The day the world watched top golfer Tiger Woods crash his Cadillac into a fire hydrant in November 2009 at his Florida mansion, pursued by his wife swinging a golf club, was a moment as dramatic as OJ’s televised car police chase. This was the most highly paid sportsman in the world, with hundreds of millions in endorsements from global companies vying for his friendly reassuring face – a smiling picture of integrity and honest hard work – to represent them.
The revelations that followed were the equivalent of the outing of the respectable Dr Jekyll and his evil twin Mr Hyde. The Tiger had become The Cheetah. His beautiful Swedish model wife had finally found out about his affairs through texts on his mobile phone which revealed all his mistresses’ numbers. Not just a few, but at least 14, and as many as 40 regular women over a four- to five-year period. This was going on even when their children were being born – and he apparently wanted to carry on having sex even after receiving a phone call informing him that his father Earl had died.
His particular choice of women was also interesting: he went for large-breasted casino and strip-club hostesses, hookers and former porn stars. The perfect family man liked kinky sex S&M, threesomes, and role-playing. He paid them retainers and then large amounts of hush money in the failed cover-up. It was the fastest drop in popularity of any US non-politician. The carefully manicured and managed superficial Mr Nice Guy had been exposed. Tiger Woods claimed he had a sex addiction and checked himself into ‘therapy’ for 45 days in an exclusive rehab clinic in Mississippi for counselling, abstinence and prayer while he hid from the world’s media and his wife’s wrath.
Sex addiction or hypersexual disorder is not recognised by most sex researchers or therapists as a genuine addiction (unless it causes genuine distress), any more than is food addiction. More traditional addictions, unlike sex, have health consequences, like heroin with its problems of tolerance, overdoses and withdrawal. After Tiger and other celebrities like the actor David Duchovny checked into $40,000-a-month rehab clinics, the sex-addiction business is now booming in the US. But is it really a disorder?
Infidelity and promiscuity is perhaps the normal state for men, without the cultural constraints of marriage. This is seen in many homosexual men’s promiscuous behaviour. Men of enormous wealth, power and ego like Tiger may feel untouchable and so lack any of the usual cultural controls. After all, he can still afford the estimated $500 million alimony payments. Nevertheless, although all men are programmed to some extent to seek sex and spread their genes widely, there is still a wide range of normality in sex drives and resulting promiscuity. A proportion of apparently healthy men class themselves as asexual. Around 1 per cent of the UK population surveyed in 1994 said they had never been sexually attracted to anyone – and a third of them were men.1 Women’s attitudes to fidelity and promiscuity are if anything more variable and complex.
Nicky and Louise are identical twins of 30 who are both successful professionals. Nicky is a dentist, Louise a pharmacist. Both are slim and attractive. They look very similar, although they have dyed their long dark hair differently. They have lived closely together most of their lives, except for some time at university between 18 and 23. They share many habits, like the same foods, clothes and drinks, going to the gym and jogging. Neither enjoys dangerous sports, cigarettes, drugs or gambling.
Where they differ most is in attitudes to men. Both are single, but Nicky has had five sexual partners and Louise 25. They have a similar theoretical taste in men, rating the same film stars such as Clive Owen and Johnny Depp and even Sean Connery. Louise said she was attracted to four of her sister’s ex-boyfriends. Nicky in contrast said: ‘I couldn’t contemplate sleeping with any of my sister’s many choices. I never thought they were right for her.’ Louise admitted to having been unfaithful on a few occasions, and apart from once, she didn’t now regret it; Nicky said she could never do that and stayed with her first boyfriend for six years, although looking back she admitted: ‘I was stupid to stay so long. He didn’t value me enough and wasn’t right for me.’ Louise admits to being impulsive in love. Nicky is very cautious, not wanting to get hurt.
Both enjoy sex and say they have orgasms, they both believe in God in some form and attended a Catholic school and were taught equally about guilt. The twins believe that one life event may have changed them or accentuated some small differences. They couldn’t recall many early events, but when they were 15 they found out their father had been secretly keeping a mistress for several years. Nicky took this very badly and resented her father and the pain it caused their mother, whereas Louise, although also upset, took a less emotional view. Nicky explained: ‘I could never be unfaithful or go out with a man in a relationship, as I feel bad for the other partner.’ Louise has no such regrets: ‘I’m choosy with my men, but I’ve been out with attached or married men and it’s not the ideal scenario, but I realise I’m more pragmatic and not going to change the world or change men. I think my sister should have more fun – she thinks about consequences too much.’
