When Orgasms Do Not Equal Pleasure: Accounts of "Bad" Orgasm Experiences During Consensual Sexual Encounters

Sexual Self-Esteem and Orgasm Consistency: Exploring the Unique Roles of Body Image and Genital Image

We explored the unique roles that body and genital image play in behavior-specific orgasm consistency, beyond overall sexual self-esteem. US adults (N = 599; 64% women) completed questionnaires online. Hierarchical regression analyses predicted orgasm consistency during receptive oral sex and penile-vaginal intercourse (PVI) with additional clitoral stimulation (WAS) and with no additional clitoral stimulation (NAS) for the woman. Body image, genital image, and gender were entered in later steps to assess model improvement above sexual self-esteem. Models accounted for age, sexual and racial minority identities, and current relationship status. Results indicated that genital image improved all models and predicted higher orgasm consistency across all behaviors for men and women. For orgasm during receptive oral sex and PVI-NAS, sexual self-esteem was no longer significant once genital image was included. Genital image was a stronger predictor of women's versus men's orgasm during PVI-NAS; no significant gender differences were found for oral sex and PVI-WAS. Body image was not significant in any models, contrary to expectations, suggesting role overlap with sexual self-esteem. Genital image appears to play a unique role in sexual pleasure beyond overall sexual self-esteem and body image.

Pleasurable and problematic receptive anal intercourse and diseases of the colon, rectum and anus

The ability to experience pleasurable sexual activity is important for human health. Receptive anal intercourse (RAI) is a common, though frequently stigmatized, pleasurable sexual activity. Little is known about how diseases of the colon, rectum, and anus and their treatments affect RAI. Engaging in RAI with gastrointestinal disease can be difficult due to the unpredictability of symptoms and treatment-related toxic effects. Patients might experience sphincter hypertonicity, gastrointestinal symptom-specific anxiety, altered pelvic blood flow from structural disorders, decreased sensation from cancer-directed therapies or body image issues from stoma creation. These can result in problematic RAI - encompassing anodyspareunia (painful RAI), arousal dysfunction, orgasm dysfunction and decreased sexual desire. Therapeutic strategies for problematic RAI in patients living with gastrointestinal diseases and/or treatment-related dysfunction include pelvic floor muscle strengthening and stretching, psychological interventions, and restorative devices. Providing health-care professionals with a framework to discuss pleasurable RAI and diagnose problematic RAI can help improve patient outcomes. Normalizing RAI, affirming pleasure from RAI and acknowledging that the gastrointestinal system is involved in sexual pleasure, sexual function and sexual health will help transform the scientific paradigm of sexual health to one that is more just and equitable.

Exploring the Orgasm Gap Across Racial/Ethnic Groups: A Descriptive Analysis

Orgasm gaps between heterosexual men and women, and for women across sexual orientations, are well-established in research. However, no large-scale assessments of orgasm frequency by race/ethnicity exist. Here, we analyzed 10 years of cross-sectional Singles in America survey data between 2011 and 2021 to investigate the orgasm gap at the intersection of gender and racial/ethnic identity (i.e. White, Black, Hispanic/Latino, and Asian) for heterosexual participants (N = 27,347). White and Hispanic/Latino men reported greater orgasm frequency than Black and Asian men. Hispanic/Latino women reported the greatest orgasm frequency, and Asian women reported the lowest, with White and Black women's frequencies in between. The orgasm gap between men and women was largest for White (d = 0.89) and Asian (d = 0.86) groups, although Asian participants reported a lower orgasm frequency than White participants overall. The orgasm gap was smaller for Hispanic/Latino participants (d = 0.66), because Hispanic/Latino women reported a greater orgasm frequency than other racial/ethnic groups of women. The orgasm gap was smaller for Black participants (d = 0.61), because Black men reported a lower orgasm frequency than some other racial/ethnic groups of men. This descriptive study serves as an important starting point for future research on orgasm experiences across racial/ethnic groups.

