Clitoral Stimulation Research Articles

Women’s Sexual Agency, Pleasure, and Orgasm in Popular Netflix Series: A Quantitative Content Analysis of Mixed-Gender Scenes

Media representations of sexuality can play a relevant role in the development of gender stereotypes and sexual learning processes. In the current pre-registered study, we examined the representation of sexuality in content on Netflix, a dominant force in global mass media consumption. We coded 271 mixed-gender sexual scenes across seven highly popular Netflix series for orgasm portrayal, depiction of sexual behaviors, including clitoral stimulation, and gendered sexual scripts (i.e., initiation, control, and expression of desires). Our results revealed a nuanced picture of women’s sexual pleasure representation. Women’s orgasms were depicted less frequently than men’s, although orgasm portrayal was generally rare. Sexual behaviors were mostly limited to penile-vaginal intercourse, though cunnilingus was depicted more frequently than fellatio. Regarding gendered sexual scripts, women were portrayed as equally sexually agentic as men, initiating sexual encounters, taking control, and expressing their needs and desires. Our findings indicate that this content simultaneously reinforces and challenges gender stereotypes related to sexual experiences, highlighting the need for sexual educators to critically address the realism of mainstream media portrayals to foster a nuanced understanding of sexuality and pleasure.

(118) ORGASM AND HEART RATE VARIABILITY IN FEMALE BREAST CANCER SURVIVORS: RESULTS FROM A PSYCHOPHYSIOLOGY STUDY

Abstract Introduction Over 70 % of female breast cancer survivors suffer from sexual dysfunction. Sexual dysfunction can cause great amounts of stress and negatively impact overall health and well-being. Most studies focus on sexual arousal disorders and hypoactive sexual desire disorders. The research on orgasm in this specific group is limited. A better understanding of sexual function in breast cancer patients may yield potential targets for new treatment strategies for sexual dysfunction in this population. Low heart rate variability (HRV) has been shown to be predictive of erectile dysfunction and female sexual arousal as well as orgasm frequency. Reduced HRV and low cardiac vagal tone have previously been reported in breast cancer survivors during the first year post-treatment. If HRV is a reliable indicator of female sexual dysfunction, it could be used to assess and monitor it in a clinical setting. Objectives This study aimed to explore whether there is a link between HRV and both, sexual arousal and the ability to orgasm. We were expecting to find a difference in HRV between breast cancer survivors and healthy controls as well as orgasmic and anorgasmic women. Methods Participants were prescreened during a telephone interview. We included 40 premenopausal breast cancer survivors currently on hormonal treatment with an age range of 29 to 57 years (M = 43.5, SD = 6.4) and 20 healthy controls with an age range of 22 to 35 (M = 27.6, SD = 3.2). The vaginal pulse amplitude, heart rate variability (SDNN), subjective sexual arousal and self-reported number of orgasms were assessed in response to audiovisual sexual stimuli and vibrotactile clitoral stimulation in breast cancer survivors and healthy controls. Validated patient-reported outcome measures were used to assess sexual dysfunctions (Female Sexual Function Index, Female Sexual Distress Scale − Desire/Arousal/Orgasm), sexual self-esteem (Sexual Self-Esteem Inventory-Short Form), health-related quality of life (Patient-Reported Outcomes Measurement Information System 29 (PROMIS-29) profile questionnaire). Results Breast cancer survivors showed lower sexual function, health-related quality of life, sexual self-esteem and higher sexual distress than healthy controls. Preliminary results show a difference in baseline HRV scores between healthy controls and breast cancer survivors. However, this finding is likely due to age differences between our two groups and not cancer treatment effects. We could find no apparent differences in baseline HRV between anorgasmic and orgasmic women. Further analyses on the predictive value of HRV during sexual arousal for orgasm occurrence will be conducted. Conclusions Our data did not corroborate either of our hypotheses related to baseline HRV. For the evaluation of HRV as a predictor for orgasm occurrence, further exploratory analyses will follow. More research on the physiological parameters of sexual dysfunction is needed to reveal underlying mechanisms and find targets for future therapies.

