What’s the Key to Female Orgasm During Sex?

THURSDAY, April 21, 2016 (HealthDay News) — Despite what's often portrayed in movies and on TV, most women can't orgasm with penetration alone during sexual intercourse.
And simple anatomy is to blame, a new evidence review suggests.
Each woman's ability to orgasm during sex depends almost wholly on physical development that occurred while she was still in the womb, according to the review authors.
During gestation, the clitoris begins to drift up and away from the vaginal opening, the researchers said.
But among women whose clitoris drifted too far up, it may be very difficult or even impossible to have an orgasm during sex, because traditional lovemaking doesn't provide enough friction to stimulate the clitoris, said Dr. Maureen Whelihan. She's an obstetrician and gynecologist in West Palm Beach, Fla., and an expert with the American College of Obstetricians and Gynecologists.
"It's not her fault. She was born that way," said Whelihan, who was not involved with the research but reviewed the findings.
The researchers said they have figured out the distance between a woman's clitoris and her urinary opening that can predict whether she will be able to orgasm during sex, without any additional stimulation.
The "magic number" is 2.5 centimeters—slightly less than 1 inch, said Elisabeth Lloyd, who was not involved with the new study. Lloyd is an affiliated faculty scholar with the Kinsey Institute for Research in Sex, Gender and Reproduction at Indiana University-Bloomington.
"It's so strong a correlation that if you give us a woman who has a distance of 3 centimeters, we can very reliably predict she won't have orgasm with intercourse," Lloyd said. "Women can do this measurement themselves or with their partner, to help explain their own sexual experience."
Other factors, such as penis size, the skill of the sexual partner or the intensity of desire "might have some effect, but it really is the anatomical distance that seems to be predictive," Lloyd said.
Exposure to male hormones in the womb increases the amount of drift, Lloyd said. "If she's exposed to a lot of androgen, the clitoral bud migrates far away," she said.
Between 70 percent to 90 percent of women are unable to achieve orgasm with penetration alone, Whelihan said.

"Of those that claim they can have purely vaginal orgasms, 90 percent of them say they have to be on top," she added. "Guess what? When you're on top, sitting on the partner's erection and grinding on his abdomen, it's really not just a vaginal orgasm. You're rubbing your clitoris on his abdomen or pelvis."
Nine out of 10 women in her practice have had an orgasm during their life, Whelihan said, but nearly all needed direct clitoral stimulation to achieve it.
What about the G-spot, the erogenous area purported to exist inside the vagina? Autopsies haven't consistently supported the existence of the G-spot, the evidence review said.
A majority of sex experts don't believe there is such a thing, Whelihan said. "According to most of the experts, we believe if the G-spot exists then it only exists in a few women," she said.
Couples determined to achieve female orgasm during intercourse should start paying more attention to the clitoris, Lloyd and Whelihan said.
Couples can use positions where the female is on top, which allows the woman to get more friction against her clitoris. Or they can use a sexual position that allows either the man or the woman to rub the clitoris during sex, either with fingers or a sex toy, Whelihan said.
"There are many ways to have an orgasm where she's having hers while he's having his," she said. "Couples should not focus on something that will never change anatomically, and instead find ways to allow for some type of clitoral stimulation during penetration."
However, couples also should remember that orgasm with intercourse is not necessary for a woman to have a healthy or enjoyable sex life, Lloyd added.
"I think this approach is traditional, and it's very common, but it's problematic. We've learned in our research there are so many women who do not have orgasm with intercourse on a regular basis," Lloyd said. "To put this banner of healthiness as having orgasm with intercourse kind of stacks the deck against these women who, because of their anatomy, cannot have orgasm with intercourse."
The evidence review was conducted by Leslie Hoffman of the department of anatomy at Indiana University School of Medicine, and colleagues. The report was published online April 4 in the journal Clinical Anatomy.
SOURCES: Elisabeth Lloyd, Ph.D., affiliated faculty scholar, Kinsey Institute for Research in Sex, Gender and Reproduction, Indiana University-Bloomington; Maureen Whelihan, M.D., obstetrician/gynecologist, West Palm Beach, Fla, and an expert for the American College of Obstetricians and Gynecologists; April 4, 2016, Clinical Anatomy, online

My girlfriend doesn't want me to wear a condom... but I do

Alice,
I am a guy, and well, me and my girlfriend want sex, but she says she wants me to not use a condom so I can get the real feeling. But, I don't want a child at my age and at this point. How can I tell her that I want to use condoms?