Feasibility Cues during a Sexual Encounter Impact the Strength of Heterosexual Women's Orgasm Goal Pursuit

The "orgasm gap" for women who have sex with men remains a pressing gender equity issue. Recent research found that women who pursued orgasm as a goal were more likely to have one. The current research replicated this relationship between orgasm goal pursuit and orgasm frequency for heterosexual women, and found that this relationship did not exist for heterosexual men (Study 1). Then, across two experimental studies, we examined how heterosexual women vary their orgasm goal pursuit across sexual encounters. In Study 2, women who read that a hypothetical sexual encounter would be "quick" reported less intent to pursue orgasm than women who were told they could "take their time" or received no time information. In Study 3, women who read that their hypothetical sexual partner seemed selfish reported less intent to pursue orgasm than women who were given a non-selfish partner or no partner information. Importantly, these effects were mediated by women's perceived orgasm likelihood in the scenario. These results suggest that women shift their pursuit of orgasm depending on cues which signal whether orgasm will be feasible. This research used self-regulation theory to understand women's motivations for pursuing orgasm during sexual encounters with men, with implications for reducing the orgasm gap.

A Gender Hypothesis of sex disparities in adverse drug events

Pharmacovigilance databases contain larger numbers of adverse drug events (ADEs) that occurred in women compared to men. The cause of this disparity is frequently attributed to sex-linked biological factors. We offer an alternative Gender Hypothesis, positing that gendered social factors are central to the production of aggregate sex disparities in ADE reports. We describe four pathways through which gender may influence observed sex disparities in pharmacovigilance databases: healthcare utilization; bias and discrimination in the clinic; experience of a drug event as adverse; and pre-existing social and structural determinants of health. We then use data from the U.S. FDA Adverse Event Reporting System (FAERS) to explore how the Gender Hypothesis might generate novel predictions and explanations of sex disparities in ADEs in existing widely referenced datasets. Analyzing more than 3 million records of ADEs between 2014 and 2022, we find that patient-reported ADEs show a larger female skew than healthcare provider-reported ADEs and that the sex disparity is markedly smaller for outcomes involving death or hospitalization. We also find that the sex disparity varies greatly across types of ADEs, for example, cosmetically salient ADEs are skewed heavily female and sexual dysfunction ADEs are skewed male. Together, we interpret these findings as providing evidence of the promise of the Gender Hypothesis for identifying intervenable mechanisms and pathways contributing to sex disparities in ADEs. Rigorous application of the Gender Hypothesis to additional datasets and in future research studies could yield new insights into the causes of sex disparities in ADEs.

Negative Sexual Experiences Among Gay, Bisexual, and Other Men Who Have Sex with Men Using GPS-Enabled Hook-Up Apps and Websites

Gay, bisexual, and other men who have sex with men (GBMSM) often use GPS-enabled dating apps and websites to facilitate in-person sexual encounters. Many of these encounters are positive and enjoyable. However, there is limited research on GBMSM's negative experiences with partners from hookup and dating apps/websites, especially those characterized by threats to GBMSM's sexual, physical, and/or psychological safety. In this report, we investigated this matter. We analyzed data from interviews with GBMSM (N = 60) and identified four categories of negative sexual experiences, each of which were comprised by sub-categories: 1) sexual violence (physical sexual assault, verbal sexual coercion, intoxicated assault/coercion), 2) sexual health risk behaviors (condom use resistance and coercion, deception related to HIV/STI status), 3) non-negotiated behaviors (undiscussed/unexpected sex acts, rough sex, sexualized racism, undesired substance use by the partner), and 4) threats to physical safety beyond sexual violence (being blocked from leaving, stalked, robbed, drugged). These results can inform future research and interventions that aim to promote safety on dating apps/websites within the GBMSM community.

Sexual pleasure during college students' most recent partnered sexual experiences

ObjectiveWe explored college students' sexual pleasure using a new self-report measure, the Body, Emotions, Sensations, Touch/Trust (B.E.S.T.) Scale of Sexual Pleasure. Participants: Data were from 3997 randomly sampled students with a partnered sexual experience. Methods: Students completed an online survey about their most recent partnered sexual experience. Data was collected in January 2020. Results: Students find the nonphysical aspects of partnered sex (e.g., emotions, trust, connection with partners) as pleasurable as physical aspects (e.g., behaviors engaged and received, bodily sensations). Self-reported arousal, wantedness, and emotional intimacy were the strongest correlates of male, female, and transgender/gender non-binary students' sexual pleasure. Few sexual behaviors were associated with sexual pleasure and only one - cuddling for women - was associated with greater sexual pleasure. Conclusions: Students find their partnered sexual experiences pleasurable. Students' sex may be more pleasurable when they feel ready for sex, desire sex, and feel close to their partners.

