Our cultural prioritization of penile-vaginal intercourse over more clitorally focused sexual activities is linked to the gendered orgasm gap

Orgasm Equality: Scientific Findings and Societal Implications. Elizabeth A. Mahar, Laurie B. Mintz & Brianna M. Akers. Current Sexual Health Reports, Jan 8 2020. https://link.springer.com/article/10.1007/s11930-020-00237-9

Abstract
Purpose of Review: Studies have consistently found that there is a gendered orgasm gap, with men experiencing orgasm more frequently than women in heterosexual sexual encounters. This literature review aims to highlight the current state of research on orgasm equality and to explore the reasons underlying this orgasm gap.

Recent Findings: Our review of recently published studies indicates that the gendered orgasm gap still exists today. Additionally, these studies underscore how sociocultural factors can contribute to the differences in reported orgasm frequency between men and women in heterosexual encounters.

Summary: This review suggests that our cultural prioritization of penile-vaginal intercourse over more clitorally focused sexual activities is linked to the gendered orgasm gap. Additional related contributing sociocultural factors may include women’s lack of entitlement to partnered sexual pleasure, societal scripts about masculinity, and women’s cognitive distractions during partnered sex. Recommendations to increase orgasm equality are discussed.


Sociocultural Explanations for the Gendered Orgasm Gap

In all sexual contexts in which women have the most orgasms
(e.g., masturbation, relationship sex, sex with other women),
there tends to be greater focus on clitoral stimulation.
Research finds that when women masturbate the vast majority
stimulate their clitoris, either alone or coupled with penetration [22, 29, 30]. Additionally, in casual sex, women receive
less oral sex and other forms of clitoral stimulation than they
do in relationship sex [31]. Finally, one study found that women in same-sex relationships reported more frequent orgasms
resulting from their partners’ stimulation of their clitoris and
from oral sex than women in heterosexual relationships [32•].
In short, these findings suggest that a likely reason for the
gendered orgasm gap is that during heterosexual sexual encounters, many women are not getting the clitoral stimulation
they may need to orgasm [19]. This lack of clitoral stimulation
has been theorized to be linked to several underlying cultural
factors including our cultural overvaluing of intercourse,
women’s lack of entitlement to sexual pleasure, a conflation
of penetration-based orgasms and masculinity, and our lacking
sex education system.


Cultural Overvaluing of Intercourse

Scholars have implicated our cultural devaluing of women’s
sexual pleasure and clitoral stimulation, and parallel
overvaluing of men’s sexual pleasure and intercourse to underlie the orgasm gap (e.g., [2, 33]). This overvaluing of intercourse is reflected in what has been termed our current
cultural script for heterosexual sex, which proceeds as follows: foreplay (just to get the woman ready for intercourse),
intercourse, male orgasm, and sex over [18, 33, 34]. In this
scenario, the man is responsible to give the woman an orgasm
during intercourse giving by lasting long and thrusting hard
[34].
This cultural prioritization of intercourse is reflected and
perpetuated in our language and media. We use the words sex
and intercourse5 as if they were one and the same and relegate
everything before to “foreplay,” implying it is a lesser form of
sex than intercourse [35]. Recent studies indicate that media
images of heterosexual sex generally portray women
orgasming from intercourse alone, if they orgasm at all. To
illustrate, content analyses of pornography indicate that the
orgasm gap is reflected there, with only about 17–18% of
women in comparison to 76–78% of men shown to reach
orgasm, and most of women’s orgasms shown to be achieved
through vaginal or anal intercourse [36, 37]. One recent study
used content analysis to code PornHub’s 50 most viewed
videos of all time and found that in the videos where women
are shown reaching orgasm, only 25% of the orgasms involve
some form of direct or indirect clitoral stimulation [36].
Additional evidence of media emphasizing intercourse is a
study that textually analyzed top articles from Men’s Health,
a popular men’s magazine, and discovered a focus on female
orgasms achieved through vaginal penetration [38]. Even in
instances where these articles encouraged sexual variety, they
spoke of variety almost exclusively in terms of intercourse
positions [38]. Such popular press advice runs counter not
only to research that indicates that most women do not orgasm
from penetration alone, but also to findings that combining
intercourse with other more clitorally focused sexual activities
during partnered sex is associated with women’s increased
3 orgasm frequency [9•, 39]. For example, one study found that Shirazi et al. [26] demonstrated that the way questions are phrased regarding
the occurrence of orgasm during intercourse modulates women’s reported
frequency of such orgasms, with the highest rate of orgasm reported when
the question specifies that intercourse include concurrent clitoral stimulation
and the lowest rate of orgasm reported when the question specifies no such
concurrent stimulation, with a mid-range rate found when this was left
unspecified.
4 In this convenience sample, 19% said they rarely if ever orgasmed with a
partner.
5 Given our cultural usage of the words sex and intercourse as equivalent,
research asking about women’s orgasms during “sex” could lead to lower
reports of orgasms than actually occur during partnered sexual activity because
many heterosexual women exclude activities that are associated with increased
likelihood of orgasm (e.g., receiving oral sex) from their personal definitions of
sex [9•, 35]. Researchers are thus advised to use precise wording in their
studies of orgasm.
women report more frequent orgasms if their sexual encounters include deep kissing, manual genital stimulation, and/or
oral sex in addition to intercourse [9•].

