Evolutionary Role of the Female Orgasm: Insights into Mate Choice and Beyond.

The female orgasm remains a subject of extensive debate within evolutionary sciences, primarily due to the absence of a consensus regarding its adaptive function. Some hypotheses propose that it could function as a mechanism for mate selection, possibly linked to reproductive strategies. Studies have observed that lesbian women tend to experience orgasms more frequently than straight women, suggesting a potential link to advantageous partner characteristics. We explored the connection between the female orgasm and mate selection, aiming to ascertain its role as an adaptive tool for mate choice. A total of 939 sexually active Brazilian women (Mage = 28.3 years) engaged in committed relationships participated by completing the Marital Empathy Questionnaire, the Female Sexual Function Index, and evaluations of their partners' attributes. Analysis using structural equation models revealed that higher orgasm scores were positively associated with perceptions of partner kindness, intelligence, good health, physical attractiveness, and empathy. However, the small effect sizes of these associations warrant caution in their interpretation, and no significant association was found for relationship duration, financial prospects, dominance, and masculinity/femininity. Additionally, no differences were found between women in same-sex and other-sex relationships regarding orgasm frequency and its association with partner traits. The findings partially support the mate-choice theory, encompassing both sire-choice and pair-bond hypotheses, suggesting that female orgasm is positively associated with some partner attributes related to genetic quality and the capability for emotional connection and resource investment. Therefore, female orgasm may offer information about the partner that might not be primarily accessed and contribute to relationship maintenance.

The complexity of female orgasm and ejaculation.

The anatomy and physiology of the female orgasm are often neglected. The female orgasm is a normal psychophysiological function to all women, and some even can achieve ejaculation as part of the normal physiological response at the height of sexual arousal. The complexity of female sexuality requires a deep understanding of genital anatomy. The clitoris is the principal organ for female pleasure. The vaginal stimulation of the anterior vaginal wall led women to orgasm due to the stimulation of the clitourethrovaginal complex and not due to stimulation of a particular organ called the G spot in the anterior distal vaginal wall. Female ejaculation follows orgasm. It consists of the orgasmic expulsion of a smaller quantity of whitish fluid produced by the female prostate. Squirting can be differentiated from female ejaculation because it is the orgasmic transurethral expulsion of a substantial amount of diluted urine during sexual activity, and it is not considered pathological. The female orgasm is influenced by many aspects such as communication, emotional intimacy, long-standing relationship, adequate body image and self-esteem, proper touching and knowledge of the female body, regular masturbation, male sexual performance, male and female fertility, chronic pain, and capacity to engage in new sexual acts. Stronger orgasms could be achieved when clitoral stimulation, anterior vaginal wall stimulation, and oral sex is involved in the same sexual act.

The relationship between clitourethrovaginal complex and female orgasm.

AIM: Orgasm is the ultimate pleasurable sexual experience in sexual life, a phenomenon that is difficult to depict and uncertain. A satisfying sexual life plays a vital role in the physical and mental health of men and women, the relationship between husband and wife, and family harmony. In the past, it was thought that female orgasm was related to the G-spot in the vagina, but it has never been proven. In this review, we focus on the anatomy of the vaginal vestibule, vagina, Urethra, Skene gland, and clitoris to explore the origin of female orgasm. METHODS: The published articles were reviewed, including original articles, reviews, letters to the editor, and case reports, regarding the female reproductive system. RESULTS: The concept of the clitourethrovaginal complex (CUV) explains the mechanism of the female orgasm, which is not produced by a single organ acting alone, but by the synergistic action of multiple organs and tissues. CONCLUSION: The concept of CUV complex not only reveals the principle of female orgasm but also provides new ideas for the diagnosis and treatment of female sexual medicine in the future.

Immunohistochemical Investigation of Autonomic and Sensory Innervation of Anterior Vaginal Wall Female Periurethral Tissue: A Study of the Surgical Field of Mid-Urethral Sling Surgery Using Cadaveric Simulation.

