Questions about Sexual Pleasure

Why does sexual pleasure vary so much from one woman to the next?

Q: I'd like your medical opinion on something. I've had sex with over 60 women and I've noticed that there is a huge difference in the pleasure I feel during sex with different women. With most of the women it's very pleasurable, with a few it's so little pleasure it's barely worth doing, and with some others it is so pleasurable it's off-the-scale, out-of-this-world, mind-blowing pleasure. Why is that? I used to think that tightness was the only thing that made any difference, but there's more to it than that. I don't think that this variation is attributable to how horny I am because some women are consistently duds and others are consistently extraordinary. Plus, on a few occasions I've had sex with two women, changing partners every few minutes, and I know there can be a significant difference. Why? Another thing I wonder about is why sex feels so different even amongst women who are extraordinary. I don't know how to explain this other than to compare it to eating pizza and eating steak. I love both equally well, but they taste entirely different. So can you see what I'm trying to say? When I think about the two women who've given me the most sexual pleasure, the sensations I got from each women was noticeably different. This really has me stumped. I know there must be some factors that make one vagina better than another, but how can two vaginas feel equally fantastic but yet very different? Thanks, Phil

A: You're correct, there is a significant difference. I've noticed it, and other men have reported to me that they've noticed it, too. There are many factors that underlie this difference, and I discussed them in a chapter in The Science of Sex. One of the reasons why I explained this so extensively is because men sometimes dump women who are "duds," as you termed them. What's important for women to realize is that many of the factors that influence this variation in pleasure are things they can influence.

I don't intend to minimize the importance of love in a relationship, but the fact is that an average couple in the United States begins having sex after three dates. I think it is safe to assume that most men are not truly in love after three dates, so if they don't obtain the pleasure they're seeking they don't feel compelled to stick with that woman. I've heard many women wondering aloud, "Why did he dump me right after we slept together?" Well, it's not because your bedroom was messy, trust me. Maybe the guy suddenly realized he needed to spend more time mowing his lawn . . . or maybe he's been spoiled by sleeping with women who gave him substantially more pleasure. Such pleasure is addicting, and once a man has experienced it, he will often turn up his nose at women who have less to offer in the bedroom. My message to women is this: you can't change the expectations of men, but you don't have to be snubbed. If what you have isn't good enough for the men in your life, you can make it better. I'd like for all women to be superstars in that department, because that would force men to choose partners for more substantial reasons. As a doctor, I've witnessed the pain experienced by women who are repeatedly rejected after The Night. Again, women are dumped for other reasons, but this is one, so why ignore it?

To answer your question about why sexual pleasure can be quantitatively the same but qualitatively different (i.e., both are equally pleasurable but in different ways), the primary reason for this is because there are so many factors that account for the differences in sensation amongst women. As an analogy, consider the three basic colors (red, blue, and green) that are combined to produce the spectrum of colors on your computer monitor or television set. Those three colors can combine to produce equally beautiful but substantially different colors. Or imagine the different flavors produced by cooks who combine flour, sugar, butter, and eggs in different ways to produce entirely different foods. The ingredients may be the same, but when the proportions are varied the end result can be quite different.

What does sex feel like for the opposite sex?

Q: I'm curious as to what sex feels like for women. As a man, I know just what sex feels like for me, but I doubt that it feels the same for women because of differences in anatomy. I've asked my girlfriend to explain what it's like for her, but she isn't telling me much by saying it feels really good. As a doctor, I'm sure you have a much better understanding of the differences in sensation between the sexes, and you can probably offer a much better explanation. Thanks for solving this mystery, doc. Ben

A: Here is an excerpt from an earlier edition of The Science of Sex (the current edition has more information, and a must-see illustration):