Women’s Lack of Entitlement to Sexual Pleasure

Research suggests that women may set the bar for satisfactory
sex quite low—specifically, the absence of pain and degradation rather than as the presence of pleasure and orgasm [40].
Indeed, research finds that many heterosexual women express
going into partnered sexual activity expecting not to orgasm
[41] and valuing their partners’ orgasms more than their own
[42, 43]. In fact, when women report on their sexual satisfaction, these reports often reflect their perception of their partners’ sexual satisfaction rather than their own [44, 45].
Women prioritizing providing their partners—rather than
themselves—pleasure during sexual encounters has been connected with them feeling less entitled to sexual pleasure and
also less likely to communicate to their partners how they need
to be stimulated in order to orgasm, two factors positively
associated with reaching orgasm in the research literature
[9•, 11, 46, 47].
Women’s lack of entitlement to sexual pleasure may be
especially pronounced during casual sex. One qualitative study
[31] found a double standard in which both men and women
question women’s (but not men’s) entitlement to pleasure in
hookups, while believing strongly in women’s (as well as
men’s) entitlement to pleasure during relationship sex. This
sexual double standard seems to translate directly to behaviors
focused on clitoral stimulation. A large-scale study [15] found
that “men are more likely to engage in cunnilingus—a practice
strongly associated with women’s orgasm—in relationships
than in hookups. In contrast, women engage in fellatio at high
rates across all contexts” (p. 362). Relatedly, another practice
strongly related to women’s orgasms—clitoral self-stimulation
during intercourse—was found to be more common in relationship sex than in casual sex. According to the authors, these
findings suggest that the orgasm gap is larger in casual sex
because women are less likely to feel entitled to seek their
own sexual pleasure and men are less motivated men to provide their partners with pleasure, with both resulting in less
clitoral stimulation for women.


