Female orgasm frequency, correlates and measurement in the preconception period

We used cross-sectional data from Pregnancy Study Online (PRESTO), an online cohort of participants attempting conception. PRESTO began enrolling participants in June 2013. Eligible participants were residents of the United States or Canada, aged 21–45 years old, had a uterus, and were attempting to conceive with one male partner without fertility treatment. 23 Participants were recruited via online advertising, posted flyers, and word of mouth. Upon enrollment, participants completed an extensive baseline questionnaire. In March 2021, we added the Sexual Health and Wellbeing Questionnaire (SHWQ), an optional questionnaire about sexual health, to the PRESTO protocol. Participants who enrolled in PRESTO after the launch of the SHWQ received an email 30 days after enrollment inviting them to complete it, and participants who enrolled prior to its launch were retroactively invited to complete the SHWQ, responding based on their experience at the time of their initial study enrollment. Approximately 60% of participants prospectively completed the SHWQ. 24 To reduce risk of misclassification of orgasm frequency due to retrospective SHWQ completion, we excluded participants who enrolled in PRESTO >1 year prior to the SHWQ launch (April 2020). We also excluded any participants who reported no sexual activity in the past 4 weeks (3.2%). All study procedures were reviewed and approved by the Boston University Medical Campus Institutional Review Board and participants provided informed consent online. We used multiple questions to capture different aspects of orgasm frequency and experience. To assess recent orgasm frequency, we used one question from the Female Sexual Function Index 25 : “Over the past 4 weeks, when you had sexual stimulation or intercourse, how often did you reach orgasm (climax)?” Response options included ‘Almost never or never,’ ‘A few times (less than half the time),’ ‘Sometimes (about half the time),’ ‘Most times (more than half the time),’ and “Almost always or always.” To assess lifetime orgasmic experience: “In general ( not specifically over the past 4 weeks), which of the following best describes your experience with orgasm and vaginal penetration (intercourse)?” Response options included “I need my clitoris to be stimulated in order to have an orgasm during intercourse,” “Although I don’t need my clitoris to be stimulated in order to have an orgasm during intercourse, my orgasms feel better if my clitoris is stimulated during intercourse,” “Vaginal penetration alone is enough to help me have an orgasm (I don’t need my clitoris to be stimulated in order to have an orgasm),” “I don’t have orgasms during intercourse,” “Prefer not to answer,” or “Other.” In February 2025, we added the Orgasmometer-F, a self-report scale for orgasmic intensity. 26 Participants who reported sexual activity in the past 4 weeks were shown an image of a thermometer as a visual prompt to respond to the following question: “Considering a Likert scale ranging from 0 to 10, where 0 corresponds to feeling no orgasmic intensity and 10 to feeling maximum orgasmic intensity, how would you rate your orgasmic intensity in the past 4 weeks?” We conducted a targeted literature review to identify potential correlates of orgasm frequency. We searched Google Scholar and PubMed using terms including “predictors of orgasm frequency in women,” and “predictors of orgasm.” We also searched the reference lists of relevant articles to identify additional sources. 27 – 32 Guided by the literature review, we identified potential correlates available in our data. We selected additional potential correlates based on research team expertise. Data on all potential correlates were assessed via self-report on three different questionnaires: 1) the baseline questionnaire, completed by all participants at study enrollment; 2) the SHWQ; and 3) the Life Course Questionnaire, which is an optional questionnaire that participants were invited to complete 30 days after enrollment. The full list of corelates and details on their assessment are displayed in Table 1 . We descriptively reported the distribution of orgasm frequency, lifetime orgasm experience, and Orgasmometer-F scores. We assessed the correlate distribution by orgasm frequency. For each level of each correlate, we subtracted the proportion of participants reporting the lowest level of orgasm frequency from the proportion of participants reporting the highest level of orgasm frequency to calculate a percentage-point difference. We standardized these differences by subtracting them from the expected difference, based on the overall sample distribution, to enable comparison across correlates. We calculated Wald-type 95% confidence intervals (95% CI) using the binomial standard error for the difference in proportions. We also descriptively evaluated the relationship between orgasm frequency and lifetime orgasm experience. We calculated the relationship between orgasm frequency and intensity (Orgasmometer-F scores) by plotting Orgasmometer-F scores for each value of orgasm frequency, including a regression line calculated using a simple linear regression model and 95% confidence intervals, and calculating Pearson’s correlation coefficient (r). We similarly plotted Orgasmometer-F scores for each category of lifetime orgasm type. Generative artificial intelligence ( ChatGPT.com ) was used for support generating statistical code in R. All code was reviewed for accuracy by an experienced R coder, and all output was validated using human-generated code in SAS.