Sooner or later, most people wonder what people of the opposite sex experience during sexual stimulation. To understand this, you need to have at least a rudimentary comprehension of the development of genitalia before birth. Early in development, the sexes are anatomically indistinguishable. From this identical base, hormonal and other factors mold the genitalia into either the male or female form. The important point to grasp from this is that male structures have an analogous female counterpart in terms of origin, and vice versa. That is, the same tissue is sculpted into structurally different forms. While it may appear different, the innervation — the way the nerves "hook up" — is essentially identical. From a purely mechanistic point of view in terms of sensation, the genitalia are nothing more than devices that stimulate the sexual nerves. Given that the nerves are identical, it is not surprising that the sensations experienced by the sexes are similar. Anatomical differences account for some minor disparity in sensation, but the overall experience is much the same. For example, when a man touches his scrotum, he feels what a woman experiences when she touches her labia majora (the hair-covered outer lips). Penile sensation is analogous to that of the clitoris, vagina, and labia minora (inner lips) combined. Just as a woman experiences different sensations when stimulation is alternated between the clitoris, vagina, and labia minora, a man will also experience different sensations when different areas of his penis are touched.

Having said this, it is important to note that there are differences in the sensations experienced by the sexes during intercourse. This disparity in sensation is attributable to two factors: anatomic and tactile variation. The first results from the indirect stimulation of the glans clitoris during intercourse, as contrasted with the direct stimulation of the penis. The second factor, which is just as important, results from a variation in perceived sensation due to tactile (touch) dissimilarities between the penis and the vagina. Obviously, a penis does not feel the same as a vagina. Ergo, they cannot impart the same sensations during intercourse, even if the nerves supplying them are identical. For example, when a penis is touched by hand, and then by a vagina, the sensation is greatly different. Because the texture of a vagina differs from that of ordinary skin, the nerves are stimulated in a different manner. This difference in nerve stimulation results in a different nerve impulse, or signal, being conducted to the brain. The brain then interprets the variation in signals as variations in texture.

While the sensations during intercourse may differ, a very close appreciation of the sensations experienced by the opposite sex can be approximated when provision is made for the tactile variation of the penis and the vagina. Given the similarity in feel between the tongue and the lips (especially their inner lining, or mucosa) and that of the vagina, the sensations experienced by a woman when she is orally stimulated (cunnilingus) is quite similar to what a man experiences during intercourse, assuming that her labia minora and clitoral glans are stimulated. The sensations experienced by a woman during intercourse can be approximated in a man when he is orally stimulated by the moistened outer lips of the mouth on the dorsal (bottom) aspect of his penis, but there is no direct stimulation of the penile glans.

Vaginal Contraceptive Film
Should masturbation be taught?
Today's "sexperts": they're sexy, but are they knowledgeable?

Q: What do you think of vaginal contraceptive film? Susan

A: Not much. Coincidentally, I just saw a commercial for VCF^® Vaginal Contraceptive Film in which former Surgeon General Joycelyn Elders said it's "the non-hormonal contraceptive you can't feel." Really? I wondered if she's ever used it. Probably not.

There is nothing like hands-on experience, or in this case . . . well, I'm sure you get my drift. I used it, back in the days when I had a girlfriend, and found that the film dissolved into a gooey, tenacious mess that seemed stickier than glue. Now for the bad news: it seemed to absorb the lubrication naturally present in the vagina. Or perhaps it didn't truly absorb it, it may have just felt that way because it was so sticky. I tried adding lubrication, but within seconds I was back to sticky ol' square one. Plus, like all contraceptives containing nonoxynol-9 as the spermicide, it tends to cause a burning sensation. So, from an aesthetic standpoint, I'm not very fond of it. Could you tell?

Its manufacturer touts that it has "an effective rate as high as 96% when used properly." That sounds impressive, but keep in mind that the real-world effectiveness of contraceptives is usually less than their maximum effectiveness "when used properly." People who have sex are sometimes too drunk or in too much of a hurry or are fumbling too much in a dark room to properly use a contraceptive. Here's one of the flaws of VCF^® Vaginal Contraceptive Film: I think it takes too long to dissolve. I have patience — anyone who can design and build a copying machine from scratch has patience! — but that patience was sorely tested by waiting . . . and waiting. From their instructions, I inferred that it dissolves in 15 minutes. Not in my experience. Another problem is that its manufacturer states it should be inserted "not more than one hour prior to intercourse." That led me to believe that its effectiveness will decrease over time. So what do you do if intercourse is prolonged? Insert one VCF^® per hour, then withdraw for at least 15 minutes before resuming intercourse? However, this won't be a problem for you if you like VCF^® as much as I did, because you won't want intercourse to last more than an hour — trust me!

