Women’s Orgasm and Its Relationship with Sexual Satisfaction and Well-being

Women’s orgasms have been subject to controversial discussions among scholars throughout history. Even today, narratives of women’s orgasm being complicated or less important (cp. to men’s) for their sexual functioning and satisfaction are prevailing and reflected in gendered sexual scripts. This review aims to compile evidence for the relationship between orgasm and sexual well-being in women. We consider orgasm’s role in women’s sexual pleasure, sexual satisfaction, and desire in the context of both casual and committed sexual encounters. Substantial evidence supports a significant link between orgasm and sexual pleasure, satisfaction, and desire in women. Orgasm has been identified as an important factor in predicting relational satisfaction as well as positive outcomes of casual sex. For instance, orgasming during casual sex completely accounts for the persistent gender differences researchers have observed in emotional and evaluative responses to casual encounters. As we cover in this review, there is no shortage of research demonstrating the myriad of favorable physical, psychological, and interpersonal associations with women’s orgasms across relational and sexual contexts. Because orgasm has continually surfaced as such a critical component of women’s positive sexual experiences, we argue the female orgasm should be taken seriously as a meaningful site of research on women’s well-being, and orgasm equality should be taken seriously in the pursuit of gender equality.


Introduction
The female orgasm has been surrounded by many myths and misconceptions, including a disbelief in its relevance that can still be observed today [1]. At one point in history, women's orgasms were deemed a necessary element for conception. With this particular narrative's debunking, contemporary sexual scripts ascribe orgasms a minor-if not absent-importance to women's sexuality [2,3].
Clinicians have long debated not only the question of whether orgasm is important for women, but also how women are supposed to experience orgasm [e.g., vaginal vs. clitoral orgasm, 1,4]. The lack of agreement among professionals has contributed to normalizing the idea that women's orgasms are unnecessary, or a "bonus" [1,4]. This is in contrast with the male orgasm, the importance and necessity of which goes largely uncontested.
Imagine that Peter, a 35-year-old man, does not experience orgasms during sex with his partner and is very satisfied with his sex life. Peter will probably be met with incomprehension from most people, since orgasms are considered indispensable for a man's satisfaction. Accordingly, recent research found that both women and men (still) believe that men are more deserving of orgasm than women in both casual and committed sexual encounters [5]. The idea that women, on the other hand, do not need orgasms for sexual satisfaction is very common. Several qualitative studies found that in women's definitions of sexual pleasure, having an orgasm played a minor role as compared to other themes like emotional intimacy or partner satisfaction [6][7][8].
Some researchers have called out the need for orgasm equality [e.g., 9], marking the orgasm gap between women and men as an issue of gender justice. From this perspective, orgasms are a resource worth pursuing for women's equality because orgasm is by and large a positive, beneficial, and rewarding experience. Not only is orgasm physiologically rewarding thanks to the substantial release of dopamine, but by activating the cerebellum, orgasms are associated with increased relaxation, improved sleep, pain relief, increased immune system functioning, and positive mental health like decreased anxiety and depression [for a review see, 10]. Neuroscience research has further identified that the postorgasm brain is in "learning mode" from the perspective of learning patterns of reward and punishment [11,12]. For example, researchers used a differently-scented stimuli pre and post orgasm to condition rats to different sexual partners. They found that over time, both sexes of rats developed preferences for sexual partners with whom they had more orgasms [11].
Considering the ongoing ambivalent socio-cultural narrative of women's orgasm being not that important on the one hand and/ or the ultimate indicator of a fulfilling sexuality on the other hand this review aims to discuss recent evidence on the question: How is orgasm experience related to women's sexual well-being? In the present review, we will focus on the relationship of women's orgasm with a. sexual pleasure, b. sexual satisfaction, and c. desire both in relationship and casual sex contexts.