The Art of Seduction: Male Endorsement of Coercive and Willful Sex Tactics

The body of sexual assault research historically focuses on survivors, specifically female survivors. Examining the beliefs of men who endorse sexually violent or coercive behavior fills an important gap in the literature. The current study surveyed 420 male participants on their endorsement of coercive dating tactics as provided in a best-selling men's dating book, as well as endorsement of dating tactics generated from a sexual willingness framework. Overall, approximately 25% of male participants reported using or endorsing coercive sexual tactics. Several demographic factors and experiences related to higher endorsement of the coercive tactics, including past or present involvement in a fraternity, knowing a sexual assault perpetrator, affiliating with a religion, and frequent pornography viewing. The same individual factors related to endorsing the coercive tactics were associated with endorsing the willful tactics as well. Implications for greater representation in research for sexual minorities are discussed, as well as future direction for effective consent education.

Sexual Pleasure Matters - and How to Define and Assess It Too. A Conceptual Framework of Sexual Pleasure and the Sexual Response

Objective

Sexual pleasure is central to current understandings of sexual function, health, and wellbeing. In this article, we suggest that we lack a sufficiently specific, yet encompassing, definition of sexual pleasure and that we therefore lack comprehensive assessments of sexual pleasure. We introduce a definition of sexual pleasure and position it centrally in an adapted framework of the sexual response. In the framework, we include a taxonomy of rewards which can be retrieved from sex and thereby aim to capture the multifaceted nature of sexual pleasure.

Methods/Results

Through narrative review, we arrive at the definition, framework, and taxonomy by integrating theories of sexual motivation and response with the literature on sexual pleasure and basic rewards. We position this literature within theories of affect and personality which allows us to differentiate between the experience of and the tendency to experience sexual pleasure (i.e., state versus trait sexual pleasure). We discuss how this conceptualization of sexual pleasure could be reflected in self-report assessments to quantitatively assess sexual pleasure.

Conclusions

The framework may aid to understand the role of the diverse facets of sexual pleasure in sexual function, health, and wellbeing and contribute to giving sexual pleasure the center position it deserves in sex research and therapy.

Sex or Socialization? Replicating Heterosexual Couples' Gender Differences in the Association between Orgasm and Satisfaction in Same-Gender/Sex Couples

Orgasm is commonly considered an important aspect of sexual activity. The current study sought to replicate and extend prior work by examining gender/sex differences in the association between orgasm and satisfaction in a sample of same-gender/sex couples. We also examined how desire for an orgasm moderated this association. Although prior research found a curvilinear association between orgasm and satisfaction for heterosexual women (but not men), we found that orgasm curvilinearly predicted relationship and sexual satisfaction across genders/sexes, indicating more frequent orgasm was associated with higher satisfaction only to an extent for all individuals in our sample. We also found that when desire for orgasm was high, orgasm was associated with higher relationship and sexual satisfaction than when desire was low, suggesting that desire for orgasm may differentially affect how orgasm is related to satisfaction. We discuss our findings in terms of sexual scripting theory, contextualizing our results by considering the socially constructed nature of sexuality and how sexual scripts may vary across individuals with different sexual and gender identities.

A trifecta: patterns in orgasm consistency, relational satisfaction, and sexual satisfaction

BACKGROUND

We based this study on the sexual wholeness model, which considers emotional, physical, and meaning elements of sexuality, and previous research that indicates variability in the associations among orgasm consistency, relational satisfaction, and sexual satisfaction.

AIM

We performed a person-based latent class approach to examine variables linked with the trifecta of orgasm consistency, relational satisfaction, and sexual satisfaction.

METHODS

We used a Mechanical Turk sample that consisted of 1645 sexually active participants (1032 women) to evaluate classes and related variables.

OUTCOMES

Women divided into 5 classes and men into 3 classes. High orgasm consistency alone did not ensure sexual or relational satisfaction.

