• Debate: Does the vaginal orgasm exist? Part 1

    This is the initial post in a blog-based debate between myself and Trisha Borowicz of the Science, Sex and the Ladies blog. Here are links to the subsequent posts:

    Part 1
    Initial post at Incredulous (This post)
    SSL rebuttal 
    Part 2
    Incredulous 
    SSL rebuttal

    Trisha Borowicz co-directed the 2014 documentary detailing the cultural (mis)understanding of female orgasm, Science, Sex and the Ladies, and has been expanding on the subjects covered in the movie at her blog for over 5 years. The SSL blog focuses on taking a critical look at the depiction, discussion and study of female orgasm in our society. When not blogging or filming with her troupe, AnC Movies, Trisha works in Indiana as a molecular biologist.

    Everyone wants to see the big O.
    Everyone wants to see the big O. Photo by César Corona.

    The resolutions

    1. Masters’s & Johnson’s  (1966) book Human Sexual Response provides the best scientific description of the definition and nature of orgasm.

    2. Orgasm is caused by direct or indirect stimulation of the clitoral glans/vulvar area in women.

    Trisha is taking the pro position on these and I will take the con. Trisha and I have previously had an exchange about a 2013 blog post of mine concerning science reporting and clitoral anatomy, however, this is a separate discussion. I have said it before, but our common ground bears repeating here.

    Common ground and the purpose of debate
    We agree that there is a long history of apathy, disregard, and politically-charged misinformation which continues to this day. Media reporting such as the io9 article I covered are generally quite ill-made, rife with omissions, inaccuracies, and salacious spin. We agree that miseducation on the facts has negative consequences for the mental and sexual health of women and men, and that these are therefore important issues to talk about and to educate about. The purpose of debate is to promote free, public discourse, to temper critical thinking skills, and to inform and educate readers and each other. This particular debate also bears on important public health concerns.

    I am also glad to debate Trisha because she has impressed me as a sincere, conscientious, and honest person.

    No dog in the hunt
    Just to be clear, it really makes no difference to me what the truth turns out to be. This topic is not a research area of mine. The answer has no bearing on any important social or moral issue. Yes, people miseducate on sex and orgasm, but those with a mind to do it will continue to do it, no matter what the truth is, or what experts, Trisha, or I say about it. Just as creationists mangle and twist evolution to support their biases, misogynists and bigots will mangle and twist Trisha’s rendition of the truth, too. The devil can cite scripture for his purpose. The idea that the facts are required to be congenial to your personal political likes and agendas is a false and pernicious notion.

    The outcome of this debate also changes nothing about how women experience their bodies or sex. Whether there is a true “vaginal orgasm” or not, my sex-ed advice is the same: there’s tons of individual variation among women, so everyone must figure out what rings their own chimes through some trial and error. This is true no matter who is right, this is true no matter what the explanations are. I am participating here because I find the subject fascinating, because I believe in the constructive power of public debate, and because there is a great deal of ignorance and misinformation out there on this subject that might be bettered by more and higher quality public discussion.

    Resolution 1
    Masters’s & Johnson’s  (1966) book Human Sexual Response provides the best scientific description of the definition and nature of orgasm.

    I emphatically reject the resolution, intrinsically and as presented by Trisha in blog posts such as this one. I will address these components separately.

    I. Masters and Johnson 1966
    Masters and Johnson made major contributions to knowledge about sex. However, the idea that the scientific understanding of the clitoris, orgasm, and female sexual response crystallized 5 decades ago thanks to a non-refereed publication based on a few experiments with tiny, unrepresentative samples in artificial, ecologically non-valid circumstances is preposterous on the face of it. As a psychologist, I do believe I would be laughed out of the room if I proposed such a basis for some description of a pan-human bit of psychology. Here is a short list of the limitations and flaws of M&J 1966.