The Importance of Orgasm for Women's Sexual Pleasure
Orgasm experience and sexual pleasure in women are highly interwoven. Sexual pleasure is broadly defined as "those positively valued feelings induced by sexual stimuli" [13], of which orgasm may be one aspect.
Despite the presupposition that women's intimate fulfillment comes from the emotional aspects of their partnerships, orgasm is actually quite important to women's pleasure during partnered sex [14,15]. Across 119 interviews with primarily young, heterosexual women, Opperman et al. [16] found that more than half of participants describe orgasm using the words pleasure or pleasurable, and as the "ultimate" pleasure and as "most amazing feeling in the world." In fact, when discussing physical pleasure during sex without orgasm, several participants identified this pleasure as less intense than associated with orgasm [16]. Other studies found that physical pleasure and desiring orgasms were factors related to "good sex" [17]. An interview study with 18 black US students (50% women) also found a relationship between sexual pleasure and experiencing orgasm [18]. In another study, Thorpe and colleagues [19] asked black women about their "peak pleasure" and found that 18.4% of participants define orgasm as one possible facilitator of "peak pleasure" when emotional (e.g., enjoyment, connection), mental (e.g., being present), and physical (e.g., arousal, vaginal wetness) foundations were set.
Quantitative data additionally support a positive association of orgasm experiences and sexual pleasure in women. In a study of over 6000 college women, orgasming during their most recent casual sex was the most important variable predicting enjoyment of the encounter [20]. Sexual pleasure was also significantly associated with orgasm frequency in a representative German sample of women [21] and correlated with orgasm during partnered sex (r = 0.44; p < 0.01) [22]. Going beyond the mere occurrence of orgasm and considering orgasm quality, Herbenick and colleagues [23 •] examined women's experiences with sexual pleasure, orgasm, and genital touching. Using a probability sample from the USA including women aged 18 to 94, they found that 77.5% of women feel their orgasms vary in quality. Major factors that enhanced orgasmic pleasure were "spending time to build up pleasure" (77.2%), "having a partner who knows what I like" (58.6%), "emotional intimacy" (55.5%), "not feeling rushed" (43.9%) and "having my clitoris touched at the same time we're having intercourse" (39.0%) [23•].

The Importance of Orgasm for Women's Sexual Satisfaction
In research, there is also a boundless supply of evidence for the importance of orgasm to women's sexual satisfaction and relational satisfaction [24,25]. As an evaluative cognition, sexual satisfaction is a multifaceted construct with widely varying across studies [26]. One general definition describes satisfaction as "the degree to which an individual is satisfied or happy with the sexual aspect of his or her relationship" [27]. It has, however, previously been observed that the measurement of sexual satisfaction underlies construct validity issues across genders [26]. Men tend to orient their sexual satisfaction ratings on their own physical pleasure, while women are more likely to define their sexual satisfaction on their partner's pleasure and feelings of safety [26,28]. This may be why researchers observe highly sexually satisfied women in sexuality studies: these other components of sexual fulfillment could allow women to maintain high satisfaction despite fewer or less guaranteed orgasms.
It is important to keep these construct validity issues in mind when looking closer at the relationship between women's orgasms and sexual satisfaction. Although inconsistencies have been found regarding this relationship [29 •], most studies do find a positive correlation between sexual satisfaction and orgasm occurrence [30][31][32]31]. Another study with participants across different age groups found that women who did not experience orgasmic dysfunctions or distress throughout their lives were far more likely to be sexually satisfied than those who did [14]. Furthermore, orgasm outshone other factors of sexual functioning (i.e., lubrication) in predicting sexual satisfaction [33]. Women 1 3 who orgasm more frequently were also more likely to be satisfied with their relationships and communicate better with their partners [34]. Although the strength of this association varies from small or moderate to large effect sizes [e.g., 32•, 33,35], there appears to be a significant relationship between women's orgasms and their sexual satisfaction.
Some studies suggest that orgasm rates are even more important for women's than men's satisfaction. Both Waterman and Chiauzzi as well as Leonhardt and colleagues found that among the heterosexual couples participating in their study, orgasm consistency was significantly associated with sexual satisfaction for females, but not for males [31,36]. However, these results are limited by the small variance in men's orgasm frequencyabove 90% for most of the men in the sample-preventing more accurate estimates of the association between orgasm and satisfaction among men [31]. Similarly, unlike the male participants in their study, Wetzel, Cultice, and Sanchez found that women report desiring an orgasm frequency rate markedly greater than their current frequency rate [37].
Gender differences in orgasm relevance for sexual satisfaction may not primarily lie in the strength of the association but rather in the form of this relationship. One recent study by Leavitt and colleagues showed that the relationship between orgasms and satisfaction for women, but not men, is curved rather than linear [29 •]. For each unit of increase in orgasm consistency, the corresponding increase for sexual satisfaction gradually became smaller. Above the threshold of orgasming 60-80% of the time, there was barely any increase in women's reported sexual satisfaction as the high end of the sexual satisfaction scale was almost reached. This means that a woman orgasming in 1/10 encounters showed lower rates in sexual satisfaction compared to a woman experiencing orgasm in 6/10 encounters, but there was no difference between the latter and a woman orgasming in 10/10 encounters.