RESULTS

We found that 5 groups emerged for women: high orgasm/low satisfaction (6%), low trifecta (8%), low orgasm/high satisfaction (16%), moderate orgasm/high satisfaction (15%), and high trifecta (55%). For men, 3 groups emerged: lower orgasm/high satisfaction (12%), moderate trifecta (14%), and high trifecta (74%). We also found that high orgasm consistency for women did not guarantee relational and sexual satisfaction, nor did lower orgasm consistency for men or women guarantee problematic relational and sexual satisfaction.

CLINICAL IMPLICATIONS

Communication, attachment, and sexual harmony were key elements associated with positive trifecta outcomes. Clinicians and educators may emphasize the importance of these variables when individuals encounter sexual or relational distress.

STRENGTHS AND LIMITATIONS

Data analytic techniques revealed a variety of groups for men and women and associations between a host of physical, psychological, and meaning variables and the trifecta of orgasm consistency, relational satisfaction, and sexual satisfaction. However, this study is cross-sectional and correlational, which limits the conclusions that we can draw from it.

CONCLUSION

While the variables of orgasm consistency, relational satisfaction, and sexual satisfaction are each informative, together they help clinicians, educators, and researchers better understand the complexity of sex.

Coercive Sexual Experiences that Include Orgasm Predict Negative Psychological, Relationship, and Sexual Outcomes

Psychological sexual coercion is known to negatively impact those who experience it, yet sexual encounters where orgasm is present are often presumed to be positive and absent of coercion. In the present study, we conducted an online survey with women (n = 179) and men (n = 251) to test associations between sexually coercive experiences that include orgasm and negative psychological, sexual, and relationship outcomes. To do so, we focused on three experiences: having an orgasm during coerced sex (CS), having a coerced orgasm during desired sex (CO), and having a coerced orgasm during coerced sex (COS). Using structural equation modeling, we found that ever having any of these coercion-plus-orgasm experiences with a current partner predicted significantly higher avoidance motivations (i.e., engaging in sex to avoid conflict with one's partner), which in turn predicted significantly worse psychological distress, sexual satisfaction, relationship satisfaction, and sexual functioning (but not dyadic sexual desire). We also found that CS, CO, and COS predicted negative outcomes to a similar degree. However, testing gender/sex as a moderator clarified that CS predicted significantly lower sexual satisfaction, sexual functioning, and sexual desire for women but not men. Furthermore, CO predicted faking orgasms in women, but COS predicted faking orgasms in men. Together, results demonstrate that experiencing psychological sexual coercion and/or orgasm coercion is significantly associated with negative outcomes even if the coerced person's orgasm occurs.

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.

Behavioral, Neural, and Molecular Mechanisms of Conditioned Mate Preference: The Role of Opioids and First Experiences of Sexual Reward

Although mechanisms of mate preference are thought to be relatively hard-wired, experience with appetitive and consummatory sexual reward has been shown to condition preferences for partner related cues and even objects that predict sexual reward. Here, we reviewed evidence from laboratory species and humans on sexually conditioned place, partner, and ejaculatory preferences in males and females, as well as the neurochemical, molecular, and epigenetic mechanisms putatively responsible. From a comprehensive review of the available data, we concluded that opioid transmission at μ opioid receptors forms the basis of sexual pleasure and reward, which then sensitizes dopamine, oxytocin, and vasopressin systems responsible for attention, arousal, and bonding, leading to cortical activation that creates awareness of attraction and desire. First experiences with sexual reward states follow a pattern of sexual imprinting, during which partner- and/or object-related cues become crystallized by conditioning into idiosyncratic “types” that are found sexually attractive and arousing. These mechanisms tie reward and reproduction together, blending proximate and ultimate causality in the maintenance of variability within a species.

