Physiology of Orgasm

  • Roy J. Levin
Part of the Current Clinical Urology book series (CCU)


The human orgasm, although tantalizingly short, is perhaps the greatest bodily pleasure that most men and women can experience without recourse to drugs. It is a complex of subjective mental with physical body changes. Its pleasure can never be recalled exactly which is perhaps one of the reasons for desiring its repetition. It dissolves body boundaries and thus unites lovers in a unique manner. In men, because it normally routinely accompanies ejaculation, it has simply been regarded as the drive reward for attempting procreation, and in evolutionary terms, as a spur to distribute their genes as widely as possible. In women, however, because it is far less easily induced, especially by coital penile thrusting alone, its putative biological purpose(s) have been subjected to extensive discussion. This has resulted in the unresolved dichotomy of whether it is an evolutionary adaptation or just a by-product. Unfortunately, the arguments from the various protagonists have become more philosophical rather than physiologically based, have produced more heat than light, and will not be repeated.


Orgasm Cortex Cerebellum Pelvic musculature Contraction Oxytocin 


  1. 1.
    Lloyd EA. The case of the female orgasm – bias in the science of evolution. Cambridge: Harvard University Press; 2005.Google Scholar
  2. 2.
    Puts DA. Review of the book. The case of the female orgasm: bias in the science of evolution. Arch Sex Behav. 2006;35:103–5.CrossRefGoogle Scholar
  3. 3.
    Puts DA, Dawood K. The evolution of female orgasm: adaptation or byproduct? Twin Res Hum Genet. 2006;9:467–72.PubMedCrossRefGoogle Scholar
  4. 4.
    Wallen K. Commentary on Puts’ (2006) review of The case of the female orgasm: bias in the science of evolution. Arch Sex Behav. 2006;35:633–6.PubMedCrossRefGoogle Scholar
  5. 5.
    Kinsey AC, Pomeroy WB, Martin CE, Gebhard PH. Sexual behaviour in the human female. Philadelphia: WB Saunders; 1953.Google Scholar
  6. 6.
    Masters W, Johnson V. Human sexual response. Boston: Little Brown; 1966.Google Scholar
  7. 7.
    Levin RJ. The female orgasm – a current appraisal. J Psychosom Res. 1981;25:119–23.PubMedCrossRefGoogle Scholar
  8. 8.
    Levin RJ. An orgasm is ….who defines what an orgasm is? Sex Relat Ther. 2004;19:101–7.CrossRefGoogle Scholar
  9. 9.
    Levin RJ. The physiology and pathophysiology of the female orgasm. In: Goldstein I, Meston CM, Davis SR, Traish AM, editors. Women’s sexual function and dysfunction – study, diagnosis and treatment. London: Taylor & Francis; 2006. p. 228–35.Google Scholar
  10. 10.
    Mah K, Binik YM. The nature of the human orgasm: a critical review of major trends. Clin Psychol Rev. 2001;21:823–56.PubMedCrossRefGoogle Scholar
  11. 11.
    Margolis J. O: The intimate history of the orgasm. London: Century, The Random House Group; 2004.Google Scholar
  12. 12.
    Meston CM, Hull E, Levin RJ, Sipski M. Women’s orgasm. In: Lue TF, Basson R, Rosen R, Giuliano F, Khoury S, Montorsi F, editors. Sexual medicine – sexual dysfunctions in men and women. Paris: Health Publications: Editions 21; 2004. p. 785–850.Google Scholar
  13. 13.
    Komisaruk BR, Beyer-Flores C, Whipple B. The science of orgasm. Baltimore: The Johns Hopkins University Press; 2006.Google Scholar
  14. 14.
    Kinsey AC, Pomeroy WD, Martin CE. Sexual behaviour in the human male. Philadelphia: Saunders; 1948.Google Scholar
  15. 15.
    Bianchi-Demicheli F, Ortigue S. Toward and understanding of the cerebral substrates of woman’s orgasm. Neuropyschologia. 2007;45(12):2645–59.CrossRefGoogle Scholar
  16. 16.
    Vance EB, Wagner NN. Written descriptions of orgasm: a study of sex differences. Arch Sex Behav. 1976;5:87–98.PubMedCrossRefGoogle Scholar
  17. 17.
    Mah K, Binik YM. Do all orgasms feel alike? Evaluating a two-dimensional model of the orgasm experience across gender and sexual context. J Sex Res. 2002;39:104–13.PubMedCrossRefGoogle Scholar
  18. 18.