OK, I'm through bashing VCF^® Vaginal Contraceptive Film. Now I'll take aim at the person who shilled for them, the esteemed former Surgeon General. As you may recall, Dr. Elders was fired for advocating that masturbation be taught. Such a radical idea offended the sensibilities of her boss, President Bill Clinton, a man renowned for his morality. I'm certainly not a prude, as should be evident from my forthright discussion of sex, but I think that anyone who thinks masturbation needs to be taught has a few screws loose or isn't running on all 8 cylinders. For heaven's sake, as a doctor I learned that even retarded people were quite adept at pleasuring themselves. Come to think of it, every male dog I've had seemed to be an expert in that! So this is something that needs to be taught to humans of normal or even superior intelligence? Why? I'll answer that quasi-rhetorical question by opining that many of our "leaders" in Washington are people with second-rate minds, and their dearth of brainpower sometimes leads them to latch onto a questionable crusade, as in the Elders' initiative to teach masturbation, as a way of justifying their professional existence. That may make them feel good about themselves, but such a flimsy raison d'être would likely cause the Founding Fathers to turn over in their graves.

In my mind, there is only one justification for teaching masturbation, and that is when people are taught advanced techniques. People don't need an introductory Masturbation 101 primer, but some could benefit from a postgraduate Masturbation 899 course that goes way beyond the basics. Why? If people were taught masturbation techniques that substantially replicated the pleasure of intercourse, young people would be less inclined to engage in premarital sex and thereby expose themselves to sexually transmitted diseases, unintended pregnancy, and the burdens of that pregnancy. The compulsion for intercourse is primarily fueled by one thing: the desire for pleasure. People seem to have an innate realization that intercourse feels better than masturbation, so humans — being the pleasure-seeking creatures that we are — do what feels best. Thus, I think that parents, church leaders, and teachers should not think that they've done everything possible to guide the next generation simply by giving them the "thou shall not boink before marriage" admonition. Behavioral psychologists know that people are more likely to not engage in unwanted behavior if they're given an equally pleasurable alternative, instead of just being told "no." Considering our abysmal track record at curbing premarital sex, you might think that the need for a fresh approach would be obvious. However, we're usually more interested in conforming to the standards of hidebound propriety and doing what everyone else is doing, rather than doing the right thing.

I've read a lot of material about sex and masturbation in college, medical school, and the years thereafter in preparation for writing The Science of Sex, and I've yet to find an author discuss what I consider to be advanced techniques of masturbation. Instead, sex authors are doing what they do in every other area of sexuality, and that is just rehashing what countless others have said. What an utter waste of time! If you read my book, you'll see that I discuss groundbreaking subjects and give a fresh approach to old ones. Rather than giving you exciting new facts by experts who are brimming with knowledge, the latest trend is for sex authors to be gorgeous young women whose claim to fame is based on appearance, not knowledge. This new breed of sexologist is comprised of individuals without advanced degrees (or any degree, in some cases) and without anything novel to say. Yet we Americans, enamored as we are with appearance, put up with the drivel emanating from these babes. So why is there a market for their echoing of ideas that were old news a few decades ago? Because they look sexy.

Publishers know that readers often purchase books because their covers are alluring, not because the content is noteworthy. Therefore, it isn't surprising that these "sexperts" are often provocatively pictured on their book covers. Taking this trend to an absurd extreme, one of today's hottest sexperts is pictured throughout her book. No matter what page you turn to, there she is, again and again. Isn't this an egregious waste of space? If a book is worth reading, that space should be filled with worthwhile information, not a picture that is repeated a hundred times.