The Importance of Orgasm for Women's Sexual Desire
Sexual pleasure is a significant motivating factor for future sexual activity. In simple terms, those who enjoy sex are more likely to want to engage in sex again [13,[38][39][40]. Considering orgasm as an aspect of sexual pleasure-what role may orgasm play for sexual desire in women? Compared to orgasm and sexual pleasure, relatively less research focuses on the association between orgasm and sexual desire. In one primary study, anticipated pleasure and orgasm centrality were significant predictors of heterosexual women's desire for sex in four cross-national samples (USA, Canada, Germany, and Denmark) [40]. Other studies have also found positive correlations between sexual desire measures and subjective orgasm experience [41,42]. A recent study examined if the gender gap in sexual desire (i.e., men report more frequent desire than women) can be explained by orgasm experience at sexual debut [43]. Results provide evidence that women's sexual desire varied based on experiencing orgasm at sexual debut and diverged from men's desire only when orgasm did not occur. Such effects were not observed for satisfaction, nor for men. This underscores the importance of orgasm equality and suggests its absence at sexual debut may play an unacknowledged role in gender differences in sexual desire by setting the "bar" for what women learn they can and cannot expect for their sexual experiences.

Women's Orgasm Experiences in Casual Sex Contexts
Even in research on casual sex, which is widely understood as incompatible with women's sexual preferences and proclivities, women who orgasmed were found to report increased sexual agency and sexual subjectivity, as well as decreased self-objectification, stereotypical beliefs about gender, and gender-role adherence [3,44]. In one study of young women's casual sex experiences, orgasm was associated with less regret [45]. In another study with young adults, Woerner and Abbey looked at individuals' reactions to their most recent casual sex encounters and found strong results using three items to measure sexual pleasure: acute sexual satisfaction, overall sexual satisfaction, and orgasm presence [46]. In fact, this conceptualization of sexual pleasure (i.e., orgasm) was the most proximal predictive factor in a model of positive responses to casual sex [46], a finding reproduced in other, high-powered studies [e.g., 20, 47 •].
Orgasmic pleasure is not only associated with positive outcomes of casual sex, but also with antecedents of casual sex. Women were more likely to have casual sex when they anticipated a pleasurable encounter [48][49][50]. Researchers have similarly found that pleasure-seeking motives (experiencing orgasm, pleasure, fun) for engaging in casual sex positively relate to orgasm consistency [51]. This effect was stronger when assertiveness was included in the model [51], supporting earlier findings that stress the positive effect of self-efficacy on sexual pleasure and orgasm [52,53]. These studies suggest that orgasm is indeed a critical component of the sexual pleasure women experience during casual sex.

Women's Orgasm Experiences in Queer Sexual Contexts
When assessing their sexual satisfaction in the context of a committed relationship, women from different social locations (e.g., race, age, sexual identity) all seem to prioritize variables around intimacy over orgasm itself [7,17,19]. Even though orgasmic pleasure may not be a required component of sexual satisfaction for them, they still considered it a desirable, welcome, and highly pleasurable experience. Heterosexual women are able to reach orgasm in the same time allotment as their male counterparts during masturbation or solo-sex experiences [54,55], and the extent of their clitoral knowledge predicts their orgasm rates during masturbation [22,56]. However, it seems their clitoral knowledge was unable to translate to their partnered heterosexual encounters because this variable did not predict the women's orgasms during sex [22]. The traditionally gendered sexual script about orgasm (e.g., it is more important for men compared to women to have an orgasm) negatively mediated the relationship between clitoral knowledge and orgasm experience.
Importantly, queer scripts (compared to conventional heterosexual scripts) are more likely to value egalitarianism or equality of experience between partners [57]. Queer sexual scripts also prioritize reciprocity and variety in bodily stimulation techniques (e.g., oral and manual stimulation), which are more likely to lead to orgasm in women than PVI [43]. This helps explain the higher orgasm rates observed in lesbian couples as compared to women in relationships with men [43,58,59]. In sum, women in queer sexual contexts are more likely to have both relational intimacy and mutual orgasmic pleasure than women in heterosexual contexts.

Discussion & Conclusion
Orgasm is a source of women's sexual well-being, a significant factor in their feelings of satisfaction and sexual pleasure, and desire for future sexual activities. Although some women may find sexual encounters to be highly pleasurable even if they do not orgasm [60], orgasm has repeatedly been found to play a crucial statistically predicting women's sexual pleasure and satisfaction. Women, of course, desire sex for a variety of reasons above and beyond sexual pleasure and orgasm. Both women and men at times desire emotional intimacy from sexual activity or may have sex to express love within the context of an ongoing committed relationship [61,62]. However, the existence of these motives does not nullify the relevance of physical pleasure and orgasm for sexual well-being. Noticeable, gendered sexual scripts and contexts mediate the probability of women experiencing orgasm and labeling it as important for their sexual well-being.