    Gerstenberg TC, Levin RJ, Wagner G. Erection and ejaculation in man – assessment of the electromyographic activity of the bulbocavernosus and ischiocavernosus muscles. Br J Urol. 1990;65:395–402.PubMedCrossRefGoogle Scholar
  19. 19.
    Kline-Graber G, Graber B. A guide to sexual satisfaction – woman’s orgasm. New York: Popular Library; 1975. p. 35.Google Scholar
  20. 20.
    Levin RJ, Wylie K. Vaginal vasomotion – its appearance, measurement, and usefulness in assessing the mechanisms of vasodilatation. J Sex Med. 2008;5:377–86.PubMedGoogle Scholar
  21. 21.
    Gould SJ, Lewontin C. The spandrels of San Marco and the Panglossian Paradigm – a critique of the adaptionist programme. Proc Soc Roy Soc (London). 1979;205:581–98.CrossRefGoogle Scholar
  22. 22.
    Bohlen JG, Held JP, Sanderson MO, Ahlgren A. The female orgasm: pelvic contractions. Arch Sex Behav. 1982;11:367–86.PubMedCrossRefGoogle Scholar
  23. 23.
    Georgiadis JR, Reinders AATS, Paans AMJ, Renken R, Kortekaas R. Man versus woman on sexual brain function: prominent differences during tactile genital stimulation, but not during orgasm. Hum Brain Mapp. 2009;30:3089–101.PubMedCrossRefGoogle Scholar
  24. 24.
    Levin RJ. The physiology of male and female sexual arousal. In: Payne-James J, Busutill A, Smock W, editors. Forensic medicine – clinical and pathological aspects. London: Greenwich Medical Media Limited; 2003. p. 379–89.Google Scholar
  25. 25.
    Passie T, Hartman U, Schneider U, Emrich HM. On the function of groaning and hyperventilation during sexual intercourse: Intensification of sexual experience by altering brain metabolism through hypercapnia. Med Hypothesis. 2003;60:660–3.CrossRefGoogle Scholar
  26. 26.
    Levin RJ. Vocalised sounds and human sex. Sex Relat Ther. 2006;21:99–107.CrossRefGoogle Scholar
  27. 27.
    Levin RJ. Is prolactin the biological ‘off switch’ for human sexual arousal? Sex Relat Ther. 2003;18:289–43.CrossRefGoogle Scholar
  28. 28.
    Levin RJ. Sexual activity, health and well-being- the beneficial roles of coitus and masturbation. Sex Relat Ther. 2007;22:135–48.CrossRefGoogle Scholar
  29. 29.
    Levin RJ. The human sexual response – similarities and differences in the anatomy and function of the male and female genitalia. In: Janssen E, editor. The psychophysiology of sex. Bloomington: Indiana University Press; 2007. p. 39–56.Google Scholar
  30. 30.
    Levin RJ. Sexual desire and the deconstruction and reconstruction of the human female sexual response model of Masters and Johnson. In: Everaerd W, Laan E, Both S, editors. Sexual appetite, desire and motivation: energetics of the sexual system. Amsterdam: Royal Netherlands Academy of Arts and Sciences; 2001. p. 63–93.Google Scholar
  31. 31.
    Levin RJ, Meston C. Nipple/breast stimulation and sexual arousal in young men and women. J Sex Med. 2006;13:450–4.CrossRefGoogle Scholar
  32. 32.
    Whipple G, Ogden G, Komisaruk BR. Physiological correlates of imagery-induced orgasm in women. Arch Sex Behav. 1992;21:121–33.PubMedCrossRefGoogle Scholar
  33. 33.
    Komisaruk B, Whipple B, Crawford A, Grimes S, Liu W-C, Kalnin A, et al. Brain activation during vaginocervical self-stimulation and orgasm in women with complete spinal cord injury; fMRI evidence of mediation by the vagus nerves. Brain Res. 2004;1024:77–88.PubMedCrossRefGoogle Scholar
  34. 34.
    Levin RJ, van Berlo W. Sexual arousal and orgasm in subjects who experience forced or non-consensual sexual stimulation – a review. J Clin Forensic Med. 2004;1:82–8.CrossRefGoogle Scholar
  35. 35.
    Levin RJ, Wagner G. Orgasm in women in the laboratory – quantitative studies on duration, intensity, latency and vaginal blood flow. Arch Sex Behav. 1985;14:439–49.PubMedCrossRefGoogle Scholar
  36. 36.