BACKGROUND: Female sexual dysfunction, including female orgasm disorder, has been reported following mid-urethral sling (MUS) surgery to treat bothersome stress urinary incontinence. Anterior vaginal wall-female periurethral tissue (AVW-FPT) likely contains autonomic and sensory innervation involved in the female sexual response, and injury to these nerves may result from MUS implantation. AIM: To characterize, using fresh cadaveric tissue, autonomic and sensory nerves in AVW- FPT using immunohistochemistry (IHC), and to assess their proximity to an implanted MUS. METHODS: AVW-FPT was excised following careful dissection from four fresh cadavers. Prior to dissection, one cadaver underwent simulation of the MUS procedure by a urogynegologist, using a fascial sling. All samples were paraffin embedded, sectioned, and stained with hematoxylin. Serial sectioning and IHC were performed to identify nerves. IHC markers were used to characterize the sensory and autonomic innervation. OUTCOMES: IHC localization of autonomic and sensory nerve markers consistent with neural tissue within the region of MUS implantation. RESULTS: IHC of AVW-FPT using protein gene product 9.5 (PGP9.5), a general nerve stain, revealed innervation throughout the region targeted by the MUS implantation. More specifically, immunoreactivity for both autonomic (tyrosine hydroxylase, TH) and sensory (Nav1.8 and S100ß) nerves were found in close proximity (<1 mm) to the implanted MUS. In addition, a subset of S100ß positive nerves also showed immunoreactivity for calcitonin gene-related peptide (CGRP). Combining the IHC findings with the surgical simulation of the MUS implantation revealed the potential for damage to both autonomic and sensory nerves as a direct result of the MUS procedure. CLINICAL TRANSLATION: The identified autonomic and sensory nerves of the AVW-FPT may contribute to the female sexual response, and yet are potentially negatively impacted by MUS procedures. Given that surgeries performed on male genital tissue, including the prostate, may cause sexual dysfunction secondary to nerve damage, and that urologists routinely provide informed consent regarding this possibility, urogynaecologists are encouraged to obtain appropriate informed consent from prospective patients undergoing the MUS procedure. STRENGTHS & LIMITATIONS: This is the first study to characterize the sensory and autonomic innervation within the surgical field of MUS implantation and demonstrate its relationship to an implanted MUS. The small sample size is a limitation of this study. CONCLUSION: The present study provides evidence of potential injury to autonomic and sensory innervation of AVW-FPT as a consequence of MUS implantation, which may help explain the underlying mechanisms involved in the reported post-operative female sexual dysfunction in some women. Giovannetti O, Tomalty D, Gaudet D, et al. Immunohistochemical Investigation of Autonomic and Sensory Innervation of Anterior Vaginal Wall Female Periurethral Tissue: A Study of the Surgical Field of Mid-Urethral Sling Surgery Using Cadaveric Simulation. J Sex Med 2021;18:1168-1180.

Factors Influencing Sexual Vocalization in Human Females.

Human females use numerous signals to attract male attention which can be ultimately motivated by enhanced paternal investment in the offspring. Sexual vocalization is a form of female sexual signaling. The majority of hypotheses attempting to explain the functional significance of vocalizations have been applied on non-human primates, while research on human females is scarce. This study investigated factors underlying sexual vocalization with a sample of 403 heterosexual Slovak females. Sexual vocalization was most frequent during penetration itself compared with other forms of sexual activities, which supports its signaling function. The most frequently reported sexual vocalizations were moaning/groaning, followed by screams and instructional commands, squeals, and words. Both the frequency and intensity of sexual vocalizations were significantly and positively associated with sexual arousal during the last sexual vaginal intercourse and sociosexuality. About 38% of females reported that they pretended vocalization and, in turn, pretended vocalization was exclusively associated with pretending orgasm. No direct evidence was found for any associations between self-reported frequency and intensity of sexual vocalization and partner satisfaction/physical attractiveness/ambition/dominance, self-perceived attractiveness, or occurrence of orgasm. The frequency (but not intensity) of sexual vocalization was positively influenced by the conception risk. On the proximate level, it seems that sexually less restricted females may use sexual vocalization to increase their sexual attractiveness to their current partner by means of boosting their partner's self-esteem. Enhanced vocalization by sexually unrestricted females may ultimately secure higher paternal investment and increase the confidence of the paternity of current sexual partner.

Cognitive-Affective Factors and Female Orgasm: A Comparative Study on Women With and Without Orgasm Difficulties.

