What is the Female Orgasm? ISSWSH Presents an Updated Definition at the 27th Annual SMSNA Fall Scientific Meeting

On Saturday, October 10, at the 27th Annual SMSNA Fall Scientific Meeting, Drs. Irwin Goldstein and Barry Komisaruk, along with Sue Goldstein, all members of the International Society for the Study of Women's Sexual Health (ISSWSH), presented a panel discussion on redefining orgasm. The panel explained that ISSWSH's original definition, which emphasized intense pleasure, did not fully account for the neurological and physiological processes involved in orgasm. Sue Goldstein explained that the updated ISSWSH definition recognizes three stages: pre-orgasm, orgasm, and post-orgasm. "Four years! It took us four years to get here," Dr. Irwin Goldstein remarked. However, the definition of female orgasmic disorder has not yet changed.

Dr. Komisaruk discussed the major sensory nerves connecting the genitals to the brain. The clitoris, cervix, and vagina project to overlapping regions of the brain's sensory cortex through different nerve pathways. He explained that women describe orgasms associated with these areas differently, with clitoral stimulation often producing more localized sensations and vaginal stimulation producing deeper sensations. Stimulation of multiple regions may contribute to a more intense orgasm. Interestingly, nipple stimulation also activates similar regions of the brain. Dr. Komisaruk noted that orgasm intensity may be related to muscle contraction intensity. Different areas of the brain become active at different times during orgasm, with activity subsiding shortly afterward. His research also suggests that excitation and inhibition occur together, with increased pain tolerance during orgasm. He described an "orgasm faucet model," in which different sources of stimulation can contribute to orgasm independently or simultaneously.

Dr. Irwin Goldstein explained how this understanding may help clinicians recognize six categories of female orgasmic dysfunction:

• Excitation insufficiency: Difficulty becoming sufficiently aroused to reach orgasm. Potential treatments may include medications that affect dopamine or serotonin signaling.

• Inhibition insufficiency: Difficulty regulating the inhibitory processes associated with orgasm, potentially involving pain. Treatments discussed included SSRIs, SNRIs, analgesics, and progesterone.

• Delayed orgasm: Orgasm develops slowly or takes longer than desired to occur. Treatment may involve approaches to increase sensitivity.

• Muted or prematurely muted orgasm: Arousal develops, but the orgasmic response is diminished or ends prematurely.

• Anhedonic orgasm: Orgasm occurs without the expected sensation of pleasure, potentially following surgery. Medication may be considered depending on the underlying cause.

• Post-orgasmic illness syndrome (POIS): Symptoms of illness following orgasm that may persist for an extended period. Dr. Goldstein discussed potential approaches involving psychotherapy and hormonal or neurotransmitter-related treatments.

Dr. Irwin Goldstein emphasized that a single definition or classification cannot fully capture the range of women's orgasmic experiences. He suggested that the traditional approach of placing women into one diagnostic category may eventually give way to more specific classifications that better reflect individual experiences.

Sue Goldstein noted that these concepts may also apply beyond women. All three panelists agreed that further research is needed to better understand orgasm and refine the classification of orgasmic disorders.