ORIGINAL RESEARCH & REVIEWS

Female Orgasm and Overall Sexual Function and Habits:

A Descriptive Study of a Cohort of U.S. Women
Osama Shaeer, MD,1 Ditte Skakke, MA, MPH, RN,2 Annamaria Giraldi, MD, PhD,2,3 Eman Shaeer, MD,4 and
Kamal Shaeer, MD1

ABSTRACT

Introduction: Few studies have investigated women’s experiences with orgasm and the factors that they cite as
important for their orgasmic function and sexual behavior related to foreplay and sexual stimulation.
Aim: To investigate and describe overall sexual function in a cohort of North American women, with a special
focus on orgasmic function, satisfaction, triggers, risk factors, and sexual behavior.
Methods: A total of 303 women aged 18e75 years completed a 100-questionnaire survey, which included the
Female Sexual Function Index (FSFI) questionnaire and questions on orgasmic function, duration of sexual
activity, sexual behaviors and relationship, and the partner’s sexual function. Statistical analysis was performed
using SPSS to illuminate factors affecting sexual function.
Outcomes: The main outcome measures are FSFI score, satisfaction with sexual life, ability to reach orgasm,
orgasm frequency, preferred sexual stimulation, and sexual habits.
Results: FSFI scores, which were calculated for the 230 women who reported having had a steady male sex
partner in the preceding 6 months, showed that 41% of the 230 women were at risk for female sexual
dysfunction (a cutoff less than 26.55) and 21% were dissatisfied with their overall sexual life. Almost 90% of the
overall cohort reported good emotional contact with their partner, that their partner was willing to have sex,
satisfaction with the partner’s penis size (wherever applicable), and good erectile function and ejaculatory control
of their partner (wherever applicable). 81% of the overall cohort claimed to be sexually active. Around 70%
(70e72) did reach orgasm frequently, but around 10% never did so. Vaginal intercourse was reported by 62% of
the overall cohort as the best trigger of orgasm, followed by external stimulation from the partner (48%) or
themselves (37%). External stimulation was reported to be the fastest trigger to orgasm.
Clinical Implications: The knowledge on how women reach orgasm and how it is related to the partners’
willingness to have sex and other factors can be incorporated in the clinical work.
Strengths & Limitations: The use of a validated questionnaire and the relative large number of participants are
strengths of the study. Limitations are the cross-sectional design, the lack of a sexual distress measure, and a
possible selection bias.
Conclusion: Most women in the overall cohort were satisfied overall with their sexual life and partner-related factors,
even though 41% (of those who cited a steady sex male partner) were at risk for female sexual dysfunction. Most
women did reach orgasm through different kinds of stimulation. Correlation was good between preferred and per-
formed sexual activities and positions. Shaeer O, Skakke D, Giraldi A, et al. Female Orgasm and Overall Sexual
Function and Habits: A Descriptive Study of a Cohort of U.S. Women. J Sex Med 2020;XX:XXXeXXX.
Copyright
2020, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.
Key Words: Female Sexual Function; Female Sexual Dysfunction; Female Orgasm; Female Sexual Function
Index (FSFI); Orgasm Risk Factor; Sexual Stimulation

4
Received July 17, 2019. Accepted January 31, 2020. Department of Obstetrics and Gynecology, Kasr El Aini Faculty of Medicine,
1
Department of Andrology, Kasr El Aini Faculty of Medicine, Cairo University, Cairo University, Giza Governorate, Egypt
Giza Governorate, Egypt; Copyright ª 2020, International Society for Sexual Medicine. Published by
2
Sexological Clinic, Psychiatric Center Copenhagen, Copenhagen, Denmark; Elsevier Inc. All rights reserved.
3 https://doi.org/10.1016/j.jsxm.2020.01.029
Institute of Clinical Medicine, University of Copenhagen, Copenhagen,
Denmark;

