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Orgasm (from Greek orgasmos, from organ to mature, swell, also sexual climax) is the peak of the plateau phase of the sexual response cycle, characterized by an intense sensation of pleasure.[1][2] Experienced by males and females, orgasm is controlled by the involuntary, or autonomic, limbic system, and is accompanied by quick cycles of muscle contraction in the lower pelvic muscles, which surround the primary sexual organs and the anus.[1] Orgasms are often associated with other involuntary actions, including muscular spasms in multiple areas of the body, a general euphoric sensation and, frequently, body movements and vocalizations are expressed.

Orgasm is an autonomic physiologic response to sexual stimulation. Brain wave patterns have shown distinct changes during orgasm, which indicate the importance of the limbic system in the orgasmic response.[1] In humans, orgasms usually result from the stimulation of the penis in males and the clitoris in females.[1] Stimulation can be by self (masturbation) or by a partner (sexual intercourse, oral sex, mutual masturbation, etc.). Partners simultaneously stimulating each other's sex organs by mutual masturbation, penetrative intercourse, or other rhythmic inter-genital contact may experience simultaneous orgasms.

The period after orgasm (known as a refractory period) is often a relaxing experience, attributed to the release of the neurohormones oxytocin and prolactin.[3] Male and female brains demonstrate similar changes during orgasm (by partner controlled orgasm), with brain activity scans showing a temporary decrease in the metabolic activity of large parts of the cerebral cortex with normal or increased metabolic activity in the limbic areas of the brain.[4]
Achieving orgasm

In men, the most common way of achieving orgasm is by the stimulation of the penis; in women, it is the stimulation of the clitoris.[1][5][6][7] Such stimulation can be achieved from a variety of activities. In men, sufficient stimulation can be achieved during vaginal or anal sexual intercourse, oral sex (fellatio), or by masturbation. This is usually accompanied by ejaculation. In women, orgasm may be achieved during vaginal sexual intercourse, oral sex (cunnilingus), masturbation, or other non-penetrative sex, and may be by the use of a sensual vibrator or an erotic electrostimulation, besides other activities. Orgasm may also be achieved by stimulation of the nipples, uterus, or other erogenous zones. In addition to physical stimulation, orgasm can be achieved from psychological arousal alone, such as during dreaming (which may be a nocturnal emission).[5]

Important in sexual stimulation are internal glands, called the Skene's glands in women and the prostate in men, two homologous structures. In common use, the term G-Spot refers to these areas.
Orgasm control

Orgasm control by self, or by a partner, is managing the physical stimulation and sensation connected with the emotional and physiologic excitement levels. Through the practice of masturbation, individuals can learn to develop control of their own body's orgasmic response and timing. In partnered stimulation, either partner can control his or her own orgasmic response and timing. With mutual agreement, either partner can similarly learn to control or enhance his or her partner's orgasmic response and timing. Partner stimulation orgasm techniques referred to as mutual masturbation or orgasm control can be learned and practiced focused on either partner to refine the control of orgasmic response of the other. Partners choose which is in control or in response to the other during mutual masturbation. By learning and practice of the shared orgasmic response between partners, orgasm control can be expanded.

Orgasm control is most effectively practiced first by self masturbation, then by partnered non-simultaneous mutual masturbation. A regular practice of mutual masturbation with partner controlled orgasmic response can improve both learned orgasm control and orgasm expansiveness for any sexual interaction. Practiced orgasm control can improve male or female orgasm experience and can improve male ejaculation control. Regular practice of partnered orgasm control allows learning, refining and expanding the orgasmic response of both partners. Techniques stimulating orgasm in either gender include manual genital stroking and/or a vibrator for self stimulation in masturbation. This can be shared with a partner observing or the stimulation can be controlled by a chosen partner of any gender. An example of a safer sex consensual partner manually stroking orgasmic control technique is described in expanded orgasm. Practiced mindful orgasmic control techniques can help learning, enhancing, and extending our body's natural limbic system orgasmic response. The practice of orgasm control applies to female and male masturbation and any gender partnered combinations. Practiced orgasm control improves learned and natural orgasmic response in most sexual interactions.
Female orgasm

Discussions of female orgasm are complicated by the fact that, perhaps artificially, orgasm in women has sometimes been labeled as two different things: the clitoral orgasm and the vaginal orgasm.

