Posts Tagged ‘female sexual function’

The Female O: What You Need To Know

November 25, 2017

Andrew Siegel MD   11/25/2017

Happy Thanksgiving weekend to all!  Among the items to be grateful for are food, shelter, family, friends and of course, love–in all its aspects.  What follows are some (hopefully illuminating) words on the female sexual climax.


Thank you, Pixabay, for image above

The word “orgasm” is derived from New Latin orgasmus and Greek orgasmós, meaning “to swell; to be excited.”  Defining orgasm is hardly necessary for anyone who has ever experienced one (and if you haven’t, Meg Ryan did a fine rendition in the movie “When Harry Met Sally”!), but it is worth reviewing some of the different medically-oriented definitions:

Kinsey: The expulsive discharge of neuromuscular tension at the peak of sexual response.

Masters and Johnson: A brief episode of physical release from the vaso-congestion and myotonic increment developed in response to sexual stimuli.

John Money: The zenith of sexual-erotic experience characterized as voluptuous rapture or ecstasy occurring simultaneously in the brain/mind and the genitalia. Irrespective of its locus of onset, the occurrence is contingent upon reciprocal intercommunication between neural networks in the brain, above, and the genitalia below, and it does not survive their disconnection by the severance of the spinal cord, but is able to survive even extensive trauma at either end.

Definition quoted at a sexual urology meeting I attended: A variable transient peak sensation of intense pleasure creating an altered state of consciousness, usually with an initiation accompanied by involuntary, rhythmic contractions of the pelvic striated circumvaginal musculature, often with concomitant uterine and anal contractions and myotonia that resolves the sexually induced vaso-congestion and myotonia, generally with an induction of well-being and contentment. 

Whoa…That last one is ridiculously technical and complex!

A simple definition is the following: A release of muscle tension accompanied by pelvic pulsations at the peak of sexual excitement that follows sexual arousal, which is marked by genital swelling, muscle tension, erect nipples, increased heart rate, heart contractility, blood pressure and breathing rate and skin flushing.

The are many descriptor terms used to describe what may happen during an orgasm: pulsations, contractions, spasms, goosebumps, shivers, hot flashes, flushing, tingling, perspiration, moaning, building, swelling, flowing, flooding, spreading, spurting, shooting, throbbing, pulsating, shuddering, trembling, quivering.

In terms of achieving orgasm, the most important organ is not a throbbing, erect penis or a pulsating, lubricated vagina, but the brain—the master organ and “governor” of sexuality.  It is capable of fostering an earth-shattering, consciousness-altering, explosive mind-body experience, but is equally capable of dooming a sexual experience to failure. It is a given that in order to have a positive sexual experience, the brain and mind must cooperate with the body.  Emotions, memories, thoughts, perceptions and sensations contribute vitally to the sexual experience.

Pathway to Sexual Climax

Accompanying arousal and sexual stimulation is increased pelvic blood flow that induces vaginal lubrication and congestion and engorgement of the vulva, vagina and clitoris.  The “orgasmic platform” is the Masters and Johnson’s term for the outer third of the vagina with engorged inner lips, which they considered to be the “base” of pelvic blood congestion. With increasing stimulation and arousal, physical tension within the genitals gradually builds and once sufficient intensity and duration of sexual stimulation surpass a threshold, involuntary rhythmic muscular contractions occur of the pelvic floor muscles, the vagina, uterus and anus, followed by the release of accumulated erotic tension and a euphoric state. Thereafter, the genital engorgement and congestion subside, muscle relaxation occurs and a peaceful state of physical and emotional bliss and afterglow become apparent.

The pelvic floor muscles contract rhythmically during climax: a total of 10-15 contractions typically occur, with the first 3-5 contractions occurring at 0.8-second intervals after which the interval between contractions lengthens and the intensity of the contractions decreases. However, orgasm is not only a genital response, but also a total body reaction causing numerous muscles to go into involuntary spasm, including the facial muscles resulting in grimacing, hand and foot muscles resulting in finger and toe curling, and numerous skeletal muscles that tense prior to release. Additionally, pupils dilate, skin flushes and the clitoral head retracts.

Clitoral vs. Vaginal Orgasm

Most women report that both clitoral and vaginal stimulation play important roles in achieving sexual climax. However, the clitoris has the greatest density of nerves, is easily accessible and typically responds readily to stimulation, so for most women is the fastest track to sexual climax. It is estimated that 70% of women require clitoral stimulation to achieve orgasm.  Clitoral orgasms are often described as a buildup of sensation in the clitoral region with intense waves of external muscle spasm and release. In contrast, vaginal orgasms are described as slower, fuller, wider, deeper, more expansive, complex, pervasive whole-body sensation.

