The female orgasm continues to be the subject of intense scientific debate. Doctors puzzle over the different means by which women can achieve orgasm, and the things that can prevent orgasm in women.
When women do achieve orgasm, "There are changes throughout the whole body, a head-to-toe kind of experience," says Sandra Leiblum, PhD, a sex therapist and director of psychological services at the New Jersey Center for Sexual Wellness in Bedminster.
How Women Achieve Orgasm
Women achieve orgasm through a four-step process first described by sex researchers William Masters and Virginia Johnson decades ago:
  1. Excitement. The woman initiates or agrees to sex, and as it commences she finds herself focusing mainly on sexual stimuli. Blood begins to engorge the clitoris, vagina, and nipples, and creates a full body sexual blush. Heart rate and blood pressure increases.
  2. Plateau. Sexual tension builds as a precursor to orgasm. The outer one-third of the vagina becomes particularly engorged with blood, creating what researchers refer to as "the orgasmic platform." Focus on sexual stimuli drowns out all other sensations. Heart rate, blood pressure, and respiration continue to increase.
  3. Orgasm. A series of rhythmic contractions occur in the uterus, vagina, andpelvic floor muscles. The sexual tension caused by lovemaking releases, and muscles throughout the body may contract. A feeling of warmth usually emanates from the pelvis and spreads throughout the entire body.
  4. Resolution. The body relaxes, with blood flowing away from the engorged sexual organs. Heart rate, blood pressure, and respiration return to normal.
Stimulation and the Female Orgasm
Women are blessed with bodies that are capable of achieving orgasm in more ways than one.
Clitoral stimulation has been proven the surest route to orgasm. "I think that clitoral stimulation is probably the closest analog to male orgasm, where you get erectile tissue, there is release, and after release it is uncomfortable to continue," says Steven R. Goldstein, MD, an obstetrician and gynecologist at the New York University Langone Medical Center in New York City and professor of obstetrics and gynecology at the New York University School of Medicine.
However, some women also can achieve orgasm through vaginal stimulation. One group of researchers credit the G-spot, a place located on the front wall of the vagina an inch or two behind the back of the pubic bone. These researchers believe that when stimulated, the G-spot causes intense sexual pleasure in some women. There is, however, not universal agreement among sex researchers as to the existence of this spot in all women.
Women also have been able to achieve orgasm through stimulation of the breasts or other parts of the body, or through the use of sexual imagery without any touch at all. Researchers have even found a nerve pathway outside of the spinal cord, through the sensory vagus nerve, that will lead a woman to orgasm through sensations transmitted directly to the brain.
"There are many nerve pathways that generate orgasm in women," says Beverly Whipple, PhD, RN, professor emerita at Rutgers University in Newark, N.J., and secretary general of the World Association for Sexual Health.
The Female Orgasm: Problems Getting There
There are physical problems that can keep a woman from achieving orgasm, but sex researchers say many of the things that block orgasm involve a woman's psyche. A woman may not be able to let go and focus completely on sexual stimuli because she is experiencing feelings of fear, guilt, distraction, anxiety, or a loss of control, Leiblum says. It is estimated that as many as a quarter of American women have problems achieving orgasm.
Doctors and sex therapists use several types of therapies to help women overcome these blocks to orgasm. Directed masturbation, sex education, and behavioral therapy are some of the means a woman might want to investigate if she cannot reach orgasm. Women might also want to try using a vibrator to provide increased clitoral stimulation, or a dildo crafted to provide better stimulation of the G-spot.