Dear Reader,
It sounds as though you and your girlfriend each have thoughtful concerns about your use of condoms. It's nice that she wants to consider your pleasure in the experience, but also equally valid that you're not interested in becoming a father at this time. It's also worth mentioning that pleasure doesn't have to come at the expense of not using a condom. It's not clear how much you both have talked about this, but it may be a good opportunity to continue the conversation. Practicing safer sex takes the cooperation of both partners for it to be successful, so being on the same page about how each partner will contribute and what each of your concerns are is key. By being open and honest about your feelings in a non-judgmental setting, you may find that you’re able to open the lines of communication to much more in your relationship!

While many people who use condoms have healthy sexual relationships, those assigned male at birth sometimes report that wearing a condom during sex diminishes sensation. However, using a dab of lube inside and outside of the condom can help. While some report that using a condom slows down their urge to orgasm, it might make sex last longer, which can be fun for you and your girlfriend!
When it comes to pregnancy prevention and sexually transmitted infection (STI) protection, condoms are a great option. To make them more appealing, you could try different sizes, shapes, textures, thicknesses, and colors to find the kind that suits you both. You could also try shopping for them together to see if there are condoms that you both like. There’s also the option of using an internal condom. Are you and your girlfriend monogamous? Have you tested negative for STIs since getting together? If you have and both feel comfortable with the idea, then you may consider other birth control methods. You and your girlfriend can research the advantages and disadvantages of different methods to determine which one best meets your needs. The Go Ask Alice! Sexual Health & Reproductive Health archives has a lot of great information about safer sex and contraception.
If after considering these alternate options you still would feel more comfortable using condoms, it’s probably a good idea to talk with your girlfriend. You can start by telling her how much you care about and value your relationship. Then you can explain your concerns about preventing an unwanted pregnancy and ask if that's a concern for her as well. Based on her response, you can talk about ways you can enjoy being intimate with each other while also practicing safer sex. It might also be helpful to reinforce that you would still enjoy having sex with her, even with a condom. This conversation can play out in many ways, so it's impossible to script the entire conversation, but in any case it’s probably best to talk with her when you both are able to sit down in a private space while not in the heat of the moment and where you won’t be distracted or interrupted.
The point of all this is to open up options for both of you, not just when it comes to being intimate, but also for other steps you take in your relationship moving forward.
Alice!

Diaphragm discomfort

Dear Alice,
I have recently married and started using a diaphragm. I practiced a few times inserting it in the Dr.'s office and before using it "for real," but I am never quite sure I'm doing it right (we've been using it about a week). I follow the instructions and it is definitely lying flat over my cervix and behind the pubic bone, but it seems to wrinkle and slide around. It also makes me feel like I need to urinate all the time. In addition, it unrolls before I get it all the way in, and I wind up COVERED in spermicide (it's also a very weird feeling). I'm worried that it won't be effective. Should I be re-fitted? I have read that starting sexual activity can change the cervix (I was celibate about 7 years before marrying). Sometimes, we just give up and use a condom instead, but I don't like that. Any help?
Signed,
 Newlywed

Dear Newlywed,
Since you're a new diaphragm user, the difficulties and discomfort you've experienced so far may be related to your inexperience with this contraceptive option. Despite the fact that you’ve already had some practice at your health care provider's office, the real-world insertion in the moment may feel different. Good news though, insertion gets easier with more practice! Diaphragms come in an array of shapes (coil, flat, arc-like) and sizes, ranging from 50 to 105 millimeters (about two to four inches) in diameter. Some folks find that using the kind of diaphragm that has two hinges and bending it into the shape of an arc is easier to place into the vagina. This prevents it from springing open before it's firmly in place then popped open again, covering the cervix completely. A properly placed diaphragm typically won't be felt once it's been placed inside of a person's vagina. If you’re still not satisfied after double-checking the fit, style, and placement of the device, you might consider an alternative method of birth control.
To help, Planned Parenthood details the steps for proper diaphragm insertion:
1.Wash hands with soap and water.
2.Put a tablespoon of spermicide in the diaphragm.
3.Get into a comfortable position, like when putting in a tampon.
4.Separate lips of the vulva with one hand and use the other to pinch the rim of the diaphragm together to fold it in half.

