#1.  How do I know if I'm having an orgasm?

This was the number one question I got from college students teaching Human Sexuality.  It was more common in women but men also asked.  My standard answer to this remains "If you don't know if you're having an orgasm then you're not having one!"

Bottom line - if you're a woman having an orgasm there's really no way to miss it!  The human body is an amazing thing and provides many cues about orgasm!  It's important to understand the female sexual response.  The most common theory was put out by Masters & Johnson's in 1966 and is broken down in four stages:  excitement, platueau, orgasm and resolution.   In 1979 Dr. Helen Kaplan proposed a three stage model that included the psychological aspects which are:  desire, excitement and orgasm.  No matter which model you follow, each stage has a unique events that occur indicating the bodies sexual response.  I'll explain them in more detail but for those of you who want a quick answer, here are the 3 tale-tell signs of orgasm:

#1.  Body and face flushing

#2.  Dialated pupils

#3.  Vaginal or pelvic contractions

It's pretty impossible for anyone to fake all of the above!   In Kaplan's desire stage the cognitive aspects of sexuality come into play such as:  experiences, judgements, perceptions, memories or yearnings.   It's everything that involves the mind!  Masters & Johnson's first stage is excitement where the heart and respiratory rate increases and blood pressure goes up.  Vasocongestion occurs and blood increases in the plevic regions.  Usually a person can feel this happen as the area becomes warm, hot or tinglely.  This is when lubrication begins for easier penetration.  Women's breast wil also swell with blood, get larger and nipples will become erect.  There is usually a visual "sex flush" from  blood that rushes to the breasts, neck and upper abdomen.  A man's penis will become more erect and his testes will elevate.  Kaplan describes the same reactions in her excitment phase but blends it with the Master's & Johnson plateau stage.

The Master's & Johnson plateau stage is when physical changes continue as erotic stimulation and sexual desire increases.  In women there is a reatraction of the clitoral shaft and what's called the "orgasmic platform".  This is when the outer third of the vaginal opening creates a significant narrowing to tighten the opening to the vaginal canal.  This of course increases the pressure on the penis which in turn is stimulating for both the man and woman!  The inner two-thirds of the vagina become wider and deeper which is called the "tenting effect" and creates a small space for a pool of a man's semen.  A woman's aerola swell and may even conceal the nipple as excitement increases.  In males, the size of the penis increases as the testes become as elevated as possible to prepare for ejaculation.  Both sexes will  show increased heart and breathing rates and increased blood pressure.

 The orgasm stage is similar in both models.  This is the sudden release of tension built up in the excitement and plateau stages.  This is what we know as the climax or "coming".  There are intense sensations that are highly pleasureable which is why people love sex!  In a woman, the clitoris retracts and we don't know what happens becuase it's never been observed!   Vasocongestion decreases and the orgasmic platform decreases.  There are strong, rhythmic contractions in the vaginal muscles that get further apart and decrease in intensity over time.   Studies show contractions can last from 13- 51 seconds.  During this time there may be involuntary motor behaviors like uncoordinated movements of arms, legs, torso, head, neck.  A sudden arching of the back is very common as are uninhibited moans and groans! 

The orgasm phase In a man creates deep muscular contractions in the urethra, copora cavernosa (inside of the penis), hip and groin area that help ejaculate semen out of the body.  Contractions are usually less than a second and get longer after a few spurts of semen.  They become irregular as more semen is expulsed with less force.  Men often report the highest and most pleasurable sensation right after all the semen is expelled.  The penis and testes don't change alot during this stage but a man can get a "sex flush".  Excessive sweat on the palms, soles of the feet and all over the body is common in about 1/3 of men. 

Master's & Johnson describe a resolution stage when the body returns to a pre-arousal stage.  In women this simply means the clitoris, labia, uterus, breasts and everything that has swollen or increased size returns to it's normal size or position.  This can take 5-10 minutes and time increases with age.  If a woman reaches the plateau stage and doesn't orgasm it make take hours for the clitoris to decrease in size.  All the more reason for a woman to climax!  Women report the most pleasure from being cuddled, nuzzled, held and caressed during this time.  In men, the penis decreases in size in two stages with the penis  50% larger than normal in the second phase until detumescence is complete.  (That is the fancy word for when a penis becomes soft and tumescence is when it becomes hard.)  The testes move back to their normal position as everything resizes itself.  Males then enter the refractory period when they become unresponsive and cannot get erect despite further stimulation.  In younger men this only lasts an hour or less but  increases to sevaral hours or even a day in older men!  Although it's been studied much less, men also report greater desires to caress and hold their partner during this time.

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