An orgasm is the peak of sexual pleasure, characterized by intense physical sensations and heightened arousal. It involves rhythmic muscular contractions and is often accompanied by ejaculation in individuals with a penis or pelvic floor muscle contractions in individuals with a vagina. During arousal, blood flow increases to the genitals, leading to erection, followed by rhythmic contractions of the pelvic muscles during ejaculation. The release of semen from the penis typically accompanies the peak of sexual pleasure, marking the climax of the sexual response cycle. The male orgasm serves as a key component of sexual satisfaction and reproduction, playing a vital role in human sexuality and intimacy. Orgasms are influenced by a complex interplay of physiological and psychological factors and can be achieved through various forms of sexual stimulation. They contribute to feelings of pleasure, intimacy, and emotional bonding between partners, and are a natural and healthy aspect of human sexuality.

What is “orgasm”?

An orgasm is a physiological response characterized by intense pleasure and release of sexual tension. It typically involves rhythmic contractions of muscles in the genital region, accompanied by sensations of pleasure and euphoria. Orgasms can occur through various forms of sexual stimulation, including masturbation, intercourse, oral sex, or even non-genital stimulation in some cases. In addition to the physical sensations, orgasms often result in a temporary alteration of consciousness and a sense of well-being. They are a natural and healthy part of human sexuality.

Phases of orgasm

The phases of the orgasmic response cycle typically involve several stages, which can vary in duration and intensity from person to person. While individual experiences may differ, the general phases of the orgasmic response cycle include:

Excitement Phase:

• During this phase, sexual arousal begins in response to physical or psychological stimuli, such as touching, kissing, or erotic thoughts.
  • Blood flow to the genitals increases, leading to genital engorgement and lubrication (in females) and penile erection (in males).
  • Heart rate and breathing may also increase as the body prepares for sexual activity.

Plateau Phase:

• In this phase, sexual arousal continues to build, reaching a heightened level of intensity.
  • Muscle tension increases throughout the body, particularly in the pelvic region.
  • Breathing and heart rate continue to rise, and individuals may experience sensations of warmth and flushing.

Orgasm Phase:

• The orgasmic phase is characterized by the peak of sexual pleasure and release of sexual tension.
  • Muscles in the genital region, including the pelvic floor muscles, undergo rhythmic contractions.
  • These contractions are typically accompanied by intense sensations of pleasure and euphoria, often described as the climax of sexual arousal.
  • In males, orgasm is typically accompanied by ejaculation, the release of semen from the penis.
  • In females, orgasm may be accompanied by contractions of the uterus and vagina, as well as the release of pelvic floor muscle tension.

Resolution Phase:

• Following orgasm, the body gradually returns to its pre-arousal state.
  • Heart rate, breathing, and blood pressure decrease as the body relaxes.
  • Muscles throughout the body, including those in the genital region, relax, and genital engorgement decreases.
  • Individuals may experience feelings of relaxation, satisfaction, and well-being after orgasm.

Types of male orgasm?

There are several types of male orgasms, each with its own unique sensations and characteristics. These may include:

• Ejaculatory orgasm: This is the most common type of male orgasm, characterized by the release of semen from the penis during ejaculation. It typically involves rhythmic contractions of the pelvic muscles and a feeling of intense pleasure.
• Non-ejaculatory orgasm: Some men are capable of experiencing orgasms without ejaculating. These orgasms may still involve intense pleasure and muscle contractions but do not result in the release of semen.
• Multiple orgasms: Some men have the ability to experience multiple orgasms in rapid succession without a refractory period (the recovery time between orgasms). This can occur through continued sexual stimulation after the initial climax.
• Prostate orgasm: Stimulation of the prostate gland, often through anal penetration or massage, can lead to a unique type of orgasm. Prostate orgasms are typically described as deep, intense, and may not necessarily involve ejaculation.
• Blended orgasms: These orgasms occur when multiple erogenous zones are stimulated simultaneously, such as the penis and the prostate or the penis and the perineum. Blended orgasms can be exceptionally intense and pleasurable.
• Full-body orgasms: Rather than being localized to the genital area, full-body orgasms involve sensations of pleasure that spread throughout the entire body. They are often achieved through practices like tantric sex or mindful breathing techniques.