BACKGROUND: Orgasmic difficulties are one of the most common sexual complaints among women. Although models of sexual dysfunction propose that cognitive-affective factors are involved in the development and maintenance of sexual difficulties, there is a need to further examine how these factors are associated with orgasmic difficulties specifically. AIM: To analyze differences between women who reported orgasm difficulties and controls in regard to sexual inhibition, sexual excitation, sexual beliefs, as well as negative automatic thoughts and affect during sexual activity. METHODS: A total of 500 women, aged 18 to 72 years, completed a Web survey focused on cognitive-affective factors and sexual health. Two hundred fifty women reported orgasm difficulties and were compared with 250 age-matched women who reported no sexual difficulties. OUTCOMES: Differences between groups regarding sexual inhibition and sexual excitation (Sexual Inhibition/Sexual Excitation Scales-Short Form), sexual beliefs (Sexual Dysfunctional Beliefs Questionnaire), negative automatic thoughts (Automatic Thoughts Subscale of the Sexual Modes Questionnaire), and affect (Positive and Negative Affect Schedule) during sexual activity. RESULTS: Women with orgasm difficulties scored higher on sexual inhibition than controls. They also reported more negative automatic thoughts during sexual activity (concerning failure and disengagement, sexual abuse, lack of affection from partner, passivity, body image) and less erotic thoughts. Women with orgasm difficulties reported experiencing higher negative affect and lower positive affect during sexual activity than women who reported no sexual difficulties. No significant differences were found regarding sexual excitation and endorsement of sexual beliefs. CLINICAL IMPLICATIONS: Helping women shift their focus from non-erotic, negative thoughts to erotic stimuli, as well as addressing sexual inhibition, can be relevant targets of interventions aimed at women's orgasm difficulties. STRENGTHS & LIMITATIONS: Strengths of the study include the use of a large sample of women who reported orgasm difficulties, offering new insights into the clinical importance of these psychological processes. Limitations include the reliance on self-report measures and a relatively homogeneous sample regarding sexual orientation, education, and age. CONCLUSION: Results highlight the role of cognitive-affective factors on women's orgasm difficulties and emphasize the potential benefit of cognitive-behavioral and/or mindfulness interventions for orgasm difficulties. Moura CV, Tavares IM, Nobre PJ. Cognitive-Affective Factors and Female Orgasm: A Comparative Study on Women With and Without Orgasm Difficulties. J Sex Med 2020;17:2220-2228.

Female Orgasm and Overall Sexual Function and Habits: A Descriptive Study of a Cohort of U.S. Women.

INTRODUCTION: Few studies have investigated women's experiences with orgasm and the factors that they cite as important for their orgasmic function and sexual behavior related to foreplay and sexual stimulation. AIM: To investigate and describe overall sexual function in a cohort of North American women, with a special focus on orgasmic function, satisfaction, triggers, risk factors, and sexual behavior. METHODS: A total of 303 women aged 18-75 years completed a 100-questionnaire survey, which included the Female Sexual Function Index (FSFI) questionnaire and questions on orgasmic function, duration of sexual activity, sexual behaviors and relationship, and the partner's sexual function. Statistical analysis was performed using SPSS to illuminate factors affecting sexual function. OUTCOMES: The main outcome measures are FSFI score, satisfaction with sexual life, ability to reach orgasm, orgasm frequency, preferred sexual stimulation, and sexual habits. RESULTS: FSFI scores, which were calculated for the 230 women who reported having had a steady male sex partner in the preceding 6 months, showed that 41% of the 230 women were at risk for female sexual dysfunction (a cutoff less than 26.55) and 21% were dissatisfied with their overall sexual life. Almost 90% of the overall cohort reported good emotional contact with their partner, that their partner was willing to have sex, satisfaction with the partner's penis size (wherever applicable), and good erectile function and ejaculatory control of their partner (wherever applicable). 81% of the overall cohort claimed to be sexually active. Around 70% (70-72) did reach orgasm frequently, but around 10% never did so. Vaginal intercourse was reported by 62% of the overall cohort as the best trigger of orgasm, followed by external stimulation from the partner (48%) or themselves (37%). External stimulation was reported to be the fastest trigger to orgasm. CLINICAL IMPLICATIONS: The knowledge on how women reach orgasm and how it is related to the partners' willingness to have sex and other factors can be incorporated in the clinical work. STRENGTHS & LIMITATIONS: The use of a validated questionnaire and the relative large number of participants are strengths of the study. Limitations are the cross-sectional design, the lack of a sexual distress measure, and a possible selection bias. CONCLUSION: Most women in the overall cohort were satisfied overall with their sexual life and partner-related factors, even though 41% (of those who cited a steady sex male partner) were at risk for female sexual dysfunction. Most women did reach orgasm through different kinds of stimulation. Correlation was good between preferred and performed sexual activities and positions. Shaeer O, Skakke D, Giraldi A, et al. Female Orgasm and Overall Sexual Function and Habits: A Descriptive Study of a Cohort of U.S. Women. J Sex Med 2020;17:1133-1143.