(041) SEXUAL DYSFUNCTION: A COMMON PROBLEM IN INDIVIDUALS WITH MULTIPLE SCLEROSIS

Abstract Introduction An estimated 2.8 million people worldwide are currently diagnosed with Multiple Sclerosis (MS). Moreover, cis-gender females are almost twice as likely to have the diagnosis than cis-gender males. Among the many physical symptoms secondary to MS, the ones related to the sex organs include numbness, vaginal dryness, erectile dysfunction and loss of libido, low desire, issues with lubrication, lack of sensation, difficulties with arousal, difficulties reaching orgasm and sexual pain. These symptoms are typically underreported, under diagnosed, and patients may find it difficult to address with a clinician. In addition, generalized fatigue, spasticity, muscle weakness, psychological changes, bowel and bladder dysfunction that also occur with MS can place strain on sexual relations with a partner and overall quality of life. Data suggest that 59.8% of cis gender females with MS report sexual dysfunction but only about 22.4% brought it up with a physician. Moreover, this study also found that 80% of these individuals wanted treatment for their sexual symptoms, highlighting the importance of exploring interventions for sexual dysfunction in MS patients. Objective This review investigated the options available for sexual dysfunction in cis gender females with MS. Methods Online databases such as Rutgers Library, PubMed, ScienceDirect, Cochrane Library and Google Scholar with key phrases such as “MS and endocrine symptoms” and “MS and sexual changes”, were used. Results Data suggest that several non-pharmacological interventions may be effective in decreasing the severity of symptoms related to sexual dysfunction in individuals with MS. One study investigated the effectiveness of sex therapy and found that sex therapy improved quality of life for those reporting sexual dysfunction. Another study examined the effects of physical therapy on sexual symptoms and found that practices such as pelvic floor exercises also contributed to a decrease in symptom severity. Other data, reported that mindfulness psych-education group intervention also was instrumental in improving female sexual function. Further, the use of clitoral stimulation devices also were found to be highly recommended to improve sexual effects. Finally, several pharmacologic agents have been explored such as flibanserin and sildenafil, but their effectiveness was limited in regard to sexual function. Conclusions Sexual dysfunction is a major concern for individuals with MS. In this population, there is often a sense of embarrassment or feeling ashamed. Therefore, clinicians should create an open environment for patients to bring up this topic of sexuality in order to develop a comprehensive treatment plan. Additionally, more research is needed on effective treatment options, both short and long term for MS patients dealing with sexual dysfunction. Disclosure No.

(116) SUBJECTIVE AND GENITAL SEXUAL RESPONSE IN FEMALE BREAST CANCER SURVIVORS: RESULTS FROM A PSYCHOPHYSIOLOGY STUDY

Abstract Introduction Sexual dysfunction is a prevalent concern affecting more than 70% of female breast cancer survivors, casting a substantial shadow on their quality of life. Beyond the physical impact of cancer and its treatments, the emotional and psychological toll of sexual dysfunction introduces additional challenges, amplifying stress levels and undermining overall well-being. Acknowledging the profound implications of sexual dysfunction in this group and the absence of therapies, there is an urgent need to delve deeper into the intricacies of its manifestations. Objective This study aimed to gather preliminary data on psychophysiological aspects of sexual function in premenopausal breast cancer patients undergoing antihormonal therapy and compare them with a healthy control group. Exploring sexual arousal in breast cancer patients may unveil potential targets for innovative treatment strategies to address sexual dysfunction in this population. Methods Participants were prescreened during a telephone interview. We included 40 premenopausal breast cancer survivors with an age range of 29 to 57 years (M = 43.5, SD = 6.36) on current hormonal treatment and 20 healthy controls with an age range of 22 to 35 (M = 27.55, SD = 3.19). Physiological measures (VPA and HRV), subjective sexual arousal (SSA) and self-reported orgasm were assessed in response to audiovisual stimuli and vibrotactile clitoral stimulation sexual stimuli in breast cancer survivors and healthy controls. Self-reported measures like the Female Sexual Function Index (FSFI), the Sexual Self-Esteem Inventory (SSEI) und the PROMIS29 were incorporated. Data were analyzed using 2-level mixed effect models. Results No significant differences in VPA scores were observed between healthy controls and breast cancer survivors. Both groups exhibited a greater genital response to clitoral vibrator use than to visual stimuli. Group differences emerged in SSA and HRV, with higher SSA and lower HRV being detected. Breast cancer survivors climaxed less frequently than healthy controls and had significantly lower self-reported sexual function. Conclusions Physiological measures of arousal in breast cancer survivors were comparable to healthy controls and only subjective arousal differed. This finding indicates that subjective arousal should be further explored as the focus of intervention and treatment methods for breast cancer patients experiencing sexual dysfunction. Our findings underscore the importance of tailored strategies that resonate with individual narratives, acknowledging the emotional intricacies of post-cancer sexual well-being. This study not only contributes to scientific knowledge but also calls for a compassionate and personalized treatment paradigm, enriching the landscape of survivorship care. Disclosure Yes, this is sponsored by industry/sponsor: WOW Tech GmbH Clarification: No industry support in study design or execution.

Neuroimaging evaluation of the long term impact of a novel paired meditation practice on brain function.

