Betty Dodson with Carlin Ross

Better Orgasms. Better World.

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This is an eye-opening  study on The Presence of Clitoral Knowledge and the Absence of Orgasm for Women. I stumbled across it over the weekend and I had to post it. So worth the read:

ABSTRACT. Women report anorgasmia and other difficulties achieving orgasm. One approach to alleviating this problem is to teach women about the clitoris. This assumes that women lack information about the clitoris and that knowledge about the clitoris is correlated with orgasm.

Using a non-random sample of 833 undergraduate students, our study investigates both assumptions. First, we test the amount of knowledge about the clitoris, the reported sources of this knowledge, and the correlation between citing a source and actual knowledge. Second, we measure the correlation between clitoral knowledge and orgasm in both masturbation and partnered sex. Among a sample of undergraduate students, the most frequently cited sources of clitoral knowledge (school and friends) were associated with the least amount of tested knowledge.

The source most likely to correlate with clitoral knowledge (self-exploration) was among the most rarely cited. Despite this, respondents correctly answered, on average, three of the five clitoral knowledge measures. Orgasm in masturbation but not partnered sex. Our results are discussed in light of gender inequality and a social construction of sexuality, endorsed by both men and women, that privileges men's sexual pleasure over women's, such that orgasm for women is pleasing, but ultimately incidental.

[Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address: Website: © 2005 by The Haworth Press, Inc. All rights reserved.]

KEYWORDS. Sexuality, sexual behavior, sex education, orgasm, sexual pleasure, youth, power, institution of heterosexuality. Whether sexual information successfully translates into knowledge and whether this information and knowledge is reflected in behavior is an empirical question. We investigate this by analyzing whether sources of information about sex convey knowledge about the clitoris and whether knowledge about the clitoris is related to the occurrence of orgasm for women. Our study had two parts. First, individuals may not know or investigate practical information about the clitoris or its function. We investigated the degree of knowledge about the clitoris among individuals, and, if respondents were informed, where this knowledge was acquired. Second, cultural conditions may suppress the use of that knowledge when it exists. The link between the experience of orgasm and knowledge has not, until now, been investigated quantitatively. We explored whether clitoral knowledge was associated with the frequency of orgasm experienced by women. In sum, focusing on clitoral knowledge as our central variable, we explored the relationships between sources of information about the clitoris, clitoral knowledge, and women's experience of orgasm. We were particularly interested in whether gender inequality mediated the transmission of knowledge and its application.

BACKGROUND
Our approach was social constructionist in that we understood sexuality to be historically and culturally contingent instead of biologically determined (Foucault, 1978; Weeks, 1985). Heterosexuality is a "political institution" in that it serves to enforce gender hierarchy with pre- scribed rules of femininity and masculinity (Rich 1980, p. 637; see also Connell, 1987; Weeks, 1985). The institution of heterosexuality operates, in part, through the social construction of the sexual body, the "nature" of sexuality, and the manifestation of these ideas in our bodies and bodily processes (Connell, 1987; Laqueur, 1990). If a pattern in sexuality emerges, we interpret it as a product of social, instead of biological, forces because of the different socialization and structural positions of women and men and the tendency to emphasize gender difference over similarity (Laqueur, 1990; Tiefer, 1995; Weeks, 1985).

We are thus not interested in positing an essential sexuality for women or men, nor are we positing an essential difference or similarity between male and female sexuality. Instead, differences and similarities are interpreted as outcomes of social processes. Some may interpret the frequency with which men and women, on average, experience orgasm as natural and find it unproblematic. Others may interpret the pattern as problematic and propose a solution (implying a moral best or ideal). In contrast to both of these interpretations, we are interested in the pattern as a social artifact that illuminates Western cultural values and their contradictions.

One aspect of the social construction of the sexual body relevant to this study is the relative invisibility of the clitoris. In various kinds of texts, the vagina is often presented as the primary site of female sexual pleasure and the clitoris is ignored or presented in greater brevity than the vagina or the penis.

(Braun & Kitzinger, 2001 on dictionaries; Holland et al., 1998 and Moore & Clarke, 1995 on anatomy texts; Levine, 2002 and Ogletree & Ginsburg, 2000 on sex education texts; Scully &
Bart, 1972 on gynecology texts).

While sex manuals and therapy have paid explicit attention to female sexual pleasure, critics argue that they reinforce gender hierarchy in that her orgasm is something that ". . .men are expected to master and control" (Vance, 1989, p. 12; see also Altman, 1989; Jackson & Scott, 1997). Furthermore, clitoral stimulation often remains only a prelude to coitus or "real sex" (Maines, 1999; McPhillips et al., 2001; Pitts & Rahman, 2001; Sanders & Reinisch, 1999).