5.Push the diaphragm as far up and back into the vagina as it'll go, dome pointing down. Tuck the edge of the diaphragm behind the pubic bone. Make sure the cervix is covered.
If you continue to sense the diaphragm shifting around or placing pressure on your bladder (causing the need to pee), then you might consider a refitting. You may remember when you were first sized for a diaphragm, your health care provider likely inserted a variety of fitting rings into your vagina. During this fitting, you and your provider will be able to determine which of the rings is the largest one that will fit comfortably inside of you. Practicing inserting and using this ring at your provider's office until you get the hang of it may help to make a difference. However, keep in mind that diaphragms do move a bit inside of a vagina as the body goes through changes (such as lubrication) during arousal.
It's also common for diaphragms to seem less comfy, even after years of tried and true use. Instances when you may strongly consider going in for a refitting include:
•Weight change of more than ten pounds
•Pregnancy
•Miscarriage or pregnancy termination
•Having had vaginal or pelvic surgery
•Any pain or discomfort, either on insertion or during use
Another common cause of discomfort is a change in the shape of a person's cervix. Having sex, whether for the first time or after a long abstinence, is one of the most common reasons for this change, though hormonal modifications may also trigger some cervical shape shifting.
Whatever the reason for your discomfort, the diaphragm's intent was never to force its users to resort to yoga-like dexterity. A trip to your health care provider will, at the very least, provide a second training session on insertion and might lead to a newly-sized and correctly and comfortably fitted diaphragm for you.
Finally, if after refitting and practice you still don't feel secure using a diaphragm, then you may consider switching to another method of birth control. You might want to ask your health care provider to discuss other contraceptive options with you and your partner. For more information about the pill and other forms of contraception, check out the Contraception section of the Go Ask Alice! Sexual and Reproductive Health archives.

Partner doesn't like doggie position

1) Dear Alice,
My partner says she does not care for the "doggie" position because it causes her pain. I, on the other hand like to experiment and want to try everything. I guess I want more than just vanilla and she says if vanilla is great, continue to go for it. I guess I'm trying to sort out facts first. First, I know that only about 8 percent of women engage in this position. I guess I want to try it occasionally because the position gives me sight sensory as well as feeling. Anyway, I tell her I'd do anything she wants, anything to satisfy her in exchange for having sex in this position. I guess it's an obsession which becomes more of an obsession when it is denied!
Back to what she says. First, is that the angle is painful. She says the position is against the normal "curve" of the penis as it would enter in missionary position. Now on to the emotional side. What happens is that she will eventually consent but then because I feel guilty I jackrabbit and I can't enjoy it! What can be done to stop the pain she says is there? Is some of it emotional?
— Barking up the wrong tree
2) Dear Alice,
I like to have sex 'doggy style' more often than I could at the moment because my wife complains that it is painful. Is that common?
doggy style

Dear Barking up the wrong tree and doggy style,
The pain your partners are experiencing could be due to a number of causes. Regardless of the percentage of people assigned female at birth who agree to have penetrative sex in the “doggie-style” position, as with all forms of sex, getting consent from your partner isn't only key, it’s necessary. Not only that, it can open up opportunities to explore new positions while also ensuring comfort for all partners. Doggy style, while this position can be exciting and pleasurable for you, it’s not uncommon for a partner who’s assigned female at birth to experience pain and discomfort. Barking up the wrong tree, it might also be worth exploring why you’re feeling guilty and why this position has become an obsession for you. Reflecting on what you and your partners want for your sex life, and how to respect each other’s choices, may provide some direction for how to move forward.  
Since your partners have stated that this position is painful, it might help to first understand some potential causes of that pain. One possibility is that there isn’t enough lubrication. Have you tried using water-based lubricant, or are you open to spending a little more time on foreplay? You may also want to ask if your partner would like you to stimulate their clitoris during sex or if more foreplay would be helpful for increasing their pleasure during the act. It’s worth noting that it can take some time for arousal (and in turn, adequate lubrication) to occur. This position could also be painful because you’re hitting the cervix with your penis. Instead of “jackrabbiting,” consider starting slow to help get things warmed up. If those causes don’t seem likely, it could simply be that you and your partner don’t fit as well in that way. The shape and size of the pleasure parts in these penetrative scenarios (e.g., penises/dildos/sex toys and vaginas) may be better suited for other positions that bring pleasure to all parties involved.