What are differences between male and female orgasm?

While both male and female orgasms involve intense pleasure and physiological responses, there are several key differences between them:

• Anatomy: The male orgasm typically involves ejaculation, which is the release of semen from the penis. This ejaculation is often accompanied by rhythmic contractions of the pelvic muscles. In contrast, the female orgasm does not involve ejaculation. Instead, it is characterized by rhythmic contractions of the pelvic muscles and may or may not be accompanied by the release of fluid from the Skene’s glands (often referred to as female ejaculation), which is different from the release of semen.
• Refractory period: Following ejaculation, most men experience a refractory period during which they are unable to achieve another orgasm. This period can last from minutes to hours and is characterized by a temporary decrease in sexual arousal. Many women do not experience a refractory period and can achieve multiple orgasms in quick succession.
• Duration and intensity: Male orgasms are typically shorter in duration compared to female orgasms, which can last longer and involve multiple waves of pleasure. Female orgasms are often described as more varied in intensity and sensation, ranging from subtle to intensely pleasurable.
• Stimulation: While both male and female orgasms can be achieved through various forms of sexual stimulation, the specific techniques and erogenous zones involved may differ. For example, many women require clitoral stimulation to reach orgasm, whereas others may experience orgasm through vaginal or G-spot stimulation. Male orgasms are often associated with stimulation of the penis, but can also involve stimulation of the prostate gland or other erogenous zones.
• Psychological factors: Both men and women can experience psychological arousal leading to orgasm, but individual experiences may vary. Factors such as stress, mood, and emotional connection can influence the intensity and frequency of orgasms in both genders.

Male multiple orgasms

Male multiple orgasms refer to the ability of some men to experience multiple climaxes within a short period of time, often without a refractory period. While most men experience a refractory period after ejaculation during which they are unable to achieve another orgasm, some men are capable of having multiple orgasms without a significant break in sexual activity.

Here are some tips and techniques that some men use to achieve multiple orgasms:

• Edging: Edging involves bringing yourself close to the point of orgasm and then backing off before reaching climax. By repeating this process several times, you can build up sexual tension and potentially experience multiple orgasms when you finally allow yourself to ejaculate.
• PC muscle control: The pubococcygeus (PC) muscle is involved in ejaculation and orgasm. Strengthening and learning to control this muscle through exercises such as Kegels can help some men achieve multiple orgasms by delaying ejaculation and prolonging sexual pleasure.
• Delayed ejaculation techniques: Techniques such as the “squeeze technique” or “start-stop technique” involve interrupting sexual activity to delay ejaculation. By practicing these techniques, some men may be able to achieve multiple orgasms without ejaculating.
• Tantric techniques: Tantric sex involves focusing on the connection between mind, body, and spirit during sexual activity. By practicing tantric techniques such as breath control, meditation, and visualization, some men report being able to achieve multiple orgasms and heightened states of pleasure.
• Communication and experimentation: Every man is different, so it’s essential to communicate with your partner and experiment with different techniques to find what works best for you. Pay attention to your body’s responses and adjust your approach accordingly.

It’s important to note that not all men are capable of achieving multiple orgasms, and individual experiences may vary. Additionally, some men may find that attempting to have multiple orgasms leads to discomfort or decreased sexual satisfaction. As with any sexual practice, it’s essential to prioritize communication, consent, and mutual pleasure with your partner. If you have concerns about your sexual health or ability to achieve multiple orgasms, consider consulting with a urologist.

What factors negatively and positively affect orgasm?

Several factors can influence the quality and likelihood of experiencing an orgasm, both positively and negatively:

Positive Factors:

• Communication and Connection: Open communication with sexual partners, understanding each other’s desires, and feeling emotionally connected can enhance the likelihood of experiencing orgasms.
• Foreplay: Sufficient foreplay, including kissing, touching, and other forms of sexual stimulation, can increase arousal and make orgasms more likely.
• Relaxation and Comfort: Feeling relaxed, comfortable, and free of stress or anxiety can create an environment conducive to orgasm.
• Sexual Health: Good sexual health, including proper genital hygiene and addressing any medical conditions that may affect sexual function, can positively impact orgasms.
• Sexual Technique: Learning and practicing effective sexual techniques, such as focusing on clitoral or penile stimulation, can enhance the intensity and frequency of orgasms.