A growing number of advanced neuroimaging studies have compared brain structure and function in long term meditators to non-meditators. The goal is to determine if there may be long term effects on the brain from practicing meditation. In this paper, we present new data on the long term effects of a novel meditation practice in which the focus is on clitoral stimulation. The findings from such a study have implications for potential therapeutic uses with regard to various neurological or psychiatric conditions. We evaluated the cerebral glucose metabolism in 40 subjects with an extended history (>1 year of practice, 2-3 times per week) performing the meditation practice called Orgasmic Meditation (OM) and compared their brains to a group of non-meditating healthy controls (N = 19). Both meditation and non-meditation subjects underwent brain PET after injection with 148 to 296 MBq of FDG using a standard imaging protocol. Resting FDG PET scans of the OM group were compared to the resting scans of healthy, non-meditating, controls using statistical parametric mapping. The OM group showed significant differences in metabolic activity at rest compared to the controls. Specifically, there was significantly lower metabolism in select areas of the frontal, temporal, and parietal lobes, as well as the anterior cingulate, insula, and thalamus, in the OM group compared to the controls. In addition, there were notable distinctions between the males and females with the females demonstrating significantly lower metabolism in the thalamus and insula. Overall, these findings suggest that the long term meditation practitioners of OM have different patterns of resting brain metabolism. Since these areas of the brain in which OM practitioners differ from controls are involved in cognition, attention, and emotional regulation, such findings have implications for understanding how this meditation practice might affect practitioners over long periods of time.

Sexual Self-Esteem and Orgasm Consistency: Exploring the Unique Roles of Body Image and Genital Image.

We explored the unique roles that body and genital image play in behavior-specific orgasm consistency, beyond overall sexual self-esteem. US adults (N = 599; 64% women) completed questionnaires online. Hierarchical regression analyses predicted orgasm consistency during receptive oral sex and penile-vaginal intercourse (PVI) with additional clitoral stimulation (WAS) and with no additional clitoral stimulation (NAS) for the woman. Body image, genital image, and gender were entered in later steps to assess model improvement above sexual self-esteem. Models accounted for age, sexual and racial minority identities, and current relationship status. Results indicated that genital image improved all models and predicted higher orgasm consistency across all behaviors for men and women. For orgasm during receptive oral sex and PVI-NAS, sexual self-esteem was no longer significant once genital image was included. Genital image was a stronger predictor of women's versus men's orgasm during PVI-NAS; no significant gender differences were found for oral sex and PVI-WAS. Body image was not significant in any models, contrary to expectations, suggesting role overlap with sexual self-esteem. Genital image appears to play a unique role in sexual pleasure beyond overall sexual self-esteem and body image.

The Role of Partner Gender: How Sexual Expectations Shape the Pursuit of an Orgasm Goal for Heterosexual, Lesbian, and Bisexual Women

Previous research has established that gendered sexual scripts shape sexual behavior. This study seeks to expand prior work on orgasm disparities for women across sexual orientations by exploring the role of partner gender. Across two studies, we examined how the gender of women’s sexual partners influenced their orgasm goal pursuit. We compared lesbian and heterosexual women’s experience with their most recent partner in Study 1, and experimentally compared bisexual women partnered with a woman or a man in a hypothetical sexual encounter in Study 2. In both studies, women reported higher clitoral stimulation and orgasm expectations when partnered with a woman compared to a man. Moreover, partner gender had a significant indirect effect on women’s orgasm goal pursuit through clitoral stimulation and expectations for orgasm. These results suggest that sexual scripts associated with partner gender play a key role in the orgasm gap for women who have sex with men.

Alterations in cerebral glucose metabolism measured by FDG PET in subjects performing a meditation practice based on clitoral stimulation

Background The relationship between sexuality, or the libido, and spirituality or religion has long been debated in psychiatry. Recent studies have explored the neurophysiology of both sexual experiences and spiritual practices such as meditation or prayer. In the present study, we report changes in cerebral glucose metabolism in a unique meditation practice augmented by clitoral stimulation called, Orgasmic Meditation, in which a spiritual state is described to be attained by both male and female participants engaged in the practice as a pair. Methods Male (N=20) and female (N=20) subjects had an intravenous catheter connected to a bag of normal saline inserted prior to the practice. During the practice, men stimulated their partner’s clitoris for exactly 15 minutes (he received no sexual stimulation). Midway through the practice, researchers injected 18F-fluorodeoxyglucose so the scan would reflect cerebral metabolism during the practice. Positron emission tomography (PET) imaging was performed approximately 30 minutes later. Results In the female participants, the meditation state showed significant decreases in the left inferior frontal, inferior parietal, insula, middle temporal, and orbitofrontal regions as well as in the right angular gyrus, anterior cingulate and parahippocampus compared to a neutral state (p<0.01). Male subjects had significant decreases in the left middle frontal, paracentral, precentral, and postcentral regions as well as the right middle frontal and paracentral regions during meditation (p<0.01). Men also had significantly increased metabolism in the cerebellum and right postcentral and superior temporal regions (p<0.01). Conclusions These findings represent a distinct pattern of brain activity, for both men and women, that is a hybrid between that of other meditation practices and sexual stimulation. Such findings have potential psychotherapeutic implications and may deepen our understanding of the relationship between spiritual and sexual experience.

