Women are as well equipped as men to achieve sexual satisfaction – so why is “intimate justice” still so elusive? By Niki Bezzant.

When it comes to male genitalia, there’s never been a shortage of information in medical textbooks. Many, many pages over the centuries have been devoted to men’s sexual organs. Surgeons are trained to do everything possible to avoid damaging nerves and maintain sensation when operating in the area.

The same cannot be said for the anatomy of women, or the preservation of their pleasure. For hundreds of years ‒ right up until the 1990s ‒ the clitoris was considered so insignificant it was excluded from medical texts. In the 19th century, it was literally excised – surgically removed as a treatment for “hysteria” and other imaginary, female-only ailments. The clitoris was seen as the source of no end of trouble, but also so unimportant that women wouldn’t miss its removal.

Unbelievably, it wasn’t until 1998, when Australia’s first female urologist, Professor Helen O’Connell, studied the clitoris in detail and published her findings, that the full, accurate anatomy of the organ was known. In 2005, she mapped the clitoris using MRI imaging, and has since created a full three-dimensional model.

O’Connell discovered that medical science had it wrong about the clitoris. It was assumed that what was visible externally – the glans – was basically all there was to it. But she found that, like an iceberg, the clitoris goes far deeper and wider.

Beneath the pubic bone, unseen, it extends out from the glans in a wishbone shape; it has “legs” surrounding eggplant-shaped bulbs that extend up to 9cm on each side.

Viewed in 3D, the whole thing looks like a beautiful, curvy and complex moth orchid. It’s all erectile tissue, highly sensitive and capable of arousal. And it’s all surrounded by a “very large” network of nerves stretching out like tendrils. Late last year, US researchers counted these nerves for the first time: there are more than 10,000 in this one small area.

The clitoris is a unique organ, in that it exists solely for pleasure. That we’re still learning about it properly only in the 21st century is mind boggling, and might go a long way towards explaining why women’s sexual pleasure is still far less well understood than men’s.

Even now, many women still don’t understand their own anatomy – and that’s before we consider the “cliteracy” of those they’re having sex with. This may also partially explain what could be termed “the pleasure gap”. One thing we do know now is that women – especially those in heterosexual relationships – are not experiencing as much sexual pleasure as men.

Last year, researchers at Rutgers University, New Jersey, explored what’s known as the “orgasm gap”, echoing what many other studies have identified. In heterosexual couples, men reported experiencing significantly more frequent orgasms than women. What’s more, men overestimated how often their female partners orgasmed (the women didn’t have this issue).

Women in the study reported wanting more orgasms than they were having. And that lack of orgasms contributed to a sexual vicious circle: women who had fewer orgasms had less desire for orgasm, and a lower expectation of how often they should orgasm.

Principal researcher Grace Wetzel says when women’s sexual experiences are less fulfilling and less pleasurable, they may shape their sexual expectations based on those experiences, and that affects their future pursuit of pleasure and orgasm. “This can create a cycle … women end up developing a different threshold for a sexually satisfying experience than men do.”

A solid body of evidence has established that women are no less capable of experiencing orgasm than men (and are often capable of more) – the reason they’re not having as much pleasure has nothing to do with biology. So what is it, then?

Pleasure and entitlement

Every woman knows sexual pleasure isn’t just about mechanics; in fact, it’s only a small part of the picture. Rita Csako, a senior lecturer in psychology and neuroscience at Auckland University of Technology, has researched female pleasure, including for a recently published study on masturbation in women. She says psychology plays a huge role.

“Female pleasure is very complex, because a lot needs to happen in the brain,” she explains. “Actually, the majority of the experience is happening in the brain. So for females, it’s less likely that they can have really enjoyable sex simply with stimulation. For most women, it’s the mindset and the setting that counts a lot.”

It seems women may have been socialised into the pleasure gap. Although modern women feel empowered in many ways, men’s satisfaction takes priority when it comes to sex. As one research paper puts it: “Men’s orgasm is the expected outcome of sex; women’s are seen as a bonus or achievement.”

Wetzel, who now campaigns to close the orgasm gap, says some of this is down to sexual context. “The orgasm gap is greatly exacerbated in casual sex, but it can almost or completely close during masturbation, when women have sex with other women, or when women pursue orgasm very strongly.”

The 90s gave us Sex and the City’s Samantha Jones, unapologetically enjoying “sex like a man”. Photos / Supplied

A 2021 study on sexual entitlement linked men’s general status in society, as higher earners and holders of greater power, with “the widespread belief that women are less entitled to sexually pleasurable experiences than men”. That view seems to be shared by both heterosexual women and men, the researchers reported, as is the persistent belief in gender differences we see as “natural” – for example, that men naturally orgasm more easily than women.

“In traditional heterosexual gender roles, men are active and women are passive receivers of sex,” Wetzel says. “For women, sex is often socialised as something that is done to them, rather than something that they engage in for their own pursuit of genuine pleasure.”

