Research Questions & Invitations
The Female Orgasm Research Institute identifies unanswered questions intended to stimulate further research concerning female and male orgasm, orgasmic learning, sexual excitation and inhibition, sexual health, and the cultural, developmental, and historical conditions that may shape orgasmic access.
These questions are invitations to researchers to investigate, challenge, refine, and generate the evidence needed to answer them.
Questions for Further Investigation
Select a topic below to read the complete research question and the scientific, clinical, cultural, or historical rationale for investigating it.
Could Lifelong Anorgasmia or Persistently Low Orgasm Frequency Be an Overlooked Contributor to Women’s Disproportionate Alzheimer’s Disease Risk?
Female orgasm difficulty is common. The U.S. National Library of Medicine estimates that 10% to 15% of women have never experienced orgasm, while a 2025 systematic review reported that female orgasmic disorder or difficulty affects up to 41% of women worldwide. A large U.S. study also found that 95% of heterosexual men, compared with 65% of heterosexual women, reported usually or always experiencing orgasm when sexually intimate.
Women constitute nearly two-thirds of Americans living with Alzheimer's disease. Their estimated lifetime risk at age 45 is approximately one in five, compared with one in ten for men—a disparity not fully explained by women's greater longevity.
These parallel disparities do not establish a connection. Anorgasmia has not been identified as a cause or risk factor for Alzheimer's disease—but lifetime orgasmic function also appears not to have been evaluated as a distinct variable in longitudinal Alzheimer's research.
Studies have examined sexual activity and cognition, but sexual activity is not equivalent to orgasm. A four-year study found that sexual activity was associated with better preservation of memory in men but not women. Yet it measured only whether participants had engaged in any sexual activity during the previous year. Orgasm was not measured. Data from the same study population showed that 27% of sexually active women reported difficulty achieving orgasm. The "sexually active" category therefore combined women who experienced orgasm reliably with women who experienced sexual activity without orgasm.
This distinction may help explain the different results for women and men. Because men experience orgasm more consistently during sexual activity, sexual activity may function as a closer proxy for orgasm among men. Among women, using sexual activity as the measure could conceal an orgasm-specific association.
Oxytocin is one possible mechanism, but not the only one. Circulating oxytocin increases during orgasm, and preclinical Alzheimer's research suggests that oxytocin signaling may influence memory and neuroinflammation. However, Alzheimer's disease has not been established as an oxytocin-deficiency condition. Other possible pathways include sleep, stress regulation, cardiovascular and autonomic responses, neuroendocrine signaling, inflammation, and emotional well-being.
Answering this question would require longitudinal research that measures orgasmic function directly and repeatedly across adulthood—not merely sexual activity—and examines orgasm as a recurring bodily and neurophysiological function rather than only as an isolated sexual event.
U.S. National Library of Medicine. Orgasmic dysfunction in women. MedlinePlus Medical Encyclopedia. View source
Mulvehill S, Tishler J. Cannabis for female orgasmic disorder/difficulty: a systematic review. Sexual Medicine. 2025;13(4):qfaf061. View source
Definitions, classification, and epidemiology of sexual dysfunction: a consensus statement from the Fifth International Consultation on Sexual Medicine 2024. Sexual Medicine Reviews. 2026;14(2). View source
Frederick DA, St John HK, Garcia JR, Lloyd EA. Differences in orgasm frequency among gay, lesbian, bisexual, and heterosexual men and women in a U.S. national sample. Archives of Sexual Behavior. 2018;47(1):273–288. View source
Alzheimer's Association. Women's Alzheimer's Research Initiative. View source
Smith L, et al. Sexual activity and cognitive decline in older age: a prospective cohort study. Aging Clinical and Experimental Research. 2020;32(1):85–91. View source
Lee DM, Nazroo J, O'Connor DB, Blake M, Pendleton N. Sexual health and well-being among older men and women in England: findings from the English Longitudinal Study of Ageing. Archives of Sexual Behavior. 2016;45(1):133–144. View source
Wright H, Jenks RA, Lee DM. Sexual expression and cognitive function: gender-divergent associations in older adults. Archives of Sexual Behavior. 2020;49(3):941–951. View source
Carmichael MS, et al. Plasma oxytocin increases in the human sexual response. Journal of Clinical Endocrinology & Metabolism. 1987;64(1):27–31. View source
Raskind MA, et al. Cerebrospinal fluid vasopressin, oxytocin, somatostatin, and beta-endorphin in Alzheimer's disease. Archives of General Psychiatry. 1986;43(4):382–388. View source
Did Ancient Ritual Traditions Encode a Cultural Pathway to Orgasmic States?