"O" no: a Reddit analysis of orgasmic dysfunction.

Female Reddit users frequently discussed potential causes of orgasm difficulties and its implications on mental health and relationships. This study aimed to evaluate the experiences of women discussing orgasms on the Internet site Reddit. We sought to qualitatively analyze the topics that arose in users' discussions to better understand the potential causes of orgasm difficulties and its implications on quality of life. Posts on the subreddit r/TwoXChromosomes containing the keywords "orgasm" and "climax" were included in the dataset. Posts and their associated comments were qualitatively analyzed using the grounded theory approach. Two independent researchers coded each thread to identify dominant themes and emergent concepts. The most frequently coded primary topics included: (1) orgasm (32.2% [n = 337]), (2) psychological (17.8% [n = 186]), (3) relationships (15.4% [n = 161]), and (4) treatment (10.7% [n = 112]). Qualitative analysis of 107 threads and approximately 6300 comments resulted in 5 major categories: psychological aspect of orgasms, difficulty orgasming with partners, partners' responses to orgasmic dysfunction, types of orgasms, and treatments for orgasmic dysfunction. Preliminary themes included (1) the presence of an emotional component or history of trauma related to orgasmic difficulty, (2) difficulty orgasming with a partner regardless of ability to orgasm during masturbation and a variety of stimulation required to orgasm, (3) mixed partner responses to orgasmic dysfunction, (4) the definition of a normal orgasm, and (5) self-motivated treatment for orgasmic dysfunction, including clitoral stimulation devices and masturbation techniques. Notably, few posters discussed their orgasmic dysfunction with healthcare providers. The study reveals insights into the possible causes, psychosocial implications, and treatment of orgasm difficulties from a patient perspective, and can guide future research on female orgasms in a more precise, patient-oriented direction. The anonymous nature of the forum allowed for insight into sensitive topics related to female orgasms and sexual trauma. Limitations include the demographic distribution of Reddit users, which was primarily younger women in their 20s and 30s, which restricts generalizability. Reddit provides a medium for individuals with orgasm difficulties to discuss their experiences. Posts addressed users' inability to orgasm, their mental health and relationships, the stimulation required for orgasm, and treatments for orgasmic dysfunction. Interestingly, very few posts discussed healthcare, potentially suggesting that women do not classify their orgasmic dysfunction as a health issue.

Gender differences in duration and location of erotic touch in mainstream heterosexual pornography

Watching mainstream porn today is a main source for men and women to learn how to behave sexually, including how to erotically stimulate one another. To date, research into the content analysis of pornography has been limited to the measurement of the frequency or prevalence of sexual behaviours or themes. In contrast, little is known regarding porn presentation of the specific location and duration of touch, vital for orgasm, pleasure, and sexual satisfaction for both women and men. Eighty “most-viewed” video clips were selected from two popular porn sites and coded for the gender of toucher/receiver, location, and duration in seconds of erotic touch. Results showed that women received significantly less genital stimulation than men overall, with this difference drastically increasing with non-penetrative erotic touch. The men in these videos received stimulation to their main sexual organ (penis) 10 times more than women received on their most sensitive sexual organ (clitoris), and the women were found to do the majority of non-reciprocal genital touch. While accurate information is widely available regarding competent erotic touch necessary for pleasure and orgasm, unbalanced and inadequate touching is still strongly represented in popular heterosexual pornography. This study elucidates how popular, freely accessible pornography is normalizing beliefs that men’s sexual touch and pleasure are primary and that clitoral stimulation is not a priority for women’s pleasure. Implications for how these normative aspects of sexual stimulation that may be leading to difficulties in sexual pleasure, orgasm, and satisfaction are discussed.