Our sample included 6,022 participants (see Supplementary Figure 1 for sample selection). Eighty-two percent of participants identified as non-Hispanic White (82%), with 7.5% identifying as Hispanic, 3.7% as non-Hispanic multiracial, 3.3% as non-Hispanic Asian, and 2.6% as non-Hispanic Black. Sixty-eight percent of participants had a household income of ≥$100,000 U.S. dollars. Table 2 displays other demographic characteristics for the full sample and stratified by recent orgasm frequency. Table 3 displays the distribution of orgasm variables. More than half the sample reported orgasming ‘most times’ or ‘almost always or always.’ About half of participants reported that they needed clitoral stimulation to orgasm, while a quarter reported that they do not need clitoral stimulation, but it improves orgasm quality. Ten percent of the sample reported that they can orgasm with vaginal penetration alone or that they do not have orgasms during intercourse, respectively. Self-reported orgasm intensity was left-skewed, with the majority of the sample reporting a 6, 7, or 8 on the 10-point intensity scale (mean score 6.6). Lower partner social and emotional support were strong correlates of lower orgasm frequency. Participants who reported that their partner ‘rarely’ provided emotional support had a standardized percentage-point difference of -27.5 [95% CI -44.4, -10.6], indicating that the contrast between the highest and lowest orgasm frequency categories was 27.5 percentage points lower than would be expected based on the distribution in the overall sample. In contrast, those who reported that their partner showed emotional support ‘all the time’ had a standardized percentage-point difference of 5.8 (95% CI 3.9, 7.7). The standardized percentage-point difference for those reporting their partner ‘rarely’ showed love or affection was −11.0 (95% CI −36.7, 14.7). Some clinical correlates also emerged as strong predictors of lower orgasm frequency, including irritable bladder syndrome (standardized percentage point difference −15.4, 95% CI −25.5, −5.3), diabetes (standardized percentage point difference −5.8, 95% CI −18.2, 6.7), and current depressive symptoms (those reporting the highest category of depressive symptoms had a standardized percentage point difference −11.6, 95% CI −19.3, −4.0). Participants reporting the use of antidepressant or antianxiety medications in the past 4 weeks had lower orgasm frequency (standardized percentage-point difference −5.2, 95% CI −9.5, −0.9 and −4.9, CI% −8.7, −1.0, respectively). Sleep was related to orgasm frequency, with standardized percentage-point differences of −5.2%, 95% CI −9.5 to −1.0% for those reporting ≤6 nightly hours of sleep and −8.9%, 95% CI −13.0 to −4.9% for those reporting ‘fairly poor’ sleep quality. Past-month intercourse frequency was positively correlated with orgasm frequency, while months of conception attempts at study entry was negatively correlated with orgasm frequency. The strongest correlates of orgasm frequency were other sexual function domains: arousal, lubrication, desire, painful intercourse, and satisfaction. The standardized percentage point difference ranged from −63.9 (95% CI −72.1, −55.8) for participants reporting low or no arousal to −18.5 (95% −29.4, −7.6) for participants reporting almost always or always having pain with intercourse. Table 2 displays the results for all correlates. Figure 1 displays the distribution of orgasm frequency during sexual activity (past 4 weeks) and typical orgasm experience during intercourse (lifetime). For those who do not orgasm during intercourse, 57% said they never or rarely orgasmed with sexual activity in the past 4 weeks. A small proportion (8.5%) of participants who reported not having orgasms during intercourse reported that they almost always or always orgasmed during sexual activity in the past 4 weeks. Orgasm frequency and intensity (assessed via Orgasmometer-F scores) were positively correlated (r=0.50, 95% CI=0.45–0.55), although there was considerable variability in orgasm intensity ratings across frequency categories ( Figure 2A ). We also observed differences in orgasm intensity when evaluated by typical orgasm type. Those who reported no orgasms during intercourse reported the lowest orgasm intensity, while those who reported that they could orgasm through vaginal penetration alone reported the highest orgasm intensity ( Figure 2B ).