Is it selfish for a man to not want to use condoms?
Why women should dislike condoms as much as men

Q: My fiancée won't use any form of birth control other than condoms, and she wants this to be our form of birth control even after we're married. Needless to say, I'm not very happy about that. Is there a way for me to discuss this so that I don't come off as being selfish? Do you think it is selfish of me to NOT want to wear a condom? She says she cannot use the Pill. Can you suggest other options? Ben

A: First of all, I do not think it is selfish of you to object to wearing condoms. Sexual pleasure is the most intense pleasure that people can experience, and condoms substantially reduce this pleasure for men. Therefore, by insisting that you wear condoms, she is blithely asking you (or telling you) to forgo that supreme pleasure.

I don't think that it is in her interests to cavalierly disregard your pleasure. Sexual pleasure is the primary glue that binds men and women together. If you think I'm overstating this, consider the likelihood of marriage or other lifelong commitment if you could not have sex with your partner. In that case, why bother? You could assuage your need to talk to women by maintaining close friendships with them, couldn't you? I don't know any man who'd be willing to accept the responsibilities of a marriage without sex. She isn't asking you to abstain from sex, but she is evidently willing to toss down the drain a lot of the pleasure that you deserve as a husband. That isn't good for her, either, because when sexual pleasure is diminished, so is the strength of the bond between a man and a woman. That is one reason why I think it is important to amplify sexual pleasure as much as possible, because when it is enhanced, so is the strength of the bond between the couple. Furthermore, sexual activity fosters health in many ways. However, it is important to realize that the quality of the sexual experience varies from disappointing to heaven on Earth, and the health benefits are commensurate with the pleasure: so-so sex isn't as conducive to health as is fantastic sex. Therefore, in The Science of Sex I discussed many ways to intensify sexual pleasure.

If your wife cannot truly use the Pill, then there are many other alternatives. Perhaps the best one for long-term use is an IUD. When women hear IUD, their knee-jerk reaction is often, "An IUD in my body? No way!" IUDs acquired a bad reputation because the ones used years ago often caused problems, but the modern IUDs are one of the safest and most effective birth control options available. If I were a woman, my first choice for birth control would be an IUD. I don't know your age and whether you plan to have children, so other birth control options such as vasectomy or tubal ligation should be considered. If you and your fiancée can tolerate the burning induced by most spermicidal contraceptives and you aren't troubled by their lower rate of effectiveness and aesthetic drawbacks, then those might be viable alternatives.

Women often incorrectly conclude that they "cannot use the Pill" because they fear one of its potential side effects without considering some of the positive aspects of using oral contraceptives. For example, while the Pill may increase the risk of breast cancer, it reduces the risk of ovarian and endometrial (uterine) cancer and may reduce the risk of colon cancer, too. As a general rule, it is shortsighted to consider only the negative aspects of using a drug without also considering its benefits, too. This one-sided viewpoint often leads some postmenopausal women to conclude that they'd be better off without supplemental estrogen. In reality, estrogen therapy has many more benefits than risks. Even if women ignore their quality of life and appearance (which are substantially better with estrogen), the overall risk of death is less in women who take estrogen than in women who do not. (I discuss this subject in my book because the media have twisted the facts in regard to postmenopausal hormone replacement therapy. "The media" largely consist of people with degrees in journalism, not medicine. It shows.)

Hedonistic calculus and the Pill: Are women who insist on condoms selfish?

Q: My wife refuses to use the Pill, saying that no man ever died of a blood clot caused by a condom. I HATE using condoms, but when she presents her argument against the Pill this way, my reluctance to use condoms might seem selfish -- as if I care more about my pleasure than the health of my wife. Your thoughts?

A: Look at it this way. If she insists on condoms, there is a 100% chance that such usage will decrease your pleasure. On the other hand, if she used the Pill, there is an excellent chance she'd never develop a blood clot. Thus, she evidently believes that the remote risk of a blood clot is more important than the certainty that using a condom will substantially diminish your pleasure. Now who is being selfish?