Have you tried or suggested other positions that may be more comfortable for your partner? You might take this as an opportunity to think creatively about the positions that’ll provide the stimulation you're interested in, while still finding a position that's comfortable for them. There are also variations of the doggie position that might provide more comfort, one of which entails you entering from behind while lying down next to each other on your sides, instead of attempting it on your knees. Checking in throughout while trying new positions and styles is key; it'll help you both learn a bit about what is or isn't pleasurable. Additionally, it's possible that even with these new strategies, your partner may still experience pain while in this type of position.
No matter what the cause of the pain or what position(s) you engage in, it’s critical that you and your partner both freely and willingly consent to every sexual activity. Barking up the wrong tree, you state that she "eventually consents" but a large component of consent is making space for partners to be honest and communicate about what they want to do and what they don't want to do, including different positions and sex acts, and then listening to what they've said. It must be enthusiastic and without manipulation or pressure. Could your feelings of guilt be due to the fact that your partner hasn't enthusiastically consented or hasn't consented without feeling pressured? Consent means your partner says yes not only with their words, but also with their tone and body language. If your partner doesn’t enjoy the position, it’s okay and it’s their right. Just like you have your preferences for doggie style, it’s their right to have their dislikes and sexual boundaries respected, and it's not okay to talk someone into or pressure them into a sexual position or activity that they don't like or want to do.
Another factor to consider is whether there’s something other than the physical that’s bothering them. Some people may feel as though the "doggie" position is something being done to them, as opposed to something in which they’re participating. It could also be that they feel distant from their partner when they’re not facing them. The only way to learn this is to ask and then listen to your partner's response to see how they feel. If your partner feels this way, you could offer to touch their body or wrap your arms around them to increase feelings of intimacy.
If your partner finds no relief or enjoyment in any of these changes, then it might be time to take a break from doggie style. Not forcing an issue is critical in any healthy sexual relationship and can give you both the time to relax, explore your sexuality together in other ways, and potentially come back to the doggie position at another, less stressful moment. Keep in mind that it’s possible that this isn’t a position in which your partner can participate pain-free. If this is the case, you'll need to determine how this position plays into your overall enjoyment of sex. Barking up the wrong tree, can you be in a relationship in which your partner doesn't consent to this position? Are you able to enjoy other types of sexual pleasure with this partner without this position being an obsession? In what ways can you enjoy sex without this position? If this is a sticking point for you both, you may want to reflect on the potential impact on your relationship because it's ultimately about what works for both of you.
Here's to wishing you both a happy, fulfilled, and consensual sex life.

Over-the-counter remedies for genital warts?

Dear Alice,
I found out that I have a genital wart on my penis. I went to the doctor a while back and he put some medicine on it and also gave me a prescription. After using the prescribed medicine for a few weeks, the wart went away. After a few months, the wart returned. I do not have any more of the prescription, nor do I have insurance anymore. My question with this is... can you use over-the-counter wart removal medicines on genital warts?

Dear Reader,
Wart on your finger? Wart on your penis? Although they're both warts, unfortunately, they don't have the same type of treatment. This for one very major reason: the skin tissue on other parts of your body (hands and feet, for example) is much less sensitive than genital tissue. This means that using over-the-counter (OTC) remedies designed for non-genital warts could lead to more anguish than your warts may already be causing you. Ouch! While there may not be OTC options, there may be other affordable ways to treat this wart (more on this in a bit).
Genital warts, like warts on the rest of your body, are caused by various strains of the human papillomavirus, commonly known as HPV. Strains of HPV that affect the genital area can be transmitted through any type of skin-to-skin genital contact (including anal, vaginal, or oral sex) and can stay unnoticed for long stretches of time without causing warts. HPV is one of the most common STIs (sexually transmitted infections) out there, so you’re not alone. It's possible for genital warts to flare up on occasion after treatment (as you have experienced). In case you’re wondering, STIs such as herpes or syphilis can cause sores in the genital areas that may look similar to warts. Sores caused by other STIs require different treatments, so seeking a diagnosis from a health care provider can help ensure you’re taking an appropriate course of action.