Negative Factors:

• Stress and Anxiety: Stress, anxiety, or distraction can inhibit sexual arousal and make it difficult to achieve orgasm.
• Lack of Communication: Inadequate communication with sexual partners, including difficulty expressing desires or discomfort discussing sexual preferences, can hinder orgasmic experiences.
• Fatigue and Exhaustion: Physical fatigue or exhaustion can decrease libido and make it more challenging to achieve orgasm.
• Relationship Issues: Relationship conflicts, unresolved issues, or lack of emotional intimacy can negatively impact sexual satisfaction and orgasm.
• Medical Conditions: Certain medical conditions, such as hormonal imbalances, pelvic floor disorders, or neurological conditions, can interfere with sexual function and reduce the likelihood of orgasm.

Orgasmic disorders

Orgasmic disorders refer to a group of sexual dysfunctions characterized by difficulties or absence of orgasm, despite adequate sexual stimulation. These disorders can affect both men and women and may have various underlying causes. Some common types of orgasmic disorders include:

Male Orgasmic Disorder (Delayed Ejaculation):

• Delayed ejaculation (DE), also known as male orgasmic disorder, is characterized by a persistent delay or absence of ejaculation despite prolonged sexual stimulation and desire for ejaculation.
  • Causes may include psychological factors (such as anxiety or relationship issues), medical conditions (such as diabetes or neurological disorders), medication side effects, or hormonal imbalances.

Female Orgasmic Disorder (Anorgasmia):

• Anorgasmia refers to the inability to achieve orgasm despite adequate sexual stimulation. It can be classified as primary (never experiencing an orgasm) or secondary (experiencing orgasms in the past but not currently).
  • Causes may include psychological factors (such as stress or trauma), relationship issues, medical conditions (such as hormonal imbalances or pelvic floor disorders), medication side effects, or lack of sexual knowledge or experience.

Persistent Genital Arousal Disorder (PGAD):

• PGAD is a condition characterized by persistent, uncontrollable genital arousal in the absence of sexual desire or stimulation. It can be distressing and disruptive to daily life.
  • The exact cause of PGAD is not well understood but may involve neurological factors or abnormalities in the blood vessels or nerves of the pelvic region.

Premature Ejaculation (PE):

• Premature ejaculation is characterized by ejaculation that occurs sooner than desired, often within one minute of penetration, and before the individual wishes it to occur.
  • Psychological factors (such as anxiety or performance pressure), relationship issues, hypersensitivity of the penis, or abnormal levels of certain neurotransmitters may contribute to premature ejaculation.

Situational Orgasmic Disorder:

• Situational orgasmic disorder refers to difficulties with orgasm that occur only in certain situations or with specific partners. This may suggest that psychological or relational factors are contributing to the problem.

Late orgasmia

“Late orgasmia” is not a commonly used or recognized term in the field of sexual health or medicine. It’s possible that it could be a colloquial or idiosyncratic term used in specific contexts, but it doesn’t have a standard definition or meaning within the scientific literature.

If you’re referring to a delayed orgasm, this could be a condition in which an individual experiences a significant delay in achieving orgasm despite sufficient sexual stimulation. Delayed orgasm, also known as “retarded ejaculation” in men or “delayed ejaculation” more broadly, can occur due to various factors including psychological issues (such as anxiety or depression), relationship problems, certain medications, hormonal imbalances, or neurological disorders.

It’s important to note that any concerns regarding sexual health should be discussed with a healthcare professional, such as a doctor or therapist specializing in sexual health, who can provide appropriate evaluation, diagnosis, and treatment recommendations.