We will never know exactly why these twins who are otherwise so similar react so differently to men in terms of fidelity and number of sexual partners. Psychologists often stress the importance of father–daughter relationships. Clearly the two girls, like other twins we have discussed, cannot have had exactly the same bond with their parents, and the balance would differ subtly between them. Nicky appears now to identify more with her mother and doesn’t want to risk being hurt. Louise is more prepared to take emotional risks for pleasure. It is also possible that these personality differences were already in place when they were infants. Louise was the naughtier twin who took slightly more risks, while Nicky was more cautious. Evidence from recent studies in a range of animals and functional brain scans in humans suggests we have a personality type related to different levels of reflection before action. This is called SPS (sensory processing sensitivity), which like all personality traits has a moderate genetic component.2
Someone with high SPS will tend to reflect on an action much more before proceeding, while in the same situation someone with low SPS would act first and be opportunistic. These categories are akin to the plasticity genes we discussed before when talking about childhood responses to violence and abuse.3 As these two identical twins behave differently we would predict that the key genes influencing SPS would be altered epigenetically in one, making Nicky more sensitive and emotionally distractible.
Having a thoughtful, wandering mind may be protective in some situations but not in others. The Harvard psychologists Dan Gilbert and Matthew Killinsworth used an iPhone app to record at random times of the day and night the thoughts and happiness ratings of 3,000 volunteers.4 They found the activities that gave the greatest happiness were those where the subject was least distracted by other thoughts. Of these, love-making easily came top, although even then, 30 per cent of participants had their minds elsewhere.
According to anonymous surveys like the US General Social Survey and our own UK twin surveys, around 1 in 4 adults in Western countries admit to infidelity and probably even more practise it. Rates in men are slightly higher than in women (women may be more discreet), but are slowly rising in both sexes.5 The fact that these traits (both infidelity and promiscuity are linked) are so common, despite the downsides of being caught – resulting in shame, divorce, injury, and sometimes death – probably has an evolutionary basis. Women who chose an infertile, violent or unsuccessful long-term partner ideally need an escape route for their genes. This is why male-dominated societies try to suppress women’s natural instincts to keep their options open. We found the infidelity (or fidelity) trait has some genetic basis in humans, with around 40 per cent heritability in females6 – similar to heritability for divorce, which can be a wanted or unwanted side-effect.
Before the age of genetics, birds were thought to be very faithful, but genetics has revealed the sad truth, and it turns out that female bird infidelity is common and heritable, being passed on from females to male offspring. Females that take a risk and raise offspring from a brief affair produce on average fitter babies due to greater immune diversity7 – that is if they don’t get caught. Males, however, spread their chances (and plentiful sperm) wider and consequently the successful ones produce greater numbers of offspring.8 The same evolutionary drives for better genes seen in birds are likely to be operating in women, both balanced by the benefits of retaining a good male provider.
But as infidelity and divorce are in part heritable, if your parents were unfaithful or unreasonably faithful, are you destined to follow the same path? The large number of discordant twin pairs for fidelity and divorce suggest not. Culture and personality also clearly affect how satisfactory the relationship is perceived as being.9 Animal studies can also shed some light on the mechanisms and the ability of individuals to change.
The closest that worms get to socialising, cuddling and sex is eating. A slight modification to a single gene (neuropeptide Y) can make naturally sad solitary worms start feeding sociably in groups.10 In certain types of voles, scientists have been able to change genetically embedded behaviours. One species of vole, the montane variety, are naturally promiscuous, unfaithful, and dreadful fathers.11 The researchers in a clever series of studies managed to alter the gene responsible (the vasopressin receptor gene) with hormones and gene therapy and bred new voles with the altered gene. They turned the naughty Casanova male voles into perfect faithful husbands and fathers.12 These studies suggest that some of these marked social and sexual changes are actually due to very subtle changes in genes affecting the brain reward centre in the hypothalamus.