[Female orgasm during neurological disorders]. / L'orgasme féminin dans les pathologies neurologiques.

INTRODUCTION: Sexual dysfunctions, particularly orgasm dysfunction, were not routinely assessed in daily practice in neurological women. OBJECTIVE: To assess type, frequency and impact of neurological women orgasm dysfunction. METHOD: A systematic review was conducted with Medline via Pubmed and The Cochrane Database of Systematic Review. RESULTS: Neurological women's orgasm dysfunction is poorly assessed. The most of these were clinical small retrospective studies assessed by general questionnaires and some with electrophysiological assessments. Multiple sclerosis (MS) and Spinal cord injury (SCI) were the two most studied conditions. Orgasm dysfunction is observed in one third of neurological women, associated with arousal troubles, voiding and anal dysfunction. Orgasm alteration seriously impact quality of life of these patients. CONCLUSION: Specific studies could be conducted in this specific field in order to increase quality of life of these neurogenic patients suffered from such sexual dysfunction.

Sexual Inhibition is a Vulnerability Factor for Orgasm Problems in Women.

BACKGROUND: The differential role of psychological traits in the etiology and maintenance of female orgasm difficulties is yet to be consistently established. AIM: To investigate the contribution of different psychological trait features (personality, sexual inhibition and excitation, and sexual beliefs) to predict female orgasm and to assess the degree to which these dispositional factors moderate the association between sexual activity and orgasm occurrence in a large community sample of Portuguese women. METHODS: 1,002 women (18-72 years, mean age = 26.27, SD = 8.74) completed questionnaires assessing personality traits (NEO-Five Factor Inventory), sexual inhibition and sexual excitation (Sexual Inhibition/Sexual Excitation Scales-Short Form [SIS/SES]), sexual beliefs (Sexual Dysfunctional Beliefs Questionnaire), sexual behavior (frequency of sexual activities and frequency of orgasm occurrence), and social desirability (Socially Desirable Response Set). Hierarchical multiple regression and moderation analyses were conducted while controlling for the effect of covariates such as social desirability, sociodemographic and medical characteristics, and relationship factors. OUTCOMES: The main outcome measurement was orgasm frequency as predicted and moderated by personality, SIS/SES dimensions, and sexual beliefs. RESULTS: Results of the hierarchical multiple regression analysis indicated a significant predictive role for sexual inhibition (associated with fear of performance failure [SIS1] and related to the threat of performance consequences) and body image beliefs in female orgasm occurrence. The significant predictive effect of extraversion and of sexual excitation on orgasm frequency ceased to be significant with the insertion of all trait predictors in the final model. Furthermore, SIS1 significantly moderated the relation between sexual activity and orgasm occurrence. CLINICAL IMPLICATIONS: Attention should be given to individual factors impairing orgasmic response in women, particularly sexual inhibition processes. The development of clinical strategies to address and regulate them is recommended. STRENGTHS AND LIMITATIONS: Although this study investigated a large community sample, this sample was composed of heterosexual, relatively young women and thus generalization of the present results demands some caution. Social desirability was controlled for in the analyses and questionnaires were not collected face to face, which constitutes a strength of this study because social desirability is lower in self-administered online questionnaires compared with paper-and-pencil questionnaires, particularly for more sensitive sexual issues. CONCLUSION: SIS1 was found to be a vulnerability factor for female orgasmic difficulties. Future research should test these findings with different samples, particularly clinical samples of women with orgasmic problems, preferably with the use of longitudinal designs. Tavares IM, Laan ETM, Nobre PJ. Sexual Inhibition is a Vulnerability Factor for Orgasm Problems in Women. J Sex Med 2018;15:361-372.

Women's Experience of Orgasm During Intercourse: Question Semantics Affect Women's Reports and Men's Estimates of Orgasm Occurrence.

