What Causes Orgasm

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Orgasms can be induced via erotic stimulation of a variety of genital and nonge-nital sites. The clitoris and vagina (especially the anterior wall including Halban's fascia and urethra) are the most usual sites of stimulation, but stimulation of the periurethral glands (15), breast/nipple or mons (2, pp. 54, 67), mental-imagery or fantasy (2,16), or hypnosis (17) have also been reported to induce orgasm. Orgasms have been noted to occur during sleep (1,18,19), hence consciousness is not an absolute requirement. Cases of "spontaneous orgasm" have occasionally been described in the psychiatric literature where no obvious sexual stimulus can be ascertained (20). The precise mechanism that triggers orgasm has been a topic of debate for many years but, as of yet, no definitive mechanisms have been identified.

Only very recently have investigators examined the brain areas activated during orgasm in women (21). Compared to preorgasm levels of sexual arousal, the brain areas activated during orgasm in women included the paraven-tricular nucleus of the hypothalamus, the periaqueductal gray of the midbrain, the hippocampus, and the cerebellum. Other areas shown to be activated during sexual arousal include the amygdala, the anterior basal ganglia, and several regions of the cortex including the anterior cingulated, frontal, parietal, temporal, and insular cortices (22-24). Some of these areas may be more involved in the perception of sexual stimuli than with the actual triggering of orgasm. Further studies that compare brain imaging during sexual arousal without orgasm with brain imaging at orgasm are needed to determine whether there are any areas of the brain specifically involved in generating orgasm.

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