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2 Shaeer et al

INTRODUCTION The presence of other sexual dysfunctions such as lack of

desire or arousal is also a risk for difficulty in reaching orgasm.23
Female sexual dysfunction (FSD) is highly prevalent and is a
Furthermore, Garcia et al24 have suggested that women with
distressful condition that affects the lives of many women.1 This
female partners (lesbians) achieve orgasm more easily than
includes female sexual interest/arousal disorder, hypoactive sexual
women with male partners (heterosexual). They showed that
desire disorder, genito-pelvic pain/penetration disorder, and fe-
bisexual women had lower rates of orgasm (58%) than both
male orgasmic disorder (FOD). Definitions vary among different
lesbian (75%) and heterosexual women (61%). This could be
diagnostic systems.2e4
explained by many factors, as the greater comfort and familiarity
Another entity is a “sexual problem,” which can be within the women partners have with the female body, making them better
spectrum of normal female sexual function and is not a formal able to induce orgasm in another woman, different gender roles,
sexual dysfunction. A sexual dysfunction (disorder) is defined as a duration of sexual activity, or biological factors as pointed out by
distressing sexual problem.3,5,6 Several studies have shown that the authors. However, another study by Frederick et al17 found
women with a “sexual problem” do not necessarily feel sexual that bisexual women and heterosexual women had almost similar
distress and that women can be distressed about their sexual life orgasm rates (66% and 65%, respectively), whereas lesbian
without having what can be classified as a sexual dysfunction.7e9 women had a higher orgasm rate (86%).
A large U.S.-based study including 31,581 women showed that
To obtain greater knowledge on how women reach orgasm,
43% of the women reported sexual problems, 22% reported
which stimulation they prefer, what they actually practice, how
sexual distress primarily, and 12% reported any distressing sexual
the orgasmic experience varies, as well as how sexual function and
problem.10 Other investigations have also shown that low sexual
satisfaction interact, the current study aimed to
desire is the most prevalent sexual problem among women.1
Female orgasmic function has been studied to a lesser extent 1. measure overall sexual function using the Female Sexual
and primarily with a focus on FOD.11,12 Explorative and Function Index (FSFI) and compare this with women’s re-
descriptive research on non-dysfunctional orgasmic function is ported sexual satisfaction levels and
not widely represented. To be “sexually normal” implies for 2. describe women’s experiences with ability to reach orgasm,
many women that she must achieve orgasm almost every time how often they reach orgasm, what triggers orgasm, possible
she has sexual interaction with another person,13,14 and research factors inhibiting orgasm including partner-related factors,
has shown that women frequently fake orgasm to adapt the among other parameters studied.
sexual behavior to a “code of normality.”13 However, other
studies have elucidated that “normal orgasmic function” does not
METHODS
necessarily imply reaching orgasm every time one has sex.15e17
According to Levin,18 orgasmic response can occur from Design
different stimuli, classified into 2 broad categories. The first is a Data in this article are nested from a larger epidemiologic
variety of physical stimuli of different regions of the body such as study, the Global Online Sexuality Survey (GOSS). This
the genital area including the clitoris and vagina, the mons, or the ongoing online epidemiologic study of both male and female
breasts and nipples. The second is mental imagery and fantasy. The sexuality is launched across the globe in different languages with
orgasmic response can be described through objective physiolog- the aim of providing knowledge about sexual issues in the general
ical indicators and psychological responses. Physiological in- population in different countries. The first launch was in the
dicators include vaginal, anal sphincter, and uterine contractions Middle East in 201025 followed by the launch in the United
and release of prolactin.18 Meston et al19 have described the mental States in 2011.26 Other data on sexual function and dysfunctions
orgasmic response as a “variable, transient peak sensation of in men and women have been reported from the GOSS.25e30
intense pleasure, creating an altered state of consciousness,
inducing physical and mental well-being and contentment”. Study Population
Orgasm most likely leads to sexual satiation and a feedback The present sexuality survey was offered to English-speaking
mechanism that regulates sexual arousal and behavior.20,21 female and male web users in the United States in 2016 by an
Sexual dysfunctions including FOD may arise from many international online survey service provider based in the United
different biopsychosocial causes.5,22 Biological factors can States and fully funded by some of the investigators. Advertisement
include conditions such as cardiovascular disease, diabetes, was conducted as a banner that invited Web users to participate in a
neurological disorders, an unhealthy lifestyle, and the effect of survey investigating sexual health. The banner was directed to
pharmacological agents as well as alcohol and drug abuse. Psy- persons older than 18 years of age, regardless of ethnicity, sexual
chological factors include stress, depression, personal problems, orientation, marital status, or surfing preferences to avoid possible
body image issues, and relationship problems, whereas socio- bias from special sexual inclinations and interests. Participants were
logical factors might include civil status (being single), financial informed of the nature of the survey, ensuring anonymity, and
problems, and unemployment.5 non-collection of personal information including email and IP