The concept of vaginal orgasm as a separate phenomenon was first postulated by Sigmund Freud. In 1905, Freud stated that clitoral orgasm was purely an adolescent phenomenon, and upon reaching puberty the proper response of mature women was a change-over to vaginal orgasms, meaning orgasms without any clitoral stimulation. While Freud provided no evidence for this basic assumption, the consequences of this theory were considerable. Many women felt inadequate when they could not achieve orgasm via vaginal intercourse alone, involving little or no clitoral stimulation, as Freud's theory made man's penis central to a woman's sexual satisfaction.[8]

In contrast to Freud's thoughts, most women can only achieve orgasm through clitoral stimulation.[1][5][6][7] The clitoris surrounds the vagina somewhat like a horseshoe,[5] and has "legs" that extend along the vaginal lips back to the anus.[9] The urethral sponge runs along the "roof" of the vagina, and it can be stimulated through the vagina, but the vagina itself is considered to have no mechanism to stimulate pleasure or orgasm for women.[5] Negating clitoral legs, only one part of the clitoris, the urethral sponge, is in contact with the penis, fingers, or a dildo in the vagina. "The tip of the clitoris and the inner lips, which are also very sensitive, are not receiving direct stimulation during intercourse."[5] The Gräfenberg Spot, or G-Spot, is a small area behind the female pubic bone surrounding the urethra and accessible through the anterior wall of the vagina. The size of this spot appears to vary considerably from person to person. Such an orgasm is referred to as "vaginal," because it results from stimulation inside the vagina.

In 1966, Masters and Johnson published pivotal research about the phases of sexual stimulation.[10] Their work included women and men, and unlike Alfred Kinsey earlier (in 1948 and 1953), tried to determine the physiological stages before and after orgasm. Masters and Johnson observed that both clitoral and vaginal orgasms had the same stages of physical response. They argued that clitoral stimulation is the primary source of both kinds of orgasms.[11] Likewise, recent discoveries about the size of the clitoris show that clitoral tissue extends some considerable distance inside the body, around the vagina. This discovery may possibly invalidate any attempt to claim that clitoral orgasm and vaginal orgasm are two different things.[6] The link between the clitoris and the vagina reinforces the idea that the clitoris is the 'seat' of the female orgasm. It is now clear that clitoral tissue is far more widespread than the small visible part most people associate with the word. The main researcher of the studies, Australian urologist Dr. Helen O'Connell, asserts that this interconnected relationship is the physiological explanation for the conjectured G-Spot and experience of vaginal orgasm, taking into account the stimulation of the internal parts of the clitoris during vaginal penetration.[6] "The vaginal wall is, in fact, the clitoris," said O'Connell. "If you lift the skin off the vagina on the side walls, you get the bulbs of the clitoris – triangular, crescental masses of erectile tissue." The idea had been that the clitoris is more than just its glans – the "little hill".[6] It is possible that some women have more extensive clitoral tissues and nerves than others, and therefore whereas many women can only achieve orgasm by direct stimulation of the external parts of the clitoris, for others the stimulation of the more generalized tissues of the clitoris via intercourse may be sufficient.[6]

Women's orgasms have been estimated to last, on average, approximately 20 seconds,[12] and to consist of a series of muscular contractions in the pelvic area that includes the vagina, the uterus and the anus. For some women, on some occasions, these contractions begin soon after the woman reports that the orgasm has started and continue at intervals of about one second with initially increasing, and then reducing, intensity. In some instances, the series of regular contractions is followed by a few additional contractions or shudders at irregular intervals. In other cases, the woman reports having an orgasm, but no pelvic contractions are measured at all.[13]
Anal stimulation

In both sexes, pleasure can be derived from the nerve endings around the anus and the anus itself, such as during anal sex. The clitoris has "legs" that extend along the vaginal lips back to the anus,[9] which can increase pleasure through anal stimulation in women. Some men can achieve an orgasm through prostate stimulation alone.[14] This can result in pleasurable sensations and can lead to an orgasm in some cases. The prostate is located next to the rectum and is the larger, more developed[15] male homologue to the Skene's glands, which are believed to be connected to the female G-spot.[16] Jack Morin has claimed that "anal orgasm" has nothing to do with the prostate orgasm, although the two are often confused.[17]
Breast and nipple stimulation

In some women, stimulation of the breast area during sexual intercourse and foreplay, or just the simple act of having their breasts fondled, has created mild to intense orgasms. This is called a "breast orgasm" because it is an otherwise normal orgasm (the pelvic region), but one that is triggered from the stimulation of a woman's breast.[18] Most women do not experience this effect when the breasts are stimulated. According to one study that questioned 213 women, 29% of them had experienced a breast orgasm at one time or another.[19] An orgasm is believed to occur in part because of the hormone oxytocin, which is produced in the body during sexual excitement and arousal. It has also been shown that oxytocin is produced when a man or woman's nipples are stimulated and become erect.[20]
Spontaneous orgasms

Orgasms can be spontaneous, seeming to occur with no direct stimulation. Occasionally, orgasms can occur during sexual dreams (see nocturnal emission).