Most women report reliably experiencing orgasm from masturbation, but a smaller proportion of women report regularly experiencing orgasm from intercourse. Research suggests that concurrent clitoral stimulation during intercourse increases the likelihood of orgasm, yet most surveys of orgasm during intercourse leave unspecified whether vaginal intercourse does or does not include concurrent clitoral stimulation (assisted intercourse or unassisted intercourse, respectively). Using an online sample of 1569 men and 1478 women, we tested whether phrasing of questions about the occurrence of orgasm in intercourse modulates women's reported frequency and men's estimates of women's frequency of orgasm in intercourse. Participants provided estimates of orgasm when asked explicitly about intercourse with stimulation unspecified, assisted intercourse, and unassisted intercourse. Women's reports of orgasm occurrence were highest in response to assisted intercourse (51-60%), second highest in response to intercourse with clitoral stimulation unspecified (31-40%), and lowest in response to unassisted intercourse (21-30%). Men's estimates of women's orgasms were highest in response to assisted intercourse (61-70%), and lowest in response to unassisted intercourse (41-50%); in both conditions, men's estimates were significantly higher than women's reports. When clitoral stimulation was unspecified, women interpreted "orgasm in intercourse" in three ways: as from intercourse alone, as including concurrent clitoral stimulation though it was unspecified, or as an average of assisted and unassisted intercourse. Taken together, these results demonstrate that the phrasing of questions about women's orgasm produces markedly different orgasm estimates, and suggest that concurrent clitoral stimulation increases the likelihood of women experiencing orgasm in intercourse.

G-Spotplasty: A New Surgical Plastic Intervention-The Preliminary Study.

BACKGROUND: Ostrzenski's G-pot anatomical structure discovery has been verified by the anatomy, histology, MRI in vivo, and electrovaginography in vivo studies. The objectives of this scientific-clinical investigation were to develop a new surgical reconstructive intervention (G-spotplasty); to determine the ability of G-spotplasty surgical implementation; to observe for potential complications; and to gather initial information on whether G-spotplasty improves female sexual activity, sexual behaviors, and sexual concerns. METHODS: A case series study was designed and conducted with 5-year follow-up (October 2013 and October 2017). The rehearsal of new G-spotplasty was performed on fresh female cadavers. Three consecutive live women constituted this clinical study population, and they were subjected to the newly developed G-spotplasty procedure in October 2013. Preoperatively and postoperatively, a validated, self-completion instrument of Sexual Relationships and Activities Questionnaire (SRA-Q) was used to measure female sexual activity, sexual behaviors, and sexual concerns. RESULTS: Three out of twelve women met inclusion criteria and were incorporated into this study. All patients were subjected to G-spotplasty, completed 5-year follow-up, and returned completed SRA-Q in a sealed envelope. New G-spotplasty was successfully implemented without surgical difficulty and without complications. All patients reported re-establishing vaginal orgasms with different degrees of difficulties, observing return of anterior vaginal wall engorgement, and were very pleased with the outcome of G-spotplasty. CONCLUSIONS: The G-spotplasty is a simple surgical intervention, easy to implement, and improves sexual activities, sexual behaviors, and sexual concerns. The preliminary results are very promising and paved the way for additional clinical-scientific research. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Cognitive-Affective Dimensions of Female Orgasm: The Role of Automatic Thoughts and Affect During Sexual Activity.

BACKGROUND: Cognitive-affective factors contribute to female sexual dysfunctions, defined as clinically significant difficulties in the ability to respond sexually or to experience sexual pleasure. Automatic thoughts and affect presented during sexual activity are acknowledged as maintenance factors for these difficulties. However, there is a lack of studies on the influence of these cognitive-affective dimensions regarding female orgasm. AIM: To assess the role of automatic thoughts and affect during sexual activity in predicting female orgasm occurrence and to investigate the mediator role of these variables in the relation between sexual activity and orgasm occurrence. METHODS: Nine hundred twenty-six sexually active heterosexual premenopausal women reported on frequency of sexual activities and frequency of orgasm occurrence, cognitive factors, and social desirability. Participants completed the Sexual Modes Questionnaire-Automatic Thoughts Subscale, the Positive and Negative Affect Schedule, and the Socially Desirable Response Set. Multiple linear regressions and mediation analyses were performed, controlling for the effect of covariates such as social desirability, sociodemographic and medical characteristics, and relationship factors. OUTCOMES: The main outcome measurement was orgasm frequency as predicted and mediated by automatic thoughts and affect experienced during sexual activities. RESULTS: The presence of failure thoughts and lack of erotic thoughts during sexual activity significantly and negatively predicted female orgasm, whereas positive affect experienced during sexual activity significantly and positively predicted female orgasm. Moreover, negative automatic thoughts and positive affect during sexual activity were found to mediate the relation between sexual activity and female orgasm occurrence. CLINICAL IMPLICATIONS: These data suggest that the cognitive aspects of sexual involvement are critical to enhancing female orgasm experience and can aid the development of strategies that contemplate the central role of automatic thoughts and of positive emotions experienced during sexual activity. STRENGTHS AND LIMITATIONS: Data were not collected face to face, which constitutes a strength of this study, because it is known that social desirability is lower in self-administered online questionnaires compared with traditional paper-and-pencil questionnaires, particularly for more sensitive sexual issues. The fact that the sample was composed of heterosexual, premenopausal, and relatively young women demands some caution regarding generalization of the present results. CONCLUSION: The findings support the contribution of cognitive and affective factors to female orgasmic functioning. It is recommended that future research confirm these findings with other samples, particularly clinical samples of women with orgasmic difficulties. Tavares IM, Laan ETM, Nobre PJ. Cognitive-Affective Dimensions of Female Orgasm: The Role of Automatic Thoughts and Affect During Sexual Activity. J Sex Med 2017;14:818-828.