    • Tiny sample sizes that offer no statistical power to generalize
    • Use of sex workers as participants, which can hardly be called representative of women in general
    • Sex in a laboratory setting probably is not representative of other settings
    • No replications
    • Participants were “WEIRD” in the Henrichian sense: of a Western, Educated, Industrialized, Rich, and Democratic society. Trisha believes the study of one culture, ours, proves things about the human species. Henrich et al 2010 explain why this is a dreadfully bad idea, and how psychological facts, like susceptibility to visual illusions once thought to be basic to human cognition, turned out to vary with population studied.

    I further submit that M&J is not considered the “gold standard” among psychologists, psychiatrists and other researchers. Seminal, perhaps. But the reigning and authoritative model? Not hardly. One of the problems M&J stipulated themselves: the relationship between physiologic, psychological, and sociological factors is qualitatively and quantitatively “totally variable” from one woman to the next (p. 127). M&J focus on the physiologic, calling it an admittedly limited jumping off point that has a degree of objectivity, even if it does not capture the nature of the phenomenon. Later researchers have investigated the psychological and sociological components in depth.

    For example, Rosemary Basson proposed a different model of sexual response based more in desire and intimacy, writing

    This author has seriously questioned the relevance of the traditional human sex response cycle as depicted by Masters and Johnson (1966) and expanded by Helen Singer Kaplan (1979) to a large number of women (perhaps the majority) in long-term monogamous relationships.

    The Helen Kaplan citation refers to her papers on hypoactive sexual desire. Kaplan (1977) wrote that M&J did not even mention sexual desire! How can a coherent account of human sexual response neglect to consider sexual desire? As if sexuality and sexual experience is about quantified muscle contractions and blood flow.

    Research has expanded in other directions as well. MRI and sonography have provided better understanding of the biomechanics of sex than M&J ever had. They wrote that the sole purpose of the clitoris was to create or elevate sexual tension by stimulation of the glans. This is almost certainly not correct. Research is on-going, but more recent studies suggest the erectile tissue of the clitoral complex helps tent the vagina for intercourse. During intercourse, the penis tends to compress the clitoral body and jam the anterior vagina against the root of the clitoris, causing a pumping action on the Kobelt plexus (Buisson et al, 2010).

    Evolutionary psychologists have also investigated possible psychological mechanisms involved in sexual response—

    Men’s masculinity and attractiveness predict their female partners’ reported orgasm frequency and timing. [Link]
    Are There Different Types of Female Orgasm? [Link]
    Genetic influences on variation in female orgasmic function: a twin study [Link]

    Sometimes producing findings that directly contradict M&J, such as Robert King et al. 2011:

    Fundamentally, these data would seem to contradict the Masters and Johnson (1965) view that masturbatory orgasms are the same as those achieved through intercourse, especially in terms of pleasure and sensation.

    Many of the recent papers I have looked at while writing this do not even cite M&J. That is because it is (understandably) incomplete, non-generalizable, and, because of 50 years of progress is research, in many aspects erroneous and obsolete. M&J are important to the history of the scientific knowledge of sex, but it is a grand mistake to imagine their work is today a central or exalted model.

    II. Representation of M&J

    Trisha has misrepresented M&J 1966 in at least one important regard. In this blog post Trisha cited M&J in her discussion of the definition of orgasm.

    Orgasm is the sudden release of the muscle tension and blood pooling that has built up during arousal. . . This Masters and Johnson definition is the physiological definition of an orgasm, and is what I refer to when I say orgasm.

    M&J did not write or appear to believe that the definition of orgasm is a mere physiological description of events, as Trisha does. After calling them the “gold standard” and writing this paragraph on what orgasm is, I think she unintentionally mislead the reader into thinking her views are in-line with M&J. They are not. M&J took pains, several times, to spell out the importance of non-physical factors and influences: the psychosocial. To wit,

    A detailed psychosocial study of the research population cannot be presented within the framework of this text. Yet neither this book nor this chapter can be considered complete without emphasizing an acute awareness of the vital, certainly the primary influence, exerted by psychosocial factors upon human sexuality, particularly that of orgasmic attainment of the female. . . .physiologic detail is of value only when considered in relation to [behavioral theory and sociologic concept].

    M&J are saying that the physical signs are correlative indicators of orgasm, not that they literally are orgasm themselves. If you believe M&J is the “gold standard” (I would not recommend it), you should accept their contention that physiology is not the definition of orgasm.

