In pursuit of pleasure: A biopsychosocial perspective on sexual pleasure and gender
Ellen Laan (2021)
The ’dangers’ of sexual pleasure
Deep-rooted ideas that uncurbed sexuality is dangerous reinforce many caretakers’ and parents’ fears
that a positive approach to sexual health and sex education will entice innocent children and
adolescents into engaging in sex that they are not yet able to consent to. Yet, a recent review of 23
studies that looked at determinants of sexual pleasure at first partnered sexual experiences, found
that young people with the agency to consider what a pleasurable first sexual experience may mean
to them, experienced more pleasurable sexual debuts. Also, there is substantial and convincing
evidence that comprehensive sex education, even the kind that stays clear of anything remotely
associated with sexual pleasure, is associated with heterosexual adolescents engaging in penile-
vaginal intercourse at a later age, with more consistent condom and contraception use, and lower
unwanted pregnancy rates in both developed and developing countries.
Health benefits of pleasure
In a large sample of young women, sexual pleasure was positively related to autonomy, self-esteem,
and empathy. These associations were less prominent in young men. For older men, longevity
(levensduur) and better physical health were rather consistently positively associated with frequency
of sexual activity. Interestingly, longevity in heterosexual women was associated with enjoyment of
sexual activity, not with sexual frequency per se. And in line with these findings, a recent
representative German survey on sexual behaviors found that sexual pleasure was associated with
various health indicators (e.g. communication about sexually transmitted infections, condom use,
absence of sexual problems, and orgasm frequency), with sexual pleasure predicting sexual health
outcomes more strongly in women than in men.
The gendered context of pleasure
Around the world, sexual complaints are more prevalent in heterosexual women than in heterosexual
men. In most contemporary societies, heterosexual women’s sexual pleasure is still generally
subordinated to heterosexual men’s pleasure. In (religious) traditional cultures sexual pleasure of
women is judged to be more dangerous and undesirable than that of men, or even considered
irrelevant, probably because sexual pleasure of women does not appear to be directly related to
reproductive success. Consequently, only those problems that interfere with sexual pleasure of men
or with procreative sex are deemed worthly of complaint or treatment, while sexual issues that are
important and distressing to women (and individuals engaging in non-procreative sex), including a
lack of sexual pleasure, go unnoticed.
Current gender differences in experienced sexual pleasures and displeasures
Orgasm gap
Sex as experienced by women appears to be substantially less positive and may come at a greater
cost than the sex that men experience. Using a large sample size, Frederick et al. found that men of
all sexual orientations were more likely to orgasm than women. The largest sexual pleasure gap was
found between heterosexual women. Incorporating oral sex along with other sexual activities during
a sexual encounter was of particular importance for more frequent orgasms in women. Penile-vaginal
intercourse without additional glans clitoris stimulation results in orgasm in only about 25 to 30% of
heterosexual women. Women with a female sex partner had a three times greater likelihood of
,always having an orgams during partnered sexual activity than women with a male sex partner.
Women who downplay the importance of orgasm may perhaps do so to reduce cognitive dissonance.
By saying that orgasms are not important, any distress accompanying difficulties with orgams might
be reduced. Women who reported finding orgasms important were also the ones who had greatest
ease in experiencing orgasms.
Painful sex
The prevalence of pain or discomfort during penile-vaginal intercourse is high among women. In a
large representative sample of Dutch adolescents between 12 and 25 years, 46% of women reported
having experienced pain during penile-vaginal intercourse, with 11% experiencing pain ‘regularly’ to
‘always’. Only half of these women thought that having pain was a problem. Not engaging in penile-
vaginal intercourse is, by definition, not a behavioral choice that women with dyspareunia (pain
during sex) make. Heterosexual women who seek help express concern that their partner will leave
them if they do not give him access to penile-vaginal intercourse. Wanting to be ‘normal’ is also an
important determinant of persisting in painful penile-vaginal intercourse. These findings suggest that
beliefs that penile-vaginal penetration is a ‘natural’ sexual act to which men are entitled, justifying a
relationship breakup, are alive and well.