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Female Orgasm Descriptive Study 3

address. Participants were informed that they would be able to see Table 1. Women demographic
the survey results after completion and to follow the data pro- Total n (%)
spectively as information from other participants pools up. It was
stressed that the accuracy of the information they provided would Age (years) Total 303 (100)
reflect on the accuracy of the information they would eventually be 18e39 169 (56)
40e49 61(20)
able to access. To ensure reliability of responses, quality control
50e59 42 (14)
measures were applied by the service provider including estimation
>60 31 (10)
of the optimal duration for completion of the survey and excluding
Sexual orientation Total 303 (100)
fast raters. A total of 303 women (aged 18e75 years, mean age:
Exclusively or predominantly 276 (91)
39.8 years) and 610 men (mean age: 44.4 years) completed the heterosexual
survey on a scheduled cutoff date in 2016. Only the data from the Homosexual, bisexual, or others 27 (9)
female participants are included in this article. Ethnicities Total 273 (100)
Caucasian 213 (78)
Data Sampling African American 25 (9)
The GOSS survey for female participants included 100 Hispanic 17 (6)
questions. Questions encompassed a consent question, de- Asian 13 (5)
mographic data, systemic medical diseases, medications, habits of Others 5 (2)
medical importance, obstetric and maternity history. Regarding Relationship length Total 303 (100)
sexuality and relationship, the questions included information on Less than 1 year (incl. singles) 49 (16)
sexual orientation, coital frequency, preferred vs practiced coital 1e5 years 79 (26)
frequency, preferred vs practiced sexual positions and mastur- 5e10 years 59 (20)
bation, frequency of orgasm, techniques for attaining orgasm, More than 10 years 116 (38)
and the description of the orgasmic experience. Furthermore, the Children Total 303 (100)
questions asked about present sexual and romantic relationship No 84 (28)
status, the partner’s willingness to have sex and perform foreplay 1e2 144 (48)
3< 75 (24)
and afterplay, the partner’s erectile function, ejaculation control
Education Total 303 (100)
and satisfaction with the penile size (wherever applicable). Sexual
Primary school 112 (37)
function was evaluated by FSFI, a validated questionnaire that is
University 143 (47)
considered the gold standard for measuring women’s sexual Postgraduate 35 (12)
function.31 This brief, 19-item, multidimensional self-report Other 13 (4)
questionnaire measures dimensions of sexual function in Smoking Total 303 (100)
women, including desire, arousal, lubrication, orgasm, satisfac- Yes 85 (28)
tion, and pain. It is developed for heterosexual women with a Menses status Total 303
partner. The maximum score is 36. A cutoff of
26.5 indicates a Premenopausal 206 (68)
risk for sexual dysfunction.32 FSFI questions were addressed to Do not menstruate 97 (32)
and answered by the overall cohort (n ¼ 303), but the FSFI score Irregular menses 51 (25)
was calculated only for the women who reported having had a (of those who menstruate)
steady male sex partner in the preceding 6 months (n ¼ 230). Physical or mental conditions Total 303
Overweight 61 (20)
Diabetes 21 (7)
Statistical Analysis Hypertension 37 (12)
Statistical analysis was carried out using SPSS (SPSS Inc, Depression 71 (23)
Chicago, IL) for Microsoft Windows, version 19. Descriptive Stress* 174 (57)
data are presented as means ± standard deviation (SD), fre- Income Total 265 (100)
quencies, and percentages. In cases of non-normally distributed Other 3 (1)
data, a median is reported. Groups were compared using the Low (very low) 88 (33)
independent student t-test or the Chi-square test, as appropriate. Average 150 (57)
P value
.05 was considered as significant. Correlation between High (very high) 24 (9)
numerical variables was determined using the Pearson correlation *Interpersonal (13%), financial/career (21%), otherwise (23%).
test. Multivariate analysis was used to investigate the impact of
various factors on the orgasmic function and satisfaction. Orgasm relationship, stress, emotional relationship with partner, number
and frequency of orgasm were measured by the orgasm domain of sex partners, perceived erectile function and ejaculation con-
in FSFI: question 11 and 13. Possible confounders were iden- trol of partner, foreplay, and the partner’s willingness to have sex,
tified in previous research on female sexual function, satisfaction, masturbation, liking sex, the partner performing foreplay, length
distress and orgasm. They were age, education, length of of intercourse, and numbers of sex partners.