With time, genital warts may clear up on their own. Unless they're causing you distress or discomfort, the lesions themselves present little risk to you. Other strains of HPV (sometimes known as “high-risk” strains) are associated with more serious health issues, such as cancer. However, the strains that cause genital warts aren't the strains that cause cancer, so you may decide that leaving it untreated for now makes sense for you.
That said, keep in mind that the virus (though transmissible with or without visible symptoms) is more contagious during flare-ups and may be passed more easily to a sexual partner. Condoms and dental dams can help minimize the risk of spreading HPV and other STIs, but they're not 100 percent effective at doing so. Talking to partners about STIs can be awkward, but Planned Parenthood has some helpful tips for talking about HPV that might help you feel more comfortable navigating those conversations.
If finances are keeping you away from a health care provider, you may have access to some affordable options. Though it can vary from clinic to clinic, organizations such as Planned Parenthood often offer sliding scale fee structures, low cost, or free services to increase access to testing and treatment for STIs such as genital warts, even for people under age 18 (but this may vary by state). You might also contact your local health department to find out about affordable or free testing and treatment options near you.
When it comes to smoothing things over (down under), know that you have options despite your financial limitations. If you choose to wait it out and see if it heals on its own, make sure to communicate with future partners about potential risks before diving back into the sheets.

What's fisting?

Dear Just wondering,
It's understandable that you may not be up to speed on fisting. Chances are, most parents and health teachers don't cover this technique during the birds and bees talk. For now, they're excused, considering birds and bees don't have fists. Fisting is when a person puts their entire hand into another's anus or vagina. For those who enjoy this activity, it can be a highly intense and pleasurable feeling for both the receiving and giving partner. While many enjoy the sensations, there can be risks involved. Fisting can create intense pleasure, but can also cause pain and tissue damage. Throughout the experience, it's critical to keep the lines of communication open and check in frequently with partners about how they feel. The key is to go slow and talk about how it feels, and set the expectation that any partner can decide to stop at any point. It’s a sexual activity that requires trust, communication, preparation, relaxation, patience… and lots of lube.
Spontaneity can be great, but this is an activity where it’s worth spending time doing some homework before getting a fist wet. For safety's sake, it's best that fingernails on the hand that's going in be as short and smooth as possible. Next, it's time to gather safer sex materials, including a few pairs of latex or non-latex exam gloves and ample lube. Like condoms or dental dams, the gloves act as a barrier against transmission of any sexually transmitted infections, and as a bonus the material makes entry smoother. For vaginal fisting, water-based lube is a good choice since it’s generally non-irritating; silicone lube could also be used, as a thicker option. For anal play, an oil-, water-, or silicone-based lube can provide long-lasting lubrication. One disadvantage of oil-based lubes is that it can break down latex; that being said, another option can be to use nitrile gloves, which are oil-resistant. Another consideration is that oil-based lubricants can block pores and cause acne breakouts for those with sensitive skin. For more information about lube varieties, check All about lube in the Go Ask Alice! Sexual & Reproductive Health archives.

Before diving in, it might be helpful to engage in a lengthy session of foreplay to loosen up. It can be helpful to apply plenty of lube to the fisting hand, completely coating the flat parts of the hand as well as the fingers and thumb. When the receiving partner feels ready, it's good to begin by slowly inserting the fingers, one at a time, into the vagina or anus, eventually entering the body with the hand in the shape of a duckbill. When reaching further in, the fingers might curl over the thumb to make a fist. In this situation, it might be good to have the receiving partner call the shots and let their partner know what feels good or doesn’t. Once the hand is inside, the fisting partner may try gently clenching and releasing the hand as if squeezing a stress ball to "fill up" the receiving partner. Due to pressure of the vaginal wall or anus, the fisting partner may feel like their hand is being squeezed uncomfortably. If this happens, it's good to be careful not to jerk out the hand suddenly, which may hurt the receiving partner. It can be helpful to check in when it comes time to remove the fist so both partners are ready. It may be easier to remove when the receiving partner orgasms. To remove the hand, the fisting partner can gently uncurl the fist while sliding the hand out.
With patience and practice, fisting can be an incredibly fulfilling experience, but there are risks involved. If the receiving partner has any pain, fever, or bleeding afterwards, it's highly advised to seek medical care right away — these symptoms may indicate a tear in the vagina or rectum. In a couple of rare cases, fisting mishaps have led to the death of the receiving partner, which is why communication, taking it slow, and paying attention to any symptoms associated with the act are so key.
With an awareness of the risks and a commitment to care, communication, and preparation, fisting can be a deeply enjoyable experience for those who seek it out.

Will sex-ercise burn calories?