Women who lived through the first wave of feminism in the 1960s and 70s might be rolling their eyes at this point. It has, after all, been almost 50 years since Erica Jong dared to write about the “zipless f---” in her famous novel, Fear of Flying. The book was novel at the time because it dared to talk about sex frankly from a woman’s point of view.

It also dared to discuss the banality of well-worn sex. “Even if you loved your husband, there came that inevitable year when f---ing him turned as bland as Velveeta cheese … no bittersweet edge, no danger,” Jong’s protagonist famously uttered.

We’ve seen sex-positive women in popular culture since then. The 90s gave us Sex and the City’s Samantha Jones, unapologetically enjoying “sex like a man”. And in the streaming era, we have a grab-bag of shows featuring women pursuing pleasure, from Sex Education to Fleabag.

Porn problem

But there’s been another change in recent years: the ubiquity of online porn. Sex experts say it’s conditioned women into taking on a performative role during sex, which again doesn’t prioritise pleasure.

Sex and relationship therapist Serafin Upton deals with the aftermath in her practice. “I think pornography is the biggest threat to women’s pleasure,” she says.

It’s unclear how many New Zealand adults are porn consumers; overseas data shows most men and up to half of women watch porn regularly. A report in 2019 from the Chief Censor’s Office found content popular with Kiwis on one major porn site included problematic themes: aggression, non-consensual activity and a dearth of genuine female pleasure. It’s clear porn has become a default sex educator for many young people, creating a lot of their sexual “scripts”.

Csako thinks porn, alongside social media, is also negatively influencing women’s body image, which in turn can lead to less satisfying sex. “If you have very low body confidence, then your mind will take over [during sex], worrying about how you might look. And that takes away the pleasure part.”

Upton believes women are tiring of porn’s influence. “A lot of people are coming to me now and they’re saying ‘I’m done. I don’t want to have performative sex any more. I don’t want to do what I think I should be doing, or what I’ve seen on screen. I want to really figure out: what do I like?’”

She spends much of her time working with clients on the issue. “We’re trying basically to decolonise their minds from all of this abuse by pornography. We cannot have a conversation about women’s pleasure and women’s desire without talking about porn.”

Age and desire

Another aspect of the pleasure gap can be a natural waning of desire and libido. For women, this often corresponds with the waning of sex hormones in menopause and beyond, and may also include experiencing less pleasure when they do have sex.

Many women feel grief at the loss, but the experts say it’s a myth that women should simply expect to lose the sexual part of their lives as they get older. Csako reports that although there’s research showing that libido does tend to lower with age, it’s a myth that older people don’t enjoy sex.

Research carried out among retirement village residents shows that many people over 80 continue to enjoy sexual activity – sometimes more than younger people. “So I guess it depends on the cultural context.”

Csako says the culture we live in often promotes the idea of sex as something for younger people, and that menopause is a marker for the end of the sexual part of life. In reality, she suggests, “a lot of menopausal women realise their sexuality around that period”.

“Nowadays, a lot of women are challenging [societal messages] and they’re actually getting a grip on their lives. They realise: the children are leaving, so I can have more opportunities to try new things. Women in their midlife transition can go the other way; rather than giving up sexuality, they realise that now they’re free to do whatever they want to do.”

It goes without saying that there are many benefits in women of all ages seriously pursuing sexual pleasure. Sex is not only fun, it’s also an essential part of human wellbeing. Research has shown satisfying sex makes us happier and our relationships stronger.

Csako is soon to publish research on sexual satisfaction and relationship satisfaction that suggests, she says, that if sex is going well, so is the relationship. It makes sense, she reckons, because “a lot of emotional processing can be facilitated by sexual activities. And for couples, it’s a very, very strong biological connection that you’re creating when you’re having regular sex with your partner … It leads to more intimacy, and more intimacy leads to higher satisfaction in general.”

Solo orgasms are health-promoting, too. Csako’s masturbation study found women were using masturbation to deal with stress, anxiety, depression and boredom. There’s evidence that orgasms can help beat stress, promote sleep, relieve pain and even improve skin.

Mood and context

So what can women – and those having sex with them – do to get more pleasure; to achieve, as one researcher put it, “intimate justice”? Barring physical medical problems, larger relationship issues and the hormonal turbulence of menopause – all issues that need addressing first – a change of mindset is important, the experts say.

“It’s not really an erotic mindset when you go to bed and it’s happening in the same position and it’s really boring,” Csako says. “[For women] it can become like a chore. Whereas if [together with our partner] we can create an atmosphere that’s playful, we have a lot of foreplay, we talk about it, we have a shower together, we have a lovely time, and on top of it, we have sex, then there’s usually no problem with female orgasm.”

Upton agrees and notes we can have an archaic idea of foreplay. “We think it’s about what you do to somebody and what somebody does to you. But we don’t have a sense of foreplay in the context of: where are you? What do you feel like when you are there? And so I get people to design their perfect sensuous environment … and to really think about what sorts of environments and contexts set them on fire, so that they’re then open to the possibility of sex.”

Good sex starts long before entering the bedroom, she says. Creating space and time is key. “Lots of people think that they should schedule sex. Which is never going to work. People actually think – and this blows my mind – that you can go from doing things like being at work or commuting to then saying, let’s take our clothes off and have some amazing, pleasurable sex.”