    Resolution 2
    Orgasm is caused by direct or indirect stimulation of the clitoral glans/vulvar area in women.

    This is, in its exclusive “only caused” sense, clearly wrong per all available evidence.

    In our email correspondence, Trisha elaborated on this point as follows.

    Orgasm is caused by direct or indirect stimulation of the clitoral glans/vulvar area in women, in the same way that orgasm is caused by direct or indirect stimulation of the penis in men. There is no physical scientific evidence for stimulation on the inside of the vagina, by itself, causing orgasm in women. Although there is no reason to completely rule out the possibility of other physical and mental avenues for men and women (besides clitoral glans/vulvar area and penis stimulation) the lack of physical evidence for other avenues indicates these are at best quite rare indeed. As it is now, the word orgasm is often used in our culture for physical events that are not in fact orgasms, and this can cause confusion when discussing, teaching or learning about female orgasm.

    III. Direct evidence against Resolution 2

    Let’s start with, There is no physical scientific evidence for stimulation on the inside of the vagina, by itself, causing orgasm in women. This is untrue, as Trisha well knows. The literature, including M&J, Kinsey and many others document vaginal stimulation by itself causing orgasm. Trisha explains this by insisting that it is indirect stimulation of the clitoral glans. However, that is conjecture, not evidence. She offers no evidence proving that is the case.

    Those who would argue there is a coherent difference between vaginally-induced orgasm (VIO) and other sorts, and I am one of those, need not quibble about the precise mechanism, because the mechanism changes nothing about the fact. Either penetrative intercourse can cause orgasm, or not. If it can, then the distinction is meaningful. The “why” is merely the explanation why the distinction is valid. The relatively recent fMRI and sonography research suggests to me that the subsurface clitoris probably plays an important role in VIO. So?

    Asserting that it is of critical importance to one’s sexual experience the fact of whether the key sensors are in the vaginal tissue, or a couple centimeters away in the clitoral body that can often be smashed against it during penetrative intercourse, strikes me as pedantic and a little silly.

    IV. Cultural considerations
    Trisha attributes the belief in VIO as distinct from other kinds to Freud and 20th century western misogyny. Namely, the effort to place all blame for sexual dysfunction (read: lack of instant, common VIO’s) on the woman. There is truth to this, but only as it related to the social norms and moral component. We can find this deplorable without needing to reject what might be facts of the matter. Moreover, Trisha never mentions non-western cultures. She assumes that humanity in general can be understood without ever checking other cultures to see if her predictions about the negative effect of our culture on sexual response hold true. Fortunately, some have done the cross-cultural checking, but it does not bode well for Trisha’s case.

    V. Infibulated women in the Sudan
    Women in a non-western culture without all that Freud baggage and social expectation still have VIO’s. Hanny Lightfoot-Klein (1989) described the culture as such that women must hide all sexual interest and response in order to appear chaste and modest. They must hide orgasms, or, if they can’t hide them, deny that the outburst was caused by the sex acts. Nonetheless, 90% of the 300 women interviewed said they had orgasms, some even saying “always”. We know, too, that none of these were “clitoral” orgasms, because none of these women have a clitoral glans or labia. They all have a “full pharaonic” type infibulation that involves removal of virtually all external genitalia. I am beyond astonished that women who have been so tragically mutilated can ever enjoy sex at all (many of them do not). Lightfoot-Klein is not the only report of this phenomenon, in the paper she also cited Money et al. (1955) and Verkauf (1975).

    VI. Women with spinal cord injuries experience orgasms
    The clitoris and vulva are innervated by the pudendal spinal nerve. However, in women who have no sensation in the pelvic region due to spinal cord injury, sexual response including orgasm have been documented in several papers. Komisaruk et al’s (2004) replication included fMRI brain imaging showing activation consistent with orgasm. They postulate this is possible due to the vagus nerve, a cranial, not spinal, nerve with projections in the pelvis. Several studies including that one also used as stimuli penetrative vaginal-cervical stimulation, not clitoral.