The first orgasm of this type was reported among people who had spinal cord injury (SCI). Although SCI very often leads to loss of certain sensations and altered self-perception, a person with this disturbance is not deprived of sexual feelings such as sexual arousal and erotic desires. Thus some individuals are able to initiate orgasm by mere mental stimulation.

Some non-sexual activity may result in a spontaneous orgasm. The best example of such activity is a release of tension that unintentionally involves slight genital stimulation, like rubbing of the seat of the bicycle against genitals during riding, exercising, when pelvic muscles are tightened.

It was also discovered that some anti-depressant drugs may provoke spontaneous climax as a side effect.[21] There is no accurate data for how many patients who were on treatment with antidepressant drugs experienced spontaneous orgasm, as most were unwilling to acknowledge the fact.
Involuntary orgasms

Orgasms can happen as the result of forced sexual contact as during rape or sexual assault, and are often associated with feelings of shame caused by internalization of victim-blaming attitudes.[22][23] The incidence of those who experience unsolicited sexual contact and experience orgasm is very low, though possibly underreported due to shame or embarrassment. Involuntary orgasms can happen regardless of gender.[24]
Multiple orgasms

In some cases, women, or less often men,[25] either do not have a refractory period or have a very short one and thus can experience a second orgasm, and perhaps further ones, soon after the first. After the first, subsequent climaxes may be stronger or more pleasurable as the stimulation accumulates. For some women, their clitoris and nipples are very sensitive after climax, making additional stimulation initially painful.

It is possible for a man to have an orgasm without ejaculation (dry orgasm) or to ejaculate without reaching orgasm. Some men have reported having multiple consecutive orgasms, particularly without ejaculation. Males who experience dry orgasms can often produce multiple orgasms, as the refractory period is reduced.[26] Some males are able to masturbate for hours at a time, achieving orgasm many times.[26] Some men have been multiorgasmic since they can recall, while others have learned to achieve multiple orgasms.[25] In recent years, a number of books have described various techniques to achieve multiple orgasms. Most multi-orgasmic men (and their partners) report that refraining from ejaculation results in a far more energetic post-orgasm state.[27] Additionally, some men have also reported that this can produce more powerful ejaculatory orgasms when they choose to have them.

One technique is to put pressure on the perineum, about halfway between the scrotum and the anus, just before ejaculating to prevent ejaculation. This can, however, lead to retrograde ejaculation, i.e., redirecting semen into the urinary bladder rather than through the urethra to the outside. It may also cause long term damage due to the pressure put on the nerves and blood vessels in the perineum, akin to that reported by some males who ride bicycles with narrow seats for extended periods.[citation needed] Men who have had prostate or bladder surgery, for whatever reason, may also experience dry orgasms because of retrograde ejaculation.

Other techniques are analogous to reports by multi-orgasmic women indicating that they must relax and "let go" to experience multiple orgasms. These techniques involve mental and physical controls over pre-ejaculatory vasocongestion and emissions, rather than ejaculatory contractions or forced retention as above. Anecdotally, successful implementation of these techniques can result in continuous or multiple "full-body" orgasms.[28] Gentle digital stimulation of the prostate, seminal vesicles, and vas deferens provides erogenous pleasure that sustains intense emissions orgasms for some men. Some sexual aids are designed with the primary intention to stimulate the prostate.[citation needed]

Many men who began masturbation or other sexual activity prior to puberty report having been able to achieve multiple non-ejaculatory orgasms. Some evidence indicates that orgasms of men before puberty are qualitatively similar to the "normal" female experience of orgasm, suggesting that hormonal changes during puberty have a strong influence on the character of male orgasm.[29]

A number of studies have pointed to the hormone prolactin as the likely cause of male refractory period. Because of this, there is currently an experimental interest in drugs which inhibit prolactin, such as cabergoline (also known as Cabeser, or Dostinex). Anecdotal reports on cabergoline suggest it may be able to eliminate the refractory period altogether, allowing men to experience multiple ejaculatory orgasms in rapid succession. At least one scientific study supports these claims.[30] Cabergoline is a hormone-altering drug and has many potential side effects. It has not been approved for treating sexual dysfunction. Another possible reason may be an increased infusion of the hormone oxytocin. Furthermore, it is believed that the amount by which oxytocin is increased may affect the length of each refractory period.