Causes of late orgasmia

“Late orgasmia,” also known as delayed ejaculation or retarded ejaculation, refers to the difficulty or inability for a person with a penis to reach orgasm and ejaculate despite adequate sexual stimulation. This condition can have various causes, including:

• Psychological factors: Anxiety, stress, depression, relationship issues, or performance pressure can interfere with the ability to reach orgasm.
• Medical conditions: Certain medical conditions such as diabetes, neurological disorders, hormonal imbalances (e.g., low testosterone), prostate issues, or pelvic surgery can affect ejaculation.
• Medications: Some medications, including certain antidepressants (such as SSRIs), antipsychotics, blood pressure medications, and others, can delay orgasm as a side effect.
• Substance use: Alcohol, tobacco, and illicit drugs can interfere with ejaculation.
• Masturbation habits: Some individuals may develop a conditioned response to specific types of stimulation that do not translate well to partnered sexual activity.
• Age-related changes: As men age, they may experience changes in sexual function, including delayed ejaculation.
• Cultural or religious factors: Beliefs and attitudes toward sexuality can influence sexual performance and response.

It’s essential for individuals experiencing delayed ejaculation to consult with a healthcare professional to determine the underlying cause and explore appropriate treatment options, which may include therapy, medication adjustments, lifestyle changes, or other interventions.

Treatment of late orgasmia

Treatment for late orgasmia (delayed ejaculation) depends on the underlying cause. Here are some potential approaches:

• Psychological therapy: If the issue is primarily psychological, such as anxiety, stress, or relationship problems, therapy with a qualified psychologist or sex therapist may be beneficial. Cognitive-behavioral therapy (CBT), mindfulness techniques, or couples therapy can help address underlying issues.
• Medication adjustments: If delayed ejaculation is a side effect of medication, a healthcare provider may adjust the dosage or switch to an alternative medication with fewer sexual side effects. For example, switching from an SSRI antidepressant to a different class of antidepressant may alleviate the issue.
• Hormone therapy: In cases where hormonal imbalances are contributing to delayed ejaculation, hormone replacement therapy (e.g., testosterone replacement therapy) may be prescribed under the supervision of a healthcare provider.
• Sexual stimulation techniques: Exploring different types of sexual stimulation, such as varying pressure or intensity, and incorporating fantasies or erotic materials may help overcome delayed ejaculation.
• Behavioral techniques: Some individuals benefit from specific behavioral techniques designed to increase arousal and facilitate ejaculation, such as the stop-start technique or the squeeze technique. These techniques involve temporarily halting sexual activity to reduce arousal levels before resuming stimulation.
• Lifestyle changes: Adopting a healthier lifestyle, including regular exercise, balanced nutrition, stress management techniques, and reducing alcohol consumption or drug use, may improve sexual function.
• Medical interventions: In cases where delayed ejaculation is caused by underlying medical conditions, such as prostate issues or neurological disorders, medical treatment may be necessary. This could include medications, surgery, or other interventions targeted at addressing the underlying condition.

Anorgasmia

“Anorgasmia” refers to the inability to achieve orgasm despite adequate sexual stimulation. It can be a temporary or chronic condition and may affect both men and women. Anorgasmia can be categorized into different types:

Primary Anorgasmia: This occurs when an individual has never experienced an orgasm, even under optimal circumstances.

Secondary Anorgasmia: This refers to the inability to achieve orgasm after previously being able to do so. It can be caused by various factors, including physical or psychological issues.

Anorgasmia can be caused by a variety of factors, including:

• Psychological factors such as stress, anxiety, depression, trauma, or relationship issues.
• Physical factors such as hormonal imbalances, certain medications (such as antidepressants), neurological disorders, pelvic floor disorders, or chronic illnesses.
• Lifestyle factors such as excessive alcohol consumption, drug use, or smoking.