Understanding Orgasmic Difficulty in Women.

INTRODUCTION: Women's primary issue with the orgasmic phase is usually difficulty reaching orgasm. AIMS: To identify predictors of orgasmic difficulty in women within the context of a partnered sexual experience; to assess the relation between orgasmic difficulty and self-reported levels of sexual desire or interest and arousal in women; and to assess the interrelations among three dimensions of orgasmic response during partnered sex: self-reported time to reach orgasm, general difficulty or ease of reaching orgasm, and level of distress or concern. METHODS: Drawing from a community-based sample using the Internet, 866 women were queried on a 26-item survey regarding their difficulty reaching orgasm during partnered sex. Four hundred sixteen women who indicated difficulty also responded to items assessing arousal and desire difficulties, level of distress about their condition, and their estimated time to reach orgasm. MAIN OUTCOME MEASURES: Answers to a 26-item survey on surveyed women's difficulty reaching orgasm during partnered sex. RESULTS: Age, arousal difficulty, and lubrication difficulty predicted difficulty reaching orgasm in the overall sample. In the subsample of women reporting difficulty, approximately half reported issues with arousal. Women with arousal problems reported greater difficulty reaching orgasm but did not differ from those without arousal problems on measurements of orgasm latency or levels of distress. Slightly more than half the women experiencing difficulty reaching orgasm were distressed by their condition; distressed women reported greater difficulty reaching orgasm and longer latencies to orgasm than non-distressed counterparts. They also reported lower satisfaction with their sexual relationship. CONCLUSION: This study indicates the importance of assessing multiple parameters when investigating orgasmic problems in women, including arousal issues, levels of distress, and latency to orgasm. Results also clarify that women with arousal problems do not differ substantially from those without arousal problems; in contrast, women distressed by their condition differ from non-distressed women along some critical dimensions. Although orgasmic problems decreased with age, the overall relation of this variable to distress, arousal, and latency to orgasm was essentially unchanged across age groups.

Toward a More Evidence-Based Nosology and Nomenclature for Female Sexual Dysfunctions-Part II.

INTRODUCTION: Current Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) definitions of sexual dysfunction do not identify all sexual problems experienced clinically by women and are not necessarily applicable for biologic or biopsychosocial management of female sexual dysfunction. A unified nomenclature system enables clinicians, researchers, and regulatory agencies to use the same language and criteria for determining clinical end points, assessing research results, and managing patients. AIM: To develop nomenclature with classification systems for female sexual desire, arousal, and orgasm disorders with definitions pertinent to clinicians and researchers from multiple specialties who contribute to the field of sexual medicine. METHODS: Key national and international opinion leaders diverse in gender, geography, and areas of expertise met for 2 days to discuss and agree to definitions of female sexual desire, arousal, and orgasm disorders and persistent genital arousal disorder. The attendees consisted of 10 psychiatrists and psychologists; 12 health care providers in specialties such as gynecology, internal medicine, and sexual medicine; three basic scientists; and one sexuality educator, representing an array of societies working within the various areas of sexual function and dysfunction. MAIN OUTCOME MEASURE: A unified set of definitions was developed and accepted for use by the International Society for the Study of Women's Sexual Health (ISSWSH) and members of other stakeholder societies participating in the consensus meeting. RESULTS: Current DSM-5 definitions, in particular elimination of desire and arousal disorders as separate diagnoses and lack of definitions of other specific disorders, were adapted to create ISSWSH consensus nomenclature for distressing sexual dysfunctions. The ISSWSH definitions include hypoactive sexual desire disorder, female genital arousal disorder, persistent genital arousal disorder, female orgasmic disorder, pleasure dissociative orgasm disorder, and female orgasmic illness syndrome. CONCLUSION: Definitions for female sexual dysfunctions that reflect current science provide useful nomenclature for current and future management of women with sexual disorders and development of new therapies.