(010) Physiologic Response of the Pelvic Floor Muscles During Female Arousal and Orgasm: A Pilot Study

Abstract Introduction Current literature addressing women’s sexual health refers more to dysfunction than normal function. Though knowledge in neuroendocrinology and use of fMRIs has led to better understanding of how the brain and hormones interact with response to sexual function, there is a paucity of knowledge on arousal and orgasm from a physiological and functional perspective. In a review of physiologic measures in female sexual function, Woodward noted that, though the pelvic floor muscles activity with orgasm had been reported, more study was needed. He concluded that sexual research conducted in the clinical setting is not optimal as the modalities used for testing required investigators to be present to implement devices and interpret results; and that participants’ experience of elevated levels of anxiety, fear, or discomfort could influence the outcome. The Lioness Vibrator, designed and marketed as a consumer product to be used at the owners discretion, creates clitorally stimulated orgasms that are recorded automatically and downloaded to the user’s phone and a secure server of the manufacturer. The intra-vaginal Lioness measures the physiologic response of the pelvic floor muscles at rest and throughout arousal, orgasm, and recovery by utilizing pressure biofeedback technology paired with wireless Bluetooth capability. Clitoral stimulation is achieved using an external vibrator. With the afore mentioned capabilities, the Lioness Vibrator appears to be an effective method to measure the physiologic response of orgasm produced by a single variable, clitoral stimulation, without the restrictions associated with traditional clinical research. Objective To analyze biofeedback data through quantification of physiologic activity of pelvic floor muscles (PFMs) before, during, and after orgasm. The data was recorded by in-home users of the Lioness (“Smart Vibrator”, SmartBod Incorporated), an intravaginal, pressure biofeedback device capable of recording PFM activity at rest and in response to vibration of the glans clitoris. Methods Orgasmic and demographic data from 26 consenting Lioness users was collected by SmartBod and reviewed by the first author. One-hundred-sixty-two biofeedback tracings were included in the analysis of a) a two-minute PFM rest period prior to stimulation (gmf), b) time to orgasm (sec), c) peak force during orgasm (gmf), d) length of orgasm (sec), and e) two-minute PFM recovery (gmf). An algorithm developed by SmartBod was used to determine when orgasms occurred. Results Users ages ranged from 21 to 60; 17/26 were nulliparous. Five reported being either peri- or post-menopausal. Eleven found solo love-play less pleasurable than using the Lioness while nine thought the Lioness assisted orgasm was equal to solo stimulation. Average PFM resting tone was 40gmf (R=2-97gmf) compared to recovery at 58gmf (R=2-88gmf). Median time to reach orgasm averaged 513sec (R=27-1305sec) while length of orgasmic response was 38sec (R=19-126sec). Average peak force was 73gmf (R=17-108gmf). Conclusions This study highlights the variability in the reflexive PFM activity from rest to orgasm to recovery. It suggests there may be no “normal” arousal and orgasmic patterns but rather large ranges of average activity. Additional analysis and study are needed and recommended to continue the in-depth study of basic female orgasmic physiology and sexual function. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: SmartBod

(210) Clitoral Blood Flow After Use of Gel Containing L-Arginine and L-Citrulline

Abstract Introduction L-arginine and its precursor, l-citrulline, are two amino acids involved in the production of nitric oxide (NO); as a result, they increase blood flow and have been used to treat male sexual dysfunction (Alatas and Yagci, 2004). Some lubricants and gels contain l-arginine and are applied directly to the genital area to increase blood flow. Although these products have been evaluated subjectively through patient reports of increased warmth, arousal, and orgasm, to our knowledge, they have not been evaluated quantitatively in women. Moreover, the effect of gels combining both l-arginine and l-citrulline have not been reported in the medical literature. Objective To evaluate whether a topical gel containing l-arginine and l-citrulline increases blood flow to the clitoris. Methods Sonography of the clitoris was performed on a healthy 32-year-old volunteer before and after applying the gel externally to the vulva. The “before” scans were obtained using a neutral ultrasound gel (without l-arginine or l-citrulline). This allowed us to verify that the observations were due to the active ingredients of the gel, and not from massage associated with its application. Control images without gel could not be obtained, since acquisition of ultrasound images requires ultrasound gel in order to reduce acoustic impedance. The scans were obtained with a Philips Lumify™ ultrasound (Koninklijke Philips N.V., Amsterdam, Netherlands) with a L12-4 linear array transducer (4-12 MHz). Clitoral blood flow was assessed qualitatively (color Doppler images), as well as quantitatively (peak systolic velocity, end diastolic velocity, and resistive index of the deep artery of the clitoris). Results Blood flow to the clitoris increased after application of the gel containing l-arginine and l-citrulline at both evaluated time points. The maximum PSV of the deep artery of the clitoris also increased from 6.2 cm/s (before), to 8.6 cm/s (5 minutes) and 13.9 cm/s (15 minutes). The maximum EDV of the deep artery of the clitoris increased from 1.4 cm/s (before), to 1.7 cm/s (5 minutes) and 9.5 cm/s (15 minutes). The RI was 0.8 before and at 5 minutes. After 15 minutes, the RI decreased to 0.3, explained by a disproportional increase in EDV compared to PSV. Conclusions The results of this pilot study suggest that clitoral blood flow increases with the use of a gel containing l-arginine and l-citrulline. These findings can help clinicians inform patients with female sexual dysfunction. Difficulty achieving clitoral stimulation is a major cause of sexual dysfunction. Clinicians can use these findings to counsel patients about using gels to increase clitoral blood flow. Disclosure No