    See Sipski et al 1995a and b; Whipple et al 1996; and Komisaruk et al 2004.

    VII. The dildo problem
    Rather than asking them with a survey, a better way to understand what people like to do is to see what they spend their money on. Dildos and mechanical penetrative stimulators are a large industry. In his PhD dissertation, Robert King discussed a particularly striking case that defies Trisha’s explanations:

    [The sex shop called] Sh™  have an extensive lesbian clientele who have no motivation to pander to male egos, expectations or even existence in sexual terms. Thus they provide an interesting test of what women actually want, away from ideological constraint, voting with their wallets. A typical, although by no means universal, lesbian desire, as represented by products bought, is for penetration. For example the Fun Factory Strap-on™ provides internal stimulation for both (female) partners. If it were true that penetration in sex is something done only to pander to male egos then the existence of such toys requires explanation.

    VIII. On sensitivity and innervation

    It is argued that the vagina has little or no sensitivity, and therefore it is unlikely to be instrumental in orgasm, particularly compared to the highly sensitive clitoris. It is a fact that the vagina is not especially sensitive compared to other body parts. However, there are three reasons I think this argument is inadequate.

    Low or comparatively low is not equivalent to “sensually irrelevant”. Fingertips are far more sensitive than the skin of your back, but that doesn’t mean that sunburn or shoulder tattoo you got didn’t hurt a whole lot.

    Second, the anterior part of the vagina is substantially more sensitive than any others. There is no reason this difference should exist, if the vagina has nothing to do with sexual pleasure.

    Third, the argument represents confusion about what nerves, the body’s sensors, do. Sometimes they exist to report high-resolution information about fine detail. A blindfolded person could tell the difference between an apple and an orange just from the texture of those surfaces. But other times the sensor’s job is to deliver information about relevant events occurring. In both cases, the brain manufactures a holographic experience meant to represent the world and our interaction with it, and that is why they can be experientially compelling, even if the sensor resolution is very low.

    Consider the experience of a back itch, perhaps caused by a wayward thread or seam. You move to scratch it, and it feels so good! But wait, this can’t be true, the skin on the back has among the lowest number of sensors per area of any skin on your body. Why is this sensual experience compelling? It’s compelling because of the meaning of the signal, not its detail resolution. In this case, it is probably true that the system thinks there is a biting insect or other irritant on the back and it needs to be removed ASAP. A lush sensory experience elicits the behavior that accomplishes that.

    Sex is meaning-laden on many levels, including the social and sociological. It is partly about who is interacting with you, how, why, under what circumstances, etc.., Even a low-resolution sensory vagina can deliver important information about sexual events which may be far more meaningful than high resolution detail. Orgasm may be a psychosocial scratching of a rather different sort of itch. This may also explain why people are known to orgasm without genital touching at all. M&J 1966 mentions a long list of papers documenting fantasy-to-orgasm, and it is now well documented there is orgasm from breast touching, anal sex, and other non-genital interactions.

    Conclusion 
    In summary, I reject the resolutions because orgasm is a mental event, an experience; because there is overwhelming scientific evidence that penetrative intercourse with no other stimulation can produce orgasm; because many non-genital sexual activities result in orgasm; and because orgasm can occur from penetrative intercourse even when the clitoral glans and vulva are absent or anesthetized by injury.

    I would also like to reaffirm that none of my remarks about orgasms are or should be considered prescriptive or normative. There is high individual variation among women including orgasmic response to any and all forms of stimulation discussed here. This variation appears natural and can’t be considered anyone’s “fault”, indeed the very concept of fault is nonsensical here.

    Read Trisha Borowicz’s rebuttal to this postThe Female Orgasm Debate With Edward Clint at Skeptic Ink – My Response #1

    Cited

    Basson, Rosemary, 2001. Using a Different Model for Female Sexual Response to Address Women’s Problematic Low Sexual Desire. Journal of Sex & Marital Therapy, 27:395–403, 2001.

    Buisson, O., Foldes, P., Jannini, E., & Mimoun, S. (2010). Coitus as revealed by ultrasound in one volunteer couple. The journal of sexual medicine, 7(8), 2750-2754.

