Science should start taking orgasm seriously

UPDATE! An edited version of this blog has been published on The Guardian's website

A few months ago, I got interested in the science of orgasm and anorgasmia (difficulty or inability to orgasm). I even thought of it as a potential focus for my DPhil. Unfortunately that hasn't come to fruition, partly because almost nobody is doing research on it, especially at my university, so I was unable to find an appropriate supervisor. I hope to keep looking at the science of orgasm and anorgasmia as a side-project during my DPhil.

Over these months, I've had two main reactions when I've brought this up with people. Some, mostly non-scientists, react with surprised and positive enthusiasm. Others, mostly scientists, are bemused, sceptical, and think I'm joking. But (for once) I am quite serious, and I think science should start taking orgasm seriously too.

Orgasm and anorgasmia are significant to people's lives

Firstly, orgasm and sexual pleasure are fun, and not all scientific research has an "important purpose"1, so an immediate question is "why not study orgasm?". But throughout this post I'll mostly focus on the significance of tackling anorgasmia.

It affects a lot of people

A significant percentage of (cisgender) women experience anorgasmia, as do a smaller number of (cisgender) men2. Anorgasmia can also be caused or worsened by other circumstances:

  • Sex reassignment surgery can have an effect on orgasm including sometimes anorgasmia.3
  • Various injuries and diseases can cause anorgasmia.4
  • People who have had their prostates removed have a very high rate of anorgasmia.5
  • People taking medicine for mental health issues, such as the common class of anti-depressants SSRIs, have a very high rate of sexual dysfunction as a side effect, including anorgasmia.6

It has links to mental health issues

Anorgasmia can be caused or worsened by mental health issues such as anxiety7, as well as by their treatments as mentioned above. But the link goes both ways: anorgasmia is only considered a disorder when it causes "distress" to the sufferer. It can contribute to self-esteem issues and to depression and anxiety. It can also have a negative effect on relationships, which can contribute to stress and have a knock-on effect on mental health issues.

Now, if someone is experiencing anorgasmia, whether it's related to other health issues or just getting in the way of their pleasure, they might go to the doctor about it. Now, there are some things that can be suggested. But often there is not much that can be said, for the very reason that we don't really understand understand how orgasm works, so it's very difficult to get it to work when things are not going right. And since we don't understand exactly what happens when things go right, there is a risk of being told something is wrong when it's not, or vice versa, which can be dangerous. Often the only way to turn is towards anecdotal advice, which is often wrong and can do more harm than good.

There is going to be a problem until we start taking it seriously

There is a big and potentially dangerous industry built around anorgasmia

Orgasms are big business. There are countless books, blogs, and magazine articles on how to experience and improve orgasms. People have whole careers going around talking about how to tackle anorgasmia. Sex toys are designed, built, and sold with this selling-point. "Alternative medicines" are sold on this basis, and drugs are sold through back-channels with claims of improving ability to experience orgasm.

Some of this is great. Some of it is potentially dangerous to physical and mental health. Some of it is based on outdated cultural ideas passed off as biology. The trouble is that in many cases it's very difficult to tell what's doing good and what's doing harm because there is so little quality scientific research on the topic.

Much of the science that is done on orgasm is unhelpful

With something like sexual pleasure it can be difficult to distinguish between biological effects and psychological effects (which can be heavily affected by culture). Much scientific research on orgasm and anorgasmia draws heavily on cultural ideas which go back to Freud rather than on modern physiology and other biological sciences. They also draw heavily on anecdotal evidence, failing to account for the cultural-psychological influences that may be at play. The result is that what sparse scientific literature there is on the physiology of orgasm tends to be inconsistent and unreliable.

This poor science only adds confusion and lends weight to misleading claims made by people trying to make a profit.

A more promising (but still tiny) branch of research on orgasm has taken a neuroscience perspective. I have encountered research and data sets acquired by taking MRI scans of people experiencing orgasm. But in every such study that I have seen, the subjects has been (cisgender) men, a group affected by anorgasmia disproportionately rarely.

This science is lacking the correct focus to start addressing the most pressing issues at hand.

What is the way forward?

I don't really know. My attempt to jump in and save the world from anorgasmia has been stymied for now. But here are some things I would suggest that might improve the situation a tiny bit.

  • Human physiologists, neuroscientists, and others should use their expertise to study orgasm from "basic principles". Divorce our cultural and acquired ideas about orgasm from our scientific approach, and treat it like a poorly-understood biological process. Then apply the scientific expertise and rigour that would be applied to any other biological problem.
  • Do research on women. This will lead to more relevant and useful insights than research geared exclusively towards understanding orgasm in (cisgender) men (or, even worse, mice).
  • Develop models which connect what we know about the physiology of orgasm with what we know about the neuroscience of orgasm.
  • Do more to distinguish between cultural and biological factors. Papers which treat anecdotes as biological fact should never pass the editorial and review processes to reach publication.

I will occasionally blog about this topic with updates on my own side projects in orgasm science. My current project is looking at a way of distinguishing between cultural and biological factors in sexual pleasure.

If you'd like to discuss any of this with me or collaborate, email me on jimi.cullen@new.ox.ac.uk or contact me on Twitter at @jiim_e.

  1. G. H. Hardy gave a defence of this idea in A Mathematician's Apology. At time of writing, a PDF of A Mathematician's Apology is available for free as it has entered the public domain.

  2. Rosen, Raymond C. "Prevalence and risk factors of sexual dysfunction in men and women." Current Psychiatry Reports 2.3 (2000): 189-195.

  3. Two sources which discuss this are Lief, Harold I., and Lynn Hubschman. "Orgasm in the postoperative transsexual." Archives of sexual behavior 22.2 (1993): 145-155 and Lawrence, Anne A. "Sexuality before and after male-to-female sex reassignment surgery." Archives of sexual behavior 34.2 (2005): 147-166. Thankfully these both suggest a positive outlook in terms of sexual satisfaction for people who have undergone sexual reassignment surgery (SRS), but this is despite impact on physical aspects of orgasm (possibly compensated for by greater happiness and comfort). An understanding of orgasm would improve our abilities to prevent the introduction of anorgasmia with SRS and outcomes could be even more positive.

  4. Sipski, Marca L., Craig J. Alexander, and Raymond Rosen. "Sexual arousal and orgasm in women: effects of spinal cord injury." Annals of Neurology 49.1 (2001): 35-44.

  5. Barnas, Jennifer L., et al. "The prevalence and nature of orgasmic dysfunction after radical prostatectomy." BJU international 94.4 (2004): 603-605.

  6. Montejo, Angel L., et al. "Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter study of 1022 outpatients." Journal of Clinical Psychiatry 62 (2001): 10-21.

  7. Najafabady, Mitra Tadayon, Zahra Salmani, and Parvin Abedi. "Prevalence and related factors for anorgasmia among reproductive aged women in Hesarak, Iran." Clinics 66.1 (2011): 83-86.

(NB: I am working on adding more references and notes to this post. If you'd like a reference on a particular topic, get in touch, otherwise check back for the latest updates).