By Madeleine Castellanos, M.D.
Women definitely have the advantage over men in the area of sexuality in the sense that they can experience not only multiple orgasms, but can even reach orgasm through different stimulation in different areas. There are women who can reach orgasm having their breasts and nipples stimulated, some from certain areas on their thighs or knees, some from their elbows, their hips and buttocks, and still others from their back, neck or scalp. As you can see, when it comes to a woman's orgasm, there can be a very wide range of possibilities.
Most commonly, however, women reach orgasm via stimulation of the clitoris. This means that a woman usually requires stimulation on the vulva (the outside) with specific attention to her clitoris in order to peak to orgasm. How she is stimulated is not so specific and can range anywhere from a tongue during oral sex, to fingers rubbing in heavy petting or masturbation, a vibrator, a stream of water or even the vibrations of rubbing through her clothing sitting on top of a washing machine. She can pick any of these or change it up.
There are many women who can reach orgasm by clitoral stimulation, but don't think they are normal because they can't have an orgasm with penetration. They feel that there is something wrong with them because, unless they can find a position where they can rub their clitoris against their partner's body, they can't reach orgasm. And there are plenty of men too, it seems, that want to know what is wrong. Why isn't there partner having an orgasm when they have intercourse? Is there something wrong with her? Is there something he is doing wrong, or something different he needs to do? The reality is, there is nothing wrong and she is probably perfectly normal.
Only about 30% of women can reach orgasm with intercourse or penetration alone. When these women are reaching orgasm from penetration, it is usually due to rhythmic stimulation of their cervix, found at the top of the vagina. Many women describe this orgasm as happening "on the inside," as opposed to the orgasm they get from stimulating the clitoris, which they feel more "on the outside." So that leaves approximately 70% of women that cannot have orgasm with simple intercourse or penetration. These women are the norm, not the other way around. I repeat, only having orgasms from stimulation of the clitoris is normal and is the most common scenario.
It is actually two different pathways that lead to these two different types of orgasms. The most common orgasm, achieved through clitoral stimulation, is mediated through the Pudendal nerve. Interestingly enough, the Pudendal nerve also transmits sensations from the lower third of the vagina where the G-Spot is located, as well as between the clitoris and the opening of the vagina, where the U-Spot is located. The orgasm that occurs from cervical stimulation is mediated through the Hypogastric nerve. Sometimes a woman can have both of these nerve pathways stimulated at the same time during intercourse and she can also experience a "blended" orgasm, which she feels both on the inside and on the outside.
Orgasm should never be a mission and sex should focus most on pleasure and closeness. With that said, it is not unreasonable to suggest that a woman receive plenty of oral or manual stimulation before, during or after intercourse (her choice) so that she has maximal opportunity to have an orgasm (or two or three).