Desire, Upton says, comes from fluidity. “It comes from being connected to one’s environment and feeling a sense of rhythm or connection with the world; with the environment; with nature ... with their body. And you can’t schedule rhythm.”

It helps to create a space where “something like sex may be able to transpire”, she says. This means engaging in activities that give us pleasure in general, not just in the bedroom.

Energising activities often fit the bill, such as being with friends. “A lot of people, when they’re around their friends, they leave that session feeling excited and energised and nourished. They go home and use that energy – they bring that energy into the space with their partner. They’re allowing themselves permission to actually experience pleasure in the world, and then by proxy that extends to the bedroom.”

Mind and body

Csako says developing body acceptance is key, too. Recalling a scene memorably depicted in Emma Thompson’s recent movie Good Luck to You, Leo Grande, in which the 63-year-old stands naked in front of a mirror, regarding her body with a steady, neutral gaze, Csako says we need to make friends with our bodies.

“How would you make friends with someone else? Make friends with your body like that. It creates a completely different experience because if there’s no judgment, you take away the anxiety and the fear.”

Another piece of the puzzle is addressing that modern epidemic: stress.

“People are like wound-up springs … we are so strung out; we’re so busy in our heads,” notes Upton. “But in order to experience pleasure and, for most people, in order to orgasm, you need to be fairly relaxed. And stress is like fear. You can’t be scared and be turned on at the same time.”

Talk and stimulation

Once in the bedroom, practically speaking, there are things that are important to boost women’s pleasure and help close the pleasure gap for women having sex with men. The first is clitoral stimulation. Research has established that most women are unlikely to orgasm via penetrative sex alone.

“Most women are not getting the clitoral stimulation they need to experience orgasm,” says Wetzel.

Overcoming this often means a greater variety of sexual activity, particularly oral sex, manual stimulation, the use of vibrators and generally taking more time from start to finish. It does not mean longer intercourse.

The other key is communication. “Every person is different, and you can’t know what feels best for you and your partner unless you communicate with them,” she says.

Sexual communication can mean larger conversations outside of the bedroom, or more subtle cues during sex. Women can introduce the same strategies they use during masturbation, and partners can show through their words and actions that mutual pleasure is important.

It’s also important to let go of the sexual “scripts” that tell us how a sexual encounter is supposed to go and how sex is supposed to look, she says. “Focus instead on finding whatever works for you and your partner.”

Csako says one script we need to ditch is the myth that persists – particularly among older people – that sex finishes with the male orgasm.

Women often need longer, she says, and it’s okay to say, “I’m not done yet; can we carry on?

“That’s basically a cultural change we need to make. We need women to feel empowered to say, ‘I do have sexual needs and I would like them to be satisfied.’

“I think we need to work with all these myths and assumptions that are out there in society. We can challenge these myths, ideally together as a couple … and it can lead to very, very pleasurable sex lives.”

Hormones and desire

Treatments can counter hormonal changes as women age, but access may be an issue.

As we age, both men and women experience a decline in the sex hormones that drive us. But for women, the hormonal change of menopause and perimenopause (the 2-10 years leading up to menopause) is a lot more turbulent. It’s also far more likely to cause issues that can quash sexual pleasure.

The first issue is GSM (genitourinary syndrome of menopause), which most women will experience at some stage during or after menopause. It’s the loss of oestrogen in the tissues of the vulva, vagina and urethra that can cause dryness, irritation and pain, especially during sex. And sex that hurts is a sure-fire libido killer.

GSM is relatively easily addressed through a range of treatments that are easy to access. That includes vaginal oestrogen, a non-systemic, low-risk, highly effective form of hormone treatment that’s considered the gold standard for GSM. It can be used for as long as it’s needed – which may be lifelong.

The other hormonal issue that can affect libido is loss of testosterone. Though women have far less testosterone than men, they do still need some. And at menopause and beyond, it can wane.

Low sexual desire “with associated personal distress” in women is known as hypoactive sexual desire dysfunction (HSDD). It encompasses a range of symptoms, including loss of desire, lack of arousal, low sexual satisfaction and inability to orgasm.

One treatment for HSDD is testosterone therapy. It’s considered controversial, but for some women it can be highly effective. The issue is that – unlike medications for, say, male erectile dysfunction – it’s hard to access and prohibitively expensive.

The one testosterone product designed for women that’s available worldwide is not approved for use in New Zealand. It’s only accessible via a back-door arrangement under the Section 29 provision of the Medicines Act, which allows for unapproved medicines to be obtained by registered medical practitioners.

Testosterone is not a wonder drug for women. Claims of its ability to boost energy and mood have not been proven. It’s been shown to be effective in about 60% of cases of low libido in women, but menopause experts stress that other things need to be in place first.

GSM symptoms need to be sorted; other menopause issues treated (possibly via hormone replacement therapy); mental health, sleep and stress addressed and – not least – the relationship needs to be good. Testosterone can help boost libido, it seems, but it can’t make you like your partner.