Functional MRI of the Brain During Orgasm In Women

As a phenomenon worthy of neurobiological research, orgasm hasreceived less attention than its impact on human perceptual experiencewould predict, likely, at least in part, because of its inherently sensitive(inter)personal properties and historically limited research funding. Weinvestigate orgasm for two reasons: first, to explore further its intrigu-ing neurobiological reality; second, to validate the experiences of certaingroups of women who report that they feel orgasms (a) despite theirhealth professionals denying the possibility due to the women’s neuro-logical condition, for example, complete spinal cord injury; (b) in

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Functional MRI of the BrainDuring Orgasm In Women

Barry R. KomisarukBeverly Whipple

Rutgers, The State University of New Jersey

Women diagnosed with complete spinal cord injury (SCI) at T10 or higherreport sensations generated by vaginal-cervical mechanical self-stimulation(VCSS). In this paper we review brain response to sexual arousal andorgasm in such women, and further hypothesize that the afferent pathwayfor this unexpected perception is provided by Vagus nerves, which bypass thespinal cord. Using functional magnetic resonance imaging (fMRI), we ascer-tained that the region of the medulla oblongata to which the vagus nervesproject (the Nucleus of the Solitary Tract or NTS) is activated by VCSS. Wealso used an objective measure, VCSS-induced analgesia response to experi-mentally-induced finger pain, to ascertain the functionality of this pathway.During VCSS, several women experienced orgasms. Brain regions activatedduring orgasm included the hypothalamic paraventricular nucleus, amyg-dala, accumbens-bed nucleus of the stria terminalis-preoptic area, hippocam-pus, basal ganglia (especially putamen), cerebellum, and anterior cingulate,insular, parietal and frontal cortices, and lower brainstem (central gray, mes-encephalic reticular formation, and NTS). We conclude that the vagus nervesprovide a spinal cord-bypass pathway for vaginal-cervical sensibility andthat activation of this pathway can produce analgesia and orgasm.

Key Words:

brain imaging. fMRI, orgasm, spinal cord, vagina, Vagus nerves.Barry R. Komisaruk, PhD, is a Professor II in the Department of Psychology, andBeverly Whipple, Ph D, RN, FAAN, is Professor Emerita of the College of Nursing, Rut-gers, The State University of New Jersey, Newark, NJ. The authors gratefully acknowl-edge the following funding support: The Christopher Reeve Paralysis Foundation (BRK and BW), NIH-R25GM60826 (BRK), and the Charles and Johanna Busch Foundation,Rutgers, The State University of New Jersey (BRK and BW). Figures 1, 2, 4, and 6-9 arereprinted from Komisaruk et al. (2004) with permission from Elsevier. Correspondenceconcerning this article should be address to Barry R. Komisaruk, Department of Psychol-ogy, Rutgers, The State University of New Jersey, Newark, NJ 07102.(brk@psychology.rutgers.edu)

response to vaginal (“G spot”) stimulation; (c) in response to cervicalstimulation; and/or (d) by thought alone, without physical stimulation.

Orgasms–Genital and Nongenital

Although orgasm is characteristically a response to genital stimula-tion, there are many reports that other types of sensory stimulation alsogenerate orgasms, some perceived as feeling “genital” but others as“nongenital.” For example, we have documented cases of women whoclaim that they can experience orgasms just by thinking, without anyphysical stimulation; their bodily reactions—doubling of heart rate,blood pressure, pupil dilation, and pain threshold—bear out their claim(Whipple, Ogden, & Komisaruk, 1992). Men and women who havespinal cord injury have described to us that the skin near their injuryfeels hypersensitive to touch. Painful and intensely aversive if acciden-tally brushed, when stimulated in the right way and/or by the right per-son, touch can produce orgasmic feelings that may or may not beperceived as emanating from the genitalia. One woman with completespinal cord injury at the upper thoracic level experienced an area of hypersensitivity at the neck and shoulder and claimed to have orgasmsfrom stimulation of the skin of her neck. In the laboratory, her heartrate and blood pressure increased markedly during self-application of avibrator to her neck-shoulder junction, and she described experiencingan orgasm accompanied by a “tingling” sensation in her vagina (Sipski,Komisaruk, Whipple,

