Sexual stimulation and arousal The clitoris has an abundance of nerve endings, and is the human female's most
erogenous part of the body. When
sexually stimulated, it may incite
sexual arousal, which may result from mental stimulation (
sexual fantasy), activity with a
sexual partner, or
masturbation, and can lead to
orgasm. The most effective sexual stimulation of this organ is usually
manually or
orally, which is often referred to as direct clitoral stimulation; in cases involving
sexual penetration, these activities may also be referred to as additional or assisted clitoral stimulation. Direct stimulation involves physical stimulation to the external anatomy of the clitorisglans, hood, and shaft. Stimulation of the labia minora, due to it being connected with the glans and hood, may have the same effect as direct clitoral stimulation. Though these areas may also receive indirect physical stimulation during
sexual activity, such as when in friction with the labia majora, indirect clitoral stimulation is more commonly attributed to
penile-vaginal penetration.
Penile-anal penetration may also indirectly stimulate the clitoris by the shared
sensory nerves (especially the
pudendal nerve, which gives off the
inferior anal nerves and divides into two terminal branches: the
perineal nerve and the
dorsal nerve of the clitoris). Due to the glans' high sensitivity, direct stimulation to it is not always pleasurable; instead, direct stimulation to the hood or near the glans is often more pleasurable, with the majority of women preferring to use the hood to stimulate the glans, or to have the glans rolled between the labia, for indirect touch. It is also common for women to enjoy the shaft being softly caressed in concert with the occasional circling of the glans. This might be with or without digital penetration of the vagina, while other women enjoy having the entire vulva caressed. As opposed to the use of dry fingers, stimulation from well-lubricated fingers, either by
vaginal lubrication or a
personal lubricant, is usually more pleasurable for the external clitoris. As the clitoris' external location does not allow for direct stimulation by penetration, any external clitoral stimulation while in the
missionary position usually results from the
pubic bone area. As such, some couples may engage in the
woman-on-top position or the
coital alignment technique, a
sex position combining the "riding high" variation of the missionary position with pressure-counterpressure movements performed by each partner in rhythm with sexual penetration, to maximize clitoral stimulation. Same-sex female couples may engage in
tribadism (vulva-to-vulva or vulva-to-body rubbing) for ample or mutual clitoral stimulation during whole-body contact. Pressing the penis in a gliding or circular motion against the clitoris or stimulating it by the movement against another body part may also be practiced. A
vibrator (such as a
clitoral vibrator),
dildo or other
sex toy may be used. Other women stimulate the clitoris by use of a pillow or other inanimate object, by a jet of water from the faucet of a bathtub or shower, or by closing their legs and rocking. During sexual arousal, the clitoris and the rest of the vulva engorge and change color as the
erectile tissues fill with blood (
vasocongestion), and the individual experiences
vaginal contractions. The
ischiocavernosus and
bulbocavernosus muscles, which insert into the corpora cavernosa, contract and compress the dorsal vein of the clitoris (the only vein that drains the blood from the spaces in the corpora cavernosa), and the arterial blood continues a steady flow and having no way to drain out, fills the venous spaces until they become turgid and engorged with blood. This is what leads to
clitoral erection. The prepuce has retracted and the glans becomes more visible. The glans doubles in diameter upon arousal and further stimulation becomes less visible as it is covered by the swelling of the clitoral hood. The swelling protects the glans from direct contact, as direct contact at this stage can be more irritating than pleasurable. Vasocongestion eventually triggers a muscular reflex, which expels the blood that was trapped in surrounding tissues, and leads to an orgasm. A short time after stimulation has stopped, especially if orgasm has been achieved, the glans becomes visible again and returns to its normal state, with a few seconds (usually 510) to return to its normal position and 510 minutes to return to its original size. If orgasm is not achieved, the clitoris may remain engorged for a few hours, which women often find uncomfortable. Additionally, the clitoris is very sensitive after orgasm, making further stimulation initially painful for some women.
Clitoral and vaginal orgasmic factors General statistics indicate that 7080 percent of women require direct clitoral stimulation (consistent manual, oral, or other concentrated friction against the external parts of the clitoris) to reach orgasm. Indirect clitoral stimulation (for example, by means of vaginal penetration) may also be sufficient for female orgasm. The area near the entrance of the vagina (the lower third) contains nearly 90 percent of the vaginal nerve endings, and there are areas in the anterior vaginal wall and between the top junction of the labia minora and the
urinary meatus that are especially sensitive, but intense sexual pleasure, including orgasm, solely from vaginal stimulation is occasional or otherwise absent because the vagina has significantly fewer nerve endings than the clitoris. The prominent debate over the quantity of vaginal nerve endings began with
Alfred Kinsey. Although
Sigmund Freud's theory that clitoral orgasms are a prepubertal or adolescent phenomenon and that vaginal (or
G-spot) orgasms are something that only physically mature females experience had been criticized before, Kinsey was the first researcher to harshly criticize the theory. Through his observations of female masturbation and interviews with thousands of women, Kinsey found that most of the women he observed and surveyed could not have vaginal orgasms, a finding that was also supported by his knowledge of sex organ anatomy. Scholar JaniceM. Irvine stated that he "criticized Freud and other theorists for projecting male constructs of sexuality onto women" and "viewed the clitoris as the main center of sexual response". He considered the vagina to be "relatively unimportant" for sexual satisfaction, relaying that "few women inserted fingers or objects into their vaginas when they masturbated". Believing that vaginal orgasms are "a physiological impossibility" because the vagina has insufficient nerve endings for sexual pleasure or climax, he "concluded that satisfaction from penile penetration [is] mainly psychological or perhaps the result of referred sensation".