I've yet to see a woman with a blood clot caused by the Pill. Yes, I've read the studies, and I know that the risk of thromboembolic events is increased when women use the Pill. But if this were a common occurrence, after treating many thousands of women, I would have had at least one who developed a blood clot while on the Pill. Interestingly, I've treated several women for blood clots, none of whom were on the Pill. This brings up an important point. If those women were on the Pill, everyone would reflexively blame the Pill for the clot. However, women develop clots for other reasons (smoking, bad veins, bad genes, a diathesis to clot, random chance, angry Gods, etc.). Hence, many clots that are blamed on the Pill would have occurred even without it, but because some women on the Pill develop blood clots, the Pill is blamed for the clot — often incorrectly.

Given the variety of alternatives, I don't know why people sometimes think that the choice of a contraceptive is either the Pill or a condom. In any case, if you cannot change your wife's opinion, you should consider using a subcondom, as I discuss in my book. This can increase pleasure for both partners, for reasons I explain therein. While using a condom with a subcondom is more pleasurable than using just a condom, it isn't as pleasurable as intercourse without a condom. Since sexual pleasure is not something that should be cavalierly disregarded, I think women should consider this when making a contraceptive choice.

Hedonistic calculus is Bentham's strategy for balancing the pleasure or pain that a given action is likely to generate, and hence whether that act is desirable or not. While hedonistic calculus sounds like something that'd interest only pointy-headed academics or students of philosophy, we all intuitively use such calculus in making decisions in our lives. I enjoy riding motorcycles, but consciously choose not to do that any more because of the risk of that activity — which is why ER personnel sometimes refer to motorcycle riders as "organ donors." Whenever I hear wives insist on condom usage, as if their health meant everything and their husband's pleasure meant nothing, I always think of how hedonistic calculus applies to other facets of marriage. For example, in my years of working in the ER, I had ONE woman who died on her way to work and NONE who died at work. In contrast, I had countless male patients who died either commuting to and from work, or while at work. Generally, men assume the riskier occupations and often commute longer distances. I think it is second nature for men to refuse to allow women to perform genuinely dangerous work. While this can be analyzed ad infinitum by a variety of perspectives (Darwinian, pragmatic, social, etc.), the bottom line is that men are willing to assume some risk in order to benefit their partners. No doubt, many women do this too. However, some women — and your wife appears to be one of them — fail to appreciate that a good marriage involves broadening their perspective of hedonistic calculus to include not just what is best for them, but also what is best for their partners.

I'll now dispense with the highfaluting discussion of hedonistic calculus and present this matter in shirtsleeve English. When I hear female sexologists and other professionals clamoring for condoms, I think, "That's easy for you to say." Their enthusiasm would no doubt be tempered if condoms deadened their enjoyment. In my mind, they would be far more effective if they acknowledged the disparity of pleasure reduction between men and women, and discussed ways to reduce it (such as by using subcondoms, or forgoing condom usage and making better decisions about whether a given partner is an acceptable risk or not). The usual chatter about this is too simplistic and narrow in scope. As an ER doctor, I learned that sexually acquired diseases are far more common in certain groups — and I am not just referring to the well-known ethnic and racial disparities, either. The prevalence of sexually transmitted diseases varies with occupation, intelligence, personality type, locale, and other factors. People who know what to look out for can usually boink to their heart's content and stay safe. On the other hand, people who are clueless often acquire an STD the first time they hop into bed with someone. Very predictable.

Disappointed by wedding night

Q: I don't know how to put this. I'm stunned, disappointed, in disbelief. I had sex for the first time last night on my wedding night, and while it was pleasurable, it was not nearly as pleasurable as I assumed it would be. Considering how much attention is paid to sex, I thought it would be fantastic. It wasn't. Why?

A: Dang, where did I put my crystal ball, anyway? You didn't say if you are a man or woman, so I can't address some of the most common reasons for a reduction in pleasure pertaining to specific sexes. Instead, I'll discuss this topic in a general sense. First, people are often disappointed by their initial episode of sex. I was, too. However, in time, intercourse became more pleasurable with that partner, and with a subsequent partner, sex was so pleasurable it was beyond my wildest dreams — I had no idea that such intense pleasure was possible. That was quite a change from the "this is it?" shock and disappointment I felt after my first time. I can't give you a short answer that addresses all possible reasons for this variation in pleasure; that is the subject of my 218,000-word book.

