TransMed

Orgasm-Why It Happens,
Why It Doesn't



by Sheila Kirk, M.D.


One dictionary defines it as a "crises or a consummation in love making." Another states that it has to do with simultaneous satisfaction between two people participating in the sex act.

Both definitions miss the mark somewhat and avoid some of the essential ingredients of what orgasm really is.

From an anatomic and physiologic standpoint, the mechanism of orgasm is like so many other stimuli in our bodies initiating messages to be carried by our nervous system. For example, touching a hot stove provokes a rapid withdrawal of the hand and a cry of pain and often a placement of one's finger in the mouth or underwater. The whole episode is recorded in the brain but the reflex arc are in the spinal cord is what functions to pull the hand away. The reflex arc is the message conveyed from receptors in the fingers to the spinal cord and a message to pull away is sent from the spinal cord to withdraw the hand-quickly!

In like manner, stimuli to the genitalia (usually though it could be other anatomy) touch by stroking, rubbing, massaging, entering, etc. transmits to the receptors in the penile skin or the vaginal walls, the message of pleasure. The message goes to small nerves and then to larger nerves and then to the major nerves that convey that message to the brain.

To be sure male orgasm is not the same as female orgasm. In the male some of that message goes to the penis to produce erection and to accessory sex glands to produce the ingredients of the ejaculate. The messages to the female brain will be sent to lubricating glands in the vaginal walls and cervix and even the uterus to secrete lubricating fluid.

Her labia will open or relax for penetration and her lower torso musculature will be stimulated to move her body in rhythm with her partner or to tighten and contract intermittently the vaginal wall musculature. When the stimuli are maximal for both male and female and the response to that stimuli is at peak, the brain will convey message to the areas that are to respond with ejaculation in the male and complete acceptance and final pleasure in the female. All this may come at different times for the two people. It is usually a single event with ejaculation for the male but there can be multiple orgasmic events for the female of different degrees and amplitudes. It's usually pretty assured that it will happen for the male always. It's not a guarantee for the female. While there are circumstances that can limit orgasm for a male individual, they are not as frequent or common as they can be in the female.

In the female comes an overpowering surge of pleasure and gratification for both and then with exhaustion of the nerve conduction system comes relaxation. This is a rather simplistic description of the sexual act leading to orgasm but there are elements in the experience that can be influenced and altered.

To begin with, orgasm doesn't require two people. Individuals male and female can and do bring themselves to orgasm with fantasy as well as with genital manipulation. There doesn't have to be penetration for it either-genital touching and manipulation can be all that is needed.

MTF Orgasm

The genetic male taking a substantial estrogen regimen can have orgasm without ejaculation! Indeed, lack of adequate genital touching or foreplay can diminish or eliminate orgasm as well. Orgasm can be altered by a host of external stimuli as well: a phone ringing, a sound at the door, an intrusion. Orgasm can be infrequent or absent even with the same partner. In multiple sexual experiences, fear or dread can block the stimuli to the nervous system centrally. Fatigue, and substance use i.e. alcohol can influence proper nerve conduction and so can drugs prescribed for medical conditions, i.e. hormones and various psychotropic drugs. Aging and certain diseases of the nervous system and blood vessels influence orgasmic experience. And finally, surgery can be very influential.

Genital reassignment can be one of the many surgical experiences to change one's orgasm experience. Creating of the new vagina in theory should influence orgasm favorably because of the skin receptors in the penile skin and scrotum. Unfortunately, it's not infrequent that this inverted tissue does not conduct stimulus to the nervous system because connections are absent to the nerves leading to the brain. They aren't anatomically in place in the tunnel walls developed to accept the inverted skin.

The surgeon will try to preserve nerve supply in the creation of the pseudo cervix in the top of the new vagina and in the formation of the neo-clitoris. Unfortunately with tissue destruction and revision, connections of preserved nerves with nerve supply to the brain can't always be guaranteed. For this reason, the New Woman may have no vulva, vaginal or clitoral sensation and an important component leading to her sexual gratification is missing.

Another important component that must always be considered is intimacy.

This is engendered by many, many factors existing between two people. Their spiritual closeness, their compatibility, their day-to-day nearness lends to the intimacy that takes orgasm to the ultimate.

While it can be very rewarding and gratifying to one or both in a sexual experience as an act of pure animal pleasure, with intimacy the orgasm can be ecstasy beyond imagination or past experience.

This can be sadly lacking in many relationships and can certainly be the case for post-operative transsexual individuals, who may not be in an intimate relationship. In brief, orgasm has many integral parts that move between correct, functional and intact anatomy and a high level of mental comfort, stability and mutual spirituality.

Why does it work for some and not for others pre-op or post-op? A lot of questions have to be asked and then answered-and it can be difficult at times to find solutions.


Sheila Kirk, MD is a Transgender Medicine Specialist, board-certified in Obstetrics and Gynecology and in practice in Pittsburgh, PA. She is a well-known author and leading authority on transgendered medical care and research. Dr. Kirk provides international and national consultations and referrals to the TG community and health care professionals who assist in their care.

She can be reached the following ways:

    E-mail: SheilaKirk@aol.com
    Phone: (412) 781-1092 Fax: (412) 781-1096
    mailing address: Sheila Kirk, P.O. Box 38114, Blawnox, Pa 15238-8114

Back to Transgender Forum's home page