Orgasms can be triggered via different neural pathways–clitoral orgasms via the pudendal nerves and vaginal orgasms via both the pudendal nerves that provide the nerve supply to the more superficial aspect of the vagina and the hypogastric and pelvic splanchnic nerves that provide the supply to the deeper aspect of the vagina.

The truth of the matter is that lady parts are all inter-connected and work together, so grouping orgasm into clitoral versus vaginal is arbitrary and artificial.  Penetrative sexual intercourse results in indirect clitoral stimulation as the clitoral shaft moves rhythmically with penile thrusting by virtue of penile traction on the inner lips, the lips of which join together to form the hood of the clitoris. Furthermore, the “legs” and “bulbs” of the clitoris—the deep anatomy that extends below the surface—are stimulated by vaginal penetration. Upward movement in the missionary position in which there is pubic bone to pubic bone contact provides direct clitoral stimulation as well.

Anatomical variations can affect ability to achieve sexual climax. Clitoral size and the distance of the clitoris to the vaginal opening differ among women. Women whose clitoris is closer to the vaginal opening are more likely to report orgasms from sexual intercourse. Women who have difficulty or cannot achieve orgasm often have a smaller clitoral head.

Orgasms can at times be achieved by non-genital stimulation. Some women can climax simply by erotic thoughts, others by breast stimulation or foot massage.  At the time of climax, some women are capable of “ejaculating” fluid. The nature of this fluid has been controversial, thought by some to be hyper-lubrication and others to be glandular secretions (Bartholin’s and/or Skene’s glands). There are certain women who “ejaculate” very large volumes of fluid at climax and studies have shown this to be urine released due to involuntary bladder contractions that can accompany sexual climax.

Wishing you the best of health and a wonderful Thanksgiving weekend,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

 MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food


These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx




The Clitoris: What’s Under The Hood?

May 7, 2016

Andrew Siegel MD 5/7/16

The clitoris is a complex and mysterious organ possessed by all female mammals. Many men (as well as a fair share of women) are clueless (“uncliterate”) about this curious, unique and fascinating structure. The intent of this entry is to provide a primer of useful knowledge so that you can understand what is under the (clitoral) hood, literally and figuratively.  Advances in imaging—especially magnetic resonance (MR)—have provided a much clearer understanding of clitoral anatomy. Whether you are a female or a male, a greater knowledge and appreciation of the anatomy, function and nuances of this special female body part will most certainly prove useful and beneficial. 

Female External Genital Anatomy

The clitoris is part of the vulva, the outer part of the female genitals. The vulva consists of the mons, outer lips, inner lips, vestibule, vaginal opening, urethral opening and the star of the show–the clitoris.

5. vulva 

(Female external genital anatomy, from The Kegel Fix, credit to illustrator Ashley Halsey)

Clitoral Geography: Mountains, Hills and Earthquakes

The vulva is home to some hilly and bumpy terrain that is well worth gaining familiarity with so it can be traversed with finesse. The word mons derives from Latin meaning “mountain” because it is the rounded and prominent fatty tissue overlying the pubic bone. The word clitoris derives from the Greek “kleitoris” meaning “little hill.”

An earthquake is the shaking of the Earth’s surface caused by the sudden release of energy resulting from movements within the earth’s crust that creates seismic waves. If a female orgasm is thought of as an “earthquake,” the clitoris is the “epicenter.” The head of the clitoris—typically only the size of a pea—is an extraordinarily dense bundle of sensory nerve fibers.

 Pleasure (and Reproduction)

The clitoris is central to the female sexual response and sexual climax, the only human organ that exists solely for pleasure, although nature has secondary motives. The clitoris is a vital part of the anatomical design used for nature’s clever “bait and switch” trick, in which the pursuit of a pleasurable activity drives reproduction of the human species and the perpetuation of life. In the mammalian kingdom, if reproduction was not associated with sexual pleasure, how much sexual activity do you think would actually occur?

Male and Female Comparative Genital Anatomy

It might surprise you how remarkably similar the female and male external genitals are. In fact, in the first few weeks of embryonic existence, the external genitals are identical. The female embryo’s external genitals are the “default” model that will remain female in the absence of masculinizing hormones. The female clitoris and the male penis are essentially the same structure, as are the female outer lips and the male scrotum. In fact, there is not much difference in appearance between a very large clitoris and a very small penis.

Although the clitoris is the female equivalent of the penis, it is exclusively a sexual organ, whereas the penis is a urinary, sexual and reproductive organ. Like the penis, the clitoris is largely composed of erectile tissue that upon arousal and stimulation engorges with blood and with increasing stimulation becomes erect. After sexual climax, the clitoris returns to its normal relaxed state.

Interesting trivia: The female spotted hyena, squirrel monkey, lemur, and bearcat all have in common a very large clitoris. When erect, it appears very similar to the male’s penis and is used to demonstrate dominance over other members of their clans. It is referred to as a “pseudo-penis.”