    Levin RJ, Wagner G. Heart rate change and subjective intensity of orgasm. IRCS Med Sci. 1985; 13:885–6.Google Scholar
  37. 37.
    Alzate H, Useche B, Velegas M. Heart rate change as evidence for vaginally elicited orgasm and intensity. Ann Sex Res. 1989;2:345–57.CrossRefGoogle Scholar
  38. 38.
    Ortigue S, Grafton ST, Bianchi-Demicheli F. Correlation between insula activation and self-reported quality of orgasm in women. Neuroimage. 2007;37:551–60.PubMedCrossRefGoogle Scholar
  39. 39.
    Meston CM. Aging and sexuality. West J Med. 1997;167:285–90.PubMedGoogle Scholar
  40. 40.
    Butler CA. New data about female sexual response. J Sex Marital Ther. 1976;2:40–6.PubMedGoogle Scholar
  41. 41.
    Clifford RE. Subjective sexual experience in college women. Arch Sex Behav. 1978;7:183–97.PubMedCrossRefGoogle Scholar
  42. 42.
    Fisher S. The female sexual orgasm. New York: Bantam Books; 1973.Google Scholar
  43. 43.
    Singer I. The goals of human sexuality. London: Wildwood House; 1973.Google Scholar
  44. 44.
    Wimpinssinger F, Tscherney R, Stackl W. Magnetic resonance imaging of female prostate pathology. J Sex Med. 2009;6:1704–11.CrossRefGoogle Scholar
  45. 45.
    Schubach G. Urethral expulsions during sexual arousal and bladder catheterisation in seven human females. Electronic Journal of Human Sexu­ality. 2001. 4. Accessed 19 Aug 2009.
  46. 46.
    Sevely JL. Eve’s secrets. A revolutionary perspective on human sexuality. London: Bloomsbury Publishing Ltd; 1987.Google Scholar
  47. 47.
    Davidson Sr JK, Darling CA, Conway-Welch C. The role of the Graafenberg spot and female ejaculation in the female orgasmic response: an empirical analysis. J Sex Marital Ther. 1989;15:102–20.PubMedGoogle Scholar
  48. 48.
    Levin RJ. Revisiting post-ejaculatory refractory time – what we know and what we do not know in males and females. J Sex Med. 2009;6:2376–89.PubMedCrossRefGoogle Scholar
  49. 49.
    Georgiadis JR, Kortekaas R, Kuipers R, Nieuwenberg A, Pruim J, Reinders AATS, et al. Regional cerebral; blood flow changes associated with clitorally induced orgasm in healthy women. Eur J Neurosci. 2006;24:3305–16.PubMedCrossRefGoogle Scholar
  50. 50.
    Hite S. The Hite report on male sexuality. New York: Ballantine Books; 1981.Google Scholar
  51. 51.
    Perry JF. Do men have a G-spot? Aust Forum. 1988;2:37–41.Google Scholar
  52. 52.
    Newman HF, Reiss H, Northup JD. Physical basis of emission, ejaculation and orgasm in the male. Urology. 1982;19:341–50.PubMedCrossRefGoogle Scholar
  53. 53.
    Holstege G, Georgiadis JR, Paans AMJ, Meiners LC, van der Graaf FHCE, Reinders AATS. Brain activation during human ejaculation. J Neurosci. 2003;23:9185–93.PubMedGoogle Scholar
  54. 54.
    Zilbergeld B. Men and sex – a guide to sexual fulfilment. London: Souvenir Press Ltd; 1978.Google Scholar
  55. 55.
    Levin RJ. Heart rate responses can be used to differentiate simulated from real orgasms in the human male: a pilot study. In: Kothari P, Patel R, editors. Proceedings of the first conference on orgasm. Bombay: VRP Publishers; 1991. p. 49–55.Google Scholar
  56. 56.
    Levin RJ. Critically revisiting aspects of the human sexual response cycle of Masters and Johnson: correcting errors and suggesting modifications. Sex Relat Ther. 2008;23:393–9.CrossRefGoogle Scholar
  57. 57.
    Levin RJ. Measuring female genital functions – a research essential but still a clinical luxury? Sex Relat Ther. 2004;19:191–200.CrossRefGoogle Scholar
  58. 58.
    Berman JR, Berman LA, Kanaly KA. Female sexual dysfunction: new perspectives on anatomy, physiology, evaluation and treatment. EAU Update Series. 2003;1:166–77.CrossRefGoogle Scholar
  59. 59.