Conflation of Penetration-Based Orgasms and Masculinity

While studies on casual sex [15, 31] position men as not
caring about women’s pleasure, other findings suggest that
men care deeply about women’s pleasure—although they
may be misguided about how to provide that pleasure. As
detailed above, our cultural script gives men responsibility
for “giving” women orgasms by lasting long and thrusting
hard [38]. A qualitative study found that men often felt distressed and sometimes emasculated when their female partner
does not orgasm [48]. Similarly, a recent vignette study found
that men reporting having higher sexual self-esteem and feeling more masculine when they imagined that their partner
orgasmed during sex versus imagining that she did not [49].
The female partner that the men were instructed to imagine
was an attractive woman that they had had sex three times
with, so neither a first-time hookup nor a relationship partner.
Whether and how men’s feelings of masculinity would change
when imagining differing types of partners (e.g., first time
hookup, girlfriend) is an empirical question awaiting study
and could shed light on the seemingly contradictory findings
that men do not care about women’s pleasure during hookups
and findings that men care so deeply about women’s orgasms
that they see “giving” one to be a reflection of their manhood.
Regardless of the results of such future research, existing
research indicates that women are expected to protect men’s
egos by orgasming during intercourse. One qualitative study
[28] found that female participants reported being concerned
that it would hurt the male partner’s ego if they did not have an
intercourse-based orgasm. The women in this study also believed that asking their partners for clitoral stimulation would
hurt their partners’ feelings. Given such findings, it is no wonder that a majority of women report having faked an orgasm
during intercourse, with some of the most common reasons for
faking being to protect their partners’ egos and to give their
partners pleasure [28, 34, 50]. Women also report faking orgasms to avoid appearing abnormal, because they, too, believe
they should be orgasm from intercourse alone [34]. A qualitative study found that women report feeling abnormal or
dysfunctional when they do not orgasm during penilevaginal intercourse [45].
In sum, several deeply intertwined sociocultural factors
related to expectations of female orgasm during intercourse
are linked to the gendered orgasm gap. Nevertheless, additional sociocultural factors have been implicated in women’s comparatively lower rate of orgasm when compared to men.


Additional Sociocultural Factors

Two additional cultural factors that may underlie the orgasm
gap are women’s cognitive distraction during sexual encounters and our lacking sex education system. Regarding the latter, the United States’sex education system often presents sex
as dangerous rather than pleasurable and particularly fails to
cover women’s sexual pleasure by excluding mention of
women’s external genital anatomy or women’s orgasms [20,
51, 52].
Women also report higher levels of both overall cognitive
distractions and appearance-focused cognitive distractions
during sexual activity than men [53] and these cognitive distractions are linked to lower levels of sexual satisfaction [54]
and orgasm [55]. One specific area of appearance-focused
cognitive distraction is women’s genital self-image, with
women’s positive feelings towards their genitals associated
with sexual satisfaction and enhanced orgasmic capacity with
a partner [56, 57]. Another common focus of cognitive distraction (for both women and men) is performance anxiety,
including worries about pleasing one’s partner and about if
one is going to orgasm. While for men, there is often concern
about orgasming too quickly, for women, the concern often
focused on taking too long to orgasm [24]. Regardless of the
content of the performance-based worry, there is evidence that
mindfulness, an approach characterized by “acceptance and
non-judgment of the present moment,” may enhance women’s
orgasmic capacity by decreasing cognitive distractions, such
as concerns about appearance or performance, during sexual
activity (p. 418) [58]. Mindfulness is useful in taking the focus
away from a performance-oriented view of sex and placing the
focus on pleasure and eroticism. Indeed, despite the focus of
this review on the gendered orgasm gap, it is essential to
underscore that pressure to achieve orgasm is linked to stress
in women [50] and that pressure to achieve orgasm (for both
women and men) makes orgasm less likely, given that orgasm
is often the result of a pleasuring/eroticism process rather than
a performance imperative [33]. Additionally, women differ
greatly in how important orgasm is to their sexual satisfaction
[24]. Thus, prior to turning to strategies to close the orgasm
gap, it is important to examine the issue of the importance of
orgasm to women’s sexual satisfaction.


How Important Is Orgasm to Women’s Sexual Satisfaction?

As detailed in a seminal review article [24], women differ
greatly in how important orgasm is to their sexual satisfaction.
Such individual differences may also be reflected in seemingly contradictory research findings, with some research finding
that many women report feeling sexual satisfaction even when
they do not orgasm [50] and other research reporting that
women’s orgasms are associated with increased sexual satisfaction and positive outcomes [10, 13, 31]. While we do not
dispute either set of findings, we also acknowledge that it is
difficult to separate the importance women place on their own
orgasms from the sociocultural factors that underlie the gendered orgasm gap. To explain, given our cultural scripts that
prioritize penetrative sex, when women are unable to reliably
orgasm through this method of stimulation, they may come
not to expect orgasms [41] and—as a way of reducing feelings
of abnormality—come to view their own orgasm as unimportant [59]. Potentially bolstering this view is the finding that
both men [44] and lesbian women are more likely than heterosexual women to include orgasm as a metric of their
partnered sexual pleasure [41, 46]. In other words, those most
likely to orgasm during partnered sexual encounters due to
being less negatively affected by the prioritization of intercourse are those most likely to view orgasm as most
important. While we are not suggesting that orgasm be set as
an imperative goal to achieve, that orgasm must be equally
important to all women, or that that every sexual encounter
needs to be completely synchronous (i.e., equally pleasurable
and orgasmic for both partners), consistent and robust research
findings concerning a gendered orgasm gap points to an underlying societal issue to be addressed.


