It's been decades since the sexual revolution but many women remain anxious in bed because they're worried they're not having the right kind of orgasm, some leading sex therapists say.
The anxiety is based on the notion that women can experience distinct types of orgasms, including vaginal orgasms and clitoral orgasms.
It's long been a popular idea that a vaginal orgasm is desirable because it's supposed to be more intense and because it's more likely to occur during intercourse with a partner.
But the notion there is a distinct 'vaginal orgasm' that is different to any other kind of orgasm is incorrect, many say.
(A recent paper on the subject also dismissed this notion.)
Sexologist and author Dr Vivienne Cass says the bulk of research suggests there is only one 'orgasm response' in women.
"There's not a separate thing called a vaginal orgasm," says Cass, adjunct associate professor in Curtin University's department of public health sexology program.
"I would say there's not a vaginal orgasm, there's not a clitoral orgasm, there's physiologically just one orgasm response. But there are many different ways women can experience that – where they feel it, what they feel, what they feel about it. And there are women who can have an orgasm without being touched at all."
Rosemary Coates, also an associate professor in sexology at Curtin University and past president of the World Association for Sexual Health, agrees and says for the past 40 years she's taught that orgasms are triggered through the clitoris.
"However, there are physiological changes that take place in the vulva including the vagina and the uterus. Some women feel the rhythmic spasms in these areas during orgasm."
But if women want to call certain orgasms vaginal orgasms, some experts have no problem with it.
"I think we should stop having these distinctions because it's just academic verbal bandying really," says NSW president of the Society of Australian Sexologists and former GP Dr Margaret Redelman. "In the practical sense of helping women enjoy their sexuality, we create a problem. Women say 'I'm not having orgasms the right way' and I think that's very damaging."
Clitoris is more than meets the eye
The term vaginal orgasm has been used to describe the orgasm some women have when they are receiving stimulation only from penetration of the vagina.
Some women report that this orgasm feels different from the orgasm they have when they are stimulated more directly through the external part of their clitoris, the glans, which sits a small distance above the entrance to the vagina.
It used to be thought this so-called "magic button" – that contains around 6,000 to 8,000 nerve endings and is highly pleasurably when touched the right way – was the entire clitoris.
But since the late 1990s, it's been known that the clitoris is actually much larger; the glans is just the external tip but there is other tissue that extends deeper inside the body, and wraps around the vagina and the urethra, the tube through which urine passes from the bladder to the outside.
Both the internal and external parts of the clitoris are made of erectile tissue which swells with blood when a woman is aroused.
So being able to have an orgasm through penetration of the vagina alone does not mean there is no involvement of the clitoris.
Yes, yes, yes
Both Cass and Redelman believe the vagina itself is not a very sensitive organ and say it has relatively few nerve endings. But certain sex positions can enhance clitoral stimulation.
Also, Cass says "there are short ligaments that join the clitoral hood [the fold of skin surrounding the glans] to the vulva, so when the vulva's being incidentally moved during penetration, that is actually stimulating the glans of the clitoris."
She adds that some women find the pressure of intercourse, both on the vaginal walls and through the walls onto the internal parts of the clitoris and other tissues, perhaps including the cervix, is enough to bring them to orgasm.
"But when we talk about clitoral stimulation, usually people are talking about touching on the outside of the body and the truth is most women do need that."
Redelman agrees women vary greatly in their sensitivity to sexual stimuli: "Some women can be sitting on the bus on the way to work and flex their thighs and have an orgasm."
I'll have what she's having
Many now see the distinction between a 'vaginal' and a 'clitoral' orgasm as artificial and unhelpful.
Cass says research and surveys suggests only around 30 per cent of women can orgasm "just through penetration of some sort" but she believes this may be an overestimate because some of the studies were not high quality.
Says Coates: "The myth of a vaginal orgasm was based on [psychoanalyst Sigmund] Freud's rather misogynistic views on women's sexuality. Up until the 1960s, various 'experts' assumed that women who did not experience an orgasm during vaginal intercourse were immature.
"In fact, when the anatomy of the vulva is clearly understood [along with] the biomechanics of the sex act, particularly in heterosexual 'missionary' position, one can easily see how a lack of appropriate stimulation of the clitoris will result in difficulty in obtaining orgasm."
Nonetheless the quest to climax during sexual intercourse remains.
"Women come to me and say they can't orgasm," says Cass. "But then I find out they actually can very easily have an orgasm, they just aren't having one during intercourse. That pressure is there."
"Some people are fixated on this: 'My partner has to have an orgasm through intercourse'," Redelman says. "But of course that kind of pressure actually almost guarantees that she's not going to do it."
Both she and Cass believe couples can be taught ways to provide extra stimulation during intercourse. But focusing too much on this can be harmful.
"The primary thing is to enjoy lovemaking," Redelman says. "The brain is the biggest sex organ. If you're doing things together that give you sexual arousal... to me that's perfect lovemaking.
"I think we should just let women be different, be individuals. However they arrive at orgasm, that's the right way to do it for them."
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