(522) Possible Role of the Sex Script in the Orgasm Gap Between Genders: How Sodomy is an Egalitarian Practice

Abstract Introduction The orgasm gap between genders is found in scientific and generalist literature: men, of all sexual orientations, report reaching orgasm during nearly 90% of sexual intercourses, while heterosexual women only achieve orgasm during 65% of intercourse. Objective We want to demonstrate that the sexual script of penis/vagina penetration is anatomically less satisfactory than anal penetration, and carries risks for women: unwanted pregnancy, iatrogenic risks of contraception We want to highlight, that in terms of gender, this script is unequal, while during sodomy, role can be exchanged, with the help of a dildo, the man can discover his passivity, and no longuer submit to the erection's performance. Methods Literature review: -we introduced the words “orgasm gap” on PubMed for the last five years -press articles Results We have found only four survey about the orgasm gender gap on PubMed When the women can't achieve orgasm, they are generally advised clitoral stimulation During the consultation we hear the women say: I do not feel anything during vaginal penetration, indeed the vaginal mucosa is weakly innervated, and vagina does not have sphincters, which decreases the sensation after childbirth. Conversely the anal region and the rectal mucosa are strongly innervated. Conclusions Sodomy requires learning as sport or music. This learning can cause unpleasant sensations, but when the technique is acquired, as for sport or music, the pleasure is deep intense and continuous. We do not stop sport or music because of aches and pains of the beginner. Sodomy is egalitarian, that can be practiced by all genders, bringing intense pleasure, too often reserved for initiates, and therefore we can say that sodomy is sacred, leaving to the laymen the few orgasmic tremors obtained painfully by external stimulation of the penis or the clitoris. Disclosure No

Hormone-dependent sexual responses of female mice in response to manual genital stimulation

Although copulatory behavior is thought to have a strong innate basis in mice, there is also clear evidence that sexual experience shapes its expression. Reinforcement of behavior through rewarding genital tactile stimulation is a primary candidate mechanism for this modification. In rats, manual tactile clitoral stimulation is rewarding only when it is temporally distributed, which is hypothesized to result from an innate preference for species-typical copulatory patterning. Here we test this hypothesis using mice, which have a temporal copulatory pattern which is distinctly less temporally distributed than that of rats. Female mice received manual clitoral stimulation which was either temporally continuous every second, or stimulation which was temporally distributed, occurring every 5 s, This pattern of stimulation was paired with environmental cues in a conditioned place preference apparatus to assess reward. Neural activation in response to this stimulation was evaluated by measuring FOS immunoreactivity. Results indicated that both temporal patterns of clitoral stimulation were rewarding, but that continuous stimulation better reproduced brain activation associated with sexual reward. Furthermore, continuous, but not distributed stimulation elicited a lordosis response in some females, and this response increased within and across days. Sexual reward, neural activation and lordosis resulting from tactile genital stimulation were eliminated by ovariectomy and restored with combined 17β-estradiol and progesterone treatment but not 17β-estradiol treatment alone. These observations are consistent with the hypothesis that sexual reward resulting from species-typical genital tactile stimulation has a permissive effect on copulatory behavior of female mice.

A Feminist Sexology Perspective on the Multifunctional Clitoris: Dispelling the Sole Purpose Myth

The imposition of gender hierarchy has stigmatized and distorted knowledge about the clitoris. In instances when educators and activists resist the status quo by acknowledging and attempting to celebrate the clitoris, they often assert that the clitoris’s sole function is sexual pleasure. Though recognizing the clitoral role in pleasure supports liberatory progress, the sole function premise is inaccurate. The clitoris has multiple functions. The clitoris receives and transmutes sensation into sexual response psychophysiology: desire, arousal, plateau, orgasm, and resolution. Thus, together with the clitoris’s significant role in pleasure, it also functions in bodily protection and safety. Clitoral stimulation can reasonably be acknowledged as a prophylactic health behavior. The clitoris has reproductive functions as well. The clitoris supports reproduction while simultaneously fully functioning outside of reproductive sexuality, i.e., penile vaginal intercourse. The gendered lens through which we view the clitoris had hidden this sexual knowledge. Patriarchal cultures have not been able to conceptualize sexual pleasure, sexual safety, and freedom to participate (or not) in reproductive sexuality as characteristics that might co-occur for women as a sociopolitical identity, be they cisgender, transgender, or intersex women. This article presents evidence of simultaneous clitoral functionality in all these realms.

