there are no medications, botanicals, or surgeries that have shown convincing evidence of efficacy for orgasmic disorder. Elaeagnus angustifolia, a plant-derived extract that has been touted for anorgasmia, and sildenafil (a.k.a. Viagra) have been studied via a randomized trial but have not been shown to be effective. Although endogenous oxytocin has been known to increase during orgasm of both men and women, a randomized, cross-over trial comparing oxytocin to placebo was not effective for orgasm. Additionally, vasodilators such as 2 percent theophylline and 0.3 percent isosorbide dinitrate were compared to placebo in a four-week randomized controlled trial (RCT), and again neither was better than placebo. Additionally, none of the genital cosmetic procedures (G-spot injection, “The O-shot,” clitoral hood reduction, laser vaginal rejuvenation, etc.) have been scientifically proven to help improve the female sexual response or to facilitate orgasm.

For women who have orgasmic dysfunction despite overcoming all the barriers discussed above, they should be referred to the appropriate professional depending on what is creating the largest barrier to their ability to orgasm. For example, if she has never orgasmed, she may benefit from a sex therapist who can coach her through sex education and directed masturbation as well as cognitive-behavior sex therapy. For a woman who is distracted by thoughts that inhibit sexual arousal and orgasm, she may benefit from seeing a therapist who specializes in mindfulness training. If the orgasmic dysfunction is a result of interpersonal nature, then couples therapy may be a good starting point.

Bottom line: It’s probably obvious that closing the orgasm gap isn’t going to be easy, not for individual women or our culture. Still, it’s worth the effort. Both men and women will be happier if sexual intimacy and orgasm are a shared event and equal for both.

Sam Siddighi is a urogynecologist. Neil Baum is a urologist.