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4 Shaeer et al

Ethic and Informed Consent sexual satisfaction?” Furthermore, 29% reported that the bigger
Ethical approval was obtained from the ethical committee of the penis, the better the sexual satisfaction, whereas 51% re-
the Research Ethical Committee at the Andrology Department, ported that a bigger penis did not matter for sexual satisfaction
Cairo University Hospital, Cairo, Egypt. All participants actively (“Do you think that the bigger the penis is, the higher is your sexual
gave consent to participate in the study. They were informed at pleasure/satisfaction?”).
the webpage about the nature of the study, that it was anony- When asked, “Do you think that your partner suffers weak erec-
mous and had to actively choose the “I am happy to participate” tion?” and “Do you think your partner ejaculates too early?” 11%
before they could proceed with the study. reported weak erection and 14% reported early ejaculation. 89%
and 86%, respectively, answered “never,” “rarely,” or “sometimes.”
RESULTS
Demographic Findings Sexual Preferences and Habits
A total of 303 women living in the United States responded to 79% of the overall cohort of women answered “yes” when
the survey. Demographic data are shown in Table 1. A majority asked, “Do you like sex?” The women reported that they had
of the women (n ¼ 220) were between 18 and 49 years, with a intercourse 8 ± 9.9 (SD) times per month on average. They
mean age of 39.8 ± 13.3 years. The majority of women were reported 12 ± 10.7 (SD) times per month when asked, “In your
heterosexuals (91%), and 38% had been in a relationship for opinion, how many times should one have intercourse every month
more than 38 years. (on average)?” When asked, “Are you comfortable with that fre-
quency (number of times you have intercourse every month)?” 57%
answered “yes”. However, 36% would prefer more and 7%
Sexual Function and Experiences would prefer less frequent intercourse. The reported mean for
Among the 303 women, the mean age for the first sexual intercourse duration (“How long (in minutes) does intercourse
intercourse was 17.6 years (SD ± 4.4). Of those, 230 women take?”) was 18.5 ± 17.9 (SD) minutes, and the mean for
(76%) had been engaged in a sexual relationship (including preferred duration (In your opinion, how long do you think in-
coitus) with a male partner during the last 6 months. FSFI score tercourse should take?) was 24.2 ± 20 (SD) minutes.
was calculated only for this group. Mean FSFI score was 26.3
76% of the women practiced masturbation in different fre-
(SD ± 7.3). As shown in Table 2, 41% of the 230 women had a
quencies. Of those, 51% performed external stimulation only,
score less than 26.55 indicating a risk for FSD.
5% performed internal stimulation only, and 44% performed
Multivariate analysis showed that the total FSFI score was both external and internal stimulation (“If you do masturbate, how
significantly negatively associated with having irregular menses, do you perform masturbation?”).
depression, stress, not liking sex, the partner’s unwillingness to
As shown in Figure 1, the women were asked to rate their
have sex, too little foreplay or afterplay, low frequency of sex,
preferred sexual positions and activities on a scale from 0 to 10.
irregular frequency of sex, poor emotional relationship with the
Then, they rated how often they did the same positions and
partner, and dissatisfaction with the partner’s erectile function,
activities. As the figure shows, vaginal intercourse and oral sex
ejaculatory control, or penis size. No association was found with
were rated the highest, and a good agreement between the most
income, diabetes, cardiovascular disease, overweight, smoking,
preferred and performed activities was found. However, it was
children, and previous births.
also shown that the women wanted to have certain activities
(“using a special apparatus,” cunnilingus, fellatio, 69 position,
Satisfaction with Sexual Life and Partner and vaginal penetration in standing position) more often than
Using the FSFI question on satisfaction in the overall cohort they actually practiced.
(n ¼ 303), 54% reported being overall satisfied (very or
83% reported that their partner performed foreplay (“Does
moderately) with their sexual life over the past 4 weeks. 21%
your partner perform foreplay (stimulation/teasing by hand or
reported dissatisfaction (very or moderately dissatisfied), and
mouth before intercourse”)). Of those, 48% found the amount of
25% were indifferent.
foreplay to be adequate, 30% would prefer more, and 5%
When asked, “How do you evaluate your emotional relationship would prefer less. In contrast, only 44% of the women
with your sexual partner?” 89% reported having a good emotional answered “yes” when asked, “Does your partner perform afterplay
relationship (good, very good, or excellent) with their sexual (stimulation/teasing by hand or mouth after intercourse)?” Of
partner. In addition, 88% of the women reported that their those, 29% found the amount to be adequate, 11% would
partner was willing to have sex (willing, very willing, or totally prefer more, and 4% would prefer less. The women apparently
willing) when asked, “How willing is your partner to have sex?” valued foreplay more than afterplay, with 88% reporting that
Most women (89%) responded “yes” when asked, “Do you foreplay was important or very important for sexual satisfac-
find the size of your partner’s penis satisfactory?” 43% agreed when tion, whereas only 48% reported afterplay as important for
asked, “Do you think that size of the penis is important for your sexual satisfaction.