Sex education is deeply gendered in ways that reflect this social construction of the body and of sexuality. Boys' sexuality is generally overtly linked with pleasure, for example, the insistence of the male sex drive, wet dreams, and orgasm in the context of reproduction (Vance, 1989). Conversely, sex education associates female sexuality primarily with reproduction (Beyer & Ogletree, 1996; Holland et al., 1998; Levine, 2002) or presents females solely as victims of coercion (Beyer & Ogletree, 1996; Fine, 1988).

As with teachers in the classroom, parents at home often do not discuss the location, function, existence of the clitoris (Kreinin, 2002; Ogletree & Ginsburg, 2000) or pleasurable aspects of sex (Brock & Jennings, 1993; Tolman, 1994). Holland and colleagues (1998, p. 80) argue that "one of the sources from which young women learn about sex encourages or equips them to pursue sexual autonomy" (see also Thompson, 1989). Instead, girls are taught to think about their sexuality as something that can "get them into trouble" and are more likely than teenage boys to associate sexual desire with violence, disease, pregnancy, and social opprobrium (Tolman, 1994). The effects of the erasure of the clitoris from discourse and the concurrent privileging of male sexual pleasure can be seen in adult women's reports of their experiences. The most recent representative national survey of sexuality (Laumann et al., 1994) reported that, while 75 percent of heterosexual men reported having orgasms from partnered sex on a regular basis, only about 29 percent of women reported the same (see also Kinsey, 1958). We argue that, if our society intensely valued female orgasm, women would experience orgasms at a high rate regardless of any biological predisposition. (Note that women who have sex with women report orgasms about 83% of the time [Douglass & Douglass, 1997; see also Thompson, 1989].)

We do not propose an ideal rate of orgasm for women or that the gap between men and women naturally is or morally should be closed. Instead, we interpret the different rates of orgasm as symbolic of the devaluing of women's orgasm and the privileging of male sexual pleasure encoded in the institution of heterosexuality. Since it is the ". . . male body and its needs that shape the normalized heterosexual encounter" (Holland et al., 1998, p. 108), we would expect "real sex" to be conflated with coitus because it largely results in orgasm for men (Laumann et al., 1994). We suspect that, if either partner prioritizes male pleasure or believes the other to do so, knowledge about female orgasm may be absent or remain unapplied.

An empowerment politics, in which women are taught about their sexual pleasure and how to negotiate it (Holland et al., 1998; Vanwesenbeeck, 1997), assumes that men and women have equal resources and power with which to negotiate (Jackson & Scott, 1997). However, in a system of gender inequality, her subordinate position may be less important to the woman than the (sometimes critical) benefits she gains from her relationship to her partner. In this case, "half of the heterosexual couple is expected to sacrifice orgasmic mutuality in order to avoid the inevitable stresses on the relationship caused by rocking the androcentric boat" (Maines, 1999, p. 119). Furthermore, if the orgasm gap is interpreted as biological (Pastor, n.d.), some women may not expect their sexual encounters to be orgasmic, while the rest quickly learn that it is not and adjust their expectations accordingly (Holland et al., 1998; Levine, 2002; Vanwesenbeeck, 1997).

The social construction of the sexual body and sexual activity combined with the erasure of the clitoris in scientific and educational discourses suggests that the relatively low rate of orgasm for women may be related to a lack of knowledge. Furthermore, if heterosexuality enforces female passivity (in sex and elsewhere), knowledge may be mired in power relations that inhibit its application. These theoretical interests motivated our study. First, we explored the sources of information respondents believed were helpful in learning about the clitoris. Second, we assessed their level of knowledge about the clitoris. Third, we explored the relationship between the sources respondents reported using and their level of knowledge to investigate whether some sources were associated with greater clitoral knowledge than others. Last, we investigated the extent to which levels of clitoral knowledge were related to differences in the frequency of orgasm reported by women with masturbation and partnered sex. This allowed us to investigate whether
clitoral knowledge might contribute to closing the orgasm gap.

METHODOLOGY
Study Sample
Our University human subjects board reviewed and approved our survey on the condition that we remove questions related to the respondent's race (to ensure confidentiality when there are so few non-white students). All respondents received and signed a letter that explained informed consent and the voluntary and anonymous nature of their participation. The survey of 28 questions addressing respondents' high school sex education, sexual knowledge, behaviors, and experiences was administered to 985 undergraduates at the University of Wisconsin-Madison during Spring and Fall 2002. The survey was administered in three introductory level sociology courses: Survey of Sociology, Criminology, and Human Sexuality. Each of these courses fulfills a general education requirement and draws a wide range of students.