An Empirical Investigation of Variations in Outcomes Associated with Heterosexual Adults' Most Recent Mixed-Sex Threesome Experience

Research reveals that a substantial proportion of North American adults report interest in and experience with mixed-sex threesomes (MSTs; sexual activity involving three people at the same time in which persons of more than one sex are present). Despite the prevalence of MST participation, little is known about the outcomes of MST experiences. Thus, the current study assessed MST outcomes using various metrics including the extent to which one's most recent MST met expectations, the likelihood of participating in the MST again, and whether an orgasm was experienced. In addition, the extent to which one's sex, the sex of those involved, and the inclusion of one's romantic partner impacted outcomes was examined. Data from 276 heterosexual adults (217 men, 59 women) revealed that, overall, adults report fairly positive outcomes from their most recent MST and that males reported more positive outcomes than did females (particularly when engaging in a MST with two members of the other sex). In addition, MSTs involving one's romantic partner resulted in more positive outcomes than did those with casual partners. These results confirm that MSTs can be a satisfying experience particularly for heterosexual males and those participating with a romantic partner. Implications for educators looking to destigmatize various forms of nonmonogamies and for practitioners who intend to assist adults interested in safely exploring multi-person sexual behavior are discussed.

The Roles of Body Image, Sexual Motives, and Distraction in Women's Sexual Pleasure

Women with body image concerns are more likely to experience sexual difficulties (e.g., with arousal, lubrication, orgasm). However, the processes by which body image impacts sexual well-being are poorly understood. We theorized that women with negative body image are less likely to view sex in terms of reward, leading them to have weaker approach sexual motives (i.e., to pursue positive experiences such as pleasure). Rather, women with negative body image may have sex to avoid personal insecurities and negative emotions, leading them to have stronger avoidance sexual motives (i.e., to cope with negative affect or to avoid partner conflict). In turn, we theorized that stronger approach sexual motives may allow women to be more focused on erotic cues during sex, thereby enhancing sexual pleasure, whereas avoidance motives may lead to greater distraction, interfering with sexual pleasure. Women (N = 1619) were recruited from online venues and reported on their body image and most recent sex. We found that body dissatisfaction was associated with weaker self-focused approach motives and in turn more distraction. Additionally, body dissatisfaction was associated with stronger self- and partner-focused avoidance motives and in turn more distraction. In turn, more distraction was associated with less pleasure and worse sexual function. To the best of our knowledge, this is the first investigation of whether body image in women is associated with their sexual motives. Findings highlight the importance of sexual motives in explaining the link between body image and sexual pleasure and function.

Expectations and Sexual Desire in Romantic Relationships: An Experimental Investigation of Pleasure and Emotional Closeness Expectancies among Young Adults

Drawing from expectancy-value theory, the current study documented expected likelihoods (i.e., expectancies) of orgasm, non-orgasmic sexual pleasure, and emotional closeness during sex with a romantic partner, then tested their causal roles in sexual desire. Participants (N = 582, 50.3% women) were drawn from college student and online samples of young adults in the US. Expectancies were high overall; men reported much higher orgasm expectancies than women and this gender difference was larger in the college sample. Using a within-subjects, factorial experimental design, hypothetical vignettes manipulated participants' expectancies (high/low) pertaining to sex with a romantic partner. Multilevel models indicated emotional closeness expectancies had the strongest effects on men's and women's desire. Orgasm expectancies had stronger effects among the online sample, yet had the weakest effects on desire overall. Both emotional closeness and non-orgasmic pleasure expectancies had stronger effects on women's desire than on men's. Findings indicate young adults' expectations for their romantic sexual experiences may play strong roles in stimulating or stifling their sexual desire, suggesting some desire differences may be partially explained by differences in expectancies, and underscore sex as an important mechanism for fostering intimacy and experiencing pleasure for both young men and young women. Implications for clinical practice are discussed.

Porn Sex versus Real Sex: Sexual Behaviors Reported by a U.S. Probability Survey Compared to Depictions of Sex in Mainstream Internet-Based Male-Female Pornography

Using data from a 2014 U.S. nationally representative probability survey and a 2014 content analysis of 2562 male-female videos from two popular pornographic websites, this study aimed to: (1) compare the prevalence of survey respondents' event-level sexual behaviors with those depicted in mainstream pornography online videos; (2) compare event-level condom use with condom use prevalence in pornographic videos; (3) compare event-level orgasm with prevalence of orgasms in pornographic videos; and (4) assess whether respondents' partnered use of pornography was associated with the sexual behaviors in which they report engaging. We found that kissing, male orgasm, female orgasm, and condom use were significantly less prevalent in the pornographic videos than in survey respondents' most recent sexual experiences. Conversely, penile-anal intercourse and fellatio were significantly more prevalent in the pornographic videos than in participants' reports of their most recent sexual experience. There were no significant differences between the prevalence of cunnilingus or sex toy use represented in the videos as compared to survey respondents' reports. Finally, we found that individuals who reported partnered pornography use during their most recent sexual experience were more likely to report having engaged in oral sex, penile-anal intercourse, and sex toy use and were also more likely to report female orgasm during their most recent sexual experience.