Nature and origin of "squirting" in female sexuality.

INTRODUCTION: During sexual stimulation, some women report the discharge of a noticeable amount of fluid from the urethra, a phenomenon also called "squirting." To date, both the nature and the origin of squirting remain controversial. In this investigation, we not only analyzed the biochemical nature of the emitted fluid, but also explored the presence of any pelvic liquid collection that could result from sexual arousal and explain a massive fluid emission. METHODS: Seven women, without gynecologic abnormalities and who reported recurrent and massive fluid emission during sexual stimulation, underwent provoked sexual arousal. Pelvic ultrasound scans were performed after voluntary urination (US1), and during sexual stimulation just before (US2) and after (US3) squirting. Urea, creatinine, uric acid, and prostatic-specific antigen (PSA) concentrations were assessed in urinary samples before sexual stimulation (BSU) and after squirting (ASU), and squirting sample itself (S). RESULTS: In all participants, US1 confirmed thorough bladder emptiness. After a variable time of sexual excitation, US2 (just before squirting) showed noticeable bladder filling, and US3 (just after squirting) demonstrated that the bladder had been emptied again. Biochemical analysis of BSU, S, and ASU showed comparable urea, creatinine, and uric acid concentrations in all participants. Yet, whereas PSA was not detected in BSU in six out of seven participants, this antigen was present in S and ASU in five out of seven participants. CONCLUSIONS: The present data based on ultrasonographic bladder monitoring and biochemical analyses indicate that squirting is essentially the involuntary emission of urine during sexual activity, although a marginal contribution of prostatic secretions to the emitted fluid often exists.

Secondary Female Anorgasmia in Patients with Obsessive Traits: A Study.

Background: In the literature, female anorgasmia (AO) is closely related to obsessive-compulsive disorder (OCD), but no publication has explored the role of individual obsessive traits that may also be typical of other disorders, assuming that repetitive thoughts and compulsions must necessarily correspond to an obsessive-type neurotic profile. It is worth investigating and assessing the specific weight of other morbid conditions involved, beyond OCD. Materials and Methods: This study was conducted during 2022-2023 by selecting 208 Italian clinical patients from private databases. They submitted to individual clinical interviews and two psychometric questionnaires (Perrotta Integrative Clinical Interviews 3, PICI-3-TA, and Perrotta Individual Sexual Matrix Questionnaire, PSM-Q). Results: Among the 208 patients (M: 39.05 years), divided into subgroups by age and obsessive symptomatology, no significant differences were found between the subgroups in the comparisons of the data obtained from the administration of the PSM-Q. Conclusions: This study confirms that it is not OCD that correlates with OA but obsessive traits, which are also common to other psychopathological disorders, such as bipolar disorder, borderline disorder, manic, and psychotic disorders and, therefore, in psychotherapy, it is necessary to intervene with a clinical approach that has in mind the patient's psychopathological personality picture and the causes that originated or reinforced OA.

Assessment of the effect of cannabis use before partnered sex on women with and without orgasm difficulty.

Background: Up to 41% of women face challenges achieving orgasm, a statistic unchanged for 50 years. Aim: To evaluate the effect of cannabis use before partnered sex on women with and without difficulty achieving orgasm. Methods: This observational study evaluated responses from female study participants relating to their demographics, sexual activities, mental well-being, cannabis usage, and orgasm-related questions from the Female Sexual Function Index (FSFI). Outcomes: Outcomes included orgasm frequency, difficulty, and satisfaction related to cannabis use or lack of use before partnered sex, largely based on the FSFI orgasm subscale. Results: Of the 1037 survey responses, 410 were valid and complete. Twenty-three surveys (5.6% returned) were excluded due to failure to meet the study's criteria. Of the valid surveys, most women (52%, n = 202) reported difficulty achieving orgasm during sexual activity with a partner. These women were primarily between 25 and 34 years of age (45%, n = 91); 75% identified their race as White (n = 152/202); 52% (n = 105) identified as LGBTQI+ (lesbian, gay, bisexual, transgender, queer/questioning, intersex, or other); and 82% (n = 165) were married or in a relationship. Among participants who experienced challenges in achieving orgasm, 72.8% (n = 147, P < .001) reported that cannabis use before partnered sex increased orgasm frequency, 67% stated that it improved orgasm satisfaction (n = 136, P < .001), and 71% indicated that cannabis use made orgasm easier (n = 143, P < .001). The frequency of cannabis use before partnered sex correlated with increased orgasm frequency for women who experienced difficulties achieving orgasm (n = 202, P < .001). The reasons for cannabis use before partnered sex resulted in a more positive orgasm response (n = 202, P = .22). Clinical Implications: Cannabis may be a treatment for women with difficulty achieving orgasm during partnered sex. Strengths and Limitations: The researchers examined the challenge of achieving orgasm and considered the covariates reported in the literature, including the FSFI orgasm subscale. The findings may not be generalizable to women who rarely or never use cannabis before sex, women who have never experienced an orgasm, or women who do not have female genitalia. Additionally, the specific type of cannabis used, its chemical composition, the quantity used, and whether or not the partner used cannabis were not assessed in this study. Conclusion: Cannabis-related treatment appears to provide benefit to women who have female orgasm difficulties or dysfunction.