    Henrich, J., Heine, S. J., & Norenzayan, A. 2010. The weirdest people in the world?. Behavioral and brain sciences, 33(2-3), 61-83.

    Kaplan, Helen Singer, 1977. Hypoactive sexual desire. Journal of Sex & Marital Therapy 3.1: 3-9.

    Barry R. Komisaruk, Beverly Whipple, Audrita Crawford, Sherry Grimes, Wen-Ching Liu, Andrew Kalnin, Kristine Mosier, 2004. Brain activation during vaginocervical self-stimulation and orgasm in women with complete spinal cord injury: fMRI evidence of mediation by the Vagus nerves, Brain Research, Volume 1024, Issues 1–2, 22. Pages 77-88.

    Lightfoot-Klein, Hanny, 1989. The Sexual Experience and Marital Adjustment of Genitally Circumcised and Infibulated Females in the Sudan. The Journal of Sex Research. Vol. 26, No. 3, pp. 375-392.

    Money, J., et al. , 1955. Hermaphroditism: Recommendations Concerning Assignment
    of Sex, and Psychologic Management. Bulletin of Johns Hopkins Hospital, 97(4),
    284-300.

    M. Sipski, C. Alexander, R. Rosen, 1995a. Orgasm in women with spinal cord injuries: a laboratory-based assessment. Arch. Phys. Med. Rehabil., 76, pp. 1097–1102.

    M.L. Sipski, C.J. Alexander, 1995b. Spinal cord injury and female sexuality. Annu. Rev. Sex Res., 6 (1995), pp. 224–244.

    Verkauf, B. S. , 1975. Acquired Clitoral Enlargement. Medical Aspects of Human Sexuality, 9(4), 134.

    B. Whipple, C.A. Gerdes, B.R. Komisaruk, 1996. Sexual response to self-stimulation in women with complete spinal cord injury J. Sex Res., 33, pp. 231–240.

    Category: Critical ThinkingfeaturedFeatured Incscienceskepticismsocial justice

  • Article by: Edward Clint

    Ed Clint is a bioanthropology graduate student at UCLA, cofounder of Skeptic Ink, and USAF veteran.
    • Well done. I had been hoping to see a piece like this, as many hold M&J as the gold standard, even many skeptics. I like that you made it clear that there are variations in people. I’ve seen some take the approach that something must be wrong if someone with a vagina cannot have a vaginal orgasm, while others hold the belief that it’s not even possible. As you’ve shown, it’s different for different people.

      • Thank you, Cherry. I hoped to emphasize that the facts don’t, in and of themselves, determine whether society gains a healthy, sane, or compassionate attitude. In this case, it seems to be a fact that some women will readily have these sorts of orgasms and others will not (contra earlier “frigid woman” castigations).
        It’s tempting to imagine we solve the problem by correcting on the facts, but this is untrue. Even if we magically made every single person 100% knowledgeable about these facts, the misogynists among them might simply point out the relative inferiority of the clitoris to the penis (which has a near-1000 batting average) and still blame women… on the basis of the quite correct facts.

        Conversely, if we’re willing to draw a moral argument where one is required, we can object to all of these problems on the basis of the obvious harm they cause. Facts can change over time as science and research mature, but appeals to compassion and reason are perennial winners, no matter the details.

      • Hi Cherry, This is Trisha, the woman on the other side of this debate. I guess I would be on the vaginal-orgasm-might-not-be-possible side, but I only say that because the evidence thus far points to that. It doesn’t mean that vaginal penetration can’t be pleasurable or feel climactic. I completely agree with you that orgasm is different for different people, but I would argue that it is largely in terms of how people understand the experience, how they get to an orgasm, and how it subjectively feels to them. I argue, however, that saying there is a large difference among women in the physiological aspects of arousal and orgasm, is a stretch. My argument is very much about clarity of language, and it is nuanced, but I hope you have some time check out my reply. I would be very interested to hear your thoughts. **forgot to add the link http://www.sciencesexandtheladies.blogspot.com/2015/01/the-female-orgasm-debate-with-edward.html