The neuropeptides vasopressin and oxytocin, the two main genes associated with bonding in voles and other mammals, are also important in humans. Oxytocin, the so-called cuddle hormone, is well known in humans to be released during childbirth and to be important in mother–child bonding. The genes as always don’t work in isolation and are dependent on other hormones for their effect. Like all genes they can be up or down regulated by epigenetics.13 In the fond prairie vole dad, the vasopressin genes are greatly over-expressed just after mating, so helping form the bond with his new girlfriend and making him hang around her and their future offspring. This mechanism of bonding is probably due to epigenetic changes in the genes from chemicals or pheromones. In humans genetic and epigenetic variations in the vasopressin receptor and oxytocin receptor gene have been linked to differences in a range of bonding behaviours – male altruism, marital status, pair bonding and autism.14
Although montane voles and unfaithful humans clearly differ in a few key characteristics, the general mechanisms may be similar. This would suggest that leopards can sometimes change their spots, and even the chronically and genetically unfaithful can reform, if the chemicals or potions are right. The potential to change emotions and behaviours by chemicals has not been lost on the pharmaceutical industry. A recent randomised placebo-controlled trial of 76 male volunteers found oxytocin nasal spray given 45 minutes before a task raised levels of sensitivity and empathy in males to female levels.15 You can now buy one of these love potions – oxytocin spray – on the Internet and try it out on your male partner. Although there are some caveats. The quality of these products is unknown, and it may be hard to surreptitiously and casually administer the nasal spray to your loved one every two hours without suspicion. Interestingly, a chemical substance in common use is also able to increase oxytocin levels – and potentially empathy. It’s called MDMA – more commonly known as the party drug Ecstasy. However, long-term use causing brain and liver damage is unlikely to produce the perfect empathetic father.
Let us now see how individuals vary in the sex act itself and the holy grail: orgasm.
Ruth Byron was a 50-year-old housewife from Blackpool with an interesting problem. She couldn’t stop having orgasms. She could have up to 100 a day. Ruth said: ‘I can have ten or more orgasms at night and then have another one on the traffic island I cross as I walk the children to school. The trigger is sex with Simon, and that can set up forty or more orgasms a day. They are growing more and more intense. That is why I sought medical help.’
Simon is her ex-lodger, lover and now husband, aged only 22. He said: ‘I can’t deny it, at first I felt like a stud. But as the weeks go by I sometimes wish it would end. We tried a sex ban so we could get some rest, but that only lasted a night. Some might say this is the best thing ever, but it is not – it rules your life.’
It certainly messed up Ruth’s life. The slightly intimidating lady’s first husband left her – perhaps to get some rest after producing ten children. Then when she was discovered by the British media and billed as ‘Britain’s most orgasmic woman’ the benefit fraud office took notice. They found out that she had been claiming her young lover as a lodger, and as well as being sentenced to community service she had to repay £6,000 in benefits. She did manage however to get some medical help for her problem, and was saved by the menopause from having further children.
Ruth’s condition was only really properly recognised in 2006, when it was called persistent genital arousal disorder. Of 23 women sufferers studied recently in the Netherlands, the majority also reported other problems such as restless legs at night, and sensitive bladders.16 Over 80 per cent couldn’t wear tights or tight underwear, and even sitting provoked orgasms in most of them. The women are not hypersexual as in nymphomania, but often feel a strong desire to relieve themselves sexually. Their male partners often feel totally dominated, and have difficulty coping. When the investigators examined the women for the study they found that touching anywhere near the genital region produced an instant and embarrassing orgasm. A key diagnostic test is that the nerves supplying the genitals are over-excitable. The fact that most of these women also suffered from restless legs syndrome alerted the researchers that there must be a common mechanism that made them rename the syndrome ‘restless genital syndrome’.
Restless legs syndrome (RLS) is an odd condition that unlike Ruth’s is quite common, affecting up to one in ten people, with a wide range of severities. It causes an unpleasant sudden urge to move the legs and is associated with odd sensations like an itch you cannot scratch. It occurs usually at rest or at night and can be quite disturbing, needing drug treatment in some. It is about 60 per cent heritable and genes associated with it have surprisingly been easy to find.17 These included traditional genes controlling brain activity as well as a special type of genetic material: non-coding RNA. These are small molecules that used to be thought of as ‘junk’. There are tens of thousands of them which we now know are far from being rubbish. They are another important player in epigenetics and act by attracting enzymes that turn gene expression off and also by causing imprinting (turning off one copy of a gene region of a chromosome).