Recommendations for Closing the Orgasm Gap

Given that sociocultural factors have been implicated in the
orgasm gap, it is likely that sociocultural interventions could
prove useful in closing the gap. In the conclusion of a recent
study on women’s pursuit of orgasm, it was proposed that an
effective societal intervention may be simply to “acknowledge
that broad claims about women’s biological capacity for orgasm are facile” (p. 8) [18]. Additionally, societal-level advocacy work aimed at women and men promoting clitoral
knowledge and the equal valuing of women’s and men’s most
reliable routes to orgasm will be useful.
Nevertheless, such awareness raising alone is likely insufficient, given that one study found that teaching women about
their clitoris is linked to orgasm frequency during masturbation but not during sex with a partner [2]. Instead, the most
empirically supported technique for women struggling with
orgasm concerns is to direct them to figure out what type of
clitoral stimulation they need via masturbation and then to
help them transfer this type of stimulation to partner sex or
in other words, helping them to engage in sexual behaviors in
which they get the same type of stimulation alone as with a
partner [33]. For women to get the same sexual stimulation
alone as with a partner entails replacing our current cultural
script for sex (i.e., foreplay, intercourse, male orgasm, sex
over) with turn-taking scripts (e.g., oral sex during which the
female orgasms followed by intercourse during which the
male orgasms; stimulation of the clitoris to prepare the woman
for intercourse, followed by intercourse during which the male
orgasms, then followed by vibrator stimulation during which
the woman orgasms) or scripts where penetration is consistently paired with clitoral stimulation (e.g., via an intercourse
position which provides clitoral stimulation to the women;
using a hand or a vibrator during intercourse). The underlying
strategy in teaching individuals to utilize such new scripts is
consistent with research finding that women are most orgasmic when including a variety of activities (e.g., oral sex, manual stimulation, intercourse) in their sexual encounter [9•]. In
short, closing the orgasm gap will require teaching women
and their male partners specific skills and methods with which
to apply clitoral knowledge to their sexual encounters [60].
Three recent studies show that this method holds promise.
One study found that undergraduate women who took a
Human Sexuality course covering topics such as women’s
genital anatomy and pleasure, cultural factors underlying the
orgasm gap, and evidence-based methods to enhance
women’s orgasm (e.g., mindfulness, masturbation training
with transfer to partner sex via sexual communication and
new sexual scripts) showed improvements on measures of
sexual functioning, including attitudes towards women’s genitals, cognitive distraction during sexual activity, and entitlement to pleasure when compared to students who took quasicontrol courses [61]. Another study found that women who
read a book (Becoming Cliterate [19]) combining feminist
analysis of the cultural reasons for the orgasm gap and the
same evidence-based methods to enhance women’s orgasm
improved on multiple measures of sexual well-being, including orgasm [62]. Finally, another study [63] found that men
who read a summary chapter aimed at male readers of this
same book (Becoming Cliterate [19]) showed improvement
on clitoral knowledge, sexual communication, dysfunctional
beliefs about women’s sexual satisfaction, and dysfunctional
beliefs conflating masculinity and sexual performance.
Additional interventions aimed at both women and men to
close the orgasm gap should continue to be developed and
empirically evaluated.
Importantly, such future interventions and research
should be more inclusive of individuals who are transgender or non-binary. We could locate only one study on orgasm frequency not exclusively focused on cisgender individuals. This study found that cisgender women in relationships with cisgender women orgasmed more than both
cisgender women in relationships with cisgender men and
individuals in relationships that include one or more transgender or non-binary partners [64]. Additional work should explore how the orgasm gap affects gender minority
individuals and aid in developing inclusive interventions
for these individuals.