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Female Orgasm Descriptive Study 5

Table 2. Risk of female sexual dysfunction

FSFI-score
26,55 FSFI-score >26,55

Age (years) n (%) n (%) Total n (%)

18e39 53 (23) 92 (40) 145 (63)

40e49 24 (10) 26 (11) 50 (21)
50e59 11 (5) 14 (7) 25 (12)
60þ 7 (3) 3 (1) 10 (4)
Total 95 (41) 135 (59) 230 (100)
A FSFI score
26.55 is considered to be a risk for female sexual dysfunction (FSD).

Orgasm When given different possibilities, the women described

72% of the sexually active women reached orgasm frequently orgasm as one or more simultaneous bodily experiences, as dis-
(most of the time, always, and sometimes) during any kind of played in Figure 3. 42% of the women experienced strong body
sexual stimulation and during vaginal intercourse, whereas contractions, 26% moderate body contractions, and 14% subtle
13e14% never had reached an orgasm or were not sure. 15e16% contractions when having an orgasm. Abdominal contraction to
reported they rarely reached orgasm. Figure 2A and Figure 2B. a different degree was experienced by 12e15% of the women.
Multivariate analysis showed that reaching orgasm frequently
(reported as most of the times, almost always, or always) was
positively correlated to the domains of “women liking sex” and DISCUSSION
the partner performing foreplay. It was negatively correlated to The aim of this study was to describe the overall sexual
“being stressed,” poor emotional relationship with the partner, function in a sample of 303 U.S. women, with a special focus on
the partner’s willingness to have sex, and perceived erectile orgasmic function and sexual habits. Several factors have been
dysfunction and premature ejaculation of the partner. No asso- investigated. Overall, we found that two-fifths of women in
ciation was found with age, educational level, length of inter- steady heterosexual relationships were at risk for FSD. However,
course, masturbation, or numbers of partners. at the same time, only one-fifth reported being dissatisfied with
81% of the overall cohort reported having been sexually active their overall sex life. However, close to half of the overall cohort
within the last 4 weeks. Of those, 60% were moderately satisfied or reported being dissatisfied with their orgasmic function.
very satisfied with their ability to reach orgasm during sexual activity These findings show that women are not necessarily dissatis-
or intercourse, measured by FSFI question (“over the past 4 weeks, fied with their sex life, despite impairment in some sexual
how satisfied were you with your ability to reach orgasm (climax) during functions. Rosen et al33 had similar results in a sample of 329
sexual activity or intercourse?”). 16% were indifferent, and 24% were randomly chosen women, aged 18e73 years. They showed that
moderately or very dissatisfied. Multivariate analysis showed that a despite sexual risk factors such as anxiety or inhibition during
high satisfaction with ability to reach orgasm (very or moderately sexual activity, lack of sexual pleasure, difficulty in achieving
satisfied with ability to reach orgasm) was positively correlated to orgasm, lack of lubrication, and painful intercourse, most women
women liking sex and the partner performing foreplay. It was (69%) rated their overall sexual life as satisfactory. A study
negatively correlated to the partner’s willingness to have sex and the among 429 randomly chosen Danish women found that one-
partner’s erectile dysfunction. No association was found with age, third scored less than 26.55 on the FSFI, but only a fifth were
educational level, length of relationship, stress, emotional relation- unsatisfied with their sexual life.8 Furthermore, Shifren et al10
ship with the partner, the partner’s perceived premature ejaculation, and colleagues found in their sample of 31,581 U.S. women
and the woman masturbating. that the prevalence of sexual problem sans distress was consid-
When reporting what kind of stimulation the women needed erably higher (43%) than the prevalence of distressing sexual
or preferred to be able to reach orgasm, 62% reported that in- problems (22%).
tercourse was the best trigger for orgasm, second best triggers Accordingly, while a proportion of women may be at risk for
were external stimulation by a partner’s hand (48%) or by mouth sexual dysfunction according to the FSFI, they do not necessarily
(48%), then external stimulation by their own hand (mastur- have a sexual dysfunction/disorder because they are not distressed
bation) (37%) or a vibrator (29%), and finally by anal inter- by the condition.8,10,33 In the present study, female sexual
course (7%). distress was not measured, which could have added insights
Stimulation time to reach orgasm was reported to be about what proportion of the women had FSD, defined as a low
10.2 ± 10 (SD) minutes (median: 8 minutes) by external sexual function combined with sexual distress. Nevertheless,
stimulation and 15.2 ± 14 (SD) minutes (median: 10 minutes) satisfaction with both overall sexual life and orgasmic function
by intercourse. was measured and has given an insight on how the women feel