Ecstatic ritual practices, including Dionysian and Bacchic rites and other traditions associated with orgiastic worship, were a recurring feature of ancient Mediterranean religious life, using music, dance, wine, and collective frenzy to induce altered states of consciousness. Some scholars interpret works such as the frieze in the Villa of the Mysteries at Pompeii as depicting a woman's ritual initiation before marriage, though this interpretation remains debated among classicists.
Did these ecstatic ritual traditions function, in part, as culturally structured pathways into altered or absorbed states that may have facilitated orgasmic access, and how and why were such pathways transformed, suppressed, or discontinued?
How Does a Woman With Primary Anorgasmia Learn to Orgasm?
Directed masturbation and hypnosis—one primarily a behavioral technique and the other an absorption-based technique—have both been used successfully to help women with primary anorgasmia become orgasmic.
What determines whether a woman learns to orgasm through either pathway, and do these different approaches ultimately work by increasing access to an absorbed state?
One possibility is that behavioral change does more than change stimulation or technique. It may increase permission, reduce inhibition, and allow the woman greater access to the absorbed state in which orgasm becomes possible.
Can Absorbed-State Access Help Transfer Orgasm From Solo to Partnered Sex?
Many women who experience orgasm difficulty can orgasm reliably alone but have difficulty accessing orgasm with a partner.
A relevant case study by Pfaus and Tsarski (2022) described a woman with vaginismus and orgasm difficulty who, after approximately a decade of tantra, yoga, and breathwork training, learned to enter and sustain an orgasmic state without genital touch. Her vaginismus resolved alongside this training.
Can learning to enter and sustain an absorbed state increase orgasmic access during partnered sex and allow an already-established orgasmic response to become accessible across different sexual contexts?
This question distinguishes learning orgasm for the first time from learning to access an existing orgasmic response under conditions in which it is currently unavailable. The case above suggests that an absorbed state—accessed here through sustained tantra, yoga, and breathwork practice—may be one route by which that transfer becomes possible.
Pfaus JG, Tsarski K. A Case of Female Orgasm Without Genital Stimulation. Sex Med 2022;10:100496.
Could Sexual Inhibition Be Transmitted Across Generations?
For generations, women have lived within religious, cultural, and social systems that have regulated sexual desire, bodily expression, masturbation, sexual behavior, and female sexual pleasure. Learning and environment affect biological development, and some effects of one generation's environment may influence subsequent generations.
Could some female orgasm difficulty involve intergenerational biological, developmental, and culturally learned erotic inhibition that begins before a woman's own conscious sexual learning?
Possible mechanisms could include prenatal influences, nervous-system development, epigenetic processes, intergenerational biological transmission, early conditioning, cultural transmission, or interactions among these processes.
Is Secularization Associated With Lower Rates of Female Orgasmic Difficulty?
Research shows that many societies are becoming less religious, with younger generations often participating less in organized religion, placing less importance on religion in their lives, and increasingly identifying with no religion. This process, often referred to as secularization, is occurring at different rates across countries and cultures. At the same time, many religious and cultural restrictions historically placed on masturbation, sexual desire, sexual autonomy, and female sexual pleasure have weakened in some societies.
As societies become more secular, do rates of female orgasmic difficulty decline—and, if so, is that change related to reduced sexual shame, greater sexual autonomy, more experience with masturbation and self-directed sexual learning, and greater acceptance of female sexual pleasure?
The question is not whether religion itself causes orgasm difficulty. Rather, it asks whether sexual inhibition learned through religious and cultural environments affects orgasmic access, and whether changes in those environments are accompanied by changes in women's orgasmic experiences.
Why Hasn't Greater Sexual Freedom Made Women More Orgasmic?
Kontula and Miettinen (2016) found that decades of improvements in gender equality and sexual education, along with a major increase in masturbation among women, have not been accompanied by a corresponding increase in women's orgasmic frequency.
This finding provides an important counterpoint to the secularization question above: greater social permission may not increase orgasmic access unless the underlying inhibitory and learning processes also change.