Development and Psychometric Evaluation of the Gender Identity Scale for Transgender Women in China

Transgender women are an important subgroup of the transgender umbrella and have their own unique gender identity. This article aimed to understand and measure the latent concept of gender identity among Chinese transgender women from a multi-dimensional perspective. Through a two-phase, iterative scale development process, we developed the Gender Identity Scale for Transgender Women (GIS-TW) in Chinese. Literature reviews, expert consultations, and focus groups constitute phrase 1 of the study, which resulted in the first version of GIS-TW with 30 items. In phrase 2, exploratory factor analysis on a sample of 244 Chinese transgender women revealed a six-factor solution across the 22 items. The Bem Sex Role Inventory was included to test for convergent validity, and the Rosenberg Self-Esteem Scale was used to test discriminant validity. Then we conducted the confirmatory factor analysis with an independent sample of 420 Chinese transgender women, which produced the final version of GIS-TW with 21 items. The internal consistency (Cronbach's alpha = 0.71-0.87) and test-retest stability (r = 0.73-0.87) of each factor was good. In conclusion, the GIS-TW is a reliable and valid psychometric tool for the assessment of Chinese transgender women's gender identity. Future application of the scale will help transgender women obtain better gender confirmative interventions.

Orgasm Coercion and Negative Relationship and Psychological Outcomes: The Role of Gender, Sexual Identity, Perpetration Tactics, and Perceptions of the Perpetrator's Intentions

Orgasm coercion involves pressuring a partner to orgasm by implying that not orgasming will have negative consequences. In the present study, we used mixed methods to explore (1) how various individual and contextual factors-i.e., frequency of orgasm coercion, orgasm frequency, gender/sex, sexual identity, the orgasm coercion tactics used, and perceptions of the perpetrator's intention-affect relationship and psychological outcomes associated with orgasm coercion, and (2) how different individuals characterize these outcomes. Cisgender women, cisgender men, and gender/sex minority participants (N = 308, M age = 30.44 years, SD = 8.16) described the most recent encounter in which they experienced orgasm coercion and then rated and described the positive and negative relationship and psychological outcomes associated with the incident. Quantitative results showed that the following predicted significantly higher negative relationship and psychological outcomes: a higher frequency of experiencing orgasm coercion, lower frequency of orgasming with partners in general, and experiencing orgasm coercion via physical or emotional threats. Believing that the perpetrator was motivated by altruism or social pressures mitigated these effects. And, experiencing orgasm coercion via implied fault predicted significantly higher negative relationship outcomes only for cisgender women. Additionally, being a sexual minority predicted higher negative relationship (but not psychological) outcomes, whereas being a gender/sex minority predicted higher negative psychological (but not relationship) outcomes. Qualitative results showed that relationship and psychological outcomes varied; for example, participants discussed making a partner happy, disappointment with their partner's behaviors, ending the relationship, and lasting feelings of anxiety, guilt, and abuse. Together, findings offer new insights into how orgasm coercion affects those who experience it.

Orgasm Coercion: Overlaps Between Pressuring Someone to Orgasm and Sexual Coercion

Trying to ensure that a partner orgasms during sex is generally seen as positive, but research has yet to assess how this might involve pressuring partners to orgasm in coercive ways. In the present study, we tested whether pressuring a partner to orgasm is a coercive behavior by assessing how this behavior overlaps with sexual coercion (i.e., pressuring someone into having sex). Participants of diverse gender/sex and sexual identities (N = 912, M age = 31.31 years, SD = 9.41) completed an online survey that asked them whether they had ever felt pressured by a partner to orgasm, to describe what partners have said or done to pressure them, and to answer a series of questions about the most recent incident in which this occurred. Mixed quantitative and qualitative results showed that orgasm pressure tactics were analogous to sexual coercion tactics and that being pressured to orgasm was associated with experiencing sexual coercion, faking orgasms, and negative psychological and relationship outcomes. Together, findings challenge the assumption that trying to ensure a partner's orgasm occurrence is necessarily positive and demonstrate that orgasm coercion exists.