Masters and Johnson's research, as well as
Shere Hite's, generally supported Kinsey's findings about the female orgasm. Masters and Johnson were the first researchers to determine that the clitoral structures surround and extend along and within the labia. They observed that both clitoral and vaginal orgasms have the same stages of physical response, and found that the majority of their subjects could only achieve clitoral orgasms, while a minority achieved vaginal orgasms. On that basis, they argued that clitoral stimulation is the source of both kinds of orgasms, reasoning that the clitoris is stimulated during penetration by friction against its hood. The research came at the time of the
second-wave feminist movement, which inspired
feminists to reject the distinction made between clitoral and vaginal orgasms. Feminist
Anne Koedt argued that because men "have orgasms essentially by friction with the vagina" and not the clitoral area, this is why women's biology had not been properly analyzed. "Today, with extensive knowledge of anatomy, with [C. Lombard Kelly], Kinsey, and Masters and Johnson, to mention just a few sources, there is no ignorance on the subject [of the female orgasm]", she stated in her 1970 article
The Myth of the Vaginal Orgasm. She added, "There are, however, social reasons why this knowledge has not been popularized. We are living in a male society which has not sought change in women's role". Supporting an anatomical relationship between the clitoris and vagina is a study published in 2005, which investigated the size of the clitoris; Australian
urologist Helen O'Connell, described as having initiated discourse among mainstream medical professionals to refocus on and redefine the clitoris, noted a direct relationship between the legs or roots of the clitoris and the erectile tissue of the bulbs and corpora, and the distal urethra and vagina while using
magnetic resonance imaging (MRI) technology. While some studies, using
ultrasound, have found physiological evidence of the G-spot in women who report having orgasms during vaginal intercourse, O'Connell argues that this interconnected relationship is the physiological explanation for the conjectured G-spot and experience of vaginal orgasms, taking into account the stimulation of the internal parts of the clitoris during vaginal penetration. "The
vaginal wall is, in fact, the clitoris", she said. "If you lift the skin off the vagina on the side walls, you get the bulbs of the clitoristriangular, crescental masses of erectile tissue". O'Connell etal., having performed dissections on the vulvas of
cadavers and used photography to map the structure of nerves in the clitoris, made the assertion in 1998 that there is more erectile tissue associated with the clitoris than is generally described in anatomical textbooks and were thus already aware that the clitoris is more than just its glans. They concluded that some females have more extensive clitoral tissues and nerves than others, especially having observed this in young cadavers compared to elderly ones, and therefore whereas the majority of females can only achieve orgasm by direct stimulation of the external parts of the clitoris, the stimulation of the more generalized tissues of the clitoris via vaginal intercourse may be sufficient for others. French researchers
Odile Buisson and
Pierre Foldès reported similar findings to that of O'Connell's. In 2008, they published the first complete3D
sonography of the stimulated clitoris and republished it in 2009 with new research, demonstrating how erectile tissue of the clitoris engorges and surrounds the vagina. Based on their findings, they argued that women may be able to achieve vaginal orgasm through stimulation of the G-spot because the clitoris is pulled closely to the anterior wall of the vagina when the woman is sexually aroused and during vaginal penetration. They assert that since the front wall of the vagina is inextricably linked with the internal parts of the clitoris, stimulating the vagina without activating the clitoris may be next to impossible. In their 2009 published study, it states the "coronal planes during perineal contraction and finger penetration demonstrated a close relationship between the root of the clitoris and the anterior vaginal wall". Buisson and Foldès suggested "that the special sensitivity of the lower anterior vaginal wall could be explained by pressure and movement of clitoris' root during a vaginal penetration and subsequent perineal contraction". Researcher Vincenzo Puppo, who, while agreeing that the clitoris is the center of female sexual pleasure and believing that there is no anatomical evidence of the vaginal orgasm, disagrees with O'Connell and other researchers' terminological and anatomical descriptions of the clitoris (such as referring to the vestibular bulbs as the "clitoral bulbs") and states that "the inner clitoris" does not exist because the penis cannot come in contact with the congregation of multiple nerves/veins situated until the angle of the clitoris, detailed by
Georg Ludwig Kobelt, or with the root of the clitoris, which does not have sensory receptors or erogenous sensitivity, during vaginal intercourse. Puppo's belief contrasts the general belief among researchers that vaginal orgasms are the result of clitoral stimulation; they reaffirm that clitoral tissue extends, or is at least stimulated by its bulbs, even in the area most commonly reported to be the G-spot. The G-spot is analogous to the base of the penis and has additionally been theorized, with the sentiment from researcher Amichai Kilchevsky that because female fetal development is the "default" state in the absence of substantial exposure to male hormones and therefore the penis is essentially a clitoris enlarged by such hormones, there is no evolutionary reason why females would have an entity in addition to the clitoris that can produce orgasms. The general difficulty of achieving orgasms vaginally, which is a predicament that is likely due to nature easing the process of childbearing by drastically reducing the number of vaginal nerve endings, challenge arguments that vaginal orgasms help encourage sexual intercourse to facilitate
reproduction. Supporting a distinct G-spot, however, is a study by
Rutgers University, published in 2011, which was the first to map the female genitals onto the sensory portion of the brain; the scans indicated that the brain registered distinct feelings between stimulating the clitoris, the cervix and the vaginal wallwhere the G-spot is reported to bewhen several women stimulated themselves in a
functional magnetic resonance machine.