More semen, better orgasm?

Q: Is it true that if a man ejaculates more semen, his orgasm will be more intense?

A: No. I don't know how that myth began. Perhaps it originated from people who mistook cause and effect, and noticed that more intense orgasms are sometimes associated with a greater volume of ejaculate. However, it wasn't the extra ejaculate that intensified the orgasm, it was the more intense orgasm that created stronger contractions of the genitourinary tract, thereby expelling more semen.

A one-hour orgasm?

Q: I've seen books and videos that speak of a one-hour orgasm. Is that possible?

A: That is just marketing hype. Once they've drawn you in with the hyperbole, they begin equivocating, saying something along the lines of, "It's not really a one-hour orgasm, it's a prolonged period of heightened awareness and pleasure." If that is the case, then I had a three-hour orgasm when I was in fifth grade and I'd gawk for hours at a Ski-doo snowmobile catalog. Heightened awareness? You bet. Pleasure? Ditto.

While some orgasms can be unusually prolonged, a one-hour orgasm is a pipe dream. The reason for this is simple: orgasm involves the release of neurotransmitters. The brain cannot store enough neurotransmitters to permit a one-hour orgasm. Here is an analogy. Imagine that you pump water into a water tower; that's like storing neurotransmitters in preparation for their eventual release. Now imagine that you blast a hole in the side of the water tower, and the water gushes out — that's analogous to the orgasm. There is a limit as to how long the water will flow, because the water tower has a finite size. Similarly, there is a limit to the duration of an orgasm, because the brain does not have an infinite neurotransmitter supply. Some nutrients and drugs can "pump up" the neurotransmitter stockpile to permit a longer and more intense orgasm (as I explain in my book), but nothing currently known permits a one-hour orgasm.

Status orgasmus is an orgasmic state lasting twenty seconds to one minute. Having witnessed this, I can attest that the woman did indeed appear to experience an unusually prolonged orgasm. However, I'm skeptical of women who claim to have fifteen-minute orgasms. I think they experience a prolonged preorgasmic sexual peak that feels very good, but does not deliver a fifteen-minute period of true orgasmic pleasure.

What can I do to climax during intercourse?

Q: What can I do so that I can climax during intercourse? I heard that only one-third of women regularly climax during coitus, so I'm not alone. I tried all the usual recommendations (such as more foreplay and the coital alignment technique), but they did not help.

A: You might benefit from using testosterone or other drugs to improve sexual sensitivity. Another possibility is using the Vag-TTS, which enhances vaginal sensation. All of this is discussed in The Science of Sex.

Reader heard a rumor . . . is it true?

Q: Dr. Pezzi: I think that your website is quite entertaining and informative at the same time. I enjoy it very much. I am a 19-year-old college student and I have a question regarding something that my friend heard somewhere. He said something about a correlation between sexual pleasure and the size of a woman's posterior. More specifically that a woman with a bigger ass will derive more sexual pleasure from sexual activities than one with a smaller ass. Is there any truth to this? Jared

A: I consulted several female friends, including ones with slim behinds and others with steatopygic derrières (steatopygia = an extreme accumulation of fat on the buttocks), but the latter ones were too busy moaning to answer my question. OK, I'll be serious. There is no truth to this rumor. If anything, the converse is true. Women with more testosterone are likely to have smaller buttocks, and also a better sex life because testosterone enhances libido and heightens sexual pleasure.

ContactMeFree is a dream come true for anyone involved in online dating. If you have your profile posted on a personals site but don't pay for a membership, you know how limited you are in terms of being able to send or receive messages. You probably assume that those limitations disappear if you pay for a membership. Guess what? You are still far more limited than you realize. Frankly, if you knew how limited you were, you would be furious that the personals site was charging you $20 to $50 per month and still keeping the shackles on you! The person who created ContactMeFree was so outraged by those limitations that he decided to do something about it. So he did!

You know that writer's block you get when you sit down to write the essay portion of your personal profile for online dating? And you know the difficulty you have trying to think of a catchy headline? Well, MyProfileWriter allows you to create a profile essay and headline without typing, just by clicking!