Causes of anorgasmia

Anorgasmia, the inability to achieve orgasm despite adequate sexual stimulation, can have various causes. These causes can be psychological, physiological, or a combination of both. Here are some common factors that may contribute to anorgasmia:

Psychological Factors:

• Stress and Anxiety: High levels of stress or anxiety can interfere with the ability to relax and fully engage in sexual activity, making it difficult to achieve orgasm.
  • Depression: Depression can dampen libido and affect overall sexual arousal and satisfaction, leading to difficulty achieving orgasm.
  • Body Image Issues: Negative body image or self-esteem issues may contribute to feelings of insecurity or self-consciousness during sexual activity, impacting orgasmic response.
  • Trauma or Abuse: Past traumatic experiences, including sexual abuse or assault, can have long-lasting effects on sexual function and may contribute to anorgasmia.
  • Relationship Problems: Difficulties in the relationship, such as unresolved conflicts, lack of intimacy, or communication issues, can affect sexual desire and satisfaction, making it challenging to achieve orgasm.
  • Performance Anxiety: Fear of not being able to perform sexually or satisfy one’s partner can create pressure and anxiety, leading to difficulty reaching orgasm.

Physiological Factors:

• Medications: Certain medications, particularly antidepressants (such as SSRIs), antipsychotics, and some blood pressure medications, can have side effects that interfere with sexual arousal and orgasm.
  • Hormonal Imbalances: Hormonal changes, such as those associated with menopause, pregnancy, or thyroid disorders, can affect libido and sexual response.
  • Neurological Disorders: Conditions affecting the nervous system, such as multiple sclerosis, Parkinson’s disease, or spinal cord injuries, can interfere with nerve signals involved in sexual arousal and orgasm.
  • Pelvic Floor Dysfunction: Dysfunction of the pelvic floor muscles, which support the pelvic organs and play a role in orgasm, can contribute to anorgasmia.
  • Chronic Illnesses: Certain chronic health conditions, such as diabetes, cardiovascular disease, or chronic pain conditions, can impact sexual function and orgasmic response.
  • Surgery or Trauma: Surgery or trauma to the pelvic area or genital region can cause physical changes that affect sexual sensation and function, potentially leading to anorgasmia.

Lifestyle Factors:

• Substance Abuse: Excessive alcohol consumption, drug use, or smoking can negatively impact sexual function and may contribute to anorgasmia.
  • Poor Lifestyle Habits: Lack of exercise, poor diet, and inadequate sleep can affect overall health and well-being, potentially influencing sexual function.

Treatment of anorgasmia

Treatment for anorgasmia depends on its underlying cause, which can be psychological, physical, or a combination of both. Here are some approaches that may be used in the treatment of anorgasmia:

Therapy:

• Individual therapy with a qualified psychologist or therapist can help address underlying psychological factors such as stress, anxiety, depression, trauma, or relationship issues that may be contributing to anorgasmia.
  • Couples therapy or sex therapy can help improve communication between partners, address any relationship issues, and learn techniques to enhance sexual satisfaction and intimacy.

Medication Management:

• If anorgasmia is related to medication side effects (e.g., antidepressants, antipsychotics), a doctor may consider adjusting the dosage or switching to an alternative medication with fewer sexual side effects. However, this should always be done under medical supervision.

Hormonal Therapy:

• In cases where hormonal imbalances are contributing to anorgasmia, hormonal therapy may be recommended. This could involve hormone replacement therapy or other medications to address hormonal issues.

Medical Evaluation and Treatment:

• A thorough medical evaluation may be necessary to identify and treat any underlying physical conditions that could be causing anorgasmia, such as pelvic floor disorders, neurological disorders, or chronic illnesses.
  • Pelvic floor physical therapy may be recommended to address muscle tension or dysfunction that could be contributing to anorgasmia.

Lifestyle Changes:

• Making lifestyle changes such as reducing stress, improving sleep quality, maintaining a healthy diet, exercising regularly, and reducing alcohol or drug use can also positively impact sexual function and may help alleviate anorgasmia.

Sensate Focus Exercises:

• Sensate focus exercises involve gradual and systematic exploration of physical sensations with a partner, focusing on pleasurable touch rather than achieving orgasm. These exercises can help reduce performance pressure and increase relaxation and arousal.

Education and Communication:

• Education about sexual anatomy and function, as well as open communication with sexual partners about desires, preferences, and concerns, can also be beneficial in addressing anorgasmia.