These two overlapping unusual Restless syndromes in the legs and genitals suggest that the sensitivity of nerves is important in the control of orgasms, and these are in part under genetic control. But orgasm is not just a question of local nerve sensitivity.
The two identical twins Jacquie and Margaret look very similar but feel they are very different. They were born 42 years ago and raised in South and East Africa with a tough Scots father and religious South African mother. ‘We were raised strictly to believe in no sex before marriage and never to let someone bully you into doing something you didn’t want to,’ explains Jacquie. ‘We both became quite religious as teenagers, although my faith lessened recently and I am no longer practising. I was always the more difficult twin with my parents, while Margaret was more accepting and easy-going – although I think she is now much more stubborn and argumentative.’ The twins have never discussed sex or relationships together.
Jacquie recalls: ‘My own experiences started late. I started exploring my body and masturbating around sixteen. I started seeing boys around eighteen, and had been going out with a boy for a year or so and it was going nowhere and we were about to break up, so at age twenty-two I slept with him to keep it going. It was a mistake and a big disappointment. I hardly felt anything at all.’ Jacquie later married a local African and she realised in retrospect that her first lover had possessed ‘a tiny little boy’s penis’. Her sex life improved quickly as she got more sexually involved and lost her inhibitions. She soon found having orgasms fairly easy and could have several in a row while stimulating herself. She thought she was helped by probably having a G spot.
One day she came home to discover that her husband was having a virtual affair, via the Internet. ‘I found out he was also into Internet pornography, and I just couldn’t accept this. I realised instantly our marriage was a sham and was over.’ Since then, although not officially divorced she has had sexual relationships and slept with three other men. The last one was a one-night stand she initiated – a friend who was staying the night. ‘Unfortunately I couldn’t climax, but I didn’t regret the experience.’
Her sister Margaret is still very religious. Early sex was not really an option. Her husband was her one and only boyfriend. They started going out when she was 23 and waited three years until their wedding night for her first sexual experience. ‘I waited partly for religious reasons and also as I wanted to discover the world a bit. In the end, it wasn’t that great. I wasn’t really in the mood and felt vulnerable – but happy to get it over with.
‘We had sex at least four times a week for the first few years – but less now – but I never in the thirteen years of marriage had an orgasm.’ Until recently, at age 42, Margaret didn’t know what an orgasm was. She had tried masturbating a few times in her life, but ‘nothing ever happened’. She didn’t think she had a G spot. After watching a recent TV documentary about other women who had sexual problems, she tried masturbating again after a break of 20-odd years. ‘It was amazing. This time something just clicked, whereas before nothing happened. I thought I had a permanent biological impairment.’ She has yet to have an orgasm with her husband: she describes his technique as ‘a bit mechanical’ and hasn’t had the courage yet to discuss her recent orgasm experience.
Why don’t 1 in 6 women (like Margaret until the age of 42) ever experience orgasm, while 1 in 12 are multi-orgasmic and have them easily? Although 98 per cent of men manage to have orgasms during penetrative sexual intercourse, only a third of women do so without manual assistance. Yet this large female variation in orgasmic ability has been shown to have a clearly heritable component. In one of our most quoted twin studies (usually in women’s magazines) identical twins reported more similar patterns of orgasm either by masturbation or intercourse than non-identicals and produced a heritability of 30–40 per cent.18 An independent Australian team found virtually identical results at about the same time.19 Could the differences between twins be related to the so-called G spot?
This is another part of our work that attracted the greatest publicity – for perhaps the wrong reasons. The G spot, beloved topic of women’s magazines and sexologists, was apparently discovered by and named after Dr Ernst Gräfenberg in the 1950s, and reinvented in the Eighties, when it was linked to another mysterious phenomenon, female ejaculation.20 In our survey 56 per cent of UK women believed that they had one – namely a discreet sensitive spot on their vaginal wall that increased arousal and sometimes orgasm. But we found no greater similarity in identical twin pairs compared with non-identical pairs, thus confirming zero genetic or family influences.21 You will have worked out by now that virtually everything we have tested in twins has some genetic component.