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Alexander, 1993). Kinsey, Pomeroy, and Martin(1948), Masters and Johnson (1966), and Paget (2001) each reportedwomen who stated that they experience orgasms from breast or nipplestimulation; in addition, Paget (2001) described orgasms produced bystimulation of mouth or anus in women and men. The heroine in thenovel

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, realizing that she had had an orgasm when her loverheld her hand, says that she can experience orgasms from stimulationanywhere on her body (Alther, 1975).Consideration of the sensory pathways likely activated in some of theabove examples can suggest the bases for these experiences of orgasm.The pelvic nerve provides afferent innervation of the vagina, cervix, andrectum (Berkley, Hotta, Robbins,

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Sato, 1990; Komisaruk, Adler,

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Hutchison, 1972; Peters, Kristal,

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Komisaruk, 1987). Because activa-tion of this nerve through vaginal stimulation can generate orgasm, it isnot surprising that when activated nongenitally (i.e., rectally) it canalso generate orgasm. Indeed, women have described feeling the need todefecate during uterine contractions at parturition, indicating a secondcontext in which “cross-talk” exists between at least two organs inner-vated by the same (pelvic) nerve, leading to a form of referred sensation.

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BRAIN MRI OF WOMEN DURING ORGASM3

In men, afferent activity from the prostate (via the hypogastricnerve) during ejaculation contributes to the pleasurable sensation of orgasm, on the basis that prostatectomy is reported to diminish thisfeeling (Koeman, Van Driel, Schultz,

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Mensink, 1996). The orgasm-producing role of this afferent activity could help account for the experi-ence of orgasm in men receiving mechanostimulation of the prostateduring anal intercourse, which would add to the afferent activity gener-ated via the pelvic nerve anal afferents. The hypogastric nerve also con-veys afferent activity from the uterus and cervix (Berkley et al., 1990;Bonica, 1967; Peters et al., 1987). The orgasmic role of afferent activityvia this nerve in men may help to account for the parallel drawnbetween the feelings generated through uterine and vaginal stimulationduring childbirth and during orgasm (Newton, 1955).The orgasm-inducing effect of breast or nipple stimulation may berelated to the functional convergence in the central nervous system of their afferent (spinal nerve) pathways with vaginal and cervical affer-ents (for a review see Komisaruk & Whipple, 2000). The evidence of such convergence is that, in women, oxytocin is secreted from the poste-rior pituitary into the systemic circulation in response to either of thesetwo sources of stimulation, in the “milk-ejection” reflex and the Fergu-son reflex, respectively. The oxytocin released by suckling stimulatesthe contraction of myoepithelial cells that envelop the milk-secretingglands in the breast, forcibly expelling milk. The released oxytocin canconcurrently stimulate the uterine smooth muscle to contract. Con-versely, intrauterine pressure and the consequent mechanical stimulusagainst the cervix exerted by the fetus at parturition stimulates pelvicnerve afferents that lead to release of oxytocin in a positive feedbackmechanism, the Ferguson reflex (Ferguson, 1941). The oxytocin thusreleased can also produce expulsion of milk from the breast in womenwho are lactating at term. Because the final common pathway for oxy-tocin secretion is primarily the paraventricular nucleus of the hypothal-amus (and secondarily the supraoptic nucleus of the hypothalamus;Cross

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Wakerly, 1977), breast, nipple, cervical, and vaginal afferentactivity each evidently converge on these nuclei.Oxytocin is released into the systemic circulation during orgasm inwomen and men (Carmichael et al., 1987; Carmichael, Warburton,Dixen,

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Davidson, 1994; Blaicher et al., 1999). We have reported thatthe paraventricular nucleus of the hypothalamus is activated duringorgasm in women (Komisaruk et al., 2004, and this article). The percep-tion of orgasm is most likely

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produced by oxytocin, for injection of oxytocin neither induced nor intensified orgasm (Gooren, 1991). (How-ever, there is a report based on a single case of a woman who described