The complexity of female orgasm and ejaculation.

The anatomy and physiology of the female orgasm are often neglected. The female orgasm is a normal psychophysiological function to all women, and some even can achieve ejaculation as part of the normal physiological response at the height of sexual arousal. The complexity of female sexuality requires a deep understanding of genital anatomy. The clitoris is the principal organ for female pleasure. The vaginal stimulation of the anterior vaginal wall led women to orgasm due to the stimulation of the clitourethrovaginal complex and not due to stimulation of a particular organ called the G spot in the anterior distal vaginal wall. Female ejaculation follows orgasm. It consists of the orgasmic expulsion of a smaller quantity of whitish fluid produced by the female prostate. Squirting can be differentiated from female ejaculation because it is the orgasmic transurethral expulsion of a substantial amount of diluted urine during sexual activity, and it is not considered pathological. The female orgasm is influenced by many aspects such as communication, emotional intimacy, long-standing relationship, adequate body image and self-esteem, proper touching and knowledge of the female body, regular masturbation, male sexual performance, male and female fertility, chronic pain, and capacity to engage in new sexual acts. Stronger orgasms could be achieved when clitoral stimulation, anterior vaginal wall stimulation, and oral sex is involved in the same sexual act.

‘Pleasure with a purpose’: datafication and a phallocentric logic to sexual pleasure in the Lioness vibrator

ABSTRACT The Lioness vibrator is a so-called ‘smart vibrator’, as the vibrator is equipped with biosensors that measure the contractions of the pelvic floor muscles and the intensity of the clitoral motor. The vibrator is sold with the explicit goal for users to learn more about their sexual pleasure. In this article, I will argue that the assumed neutral perspective of knowledge production through datafication can be understood as a phallocentric perspective on sexual pleasure. In the Lioness, this logic can be seen in the way its design privileges quantitative knowledge over qualitative knowledge and logos over pathos while centring penetration and clitoral stimulation. Furthermore, the focus of the Lioness on improving your orgasm turns sexual pleasure into a phallocentric goal-oriented activity. I will show how well-meaning companies using a feminist predicate are unintentionally still privileging phallocentric ways of thinking about sexual pleasure over alterative ways of thinking.

Alterations in cerebral glucose metabolism measured by FDG PET in subjects performing a meditation practice based on clitoral stimulation

Background: The relationship between sexuality, or the libido, and spirituality or religion has long been debated in psychiatry. Recent studies have explored the neurophysiology of both sexual experiences and spiritual practices such as meditation or prayer. In the present study, we report changes in cerebral glucose metabolism in a unique meditation practice augmented by clitoral stimulation called, Orgasmic Meditation, in which a spiritual state is described to be attained by both male and female participants engaged in the practice as a pair. Methods: Male (N=20) and female (N=20) subjects had an intravenous catheter connected to a bag of normal saline inserted prior to the practice. During the practice, men stimulated their partner’s clitoris for exactly 15 minutes (he received no sexual stimulation). Midway through the practice, researchers injected 18F-fluorodeoxyglucose so the scan would reflect cerebral metabolism during the practice. Positron emission tomography (PET) imaging was performed approximately 30 minutes later. Results: In the female participants, the meditation state showed significant decreases in the left inferior frontal, inferior parietal, insula, middle temporal, and orbitofrontal regions as well as in the right angular gyrus, anterior cingulate and parahippocampus compared to a neutral state (p<0.01). Male subjects had significant decreases in the left middle frontal, paracentral, precentral, and postcentral regions as well as the right middle frontal and paracentral regions during meditation (p<0.01). Men also had significantly increased metabolism in the cerebellum and right postcentral and superior temporal regions (p<0.01). Conclusions: These findings represent a distinct pattern of brain activity, for both men and women, that is a hybrid between that of other meditation practices and sexual stimulation. Such findings have potential psychotherapeutic implications and may deepen our understanding of the relationship between spiritual and sexual experience.

Improvement in the Ability to Orgasm after the Non-Surgical Lysis Procedure for Clitoral Adhesions