Although it’s very hard to prove the non-existence of something, we concluded that as the G spot is lacking in academic credibility among gynaecologists, has not been found by scans or anatomists, and had not the tiniest genetic influence, it was probably a figment of modern imagination. It is more likely an area through which the base of the clitoris can be felt and stimulated in some women. Our conclusions were not popular. We got many angry letters from Italian and French sexologists who charge patients to find their hidden G spots and from plastic surgeons who increasingly do lucrative enhancement surgery by bulking up ‘the spot’ with injection of fillers like collagen.22 We also received outraged letters from ‘male expert lovers’ who claimed to have satisfied many women by uniquely being able to find their G spots. Strangely we didn’t receive a single letter from a woman.
As the female orgasm hasn’t been proved to have an important reproductive or survival role, why would there still be genes for such a clearly (though controversial) non-essential human trait? Theories include its role in reward for having more sex and therefore more babies. However, if this were the case, women with orgasms would have more babies and the genes would become more frequent, slowly taking over from women without orgasms. As we know, this hasn’t happened, and women who regularly orgasm are still in the minority. This suggests that despite the dramatic effects it can have on some women (and on the sales of women’s magazines) the female orgasm is just an evolutionary fossil – the counterpart of the redundant male nipple. This fossil theory proposes that the clitoris developed in the fetus as the vestigial penis before sex differentiation and subsequently got somewhat ignored thereafter in females. It was presumably easier for nature and evolution to keep the shared mechanisms of development of a ‘dummy penis’ in females than to devise something completely different. If so, could it in time, over generations, slowly disappear completely?
Male nipples as well as clitorises may also be on the way out. The brain area where sensory input is represented appears different for male and female nipples, with the female nipple occupying a very prominent area right in the centre of the genital area, while the hapless male nipple now receives little brain space in the boring, relatively insensitive chest region.23 Don’t get too worried. Evolution will probably allow another few million years before female orgasms disappear, and men’s slowly shrinking Y chromosomes are expected to die out (taking all males with them) well before then anyway, in the next million or so years.24
Going back to these orgasm-susceptibility genes, how could they be acting? Certainly on aspects of personality, which we know are important. Anatomical differences could also signify. We discussed previously the effects of testosterone in the womb, mainly on the male, but when females are exposed to high levels, as in certain diseases (like congenital adrenal hyperplasia), increases occur in the size of the genitals and clitoris. In males the range of size of penises is quite limited, for good genetic reasons: too small they get laughed at, too large they don’t fit and so can’t transmit genes. In females the size of clitorises varies enormously. Some can be barely measurable at 5 mm and others 35 mm long, resembling a small penis. The nerve supply appears to be proportional to the size, with the smaller ones having a very dense, highly concentrated system of nerve endings.
Research on whether this matters to female sexuality or pleasure is virtually non-existent. When my former PhD student Andrea Burri designed a self-rating questionnaire and diagram with instructions on use of a mirror and tested it on our British twins, most women were quite upset just at the idea, let alone willing to do any clitoral measuring. One UK study in anaesthetised women did manage it. This showed great variability in dimensions, with three times more clitoral variability in size than for vaginal depth or penis length,25 supporting the view that the clitoris was just an accident of evolution.26 However, if it really is merely an accident, it is odd that the brain has reserved a special part of its sensory detection process to the clitoris in the genital area, and that unlike most males nipples it can have such dramatic effects on the brain, emotion and behaviour.27
Another anatomical factor influenced by hormones and development that could affect female orgasm is a variant of the anogenital distance (the clitoral–anal distance of the perineum) which is related to fetal testosterone levels. Dr A. E. Narjani, an early French sexologist, proposed in 1924 that women with a short perineal distance of less than 2.5 cm (the range is 1.5 cm to 4.5 cm if you want to measure yours) should be able to have orgasms more easily during intercourse. Data from two studies collected over 80 years ago was reanalysed statistically and showed that the shorter distance correlated with ability to have an orgasm through penetration alone. It wasn’t clear if this was due to more direct contact with the clitoris externally or internally. It did however suggest that less androgen exposure in utero (and relatively more oestrogen) actually increased female orgasmic ability by altering anatomy.