Exercise-Induced Orgasm and Its Association with Sleep Orgasms and Orgasms During Partnered Sex: Findings From a U.S. Probability Survey

Prior research has described women's experiences with exercise-induced orgasm (EIO). However, little is known about men's experiences with EIO, the population prevalence of EIO, or the association of EIO with other kinds of orgasm. Using U.S. probability survey data, the objectives of the present research were to: (1) describe the lifetime prevalence of exercise-induced orgasm (EIO) and sleep orgasm; (2) assess respondents' age at first experience of EIO as well as the type of exercise connected with their first EIO; (3) examine associations between lifetime EIO experience and orgasm at respondents' most recent partnered sexual event; and (4) examine associations between lifetime EIO experience and sleep orgasms. Data were from the 2014 National Survey of Sexual Health and Behavior (1012 men and 1083 women, ages 14 years and older). About 9% of respondents reported having ever experienced exercise-induced orgasm. More men than women reported having experienced orgasm during sleep at least once in their lifetime (66.3% men, 41.8% women). The mean age for women's first EIO was significantly older than men (22.8 years women, 16.8 years men). Respondents described a wide range of exercises as associated with their first EIO (i.e., climbing ropes, abdominal exercise, yoga). Lifetime EIO experience was associated with lifetime sleep orgasms but not with event-level orgasm during partnered sex. Implications related to understanding orgasm and recommendations for clinicians and sex educators are discussed.

Psychosocial and Behavioral Aspects of Women's Sexual Pleasure: A Scoping Review

Objectives

To clarify the psychosocial and behavioral factors related to women's sexual pleasure.

Methods

A search was conducted on EBSCO and Web of Science databases using the key terms "female sexual pleasure" and "women sexual pleasure" and following PRISMA guidelines.

Results

76 articles were identified, referring to sexual practices, individual factors, interpersonal factors, societal factors, and ways of enhancing sexual pleasure.

Conclusions

Age, sexual experience, arousability, body-esteem, sexual autonomy, and sexual assertiveness seem to benefit women's sexual pleasure, while sexual compliance and a gender power imbalance seem to compromise it. Additional research regarding non-western and non-heterosexual women is still required.

"A little shiny gender breakthrough": Community understandings of gender euphoria

BACKGROUND

Gender euphoria is an important experience and concept for many, especially transgender and/or nonbinary individuals, but has not received much attention from psychological and clinical research. In contrast to gender dysphoria, which originates in psychiatry, the term "gender euphoria" has been mobilized by some LGBTQ people to describe the powerfully positive emotions that can come from one's gender/sex. As such, researchers and clinicians may benefit from conceptual clarity as to what gender euphoria is and what kinds of experiences might result in gender euphoria.

AIM

We aimed to better understand how trans community members and others conceptualize the term "gender euphoria," including its relationship to gender dysphoria, as well as the contexts and behaviors that elicit gender euphoria.

METHOD

We administered an online qualitative survey to participants (N = 47) of diverse sexualities and gender/sexes (including transgender, cisgender, and/or nonbinary participants) who had heard of or used the term "gender euphoria." Participants answered open-ended questions about where they had heard the term being used, how they would define gender euphoria and gender dysphoria, the relation between these terms, and their gender euphoric experiences.

RESULTS

Analyses resulted in five themes: (1) gender euphoria describes a joyful feeling of rightness in one's gender/sex, (2) gender euphoric experiences can be external, internal, and/or social, (3) "gender euphoria" originated in and circulates in online and in-person gender/sex minority communities, (4) dysphoria describes a negative feeling of conflict between gender/sexed aspects of one's self, and (5) the relationship between euphoria and dysphoria is complex.

DISCUSSION

These results can inform qualitative and quantitative research, gender affirmative clinical practice, political fights for transgender rights, and understandings of gendered experiences for people of all identities.