Complicated Feelings
Beyond the links to sexual satisfaction and positive emotional reactions, research indicates more complicated findings surrounding women's feelings about orgasm. When women are asked directly about the role orgasm plays in their lives, women often explicitly state that they do not care whether or not they orgasm [20,63,64]. However, indirectly, another story emerges.
Women who orgasm are much more satisfied with encounters than those who do not. Indeed, women are five times more likely to enjoy a sexual encounter if they orgasmed during the experience [20]. In sum, orgasm is strongly related to sexual satisfaction, even though women indicate it is not important for them.
A great deal of this incoherence may be explained when considering expectations and the importance women attribute to their own orgasms. Regarding orgasms as relevant for one's sexual well-being was found to be one of the strongest predictors of orgasm frequency [65]. So, in turn, the relationship may be simple: if I experience orgasm then I expect orgasm, and if I expect orgasm, it becomes more relevant for my sexual satisfaction, desire and pleasure. This implies that orgasms are not irrelevant for female sexual well-being, but rather the lower frequency of their occurrence may lead women to alter their expectations [15], and say that they are fully satisfied even if they orgasm "only" 60% of the time.
Even with shifting gender roles in contemporary U.S. culture [66], women are expected to act passively rather than agenticly when it comes to sexual encounters [67,68]. However, taking an agentic approach to sex may have positive benefits for women-for example, research indicates that taking on an empowered role during sex positively relates to their overall sexual satisfaction [52,69,70] and orgasm occurrence among women [69,71]. Recently, Wongsomboon and colleagues again showed the importance of autonomous motives (e.g., sexual pleasure) for women's sexual wellbeing [51]. Although sexual agency is correlated with sexually pleasurable outcomes, research shows that many women restrict the expression of sexually agentic behaviors for fear of backlash [72,73]. Acting in accordance with traditional sexual norms, consequently, might protect individuals against social penalties and the risk of being perceived as a less desirable (sexual) partner [74,75]. What is now needed is to challenge the sociocultural marginalization of women's pleasure and the misunderstandings surrounding women's orgasms.

Promoting Women's Pleasure
Throughout this review, we point to the importance of promoting pleasure and orgasm for women's sexual health and gender equality with men. At the same time, it bears mentioning that a hyper focus on orgasm can counterproductively create undue pressure to orgasm [63]. Because orgasm has continually surfaced as an important component of women's sexual well-being (especially in casual sex), we argue orgasm should be taken seriously as a meaningful site of intra-and interpersonal psychological processing. To meet concerns around overvaluing orgasm for sexual pleasure [e.g., 63,76], future studies may explicitly ask for orgasmic pleasure alongside other measures of sexual pleasure and satisfaction, and simple orgasm occurrence.
Practically, an emphasis on pleasure and orgasm is important because contextual and cultural factors continue to restrict women's sexual expression and desire compared to men's sexuality [40,77]. Feminist scholars have provided numerous strategies for promoting sexual pleasure in women and closing the gender orgasm gap [78]. These include improved media representation of women's sexualities, accurate sex education materials (e.g., school books illustrating the clitoris), and challenging the coital imperative by, for instance, expanding sexual repertoires. Critically discussing the autonomous, self-determined wish of wanting to experience an orgasm opposed to wanting to orgasm for her partner's sexual self-esteem (e.g., feelings of masculinity) is similarly crucial [78].
Reflecting on their commonly-employed sexual scripts and consuming pleasure-enhancing knowledge has been identified as a successful approaches for increasing heterosexual women's sexual well-being [79,80]. A holistic approach in deconstructing sexual scripts and gendered power dynamics must also adapt an intersectional perspective on sexual pleasure [81][82][83]. In this way, light might be shed on implicit privilege it is to access orgasm and sexual pleasure and we may open up pathways to the pursuit of pleasure equality among different social locations (e.g., gender, race, sexual identity, abilities, etc.) [8,84,85].
As we have reviewed, there is no shortage of research demonstrating the myriad of favorable physical, psychological, and interpersonal associations with women's orgasms across personal, relational and sexual contexts. Because orgasm has continually surfaced as such a critical component of women's positive sexual experiences, we argue the female orgasm should be taken seriously as a meaningful site of research on women's well-being, and orgasm equality should be taken seriously in the pursuit of gender equality.

Compliance with Ethical Standards
Conflict of Interest The authors declare no competing interests.

Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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