ABSTRACT Introduction Clitoral stimulation is an essential component of the orgasm experience for many women during sexual intercourse. Stimulating the clitoris indirectly stimulates other parts of the genital area, including the vagina, and ultimately affects the ability to have an orgasm experience. In a 2017 study looking at women's experiences with genital touching, sexual pleasure, and orgasm by Herbenick et al, 36.6% of women noted clitoral stimulation was necessary for orgasm and another 36% of women indicated that even though clitoral stimulation was not required it did make orgasms feel better. Clitoral adhesions (CA) can be associated with the inability to reach orgasm with clitoral stimulation. CA occur when the prepuce adheres to the glans clitoris leading to discomfort, hypersensitivity/hyposensitivity, and chronic vulvodynia. Two lysis of CA treatment modalities exist - one surgical procedure and one non-surgical office-based procedure that stretches the preputial tissue open. There are no studies that explore the ability of the non-surgical lysis of CA procedure to improve a woman's ability to achieve orgasm with external clitoral stimulation. Objective The aim of this study is two-fold: 1) to evaluate the characteristics of women who were not able to orgasm with external clitoral stimulation prior to the non-surgical lysis of CA procedure and 2) to evaluate patient satisfaction and outcomes of the non-surgical lysis of CA procedure in these same women. Methods 61 women who have been treated for CA using the non-surgical lysis procedure at one sexual medicine practice from 2017-2021 were identified using an IRB-approved retrospective chart review. An online survey was sent to these patients to evaluate the efficacy of the procedure in improving pain and sexual functioning, as well as patient satisfaction with the procedure. Results 41 women participated in the study (67% response rate) and 16 (39%) of them could not achieve orgasm with external clitoral stimulation prior to the non-surgical lysis of CA procedure. Of those 16 women who could not achieve orgasm from external clitoral stimulation, 6 (38%) were able to do so after the non-surgical lysis of CA procedure. Of these 6 women prior to the procedure, 67% had a diagnosis of vulvodynia/vestibulodynia, 67% reported discomfort or pain during sexual activity that involves physical touch of the vulva, and 83% reported lack of clitoral sensation. Unfortunately, 50% of these women who were able to orgasm with clitoral stimulation after the procedure did lose this ability over time. Nonetheless, 83% were extremely satisfied with the procedure and 100% would recommend it to a friend who also had CA. Conclusions The non-surgical lysis of CA procedure may be a worthwhile option for women who are unable to achieve orgasm with external clitoral stimulation. Of note, many of these women with CA who were unable to orgasm with clitoral stimulation also had pain or discomfort with sexual intercourse which may exacerbate the problem. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Sprout (Raleigh, NC), Absorption Pharmaceuticals

Lysis of Clitoral Adhesions Should be in the Scope of a Urologist's Care

ABSTRACT Introduction Clitoral phimosis occurs when the prepuce adheres to the glans clitoris. Similarly, penile phimosis occurs when the prepuce adheres to the glans penis. Symptoms of clitoral phimosis can include pain, difficulty with arousal, and muted or absent orgasm. While previous studies on the prevalence of clitoral phimosis in a group of 589 college students in a health clinic was 33%, and in a population of 614 patients with sexual dysfunction, it was 23%. While the treatment of penile phimosis is widely practiced by urologists, training on the diagnosis and treatment of clitoral phimosis is lacking. Lysis of clitoral phimosis is a minimally invasive, office-based procedure to stretch the preputial tissue. Lysis of clitoral phimosis can be performed with a topical anesthetic or nerve block of the dorsal nerve of the clitoris. A fine Jacobsen mosquito forceps can then be used to separate the plane between the prepuce and the glans clitoris. Following the procedure, patients are instructed to pull back the prepuce at least once daily to prevent re-adherence. Objective To determine the efficacy and patient satisfaction of the office-based lysis of clitoral phimosis procedure and to demonstrate that diagnosing and treating clitoral phimosis should be in the scope of a urologist's practice. Methods Survey responses from 41 females who underwent the lysis procedure for clitoral phimosis from one sexual medicine practice. The survey was sent to 61 patients and 41 responded (67% response rate). Results Among participants who reported pain as a symptom of phimosis (n=25), 76% saw an improvement in pain, with 44%, 28%, and 4% reporting significantly, moderately, or slightly improved pain. Among those who reported difficulty with arousal before the procedure (n=40), 62.5% saw improvement, with 25%, 25%, and 12.5% considering it to be significantly, moderately, or slightly easier to become aroused. Among those who reported difficulty achieving orgasm before the procedure (n=39), 64% saw improvement, with 25.6%, 17.9%, and 20.5% reporting that they found it significantly, moderately, or slightly easier to achieve orgasm. Of the women that could not orgasm before the procedure (n=16), 6 were able to afterward. All women who reported the ability to orgasm from external clitoral stimulation maintained this ability after the procedure (n=24). 92.7% (n=41) would recommend the procedure to a friend who had phimosis. Conclusions These findings show that most patients reported improvement in their pain and sexual function, and no patient reported loss of functioning or worsening of symptoms. The lysis procedure should be recognized as a treatment for pain and sexual dysfunction associated with clitoral phimosis. Since urologists are trained in procedural management of male preputial disorders, urologists are uniquely positioned to also routinely manage clitoral phimosis. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Sprout (Raleigh, NC), Absorption Pharmaceuticals