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6 Shaeer et al

10
A Over the past 4 weeks, when you had
9
sexual s mula on or intercourse,how o en
did you reach orgasm? (n=246)
8 Never
13,0% Always
7 (n=33) 29,0%
A few mes (n=72)
6 15,0%
Please rate the following
according to
(n=36)
5 how much you like it (from 0 to
10)

4
Please rate the following
according to
3 how much you actually do it / Some mes Most me
have it 17,0%
done(from 0 to 10)
26,0%
2 (n=42) (n= 63)

0
B How frequently do you reach
orgasm(climax) at vaginal intercourse?
(n=303)
Never Not sure
Figure 1. Preferred vs performed sexual positions and activities 5,0% (n=14) Always
9,0% (n=29)
(Mean values þ SD). 18,0%
Rarely (n=54)
16,0%
about their sexual life, but the satisfaction domain is not a (n=48)
substitute for sexual distress.31 The method used to measure
sexual function and distress has a pivotal impact on the outcome,
as described by Hayes et al.9 They concluded that some methods
to measure FSD produce significantly higher estimates than Most of the
Some mes
others. If the recall periods increase, FSD prevalence increases me
23,0%
29,0%
too. In contrast, if sexual distress is measured as a prerequisite for (n=70)
(n=88)
FSD, the prevalence decreases. Overall, the prevalence of FSD in
newer research has fallen since 1994 when the Diagnostic and Figure 2. A, Orgasm frequency at any kind of stimulation. B,
Orgasm frequency during vaginal intercourse only.
Statistical Manual of Mental Disorders-IV stipulated that both
low sexual function and sexual distress are prerequisites for a
diagnosis of FSD.9,34
Orgasm
For many years, it has been debated how frequently women can
Life circumstances naturally affect humans in social, mental, reach different kinds of orgasms, for example, clitoral or vaginal
and physiological ways and thus also affect sexual function.10 In orgasm, and whether some orgasms are “better” than others.35,36
that sense, it can be considered normal that a proportion of Masters and Johnson37 stated that from an anatomic point of
women always will be at risk for sexual dysfunction at certain view, there are no separate anatomic entities between clitoral and
times of their lives. But only a proportion of those will experience vaginal orgasm. However, Levin35,38 and Pfaus et al39 suggested
sexual distress.9 In the present study, it was found that psycho- that at least 2 types of orgasmic responses could be reached by
social factors and dissatisfaction with partner-related sexual and different genital stimuli, for example, clitoral vs anterior vaginal
emotional domains affected the FSFI score negatively. wall erogenous complex (“g-spot”) stimulation. Bronselaer et al40
In a 2012 study by Shaeer et al,30 344 women in the Middle furthermore found that deep vaginal and cervical stimulation can
East answered the same questions as in the present study. The trigger orgasm. Costa and Brody41 claimed that vaginal orgasm is
results indicated that cultural differences might affect the prev- associated with more mature psychological defense mechanisms.
alence of risk for FSD as measured by a low FSFI score, as the Other studies have concluded that the type of orgasm could be
study showed that 59% scored less than 26.55 in the sample of linked to a woman’s mental vulnerability, for example anxiety and
women from the Middle East. However, Shaeer et al30 discuss depression.36,42,43 The present study was not addressing different
that risk for FSD is exceptionally difficult to measure in the kinds of orgasm or their relative merits. We referred only to the
Middle East because of its sensitive content and the conservative frequency of women reaching what they themselves experience as
nature of the population, which may also influence the orgasm. However, the present study shows that most of the
responses. included women reached orgasm from both vaginal stimulation

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Female Orgasm Descriptive Study 7

