Différence entre orgasmes

"Y a-t-il vraiment des
différences entre orgasmes
clitoridien ou vaginal ?"
Socièté Francophone de Médecine Sexuelle,
ESSM, Milano, 1 Dec 2011
Prof. Dr. Stuart Brody
University of the West of Scotland
stuartbrody.tripod.com
Oui.
Malgré…
I. Definition:
Vaginal orgasm (VO) = woman’s orgasm
triggered purely by penile-vaginal
intercourse (PVI), without concurrent
clitoral masturbation
II. Some physiological differences between
clitoral and vaginal-cervical stimulation
Sensory nerves
Pudendal
Pelvic
Hypogastric
and Vagus
Uterus
Cervix
Vagina
Clitoris
Adapted from visualization courtesy of: Alexander Tsiaras, Anatomical Travelogue Inc., NYC
4
Women with severed spinal cord (no clitorisbrain connection) have fMRI proof of orgasm
from vaginal-cervical stimulation via Vagus
Komisaruk et al 2004; Brain Research
[la moelle épinière coupé]
fMRI (IRMF) of somatosensory cortex
response to vaginal vs. cervical vs. clitoral
stimulation
Some overlap, but also multiple differentiable
areas, consistent with innervation by different
afferent nerves
Komisaruk, B.R., Wise, N., Frangos, E., Liu, W-C., Allen, K.,
& Brody, S. (2011). Women's clitoris, vagina and cervix
mapped on the sensory cortex: fMRI evidence. Journal of
Sexual Medicine
Group Composite Genital Sensory Cortical Representation (N=11)
Clitoris
Cervix
Vagina
JSM
III. Quelles sont les differences entre les
femmes vaginallement orgasmique et les
femmes qui ne répondent pas pleinement
à la stimulation vaginale / cervicale, même
si elles répondent à une stimulation
clitoridienne?
Tubercle type (self-assessed – not with these pictures) and ever vaginal orgasm
#1 un tubercule proéminent, et nettement surélevé, au niveau de la lèvre supérieure
Brody S, Costa RM. Vaginal orgasm is more prevalent among women
with a prominent tubercle of the upper lip. Journal of Sexual Medicine 2011
A woman’s history of vaginal orgasm is
discernible from her walk
Nicholas, Brody, de Sutter, de Carufel;
Journal of Sexual Medicine, 2008
•History of VO diagnosable (81.25%
correct, p < 0.05) by appropriately trained
sexologists viewing videos of the women
walking (blind to their history)
•Greater pelvic and vertebral rotation: VO
•Chronic muscle blocks: symptom and/or
mechanism of blocked VO
•Clitoral orgasm history unrelated
HRV and orgasm source
Resting heart rate variability (HRV; La variabilité de la
fréquence cardiaque): marker of parasympathetic
activity, predictor of physical and psychological health
and longevity, index of integration between the
autonomic nervous system and prefrontal brain
function
Greater resting HRV: associated with any (past
month) vaginal orgasm (but not clitoral orgasm)
(Not confounded by cohabitation or social desirability
responding)
Costa, R.M., & Brody, S. (2011). Greater resting heart rate variability is
associated with orgasms through penile-vaginal intercourse, but not
with orgasms from other sources. Journal of Sexual Medicine, in press.
Vaginal orgasm is associated with better
psychological function
Brody, Sexual & Relationship Therapy, 2007
- representative sample of Swedish women (N >1200)
- only a minority of women never experienced VO
VO correlated with:
- greater satisfaction with sex life
- greater satisfaction with partners
- greater satisfaction with mental health
- greater satisfaction with life in general
- greater satisfaction with friendships
- less masturbation in the past 30 days
Cross-cultural replications
Brody, S. & Weiss, P. (2010). Simultaneous penile-vaginal
intercourse orgasm is associated with satisfaction (sexual,
life, partnership, and mental health). Journal of Sexual
Medicine. (Replicates association of VO with all aspects of
satisfaction; large representative sample of middle-aged
Czechs)
Tao, P., & Brody, S. (2010). Sexual behavior predictors of
satisfaction in a Chinese sample. Journal of Sexual
Medicine. (Sexual satisfaction correlates with women’s PVI
frequency and PVI orgasm frequency but not other sexual
behaviors or orgasm sources)
Weiss, P., & Brody, S. (2009). Female sexual arousal
disorder with and without a distress criterion:
prevalence and correlates in a representative Czech
sample. Journal of Sexual Medicine
Female sexual arousal disorder with distress (le
trouble de l'excitation sexuelle féminine avec
souffrance): higher risk for women without a
history of vaginal orgasm (OR = 2.78)
-representative sample; N = 1000
Brody, S., & Costa, R. M. (2008). Vaginal orgasm is associated
with less use of immature psychological defense mechanisms.