Violent sex and ‘scary’ sex
Global WHO estimates indicate that about 1 in 3 women worldwide have experienced sexual intimate
partner violence or non-partner sexual violence in their lifetime, with up to 50% of these acts of
sexual violence being committed against girls under 16. The prevalence of partner sexual violence in a
12-month period involving 44 countries was found to be around 4% in many high-income countries,
but at least 40% in some low-income countries. The lifetime prevalence of rape (or attempted rape)
among women is around 18-19% in several samples in the United States and between 4 and 17%
across several European countries. In several studies around the world, the lifetime prevalence of
completed or attempted rape among men is estimated to vary between 1 and 5%.
Members of marginalized groups face substantially increased vulnerability to sexual victimization.
These include individuals with disabilities, sexual and gender minorities, homeless individuals,
individuals engaging in various kinds of sex work, and members of indigenous populations. Women
were more likely to having felt scared during sex. For women of all sexual orientations, scary sex
included being choked, threatened, held down, hit, asking for a man to stop which he doesn’t. For
men, scary sex were described as having sex with a woman who is menstruating or receiving oral sex
while engaging in thoughts that the sex partner may have had sex with someone else the day before.
Capacity for sexual pleasure
Childhood genital responses and behavior
Evidence is accumulating that women and men do not differ in their biological capacity for sexual
response, as evidenced by observations of genital responses and behavior of girls and boys from birth
and onwards. Girls and boys commonly touch their genitals before the age of 5 and even prenatal
self-touch and orgasm-like reflexes have been observed in both sexes.
Masturbation is a common form of sexual expression in children that have reached puberty, with
boys generally starting masturbation at a younger age than girls. Boys typically learn about
masturbation from their male peers through being told or watching them, whereas girls typically
,learn about masturbation through self-discovery. The fact that masturbation is condoned or even
encouraged in boys but not or to a lesser extent in girls can have repercussions on the use and
efficacy of masturbation as a source of pleasure. By the time they are ready to engage in sex with
another person, boys may be equipped with greater knowledge than girls about what type of genital
stimulation is pleasurable to them.
Responsivity to sexual stimuli
In contrast to popular opinion that women are not very responsive to visual sexual stimuli, women do
respond to visual sexual stimuli with genital sexual arousal. Visual sexual stimuli yield highest genital
responses, more so than erotic literature or engaging in erotic fantasies. In sum, women and men do
not seem to fundamentally differ in either genital or central responsitvity to sexual stimulation.
Processing of sexual stimuli by the brain generates blood flow to the genitals with apparent ease in
women and in men. So, even the mechanism of arousal is similar in women and men.
Sexual desire
Interestingly, studies using self-report questionnaires that conceptualize sexual desire as a trait
consistently find gender differences in the stereotypical direction (with men reporting higher desire),
whereas studies that have individuals rate their feelings of sexual desire immediately following
exposure to a sexual stimulus fail to find differences between women and men.
To conclude, the almost universal idea that men have higher levels of desire than women and that
this is an innate capacity, an idea reinforced by evolutionary theories and reproductive strategies,
may depend on how sexual desire is conceptualized and measured. If sexual desire is seen as
emerging from rather than preceding ‘incentivized’ sexual arousal, as incentive motivation theory
posits, gender differences in reported feelings of desire may be the result of differences in incentive,
or sexual context, quality rather than reflective of innate differences.
Sex drive, ‘sex’ hormones, and reproductive success
In contrast to most animals, in humans neither the ability to engage in sexual activity nor the
motivation to do so is under strong hormonal control. The fact that men have 10-20 times more
testosterone, expressed in absolute levels, than women, has often wrongly been equated with the
notino that men have an innately stronger sex drive which increases as a function of deprivation.