Dr Narjani was in fact a pseudonym for Princess Marie Bonaparte, the great-grandniece of Napoleon Bonaparte, who married the Prince of Greece and Denmark. She was independently very wealthy (from Monte Carlo real estate), a student, patient and benefactor of Freud’s, who helped him escape from the Nazis. She was fascinated by her own sex drive and had several high-profile affairs, among them with the French prime minister Aristide Briand. She was persistently frustrated however by her lack of ability to have orgasms through vaginal penetration alone (which her mentor Freud convinced her was the only true orgasm). She believed in two types of frigidity, one of them amenable to psychoanalysis and the other anatomical. She, along with an Austrian surgeon, devised an operation to move the clitoris closer to the vagina. They performed the operation in six women – one of them herself – but sadly to no avail. Rather than disproving her theory, failure probably stemmed from damage caused to the nerve supply during the surgery. Nevertheless, after this brave failure she focused more on the psychological aspects of female orgasm.
Andrea Burri and Lynn Cherkas from my group performed one of the few comprehensive studies of personality traits and ability to orgasm in normal women.28 We found that when women had certain character traits such as obsessional behaviour, over-tidiness, anxiety, and a lack of so-called ‘emotional intelligence’, they complained more of sexual problems and difficulty achieving orgasm. When we published these results, the then best-selling Sun newspaper helpfully gave it the headline ‘Brainy Birds Bonk Better’, which, sadly, didn’t precisely reflect our findings. We didn’t measure IQ, but did measure the ability to empathise with others and also to register one’s own feelings.29
Emotional intelligence is part of the empathy spectrum we discussed previously as part of the autism spectrum, and involves mirror neurones. So for women, feeling relaxed and being able to easily read their partner’s (and their own) feelings and emotions are very important in achieving orgasm, whether by masturbation or intercourse. This underlines the huge gulf between men and women, and the enormous complexity of control factors underlying female sexuality.30 An analogy in contrasting the sexes is to compare the on–off switch of a light switch, for males, with the cockpit control panel of a jumbo jet for females – minus the auto-pilot.
Our twins Jacquie and Margaret’s cases show that even with near-identical genital anatomy (as in twins), what goes on in the main sexual organ – the brain – is clearly crucial. The pharmaceutical industry has found to its cost that women are much more complicated. Whereas a simple mechanical drug acting on blood vessels like Viagra transformed many men’s sex lives and made billions for the companies, for women – apart from giving them flushed cheeks – it didn’t work better than placebo. Attempts with other drugs have cost the companies billions in failed trials and attracted criticism.31
The latest hope was flibanserin, trialled by Boehringer, originally an anti-depressant acting on serotonin levels, which had the side effect of increasing libido and sex drive in many women – one of the commonest female complaints. It did actually work in placebo-controlled trials – it increased ‘sexually satisfying episodes’ (SSE) in the drug group.32 However, the catch was that on average women improved by only just over half an SSE event per month more than with the placebo tablet. The FDA in the US deemed in 2010 that half an orgasm was too few when women (unlike men) had to take the pill every day and it had other psychological side effects in one in six women. They wanted more expensive tests and the conservative company decided to drop it. Currently a US company has bought the licence and is trying to see if they can resurrect it with some more trials and get approval with a few more SSEs per woman.
One of the only licensed drugs on the market for increasing orgasm by heightening desire is a testosterone patch giving women one extra SSE per month, but it is only used after hysterectomy and has side effects. Although most of the Big Pharma companies have given up further sex research, a few smaller ones are experimenting with nasal sprays of oxytocin, which has been used in awkward social situations, autism as well as libido and mate preference, without any conclusive results as yet.33 These expensive failures suggest that a single magic bullet to address female sexual problems is not going to work, as so many processes are operating differently in each woman.