    Seecof RT, Forest S, Tennant Jr FS. Subjective perceptions to the intravenous ‘rush’ of heroin and cocaine in opioid addicts. Am J Drug Alcohol Abuse. 1986;12:79–87.PubMedCrossRefGoogle Scholar
  60. 60.
    Zernishlany Z, Alzenberg D, Weizman A. Subjective effects of MDMA (‘Ecstasy’) on humans sexual function. Eur Pyschiatry. 2001;16:127–30.CrossRefGoogle Scholar
  61. 61.
    Smith A, Ferris JA, Simpson JM, Shelley J, Pitts MK, Richters J. Cannabis use and sexual health. J Sex Med. 2009;7:787–93.PubMedCrossRefGoogle Scholar
  62. 62.
    Johnson SD, Phelps DL, Cottler LB. The association of sexual dysfunction and substance use among a community epidemiological sample. Arch Sex Behav. 2004;33:55–63.PubMedCrossRefGoogle Scholar
  63. 63.
    Halikas J, Weller R, Morse C. Effects of regular marijuana use on sexual perfomance. J Pyschoactive Drugs. 1982;14:59–70.Google Scholar
  64. 64.
    Byard RW, Hucker SJ, Haxelwood RR. A comparison of typical death scene features in cases of fatal male and female autoerotic asphyxia with a review of the literature. Forensic Sci Int. 1990;48:113–21.PubMedCrossRefGoogle Scholar
  65. 65.
    Levin RJ. Sexual arousal – its physiological roles in human reproduction. Annu Rev Sex Res. 2005;16:154–89.PubMedGoogle Scholar
  66. 66.
    Fraser LR, Adeoya-Osiguwa SA, Baxendale RW, Gibbons R. Regulation of mammalian sperm capacitation by endogenous molecules. Front Biosci. 2006;11:1636–45.PubMedCrossRefGoogle Scholar
  67. 67.
    Nicolosi A, Laumann EO, Glasser DB, Moreira ED, Paik A, Gingell C. Sexual behaviour and sexual dysfunctions after age 40: the global study of sexual attitudes and behaviours. Urology. 2004;64:991–7.PubMedCrossRefGoogle Scholar
  68. 68.
    Schmidt PJ, Steinberg EM, Negro PP, Haq N, Gibson C, Rubinow DR. Pharmacology induced hypogonadism and sexual function in healthy young women and men. Neuropsychopharmacology. 2009;34:565–76.PubMedCrossRefGoogle Scholar
  69. 69.
    Levin RJ. The impact of the menopause on the physiology of genital function. Menopause Rev. 1999;4:23–31.Google Scholar
  70. 70.
    Basson R. Sexuality and the menopause. J SOGC. 1995;(Suppl):10–5.Google Scholar
  71. 71.
    Plaut SM, Graziottin A, Heaton JWP. Sexual dysfunction. Oxford: Health Press Ltd; 2004.Google Scholar
  72. 72.
    Waldinger MD. Male ejaculation and orgasmic disorders. In: Balon R, Taylor Segraves R, editors. Handbook of sexual dysfunctions. Florida: Taylor & Francis; 2005. p. 217–48.Google Scholar
  73. 73.
    Waldinger MD, Schweitzer DH. Postorgasmic illness syndrome: two cases. J Sex Marital Ther. 2002;28:251–5.PubMedCrossRefGoogle Scholar
  74. 74.
    Davy Smith G, Frankel S, Yarnell JD. Sex and death: are they related? Findings from the Caerphilly cohort study. BMJ (Clinical Research, ed). 1997;315:1641–4.Google Scholar
  75. 75.
    Charnetski CJ, Brennan FX. Feeling good is good for you; how pleasure can boost your immune system and lengthen your life. Emmaus: Rodale Press; 2001.Google Scholar
  76. 76.
    Ellison CR. Women’s sexualities: generations of women share intimate secrets of sexual self-acceptance. Oakland: New Harbinger; 2000.Google Scholar
  77. 77.
    Van Netten JJ, Georgiadis JR, Nieuwenburg A, Kortekaas R. 8–13 Hz fluctuations in rectal pressure are an objective marker of clitorally induced orgasm in women. Arch Sex Behav. 2008;279–85.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Roy J. Levin
    • 1
  1. 1.Sexual Physiology LaboratoryPorterbrook ClinicYorkshireEngland

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