Journal of Sexual Medicine
VO (past month) correlates with:
- less total immature
psychological defenses
- less somatization, dissociation,
displacement, autistic fantasy,
devaluation, isolation of affect
Defense Style Questionnaire; not confounded by
social desirability
Orgasm from clitoral stimulation or clitoral
masturbation during PVI was associated with
more use of some immature defenses
Compare psychiatric outpatients scores:
Vaginally anorgasmic women: mean immature
defenses score ≈ depressed & social anxiety
disorder patients, and > panic & obsessivecompulsive disorder patients
Cross-cultural replication
Brody, S., Houde, S., & Hess, U. (2010). Greater tactile
sensitivity and less use of immature psychological defense
mechanisms predict women’s penile-vaginal intercourse
orgasm. Journal of Sexual Medicine
(PVI orgasm past month; compare no effect for orgasm from
non PVI sources)
Costa, R. M., & Brody, S. (2010). Immature psychological
defense mechanisms are associated with lesser vaginal
orgasm consistency and greater alcohol consumption
before sex. Journal of Sexual Medicine
Previous research: women with various psychiatric
and personality disorders have lesser ability to have
vaginal orgasm, but not lesser ability to have clitoral
climax (Kratochvil 1993; Nedoma & Sipova 1972;
Raboch 1986)
Attachment
attachement anxieux (worry their partner doesn't really
love them or won't stay with them): less Vaginal
Orgasm consistency; but more likelihood of orgasm
from clitorally-focused masturbation, vibrator, and anal
sex
attachement évitant (uncomfortable when anyone gets
too close): greater likelihood of any orgasm from
vibrator and anal sex; nonsignificant trend toward
lesser Vaginal Orgasm consistency
Costa, R.M., & Brody, S. (2011). Anxious and avoidant
attachment, vibrator use, anal sex, and impaired
vaginal orgasm. Journal of Sexual Medicine
representative sample of 1000 Czech women
(only 21.9% never had a vaginal orgasm)
Vaginal orgasm consistency was associated with:
+ being educated the vagina is important for female orgasm
+ being mentally focused on vaginal sensations during PVI
and in some analyses
+ duration of PVI (but not foreplay)
+ preferring a longer than average penis
Brody, S., & Weiss, P. (2010). Vaginal orgasm is associated with
vaginal (not clitoral) sex education, focusing mental attention on
vaginal sensations, intercourse duration, and a preference for a
longer penis. Journal of Sexual Medicine
Representative sample: 1500 middle-aged Czechs
+ IIEF-5 scores generated by men and by women similar
+ similarly positively correlated with all satisfaction
measures (r: .41-.45 with sexual, .23-.34 with other; all
p <.001)
+ IIEF-5 correlated positively with vaginal orgasm
consistency
+ Weiss, P., & Brody, S. (2011). International index of erectile function
(IIEF) scores generated by men or female partners correlate equally
well with own satisfaction (sexual, partnership, life, and mental
health). Journal of Sexual Medicine
L'évidence: plusieurs méthodes, plusieurs niveaux,
plusieurs pays/cultures
Consistent avec les associations psychologique et
physiologique des différentes activités sexuelles:
Brody, S. (2010). The relative health benefits of different
sexual activities. Journal of Sexual Medicine
Peut-être le plupart des associations entre l’orgasme
vaginale et la santé (et le bien-être) sont lier a un procès
psychosomatique (i.e., les problèmes psychologique
empêche spécifiquement l'orgasme vaginale).
Mais, c'est aussi possible qu'une partie de ces
associations sont lier a l'autre direction de causalité -c'est a dire, l'orgasme vaginale peut produire la santé ou
bien-être. En ce cas, le déni de l'orgasme vaginale peut
gâcher la santé et le bien-être des femmes.
Oui, il y a des différences physiologique et
clinique entre orgasmes clitoridien et vaginal
IMPLICATIONS:
-faites attention au sensations vaginale pendent
le coitus
-soutien la connaissance de vagin comme source
de orgasme féminin, pour éviter des dommages
iatrogène
-soutien la qualité spécifiquement de coitus pur
-rechercheurs, éducateurs, et thérapeutes doivent
être beaucoup plus spécifique