Surveys were distributed as respondents entered the classroom. After class officially began, respondents were asked to volunteer and were given 20 minutes. The students in the Human Sexuality class were surveyed the first day. Comparing the responses from the Sexuality class and the other classes did not reveal a pattern of significant differences. Ninety-eight percent of the surveys were returned. Respondents who skipped critical questions (64) were excluded, as were the self-identified gay or lesbian respondents (18), since too few of them were included for meaningful quantitative analysis. Our final sample consisted of 657 women and 226 men, for a total of 883 respondents (of these, 389 women and 140 men were given the second version of the survey in the Fall of 2002 with additional questions). Male and female respondents were, on average, 19.66 and 19.32 years old respectively. Respondents were overwhelmingly freshmen or sophomores (76 percent of women and 72 percent of men), and 99 percent of both men and women were single and had never been married. Comparison of the demographics of our sample with the demographics of the University as a whole (not shown) suggested that our sample was fairly representative of the general population of the University, though they were more likely to be female and freshman.

Clitoral Knowledge and the Experience of Orgasm for Women

Among all sexually active women in our sample, 39 percent usually or always had an orgasm in partnered sex. Among the 105 sexually active women who earned a perfect score on the clitoral knowledge measure, 40 percent usually to always had an orgasm with a partner (not shown). A perfect score on our clitoral knowledge measure was associated with an increased rate of orgasm for women of only one percent. This suggests that knowledge alone did not translate into orgasm for women. Next we explored whether increased knowledge of the clitoris correlated with a higher rate of orgasm in masturbation and partnered sex Wade, Kremer, and Brown 131

(Table 7). For women who reported masturbating, clitoral knowledge correlated highly and positively with the rate of orgasm in masturbation. The lowest mean score was among women who never have orgasms with masturbation and the highest mean score, almost 20 percent better, was among women who always did. In contrast, the relationship between clitoral knowledge and frequency of orgasm in partnered sex was not statistically significant. Variation in knowledge accounted for very little of the difference in frequency of orgasm in partnered sex.

Furthermore, women who always had an orgasm with their partner shared the highest mean score with women who never did. If only a few such women were observed they could, perhaps, be explained away as "anorgasmic" women who sought out knowledge about the clitoris specifically because they did not have orgasms with their partners. Women who did not experience orgasm with their partners, however, accounted for 28 percent of the sexually active women in the sample. The fact that women who never had orgasms with their partners scored as well on the clitoral knowledge measure as women who always did helps explain why the orgasm gap is not closed significantly when considering only the most knowledgeable women.

These 124 knowledgeable women who never experienced orgasm with their partners, when compared with other women, were approximately the same age, were as likely to cite any particular source as most important, and experienced orgasm with masturbation at approximately the same rate. They also were not significantly different in likelihood of receiving clitoral stimulation, faking orgasm, extent of their secondary school sex education, and length of relationships (a discussion of these measures is available on request). Not only did they not differ on these measures, when they did significantly differ, it was in the directions expected to increase the frequency of experiencing orgasm with a partner. They were significantly more likely to masturbate (p < .01) and more often cited their partner (p < .05) and self-exploration (p < .05) as important sources of information about the clitoris (but not more likely to have ranked them first). This explains their high score on the clitoral knowledge measure and suggests that cultural forces may inhibit the use of their knowledge.

DISCUSSION
This project investigated knowledge about the clitoris and the application of this knowledge. We found that the sources of information most often reported by our respondents were the same sources least likely to correlate with a high level of knowledge. Similarly, sources which correlated highly with clitoral knowledge were among the least likely to be used. These findings both confirm and complicate prior research that shows that both parents and school sex ducation do not teach about sexual pleasure for women (Beyer & Ogletree, 1996; Brock & Jennings, 1993; Fine, 1988; Holland et al., 1998; Kreinin, 2002; Le-vine, 2002; Ogletree& Ginsburg, 2000; Tolman,1994).

Indeed, as prior research suggests, our students do not appear to be learning about the clitoris from these sources or from friends (or they are learning and forgetting). However, they did report that these served as sources of information about the clitoris. Further research may help tease out the complex relationship between teaching, memory, and knowledge about sexuality.

Despite the incongruence between source use and usefulness of source, respondents showed a good degree of knowledge about the clitoris. They correctly answered, on average, over three out of five clitoral knowledge questions. The majority of our respondents were able to find the clitoris on a diagram of the vulva and they performed adequately on three of the four true/false questions addressing the relationship among the clitoris, coitus, and achieving orgasm for women. We judge this to be an adequate level of knowledge about the clitoris.