Dear Curious,
Burn, baby, burn — talk about a great workout! While you may experience some of the same physical effects during sex as you would during a vigorous workout (sweating, rapid heartbeat), you may not want to rely on sex as a main source of physical activity. Sex may not burn as many calories, but it still has a number of other benefits!
Many people believe sex burns more calories than it actually does. According to various research, it’s estimated that a person can burn about 20 calories during six minutes of sexual activity, and approximately 77 to 105 calories during a 25-minute timeframe. As with any physical activity, calorie expenditure during sex will vary depending on a person's weight, sex assigned at birth, overall fitness level, and the type of sexual activities involved, as well as the duration, intensity, if orgasm occurs, and position during sex. Research on sexual activity and the heart suggests that the maximum energy expenditure during sex occurs during orgasm but returns to its usual rate within two to three minutes after. So, while you may burn more calories during orgasm, this higher rate of metabolism isn’t sustained after orgasm has ended.

When compared with aerobic activities, sex doesn't burn nearly as many calories. For example, dancing and running may burn two to five times as many calories as sexual activity during similar timeframes. While sex may burn 77 to 105 calories in 25 minutes, doing an endurance exercise on a treadmill for 30 minutes burns approximately 250 to 555 calories, and dancing for 30 minutes is thought to burn about 90 to 266 calories. It can be helpful to remember that calculations to determine how many calories are burned are only estimates, and different studies have resulted in different estimates.
It may be helpful to check out the Go Ask Alice! Nutrition & Physical Activity archives for more information on energy expenditure and how it's calculated. Additionally, if you're interested in finding ways to burn calories or achieve a higher level of fitness, you may consider starting or maintaining a regular physical activity program. You could check out the Centers for Disease Control and Prevention for recommendations regarding physical activity and calorie-burning.
That being said, while there are estimates of calorie burn for various activities, there are numerous benefits to aerobic activity that go far beyond calorie burn. Be it stress relief, stronger muscles, or increased energy (among many other benefits), cardio activity can help to keep the body going. Besides calorie burn, other benefits of sex include a reduction in stress and anxiety and increased calmness. So, while sex-ercise may not be the most effective option for calorie burn (if that's your goal), you can still enjoy sex for the other benefits it provides!

What to know about dry orgasms

Dry orgasm, or orgasmic anejaculation, means that orgasm occurs without ejaculation, so the penis does not release semen as usual.
There are several possible causes of a dry orgasm. Some are temporary, but others may be long-lasting or even permanent.
Dry orgasms themselves are not a health concern, but the underlying issue may require treatment in some cases. Dry orgasms can take a mental toll if a person feels embarrassed to discuss the issue with a partner. They may also affect a person’s ability to have children.
Treatment is available for some causes of dry orgasm, so it is best to see a doctor for a diagnosis.
One common cause of a dry orgasm is having repeated orgasms.
Having multiple orgasms in a short period may cause a dry orgasm. It takes time for the body to replenish its semen stores, and having numerous orgasms can deplete these stores. This issue is not typically a cause for concern.
Some people regenerate semen faster than others, but the body should start producing more semen after a few hours of rest.
Genetic abnormalities
Some people do not produce enough semen to ejaculate, which may be due to a genetic abnormality.
If this is the case, there is nothing wrong with the person’s health.
Testosterone deficiency
Low testosterone levels may also contribute to reduced ejaculation, particularly as a person gets older, and their testosterone levels decline. It can also occur in people with hormonal imbalances.

Blockages

Some dry orgasm issues may also stem from blockages in the urethra or ejaculatory duct, which is the small tube through which the semen travels during ejaculation.
A cyst may grow within these ducts, or sperm may become trapped and fail to leave the body.
Nerve damage
Nerve damage may also lead to issues with ejaculation. Nerve damage may occur as a result of an accident that causes spinal injury or as a complication of another condition, such as cancer, diabetes, or multiple sclerosis.
Surgical treatment in a part of the body close to the penis may also cause dry orgasm.
A person who undergoes the removal of their prostate, bladder, or lymph nodes may no longer produce semen or ejaculate. These surgeries may affect the muscles or nerves that play a role in ejaculation.
For example, surgeries for prostate cancer that remove the prostate or seminal vesicles will result in permanent dry orgasm. As the American Cancer Society note, the testicles will still make sperm cells, but the body will reabsorb them rather than producing semen.
This reabsorption does not harm the body or lead to any complications other than dry orgasm.
Surgical procedures and other medical treatments that may affect ejaculation and lead to dry orgasm include:
cystectomy
prostatectomy
open prostatectomy
laser prostate surgery
lymph node dissection
transurethral resection of the prostate, or TURP
transurethral incision of the prostate, or TUIP
transurethral microwave therapy, or TUMT
radiation therapy