If greater sexual freedom, sexual education, and masturbation have not increased women's orgasmic access, what is actually inhibiting it—and is that inhibition primarily religious, cultural, relational, psychological, or something not yet identified?
This question does not assume the answer in advance. It asks what continues to stand between women and orgasm once the social permissions often assumed to be the barrier are already in place.
Kontula O, Miettinen A. Determinants of female sexual orgasms. Socioaffective Neuroscience & Psychology. 2016;6:31624.
Why Do Women Value Their Partner's Pleasure More Than Their Own?
In a large national study of Finnish women, Kontula and Miettinen (2016) found that women valued their partner's orgasm more than their own. The researchers identified this finding as an unresolved question, noting that understanding why women prioritize their partner's orgasm over their own remains a challenge for future research.
Why do many women prioritize their partner's sexual pleasure over their own, and what psychological, relational, or cultural mechanisms underlie this pattern?
This question remains insufficiently examined in the research literature. Understanding why women place greater value on their partner's pleasure than their own could clarify how sexual scripts, self-worth, and relational dynamics shape orgasmic priorities—and potentially, orgasmic access itself.
Kontula O, Miettinen A. Determinants of female sexual orgasms. Socioaffective Neuroscience & Psychology. 2016;6:31624.
What Happened to Male Orgasmic Disorder?
The diagnosis Male Orgasmic Disorder was replaced in DSM-5 by Delayed Ejaculation. Orgasm and ejaculation commonly occur together, but they are not the same physiological event. Men can experience orgasm without ejaculation, ejaculation without a satisfying orgasm, and orgasmic difficulties that may not primarily involve ejaculatory timing.
Does Delayed Ejaculation adequately represent male orgasmic difficulty, or did replacing Male Orgasmic Disorder with Delayed Ejaculation collapse two related but distinct physiological phenomena—orgasm and ejaculation—into a single ejaculatory diagnosis?
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed., text rev. Washington, DC: American Psychiatric Association Publishing; 2022.
Segraves RT. Considerations for a better definition of male orgasmic disorder in DSM-V. J Sex Med. 2010. View source
Alwaal A, Breyer BN, Lue TF. Normal male sexual function: emphasis on orgasm and ejaculation. Fertil Steril. 2015;104(5):1051–1060. View source
What Are the Long-Term Health Effects of Persistent Anorgasmia?
Research on female orgasm difficulty has largely focused on its prevalence, causes, associated distress, and treatment. Much less is known about whether persistent anorgasmia across years or decades is associated with cumulative effects on women's physical, psychological, or neurological health.
Orgasm produces measurable short-term cardiovascular, autonomic, and neuroendocrine changes. A 14-day observational diary study also found that partnered sexual activity involving orgasm was associated with shorter subjective sleep latency and better subjective sleep quality that night. Masturbation involving orgasm and sexual activity without orgasm were not associated with these changes (Oesterling et al., 2023).
These findings do not demonstrate that anorgasmia causes long-term harm, nor do they establish that the absence of orgasm is biologically equivalent to sleep deprivation. They do, however, raise an unanswered longitudinal question.
Does persistent anorgasmia across years or decades have cumulative effects on sleep, stress regulation, mood, pain, autonomic or cardiovascular function, cognition, pelvic health, or quality of life—and, if differences are found, are they caused by the absence of orgasm, by distress associated with orgasm difficulty, or by shared underlying factors?
Longitudinal research should distinguish lifelong from acquired anorgasmia, generalized from situational orgasm difficulty, and distressing from non-distressing experiences. It should also account for sexual desire and activity, relationship context, trauma, medication use, menopause and hormonal changes, physical health, and mental health.
Exton MS, Bindert A, Krüger T, Scheller F, Hartmann U, Schedlowski M. Cardiovascular and endocrine alterations after masturbation-induced orgasm in women. Psychosom Med. 1999;61(3):280–289. View source
Oesterling CF, Borg C, Juhola E, Lancel M. The influence of sexual activity on sleep: A diary study. J Sleep Res. 2023;32(4):e13814. doi:10.1111/jsr.13814. View source
These questions are offered as research invitations.
The Institute welcomes inquiries and may offer intellectual collaboration or participate in researcher-led grant applications. We do not currently provide research funding or grant-writing services.
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