Dry orgasm

A “dry orgasm” refers to an orgasm where there is no ejaculation of semen from the penis. While it may sound concerning, dry orgasms are not necessarily harmful and can occur for various reasons:

• Retrograde ejaculation: In retrograde ejaculation, the ejaculate is redirected to the bladder instead of being expelled through the urethra. This can happen due to issues with the muscles or nerves that control the bladder neck, often as a result of certain medical conditions or medications. While this results in a dry orgasm, it may also lead to cloudy urine after sexual activity.
• Medication side effects: Some medications, particularly those used to treat conditions such as high blood pressure, prostate enlargement, or psychiatric disorders, can interfere with ejaculation and cause dry orgasms.
• Surgery: Certain surgical procedures, particularly those involving the prostate or bladder, can disrupt the normal ejaculation process and result in dry orgasms.
• Psychological factors: Psychological issues such as anxiety, stress, or performance anxiety can affect ejaculation and lead to dry orgasms.
• Neurological conditions: Conditions that affect the nerves involved in ejaculation, such as multiple sclerosis or spinal cord injuries, can result in dry orgasms.
• Lifestyle factors: Excessive alcohol consumption, drug use, or certain sexual practices may contribute to dry orgasms.
• Hypogonadism: Low testosterone levels may be responsible in some cases.

How to have a better orgasm?

Having a better orgasm involves a combination of physical and psychological factors. Here are some tips that may help:

• Explore your body: Take the time to learn about your body and what feels pleasurable to you. Experiment with different forms of stimulation, such as touching, stroking, or using sex toys.
• Communicate with your partner: Open and honest communication with your partner about your desires, preferences, and boundaries can enhance sexual pleasure and lead to more satisfying orgasms.
• Focus on relaxation: Stress and tension can interfere with sexual arousal and orgasm. Practice relaxation techniques such as deep breathing, meditation, or yoga to help alleviate stress and promote a more relaxed state of mind and body.
• Foreplay: Engage in plenty of foreplay to build sexual tension and arousal before reaching orgasm. Kissing, touching, and oral stimulation can help increase sensitivity and enhance the overall experience.
• Try different positions: Experiment with different sexual positions to find what works best for you and your partner. Some positions may provide deeper penetration or stimulate different erogenous zones, leading to more intense orgasms.
• Incorporate fantasies: Fantasies and role-playing can add excitement and arousal to sexual encounters, leading to more satisfying orgasms. Share your fantasies with your partner and explore ways to incorporate them into your sex life.
• Focus on pleasure: Instead of focusing solely on achieving orgasm, focus on the sensations and pleasure of the moment. Pay attention to how your body responds to different types of stimulation and allow yourself to fully experience the sensations of pleasure.
• Practice pelvic floor exercises: Strengthening your pelvic floor muscles through exercises such as Kegels can help improve sexual function and enhance orgasm intensity.
• Experiment with solo play: Masturbation can be a great way to explore your body and learn what brings you pleasure. Take the time to masturbate regularly and experiment with different techniques and fantasies to enhance your orgasmic experiences.
• Seek professional help if needed: If you’re experiencing difficulties with orgasm or sexual function that are causing distress, consider seeking help from a healthcare professional or sex therapist who can provide guidance and support.

Summary

An orgasm is a physiological and psychological response characterized by intense pleasure and release typically associated with sexual arousal. It involves a series of physiological changes, including increased heart rate, muscle contractions, and heightened sensation, culminating in a peak of sexual pleasure. In individuals assigned male at birth, the male orgasm is often accompanied by ejaculation, the release of semen from the penis. However, orgasms can occur without ejaculation and can be experienced through various forms of sexual stimulation, including masturbation, oral sex, or intercourse. Beyond its role in sexual satisfaction and reproduction, orgasms also have potential health benefits, such as stress relief and improved mood. Overall, orgasms play a crucial role in human sexuality and intimacy, contributing to overall well-being and pleasure.

Prof. Dr. Emin ÖZBEK

Urologist

Istanbul- TURKEY