A scientific study to successfully document natural, fully ejaculatory, multiple orgasms in an adult man was conducted at Rutgers University in 1995. During the study, six fully ejaculatory orgasms were experienced in 36 minutes, with no apparent refractory period.[31] It can also be said that in some cases, the refractory period can be reduced or even eliminated through the course of puberty and on into adulthood. Later, P. Haake et al. observed a single male individual producing multiple orgasms without elevated prolactin response.[32]
Definitions of "orgasm"

Definitions of 'orgasm' vary, and there is no consensus on how to consistently classify it.[33] There were listed at least twenty-six definitions of orgasm.[34]

There is some debate whether certain types of sexual sensation should be accurately classified as 'orgasm', including female orgasms caused by G-spot stimulation alone, and the demonstration of extended or continuous orgasms lasting several minutes or even an hour.[35] The question centers around clinical definition of orgasm.

Orgasm is usually defined in a clinical context strictly by the muscular contractions involved, and also by characteristic patterns of change in heart rate, blood pressure, and often respiration rate and depth.[10] But this way of viewing, orgasm is merely physiological, while there are also psychological, endocrinological, and neurological definitions of 'orgasm'.[33]

In these and similar cases, the sensations experienced are subjective and do not necessarily involve the involuntary contractions characteristic of orgasm. However, the sensations in both sexes are extremely pleasurable and are often felt throughout the body, causing a mental state that is often described as transcendental, and with vasocongestion and associated pleasure comparable to that of a full contractionary orgasm. For example, modern findings support distinction between ejaculation and male orgasm.[34]

For this reason, there are views on both sides as to whether these can be accurately defined as orgasms.
Evolutionary function of orgasms

Male orgasms that expel sperm from the body into the vagina during intercourse may result in conception. Evolutionary biologists have several hypotheses about the role, if any, of the female orgasm in the reproductive process. In 1967, Desmond Morris first suggested in his popular-science book The Naked Ape that female orgasm evolved to encourage physical intimacy with a male partner and help reinforce the pair bond. Morris suggested that the relative difficulty in achieving female orgasm, in comparison to the male's, might be favorable in Darwinian evolution by leading the female to select mates who bear qualities like patience, care, imagination, intelligence, as opposed to qualities like size and aggression, which pertain to mate selection in other primates. Such advantageous qualities thereby become accentuated within the species, driven by the differences between male and female orgasm. If males were motivated by, and taken to the point of, orgasm in the same way as females, those advantageous qualities would not be needed, since self-interest would be enough.

Morris also proposed that orgasm might facilitate conception by exhausting the female and keeping her horizontal, thus preventing the sperm from leaking out. This possibility, sometimes called the "Poleax Hypothesis" or the "Knockout Hypothesis," is now considered highly doubtful. A number of feminists[who?] see this as misogynistic, as it favours the concept of sex as female subjugation.

Other theories are based on the idea that the female orgasm might increase fertility. For example, the 30% reduction in size of the vagina could help clench onto the penis (much like, or perhaps caused by, the pubococcygeus muscles), which would make it more stimulating for the male (thus ensuring faster or more voluminous ejaculation). The British biologists Baker and Bellis have suggested that the female orgasm may have an "upsuck" action (similar to the esophagus' ability to swallow when upside down), resulting in the retaining of favorable sperm and making conception more likely.[36] They posited a role of female orgasm in sperm competition.

A 1994 Learning Channel documentary on sex had fiber optic cameras inside the vagina of a woman while she had sexual intercourse. During her orgasm, her pelvic muscles contracted and her cervix repeatedly dipped into a pool of semen in the vaginal fornix, as if to ensure that sperm would proceed by the external orifice of the uterus, making conception more likely.[37] Elisabeth Lloyd has criticized the accompanying narration of this film clip which describes it as an example of "Sperm Upsuck", saying that it depicted normal contractions during a uterine orgasm, which have not been shown to have any effect on fertility.[38]

The observation that women tend to reach orgasm more easily when they are ovulating suggests that it is tied to increasing fertility.[39]

Other biologists surmise that the orgasm simply serves to motivate sex, thus increasing the rate of reproduction, which would be selected for during evolution. Since males typically reach orgasms faster than females, it potentially encourages a female's desire to engage in intercourse more frequently, increasing the likelihood of conception.

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