Even though a certain level of testosterone is required for men’s brains and genitals to be sensitive to
sexual stimuli, normal physiological testosterone levels above that minimum threshold seem
unrelated to levels of sexual desire. The same may be true for women, for whom testosterone is also
thought to be associated with their sexual arousability. In short, not absolute but rather relative
hormonal levels may allow women and men to be sensitive to sexual stimulation.
It is usually ignored that for (non-pregnant) women absolute testosterone levels are, on average, four
times higher than their absolute estrogen levels. And although estrogens are thought to be the
‘female sex hormone’ in reality no good evidence exists that they are related to women’s sensitivity
to sexual stimuli. In sum, the role sex hormones play in male and female reproduction should not be
equated with their role in men’s and women’s sexuality.
Labeling the vagina a reproductive rather than a sexual organ, would help women to no longer feel
sexually dysfunctional when they have difficulty becoming sexually aroused, let alone experience
orgasm, from penile-vaginal intercourse without direct or indirect stimulation of their pleasure organ,
, the clitoris. After all, who would expect men to reach orgasm without stimulation of the penis?
Sexual behaviors and attitudes: gender differences or gender similarities?
Only 4 gender differences with moderate effect sizes were found: masturbation frequency, use of
pornography, number of sex partners, and attitudes about casual sex, with men scoring higher on all
variables. Gender differences are becoming smaller with time. Taking a closer look at each of these
four differences suggests that methodological issues rather than true gender differences may be at
play. A growing body of research demonstrates that gender differences in sexual behavior can
partially be explained by social-contextual factors, including stigma and safety. In another study,
Conley et al. showed that female casual sex accepters are judged more negatively than male casual
sex accepters and that this backlash influences women’s decisions regarding whether to engage in
casual sex. More recently, Conley and colleagues showed that men’s consistently more positive
reactions to casual sex offers may be related to them being more likely than women to experience
sexual pleasure and orgasm during casual sex.
To conclude this section on the capacity for sexual pleasure, women and men do not seem to differ in
their biological or psychological capacity for sexual pleasure. Rather than seeing sexual pleasure as a
by-product of reproduction, reproduction may be better conceptualized as a by-product of sexual
pleasure. Finally, women and men are, in principle, equally arousable. The current pleasure gaps
represent not a fundamental absence of sexual desire in women but rather a severe neglect of female
erotic potential. When contextual and sociocultural factors are removed and opportunities for
sexual pleasure are increased, the sexual pleasure gender gap is likely to be removed as well.
Opportunities for sexual pleasure
Does pleasure breed desire?
When hetero-sexual women expect more opportunities for sexual pleasure based on earlier
experiences or when they prioritize their own sexual pleasure (at least as much as that of their male
partner), they are more likely to desire sexual activity. Increased opportunities for sexual pleasure
may occur either by a gradual break-down of gendered sexual scripts, by (educational) efforts to
have women stop deprioritize their own sexual pleasure in heterosexual encounters compared to
thatof their partner, or by providing adolescents with accurate information about stimulation of
whichparts of women’s genital anatomy and which sexual activities are more likely to bring about
pleasure. Changing sexual scripts that prioritize male sexual pleasure are not only likely to increase
pleasurable sexual experiences for women, but also to decrease the likelihood of engaging in
unwanted sexual activity.
The coital imperative
The coital imperative (the common view that penile-vaginal intercourse is the most important of all
sexual activities) but even the mere definition of the word ‘sex’ as penile-vaginal or penile-anal
penetration is likely to provide heterosexual women with fewer opportunities for sexual pleasure.
Also, the pervasive myth that healthy adult women should be able to orgasm through penile-vaginal
intercourse is unfavorable for heterosexual women’s sexual pleasure.
Other gendered practices and scripts
1. 200 million women have undergone some type of genital multilation globally, and annually 3
million girls are at risk of becoming genitally mutilated. A recent systematic review showed that
genitally mutilated women have a greater likelihood for reduced psychological and sexual wellbeing