Roles of Genital Self-Image, Distraction, and Anxiety in Women's Sexual Pleasure: A Preregistered Study

Women with negative genital self-image are more likely to experience sexual dysfunction , but the processes underlying this association are unknown. We theorized that this association is mediated by distraction from the arousing sexual cues that foster pleasure and orgasm . In a sample of 1,619 women who had sex in the previous four weeks, women with negative genital self-image were more likely to be distracted by self-critical concerns (i.e., appearance- and performance-based distraction and embarrassment) during sex, and in turn, experienced less sexual pleasure and worse sexual function. Additionally, this indirect effect via appearance-based distraction was strongest among women with trait-level anxiousness and social anxiety. We found a similar pattern of results when investigating the indirect effect of genital self-image on sexual function. Implications for understanding sexual function and therapeutic approaches are discussed.

When Is Enough Enough? Orgasm's Curvilinear Association With Relational and Sexual Satisfaction

BACKGROUND

Curvilinearity has been found for sexual frequency, but research has not examined whether curvilinear associations exist for other aspects of sexual relationships like orgasm consistency.

AIM

We examined whether there is curvilinearity and the nature of that curvilinearity between orgasm consistency and sexual and relational satisfaction for men and women.

METHODS

With pooled samples of 1,619 and 1,695 men and women from Amazon's Mechanical Turk, we examined the differences of orgasm consistency values and both sexual satisfaction and relationship satisfaction through analysis of variance. We then tested for curvilinearity between orgasm consistency and sexual and relational satisfaction with regression analyses.

OUTCOMES

For men we found no evidence of a curvilinear relationship, but for women we found a curvilinear relationship between orgasm consistency values and both sexual satisfaction and relationship satisfaction.

RESULTS

Across tests, the overall picture suggests that there is no curvilinear association for men, but there is for women. For women, with each unit increase in orgasm consistency, the increase in sexual satisfaction and relationship satisfaction became progressively smaller. Past the 61-80% threshold for orgasm consistency, there was little gain in sexual satisfaction and no gain in relational satisfaction.

CLINICAL TRANSLATION

Physicians, therapists, and educators can reorient women's orgasm expectations by explaining that having regular orgasms-not necessarily always-is associated with satisfaction in their relationship and sexual experience.

STRENGTHS & LIMITATIONS

Converging large samples and data analytic techniques evinced the curvilinear association between orgasm consistency and both relational and sexual satisfaction for women. However, this study is cross-sectional and correlational, which limits the conclusions we can draw from it.

CONCLUSION

While men's orgasm consistency is linearly associated with relational and sexual satisfaction, more consistent orgasms seem to be associated with women's sexual and relational satisfaction, to a point. Leavitt CE, Leonhardt ND, Busby DM, et al. When Is Enough Enough? Orgasm's Curvilinear Association With Relational and Sexual Satisfaction. J Sex Med 2021;18:167-178.

“Damned if you do, damned if you don’t”: Women’s accounts of feigning sexual pleasure

Faking orgasm has been identified as a common practice among women and feminist scholars have probed the connections between the socio-cultural meanings associated with faking and heterosex. Expanding on this line of inquiry, feigning sexual pleasure was explored in interviews with 14 women who reported having sex with men. Using a feminist critical discourse analytic approach, we attend to the dilemma that was frequently evoked in women’s accounts. Participants explained that feigning sexual pleasure was done in order to protect their partners’ ego. However, participants also talked about faking orgasm as being problematic in the sense that it was “deceitful” and “dishonest”. These contrasting discursive patterns created a dilemma whereby faking was situated as “necessary” but “dishonest”. As a way of negotiating this dilemma, participants made a distinction between exaggerating sexual pleasure and faking orgasm. We posit that exaggeration can be interpreted as a form of material (during the sexual encounter) and discursive (during accounting of the encounter) disruption of dominant discourses of heterosex such as the orgasmic imperative. Drawing on Annamarie Jagose’s and Hannah Frith’s problematizations of the prevailing tendency to position orgasm as either “authentic” or “fake”, we discuss women’s negotiation of the limited constructions of “real” pleasure.