We identified strong clinical, behavioral, and social correlates of orgasm frequency during sexual activity in a population of pregnancy planners with high levels of education and income relative to the general population. The strongest correlates were domains of sexual function, with self-reported levels of sexual arousal, desire, lubrication, and satisfaction being positively correlated with orgasm frequency, and frequency of painful intercourse negatively correlated. Self-reported orgasm frequency and usual intensity were moderately positively correlated, though there was high variability in orgasm intensity scores within each frequency category. Our findings generally align with prior studies. We found that current use of antidepressants or antianxiety medications was correlated with fewer orgasms, which is a well-documented side effect of these treatments, 33 though the relationship between mental and sexual health can be bidirectional 34 and we cannot determine temporality with our data. Similar to our findings on perceived partner emotional support, a perceived poor emotional connection with a partner was associated with orgasm difficulty in an online survey of United States residents. 32 Our findings also agree with a survey of hospital employees in Taiwan, which reported that diabetes, bladder health issues, and a perceived poor relationship were all negatively correlated with orgasm frequency. 30 We also report a relationship between sleep quality and orgasm frequency. 13 Like other studies, we did not find an appreciable correlation between education, alcohol intake, cigarette smoking, and duration of relationship and orgasm frequency. 29 , 32 Unlike prior studies, we did not observe meaningful correlations between age 28 , 35 or parity 29 , 30 and orgasm frequency, although this may be due to characteristics of our sample, including the fact that it comprised reproductive-aged pregnancy planners with generally high levels of education and income. Our findings provide important insights into correlates of orgasm experience in a population of pregnancy planners, which may represent an idiosyncratic time in an individual’s sexual life when sex has a reproductive goal. It is possible that this context changes how an individual or couple prioritizes the female orgasm, or how members of the couple experience orgasm. As such, understanding the specific correlates of orgasm during this time is worthwhile, even as they may differ from correlates in other times of life. Nonetheless, our findings lay an important foundation for etiologic orgasm research. As demonstrated previously, 27 , 28 there was strong overlap between orgasm frequency and other domains of sexual function. This is important from an etiologic perspective, as many measures of sexual function combine assessments of different domains into a single score (i.e., Female Sexual Function Index 25 ). To effectively study orgasm independently, researchers will need to disentangle these components and consider the correct analytic approach to other elements of sexual function. We also observed a positive relationship between self-reported orgasm frequency and intensity, albeit with substantial variability in intensity, which raises questions regarding the optimal approach to orgasm measurement in etiologic settings. To our knowledge, the extent to which physiologic effects of orgasm differ based on intensity is unknown. If orgasm intensity influences potential mediators in the relationship between orgasm and other outcomes (i.e., oxytocin levels), it will be necessary to capture frequency and intensity. We also saw modest differences in orgasm intensity by usual orgasm type. If the type of orgasm influences intensity, and therefore potential mediators, more details about when and how orgasms are occurring could help provide clarity in etiologic analyses. There would also be utility in validating self-reported orgasmic intensity against other measures of interest, including circulating oxytocin levels. Our findings align with prior work emphasizing the influence of question wording in assessments of orgasm experience. A study of almost 2,000 heterosexual women 36 found that when asked how frequently they typically orgasmed when having sexual intercourse ‘with additional clitoral stimulation,’ women reported a higher frequency than when the question specified intercourse ‘with no additional clitoral stimulation’ or did not specifically mention clitoral stimulation. We similarly saw strong influences of question wording: 8.5% of those who reported never orgasming during sexual intercourse reported orgasming always or almost always during sexual activity. The distinction between ‘sexual activity’ and ‘vaginal intercourse’ could cause misclassification. For example, when studying orgasm and fertility, researchers may need to specifically