45% 42 body contractions and/or abdominal contractions during

40% orgasm. Other studies have reported similar results,18,24,49
35% showing that orgasm is not a genital or pelvic response alone
30% 26 but includes several physiological components involving pelvic,
25% uterine, rectal, abdominal, and limb muscle contractions.
20% Orgasm is thus considered a total body response in which
14 15
15% 12 muscles in many different areas of the body contract to
10
10% different degrees. This distribution varies with the individual
4 4
5%
woman, and about a third of the women in the present study
0%
experienced abdominal contractions only. Because the response
choices in this study did not include pelvic or genital con-
tractions, these abdominal descriptions may cover genital/pelvic
contractions, as described by Levin18 and Garcia et al.24 There
might be an underestimation of the bodily reactions, as some
women might not be fully mentally present or aware of all
bodily reactions during orgasm, as described by Kingsberg
et al.50
Figure 3. Bodily orgasm description.
The reported mean time of intercourse among the women in
(intercourse and other internal stimulation) and external clitoral the present study was longer than the reported mean time of
stimulation performed by the partner or the woman herself. intercourse required to reach orgasm. Thus, on average, the
women seemed to have long enough stimulation time to reach
When focusing on how to reach orgasm, the present study orgasm. The length of intercourse duration could then be
showed that the women reached orgasm in different ways, considered as a contributing factor (or trigger) for good orgasmic
including intercourse, external stimulation, and least likely by function. The mean time (18.5 minutes) for intercourse duration
anal intercourse. Most women preferred intercourse as the best in the present study was relatively long than that in other studies.
trigger for orgasm. Other groups have investigated what stimu- Weiss and Brody51 reported a mean time for intercourse of
lates orgasmic function. Fugl-Meyer et al44 found that good 16.2 minutes, and Miller and Byers52 reported a mean time of
orgasmic function is associated with a relatively large repertoire of 7.03 minutes. The reason for these differences cannot be
sexual techniques, including masturbation and the ability to explained but could be reflecting different study populations,
receive touch through oral stimulation or a partner’s hand. recall bias, different ways of asking the questions, or different
Herbenick et al45 found that for some women, intercourse alone confounding factors such as physical and mental health, socio-
is sufficient for reaching orgasm, whereas others need clitoral economic factors, culture, or having children or not. However,
stimulation before, during, or after intercourse, which is in good when looking at the median time for orgasm in the present
accordance with the present study, where both intercourse and study, it was 8 minutes for external stimulation and 10 minutes
external stimulation were found to be good triggers for orgasm. for intercourse, which are more in line with what other studies
However, the women reported that the stimulation time needed have shown.
to obtain orgasm was longer with intercourse than with external
stimulation. Rowland et al46 had similar findings in their study, Relationship and Partner-Related Factors
showing that time to orgasm during partnered sex was 14 mi- The women in the present study were predominantly
nutes, compared with 8 minutes during masturbation. Other engaged in long-term relationships, though not all women in
studies have shown that orgasm occurs faster in women by steady relationships were sexually active. Long-term relation-
masturbation than by intercourse or other stimulation by a ship has earlier been considered a risk factor for sexual
partner.12,47 Thus, the present study supports previous findings dysfunction because of decreasing desire15 and decreasing fre-
that external stimulation or masturbation is the fastest way to quency of intercourse53 and, yet in contradiction, considered a
reach orgasm. However, it was also shown that intercourse is the predictor of good sexual function because of the secure and
most common stimulation when trying to reach orgasm, despite close relationship compared with singles having one-night
the longer stimulation time required than masturbation/external stands.33 Higher orgasmic function in previous studies has
stimulation. Previous research has suggested that women who been found to be associated with low relationship stress, high
frequently do masturbate have higher orgasm frequency in gen- marital and relationship satisfaction, overall high quality of the
eral.46,48 Though, the present study did not find any association relationship with the sexual partner, and the ability to adapt the
between masturbation habits and orgasm frequency or orgasm sexual act to the woman’s need.12,54e56 The present study
satisfaction. supports the latter by finding a positive association between the
When describing the bodily orgasmic responses, most of the partners performing an adequate foreplay and orgasmic
women in the present study experienced some degree of full function.