The Tip of the Iceberg, But Far From Frigid

 Most of the clitoris is hidden and internal. Commonly misrepresented as a “bean” or “button,” the external nub is the clitoral head, merely the “tip of the iceberg.” The iceberg metaphor is an apt one in terms of anatomy, but is off target with respect to what a clitoris is—the seat of female genital passion—with its head having a greater concentration of nerve endings than any other body part, a far cry from “ice.”

Clitoral Anatomy

The glans (head) is the external and visible part of the clitoris. It is located just above the opening of the urethra. The remainder of the clitoris is internal and consists of the clitoral shaft (body) and its extensions, known as crura (legs). The prepuce (foreskin), a hood of skin formed by the inner vaginal lips, covers the clitoral shaft.


(Anatomy of the vulva and the clitoris by OpenStax College – Anatomy & Physiology, Connexions Web site., Jun 19, 2013., CC BY 3.0,, no changes made to original)

The crura are wishbone-shaped and are attached to the pubic arch as it diverges on each side. The shaft and crura contain erectile tissue, consisting of spongy sinuses that become engorged with blood at the time of sexual stimulation, resulting in clitoral engorgement and erection. Beneath the crura on either side of the vaginal opening are the clitoral bulbs, sac-shaped erectile tissues that lie beneath the outer vaginal lips. With sexual stimulation, they become full, plumping and tightening the vaginal opening.

One can think of the crura and bulbs as similar to the roots of a tree, hidden from view and extending deeply below the surface, yet fundamental to the support and function of the clitoral shaft and head above, comparable to the tree’s trunk and branches.

Pelvic Floor Muscles

These important muscles are critical to sexual function in general and clitoral function in particular. They control the voluntary tightening and relaxing of the vagina, increase genital blood flow, support clitoral erection and contract rhythmically at the time of orgasm. Two of the pelvic floor muscles are especially vital to clitoral function: the ischiocavernosus and bulbocavernosus muscles that surround the crura and the bulbs, respectively. They stabilize the deep roots of the clitoris and compress the roots when engaged, increasing genital blood flow and maintaining clitoral erection, since their compressions push blood from the roots back towards the shaft and glans.

3. superficial and deep PFM

(Female pelvic floor muscles, from The Kegel Fix, credit to illustrator Ashley Halsey)

The pelvic floor muscles strongly contribute to the transformation of the clitoris from flaccid to softly swollen to rigid. By compressing the roots of the clitoris, they elevate blood pressure within the clitoris to maintain clitoral swelling and erectile rigidity. At the time of climax, these muscles contract rhythmically, and an orgasm would not be an orgasm without the contribution of these muscles working together with the clitoris.

Interesting trivia: The blood pressure within the clitoris at the time of a clitoral erection is hypertensive (high blood pressure) range, accounting for the rigidity. This is largely on the basis of the contractions of the aforementioned pelvic floor muscles. The only regions of the body where hypertension is desirable are the penis and clitoris.

Sexual Function And The Clitoris

With arousal and sexual stimulation, the clitoral erectile tissue engorges, resulting in clitoral shaft thickening and swelling of the glans. With increasing clitoral stimulation, clitoral retraction occurs, in which the clitoral shaft and glans withdraw from their overhanging position, pulling inwards against the pubic bone.

When a sufficient threshold of sexual stimulation is reached, climax occurs with contraction of the pelvic floor muscles, vagina, urethra, uterus and anus.

The clitoris plays a central role in orgasm for the majority of women and for most, clitoral stimulation is necessary to achieve orgasm. Some women require direct clitoral stimulation, while for others indirect stimulation is sufficient; about 25% are capable of achieving orgasm via vaginal intercourse alone. Vaginal intercourse often results in indirect clitoral stimulation since the crura and bulbs flank the vaginal opening and these inner parts of the clitoris are stimulated with penetrative thrusting.

Interesting trivia: Magnetic resonance studies have shown that a larger clitoral head size and shorter distance from the clitoris to the vagina are correlated with an easier ability to achieve a vaginal orgasm.

There is a clitoral literacy movement that is gaining momentum. Please visit: for more information on the clitoris and this campaign to foster awareness of this curious organ.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health– newly available on Amazon Kindle, Apple iBooks, B&N Nook and Kobo (paperback edition will be available soon).

Author page on Amazon:

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Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health and Promiscuous Eating: Understanding Our Self-Destructive Relationship With Food   

Co-creator of Private Gym and PelvicRx: comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training programs. Built upon the foundational work of Dr. Kegel, these programs empower men to increase pelvic floor muscle strength, tone, power, and endurance: or Amazon.  In the works is the female PelvicRx pelvic floor muscle training DVD. 

Pelvic Rx can be obtained at, an online store home to quality urology products for men and women. Use promo code “UROLOGY10” at checkout for 10% discount.