This suggests that even if information about the clitoris is sometimes unavailable (in school, from parents, and otherwise, see Holland et al.,1998; Moore & Clarke, 1995; Scully & Bart, 1972), our respondents were receiving this information. Only non-pornographic media was significantly related to clitoral knowledge across all treatments for both men and women. This suggests that media, a source of information spurned by many, may indeed have presented our respondents with useful knowledge about the clitoris.

It is interesting that men's clitoral knowledge is, in general, equivalent to women's, despite the fact that women have always been able to access their own bodies as a useful source of information about the clitoris. In fact, if we remove women who cite self-exploration as useful, making them more similar to men in terms of availability of information, women's mean score on the clitoral knowledge measure is 2.69 compared to 3.12 for men (p < .001). One of the mysteries produced by this study is the source of men's knowledge about the clitoris. They appear to have a generalized knowledge that is at least as high as women's and not substantially related to the (conscious or remembered) use of different sources. Conversely, despite the fact that women's clitoral knowledge was more clearly related to using various sources, clitoral knowledge did not necessarily translate into orgasm for women. Many of the women in our sample that had information about the clitoris did not experience frequent orgasm with their partners.

The fact that women with a perfect performance on the clitoral knowledge measure do not experience more orgasms suggests that while knowledge may help some individual women, for women as a group it does not increase the frequency of orgasm. Unapplied knowledge about the clitoris suggests that knowledgeable women, or their partners, do not give priority to orgasm for women. If she desires an orgasm, a woman may recognize that revealing her knowledge or asserting her desires is incompatible with feminine attractiveness under a system that perpetuates gender inequality by enforcing female passivity (Thompson, 1989; Tolman, 1994).

This suggests that information alone cannot necessarily compensate for a culturally prescriptive institution of heterosexuality that shapes interpersonal sexual interaction (Connell, 1987; Rich, 1980; Weeks, 1985). If orgasm for women is somewhat irrelevant to a complete and satisfying sexual interaction, her orgasm may be pleasing and pleasurable for both partners, but ultimately incidental.

Limitations
It is important to interpret our results with caution because of several features of our ethodology. First, our findings are not generalizable since our sample consisted entirely of students at our academic institution. Homogeneity in age, class, race, and geographic location, at the very least, limits the generalizability of our findings. Since our sampling method was non-random, our findings cannot be generalized even to this population.

Second, we did not use tested or standard survey instruments. The survey instrument was unique to this study, and its validity was not assessed. Influential variables may not have been included. The survey instrument itself played a role in constructing these findings. Further, our data were potentially biased due to the method of collection. Since our survey relied on recall, data was potentially biased by memory distortion. In addition, since our survey dealt with a sensitive topic yet was completed in limited privacy (classrooms), it is possible that our findings were affected by this context leading, for example, to falsification or other reporting bias.

Third, in that the terms and concepts were socially constructed, we were, to the best of our ability, measuring partially shared cultural understandings. To a great degree, adequate agreement about the meanings of terms (for example, "orgasm") was assumed. Further, given the socially constructed nature of the topic, any method that claimed to measure some "truth" about respondents must be carefully interpreted. Embedded within all research premised on a social constructionist framework is a contradiction between the belief that reality is plastic and that reality is measurable. We acknowledge this contradiction, a general epistemological feature of sociological research in this vein, and we have tried to negotiate it in this manuscript.

CONCLUSION
Our results suggest that knowledge does not necessarily give women the agency required to pursue sexual health. Information alone may not be able to compensate for a culturally prescriptive institution of heterosexuality that shapes interpersonal sexual interaction in ways that reinscribe gender inequality by enforcing female passivity (Connell, 1987; Rich, 1980; Weeks, 1985). If acting on her clitoral knowledge means she no longer qualifies as properly feminine (Thompson, 1989; Tolman, 1994), a young woman may not give priority to her own orgasm. This reminds us that anorgasmia may not always have a biomedical cause. Furthermore, the cultural devaluation of female orgasm by men and women alike may constrain women's ability to choose it, and this choice represents only one of the many she may not feel free to make. In this sense, our findings are directly relevant to other means of safeguarding health, such as setting sexual boundaries and using condoms. We cannot expect individual women to make smart choices about their sexual health as if they had equality with individual men, when they are embedded in a social structure in which they do not.

Lisa D. Wade
Emily C. Kremer

Jessica Brown