Female orgasms: What you need to know

Unlike some animals, human females can have sex any time of the month, and they do not have to orgasm to ovulate or get pregnant.
Male-dominated scientific norms mean that much about the female orgasm remains misunderstood, and many harmful myths persist.
A female orgasm can be highly pleasurable and occur during masturbation or sexual activity with one or more partners. Scientists are unsure whether it has additional benefits.
In this article, we look at why female orgasms occur and what happens during an orgasm. We also debunk some common misconceptions.
The benefits of the male orgasm are clear. Men must ejaculate to deposit sperm in the vagina, possibly leading to pregnancy. The male orgasm, therefore, serves a clear evolutionary purpose.
The purpose of the female orgasm is less clear. Researchers have suggested numerous potential benefits, but few have been rigorously tested, and no theory has conclusive scientific support.
Not everything the body does has a clear purpose, however. Scientists have not discovered the evolutionary benefits of some traits that have persisted in humans.
A 2016 study argues that the female orgasm may have no obvious evolutionary benefit and that it may be a relic of a time when the hormones associated with orgasm were necessary for a woman to ovulate.
Since there was no evolutionary need to eliminate the female orgasm, it persisted even when it was no longer necessary for fertility.
Orgasm may serve important purposes, however. The pleasure it can cause can encourage females to have sex. This may also promote bonding with a sexual partner, which does have significant evolutionary benefits.

What happens during an orgasm?
During arousal, blood flow to the genitals increases, causing them to become more sensitive.
As arousal increases, a person’s heart rate, blood pressure, and breathing rate may also increase. As orgasm approaches, the muscles may twitch or spasm. Many women experience rhythmic muscle spasms in the vagina during an orgasm.
Several researchers have proposed that sexual response follows specific stages, though their theories about these stages differ.
Still, most theories include the following stages:
excitement, during which arousal builds

plateau, during which arousal increases and levels off
orgasm, which causes intense feelings of pleasure
resolution, during which arousal diminishes
Many females are able to have another orgasm after resolution, whereas males usually require a period of rest before having another orgasm.
Health benefits
While the internet is filled with articles promising that orgasms improve skin, hair, and overall health, there is little scientific evidence that orgasms offer any specific health benefits.
Scientists have not identified any evolutionary benefits of female orgasms or found that orgasms improve health.
But orgasms are pleasurable, and pleasure can be its own benefit. Pleasurable sex may improve a person’s mood, relieve stress, boost immunity, and foster better relationships.
Women do not need to orgasm to get pregnant. However, a limited body of evidence suggests that orgasms may boost fertility.
One very small study, for example, measured whether there was better sperm retention after female orgasm. While the results confirmed this, proving that the female body retains sperm better after an orgasm will require larger studies with designs of higher quality.
People hold many misconceptions about female orgasms. Some myths include:
Women who cannot orgasm have psychological problems.
While trauma, relationship issues, and poor mental health can make it more difficult to orgasm, many people with healthy sexual attitudes and good relationships still have difficulties.
An orgasm is both a physical and psychological response, and numerous health problems can make it more difficult to enjoy sex in this way.
Some people struggle to orgasm due to inadequate lubrication. This may happen while taking hormonal birth control, or during or after pregnancy, or due to menopause.
Also, women can experience vulvodynia, which refers to unexplained pain in the vagina or around the vulva. Treating this and other medical conditions may improve sexual pleasure.
Orgasms from penetrative sex are common or the healthiest form of sexual expression.
Self-appointed experts, mostly men, have long told women that they must orgasm from heterosexual intercourse. However, many women can only orgasm from clitoral stimulation.
Sigmund Freud argued that the vaginal orgasm was the superior and more mature orgasm. No evidence supports this claim.
Women cannot have vaginal orgasms.
While vaginal orgasms are less common than those from clitoral stimulation, some women have them — with or without other stimulation.
The female orgasm can result from many types of stimulation, including vaginal, clitoral, and nipple contact.
Not everyone orgasms from the same type of stimulation.
Women need to be in love to orgasm.