Barry Komisaruk, head of the research findings, stated that he feels that "the bulk of the evidence shows that the G-spot is not a particular thing" and that it is "a region, it's a convergence of many different structures".
Vestigiality, adaptionist and reproductive views Whether the clitoris is
vestigial, an
adaptation, or serves a
reproductive function has been debated.
Geoffrey Miller stated that
Helen Fisher,
Meredith Small and
Sarah Blaffer Hrdy "have viewed the clitoral orgasm as a legitimate adaptation in its own right, with major implications for female sexual behavior and sexual evolution". Like
Lynn Margulis and
Natalie Angier, Miller believes, "The human clitoris shows no apparent signs of having evolved directly through male
mate choice. It is not especially large, brightly colored, specifically shaped or selectively displayed during courtship". He contrasts this with other female species that have clitorises as long as their male counterparts. He said the human clitoris "could have evolved to be much more conspicuous if males had preferred sexual partners with larger brighter clitorises" and that "its inconspicuous design combined with its exquisite sensitivity suggests that the clitoris is important not as an object of male mate choice, but as a mechanism of female choice". While Miller stated that male scientists such as
Stephen Jay Gould and
Donald Symons "have viewed the female clitoral orgasm as an evolutionary side-effect of the male capacity for penile orgasm" and that they "suggested that clitoral orgasm cannot be an adaptation because it is too hard to achieve", Gould acknowledged that "most female orgasms emanate from a clitoral, rather than vaginal (or some other), site" and that his nonadaptive belief "has been widely misunderstood as a denial of either the adaptive value of female orgasm in general or even as a claim that female orgasms lack significance in some broader sense". He said that although he accepts that "clitoral orgasm plays a pleasurable and central role in female sexuality and its joys", "[a]ll these favorable attributes, however, emerge just as clearly and just as easily, whether the clitoral site of orgasm arose as a
spandrel or an adaptation". He added that the "male biologists who fretted over [the adaptionist questions] simply assumed that a deeply vaginal site, nearer the region of fertilization, would offer greater selective benefit" due to their
Darwinian,
summum bonum beliefs about enhanced reproductive success. Similar to Gould's beliefs about adaptionist views and that "females grow nipples as adaptations for suckling, and males grow smaller unused nipples as a spandrel based upon the value of single development channels", American philosopher
Elisabeth Lloyd suggested that there is little evidence to support an adaptionist account of female orgasm. Canadian sexologist
Meredith L. Chivers stated that "Lloyd views female orgasm as an
ontogenetic leftover; women have orgasms because the urogenital neurophysiology for orgasm is so strongly selected for in males that this developmental blueprint gets expressed in females without affecting fitness" and this is similar to "males hav[ing] nipples that serve no fitness-related function". At the 2002 conference for Canadian
Society of Women in Philosophy,
Nancy Tuana argued that the clitoris is unnecessary in reproduction; she stated that it has been ignored because of "a fear of pleasure. It is pleasure separated from reproduction. That's the fear". She reasoned that this fear causes ignorance, which veils female sexuality. O'Connell stated, "It boils down to rivalry between the sexes: the idea that one sex is sexual and the other reproductive. The truth is that both are sexual and both are reproductive". She reiterated that the vestibular bulbs appear to be part of the clitoris and that the distal urethra and vagina are intimately related structures, although they are not erectile in character, forming a tissue cluster with the clitoris that appears to be the location of female sexual function and orgasm. == Clinical significance ==