assess whether orgasm occurred in the context of partnered vaginal intercourse. Precise questions are critical for effective etiologic orgasm research and may require researchers to develop and validate their own questions that would be maximally salient to their studies. Our study should be interpreted in the context of its strengths and limitations. We were able to evaluate multiple self-reported assessments of orgasm in a large sample. Our results may not be broadly generalizable given that our study includes pregnancy planners with high levels of education and income relative to the U.S. population. However, research in this population is relevant for the etiologic study of orgasm and reproductive health (i.e., fertility), and insights, particularly about orgasm measurement, could translate to other populations. Our results are also vulnerable to selection bias, as some of our evaluated correlates are associated with non-response to the SHWQ 24 (e.g., months of conception attempts, intercourse frequency); if orgasm experience also influences SHWQ response rates, this may bias our findings. Finally, though we used validated instruments, our findings may have been enhanced by the assessment of other aspects of orgasm experience (e.g., physical sensations or emotions) and experiences of orgasm during masturbation. Our questions did not specify masturbatory versus partnered orgasm experience, which may influence the interpretability of our findings if there are different correlates of orgasm in partnered versus solo contexts. Our study contributes to existing literature and lays the groundwork for effective etiologic research about orgasm, which has the potential to impact the understanding and promotion of human sexuality and health.

Orgasm has been defined as a transient peak of intense pleasure, which can elicit an alternate state of consciousness and involuntary bodily movements. 1 Orgasm is commonly a desired outcome of sexual activity 2 and can be a strong motivator to pursue sexual activity. 3 There is an increasing acknowledgement, including from the World Health Organization, that sexual well-being and pleasure, which can include orgasm, are critical components of sexual health. 4 Indeed, in the context of familiar sexual partners, women’s orgasms are associated with greater sexual 5 and relational satisfaction. 6 Research evaluating the relationship between orgasm and broader health outcomes is relatively sparse, 7 , 8 despite biologic plausibility. Orgasm can cause physiologic changes, including the release of neurochemicals like adrenaline 9 or oxytocin, 10 increased pain tolerance, 11 and subsequent relaxation, 12 all of which may have health implications. 8 A daily diary study suggested that partnered sexual activity with orgasm before sleep improved sleep quality. 13 Orgasm may also be related to mental health: some evidence suggests that improving orgasmic ability may correlate with lower depressive symptoms. 14 In particular, the relationship between female orgasm and time-to-pregnancy has been a long-standing scientific controversy. 15 Orgasm is hypothesized to facilitate conception via multiple potential pathways, including increasing circulating oxytocin levels, 16 causing transient cervical dilation, 17 and facilitating sperm retention. 18 Conversely, some researchers have criticized this body of evidence as lacking robust human studies, instead asserting that the evidence best supports the theory that female orgasm evolved as a byproduct of male orgasm. 19 A 2024 prospective cohort study reported a U-shaped association between orgasm frequency and time-to-pregnancy, though the findings were limited by retrospective assessment of orgasm frequency in the past 4 weeks. 20 Though there is clear scientific rationale for the etiologic study of orgasm as both an exposure and outcome, research is limited. Because orgasm occurs in a complex context of biological, physiological, and psychosocial factors, 21 and is a multidimensional phenomenon that can be challenging to measure, 21 a strong epidemiologic foundation is required to support methodologically rigorous etiologic research. We aim to lay such groundwork by contributing knowledge about the frequency, correlates, and measurement of orgasm in a large, questionnaire-based cohort study of North American pregnancy planners. Specifically, to evaluate population-level measurement of different aspects of orgasm, we describe orgasm experience in this population and explore relationships between different aspects of self-reported orgasm experience. Additionally, we used a biopsychosocial framework 22 to identify biological, behavioral, and contextual correlates of orgasm frequency among pregnancy planners, with an emphasis on clinical and medical factors that may be particularly relevant as confounders in etiologic analyses of orgasm.