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8 Shaeer et al

Several factors in the present study suggest long length of penetration, and too early ejaculation interrupt and shortens the
relationship as a predictor of good orgasmic function. The intercourse. The study showed a negative correlation between
women evaluated their emotional relationship with their partner women’s orgasm frequency and the partner having weak erection
as predominantly good and find that their respective partners or too early ejaculation. This is in line with previous research,
were overall very willing to have sex with them, which indicates which showed that male partner’s ejaculatory or erectile
easy access to dyadic sexual activity and stimulation with a dysfunction negatively affects women’s sexual satisfaction, sexual
partner. Regression analyses, though, showed no association function, and orgasmic function.58,59
between length of relationship and orgasm satisfaction or be- Previous studies have focused on the importance of penis size
tween FSFI scores (risk of FSD) and relationship duration. A for women’s sexual satisfaction. Masters and Johnson37 claimed
study by Wahlin-Jacobsen et al7 found that longer relationship is in the 1970s that penis size does not matter. However, not all
associated with low sexual desire, sexual distress, and FSD. They empirical evidence supports this argument. Later studies, such as
did not investigate effects on orgasm specifically. that of Dixon et al60 found that women believe that penis size
Half of the women in the present study did not experience any matters and consider it to be important for their sexual satis-
or would prefer to experience more foreplay and afterplay, and faction. A large U.S. study showed that women’s preferred penis
about half of the women were satisfied with the amount of size is 16.3 cm in length and 12.7 cm in circumference.61 The
afterplay. The question arises of whether half of the women being present study offers no support one way or the other. A little less
satisfied are enough or if one-third being directly unsatisfied and than half of the women reported that penis size is important for
requiring more is too many? Leeners et al12 reported that the sexual satisfaction, whereas more than a third reported that it is
likelihood of female orgasm is influenced by the couple’s ability not. If the question is whether a bigger penis is more satisfactory
to meet the woman’s need, and others have shown that women than a smaller penis, about half of the women said no but one-
may be distressed by a partner’s lack of sexual performance and third said yes. Most of the women found their partner’s penis size
then not feel sexually satisfied.56 In that sense, adequate foreplay was satisfactory, indicating that the size does not seem to be of
and afterplay could be considered as triggers for good orgasmic great importance for their sexual satisfaction in the present study.
function and too little or too much relative to what is desired However, we cannot conclude that the absence of this issue
could be considered as a risk factor. This is supported by the means that penis size does not matter for the women, and we do
present study where a positive correlation was found between the not have data on actual penis sizes of the partners.
partner performing foreplay and high orgasm frequency and
satisfaction with orgasmic function.
Strengths and Limitations
A relatively large proportion of the women in the present The strengths of this study are anonymity, lack of confron-
study experienced agreement between preferred and actually
tation stress, the use of a validated questionnaire, and the in-
practiced sexual activities and positions. Vaginal intercourse was
clusion of particularly curious questions such as description of
the most preferred activity, and nearly all were satisfied with how orgasm, method of stimulation, and satisfaction with the part-
much they experienced it. Almost all of the women reported that
ner’s performance and penis size.
their partners were overall willing to have sex with them, but still
most women reported wanting to have intercourse more A limitation is that we did not measure female sexual distress.
frequently than they actually did. The cross-sectional design is also a limitation because no cau-
sality can be ascribed. Furthermore, the design carries a risk of
Although the women in the present study reported a mean
selection bias because participants were recruited through the
time for intercourse duration that was longer than the mean time
internet, limiting the population to internet users and leaving the
for reaching orgasm during intercourse, they still also indicated
possibility of having attracted some women with a special interest
wanting longer intercourse duration. In a sister study (GOSS)
in sexual matters or with sexual problems. From the present
among Middle Eastern women (n ¼ 344), Shaeer et al30 found
design, we cannot clarify these potential biases further.
that the women also wished for longer intercourse duration than
they experienced. These results could indicate that orgasm is not
the only benefit or goal with sexual stimulation or activity. Other Possible Clinical Implications and Further Research
studies, for example, Meston and Buss,57 have shown that The current results show that women can reach and experi-
pleasure, physical desirability, love, commitment, stress reduc- ence orgasm in different ways. Orgasmic ability in women is also
tion, self-esteem boost, and self-expression also are positive ele- associated with the male partner’s willingness to have sex in the
ments to gain from sex. Further research is needed to estimate way that the woman prefers. This factor applies for foreplay,
how important orgasms and other goals are for women when afterplay, sexual positions, and activities. It also shows that the
they participate in sexual activity. duration time for intercourse varies widely among participants.
A smaller subset of the women in the present study reported In the clinical practice, it is therefore important to include
that their partners had a weak erection or too early ejaculation. questions on the women and couples sexual habits and explore if
Weak male erection reduces the possibility of vaginal she receives the “right” stimulation if she has orgasmic problems.

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Female Orgasm Descriptive Study 9

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