Female Sexual Health: Screening and Evaluation.

Female sexual dysfunction is highly prevalent, affecting 30% to 50% of cisgender women globally. Low sexual desire, sexual arousal disorder, and orgasm disorder affect 10% to 20%, 6% to 20%, and 4% to 14% of women, respectively. Dyspareunia or pain with intercourse affects 8% to 22% of women. Universal screening is recommended; and a thorough medical history and physical examination are the foundations of evaluation and assessment. Laboratory tests and imaging are sometimes warranted, but referral to a sexual medicine expert is suggested if the practitioner is unfamiliar or uncomfortable with treatment.

[Women's orgasmic disorders]. / Les troubles de l'orgasme féminin.

OBJECTIVE: To evaluate the clinical presentation of women's orgasmic disorders (OD) and therapeutic options, suggested in the literature. MATERIAL AND METHODS: Review of articles published on this subject in the Medline (Pubmed) database, selected according to their scientific relevance, of consensus conferences and published guidelines. RESULTS: At present it is thought that the orgasm is a potentiality which a woman can learn to develop with experience, and practice over time. Primary anorgasmia in young females (<35 years) is very often due to lack of experience or lack of skill in the partner or partners. Secondary anorgasmia is often linked to difficulties of live, more rarely to problems with the partner. In both cases, informed advice to the patient and her partner can provide simple ways of modifying and diversifying sexual practice, slight changes can be sufficient. For the woman, learning to "let go" is essential. Speaking to the partner can help to eliminate and diversify sexual behaviour which can be responsible for this problem. However, OD, particularly the secondary type, is less attributable to the male performance than to the emotional and affective aspect. Primary anorgasmia, if total, persisting in the mature woman, evokes more structural problems (body image, sexual abuse, guilt…) and requires specialized management. CONCLUSIONS: Currently, female sexual desire is often evoked, however, one woman in four suffers from OD to a greater or lesser extent. Orgasmic dysfunction in women is frequent and is the second most common reason for consulting a sexologist. Evaluating the context is essential to differentiate primary from secondary OD, in order to give an appropriate treatment.

The female orgasm and the homology concept in evolutionary biology.

The definition of homology and its application to reproductive structures, external genitalia, and the physiology of sexual pleasure has a tortuous history. While nowadays there is a consensus on the developmental homology of genital and reproductive systems, there is no agreement on the physiological translation, or the evolutionary origination and roles, of these structural correspondences and their divergent histories. This paper analyzes the impact of evolutionary perspectives on the homology concept as applied to the female orgasm, and their consequences for the biological and social understanding of female sexuality and reproduction. After a survey of the history of pre-evolutionary biomedical views on sexual difference and sexual pleasure, we examine how the concept of sexual homology was shaped in the new phylogenetic framework of the late 19th century. We then analyse the debates on the anatomical locus of female pleasure at the crossroads of theories of sexual evolution and new scientific discourses in psychoanalysis and sex studies. Moving back to evolutionary biology, we explore the consequences of neglecting homology in adaptive explanations of the female orgasm. The last two sections investigate the role played by different articulations of the homology concept in evolutionary developmental explanations of the origin and evolution of the female orgasm. These include the role of sexual, developmental homology in the byproduct hypothesis, and a more recent hypothesis where a phylogenetic, physiological concept of homology is used to account for the origination of the female orgasm. We conclude with a brief discussion on the social implications for the understanding of female pleasure derived from these different homology frameworks.