There is one substance that has been universally successful in all the ten or more female trials, but that so far hasn’t been allowed to be commercialised by the authorities, despite it being completely safe. It increased desire and orgasm rates significantly by around 50 per cent. It is called the placebo. This emphasises the importance of the brain, emotions and expectation, and explains the continued success of aphrodisiac potions like ‘Spanish fly’. As well as female emotions, some parts of the external environment are also hard to fully control – among them men. Satisfaction with the partner is a major factor, for a number of reasons. Women may sometimes have to take matters into their own hands. I spoke to a number of sex counsellors, including Julia Heiman, the director of the famous Kinsey Institute in Indiana, about how many of the 10–15 per cent of otherwise normal women who have never had an orgasm would respond to intensive therapy. She believed that with behavioural therapy and practical sessions on masturbation from an expert, the vast majority of women would eventually experience one – if they persisted long enough.34 She believed it was more a question of threshold and sensitivity, rather than a yes/no phenomenon. Some women can orgasm just by fantasising; others may need an hour or two with soft music, vibrators and several gin and tonics.
The twin case-studies and the research around the topics of sexuality, fidelity and orgasm clearly show that the key controlling organ is not between your legs but within your head. This can be modified early on by genes and hormones influencing the brain’s delicate development, and – although this is not yet proven – probably by external agents like hormone disruptor chemicals. After puberty it appears harder to change behaviours and habits, but clearly there are many examples where outside influences have modified the genes. The final story of ‘anorgasmic’ Margaret shows that even after 20-odd years, patterns are not hard-wired. Watching a simple TV documentary programme, together with a realisation that it is possible to change, meant that she experimented and managed to experience her first orgasms at 42 years of age.
The latest brain-scan research is beginning to show us how orgasms, emotions and brain structure may be related. Two research teams from the US and Netherlands have been putting intrepid volunteer females into functional MRI scanners and asking them to either masturbate or be manually stimulated by their partner – while keeping their head very still. While the women who are both able and willing to do this are unlikely to be very ‘average’, they do provide fascinating results. Both studies showed that the act of thinking about sexual stimulation, being physically stimulated and then the orgasm itself lit up over 20 common areas of the brain. Upon orgasm the blood flow was increased, but generally in the same areas. These include brain areas for touch, reward and pain. What was of great interest to the New Jersey team was the region that was activated first: the prefrontal cortex (PFC). This site in the front of the brain is involved in consciousness, self-evaluation and empathy; it had not been seen before in this context. The PFC area actually lit up more strongly when masturbation was imagined rather than carried out, suggesting that this could be the key fantasy centre and showing that those mysterious mirror neurones are involved yet again.35
Involvement of a small part of the PFC called the OFC (left orbito-frontal complex) was highlighted by the other Dutch group.36 They saw significant deactivation in this area during orgasm and speculated that it needed to be switched off first for the woman to relax and have the orgasm. This would fit with the findings that personality traits like anxiety, introversion and lack of empathy make it much harder for women to orgasm. The other interesting area that lit up during orgasm was the anterior cingulate gyrus, which is important in pain control. Surprisingly, there are quite a few links between orgasm pathways and pain, involving the nerves and brain pathways.
A rare but well-reported event in some women at the crucial moment of childbirth is an unexpected orgasm – so-called ‘orgasmic childbirth’.37 Some believe that the orgasm may have a role in preparing women for childbirth and lessening the pain, but there is no real data on this. Most women however would see this as rather poor preparation, as they don’t generally recall childbirth as an orgasmic experience. The true mystery of the orgasm is underlined by studies showing that women with complete spinal cord paralysis can still have real orgasms when skin near their injured area is stimulated. Or other studies showing that vaginal self-stimulation with or without orgasms can raise pain thresholds by 40–100 per cent. In rats, giving neuropeptides like oxytocin facilitated the theoretical equivalent of an orgasm as well as working as a pain reliever.38
Pain researchers have for a few years been using cognitive feedback measures and brain scans to help patients with chronic pain visualise how their different brain areas light up in sequence. The sex researchers hope to use brain imaging in the same way in women who can’t achieve orgasm. We don’t yet have any human data on the role of epigenetics and orgasms, but in a recent ongoing experiment we have taken 25 identical twin pairs with extreme and discordant pain thresholds and tested every gene’s methylation status at over 20 million sites. We have found four key pain genes that are switched on epigenetically in one twin and inactivated in the other.39 This gives great hopes for new pain therapies and suggests that the same will be true for orgasm differences.
While we are slowly uncovering the mechanisms of pain, maybe it is just as well that we will never totally understand all the mysteries of the female orgasm. Comprehending its complexity could, however, be very important for some women. What turns you or your genes on or off is clearly a key part of our sex lives.