Let’s Talk About Sex (& Pleasure)!
By Dee Hartmann, PT, DPT
Are you currently having wonderfully pleasurable sex that just happens whenever the urge comes along? If so, way to go! I’m over the moon excited for you!
But if you read that and think, “geeze…don’t I wish”, then please read on.
How much do you know about sex and how it really works? What do you know about your own sexual anatomy? Do you think it’s your partner’s responsibility to “give you an orgasm”? Do you explore your own self-pleasure and, if so, how often? If you have a self-pleasure practice, do you use it during partnered intimacy, either before, during or after the “sex part” (aka – your partner’s penetration and orgasm)? Think about that for a second.
If any of that rings true, you may not know what you don’t know! That’s not a slam on you or your lack to knowledge, as it’s actually quite common to not know. Rather, it just brings to light something that often happens – if you don’t know the ABCs of how sex works, how are you supposed to figure out how to find pleasure in it? Our desire to repeat doing something, be it sexual or otherwise, needs to give us some form of pleasure or satisfaction. So, let’s start at the very beginning.
We’ll take the easy part first – pleasure. In our current world, the word ‘pleasure’ is often highjacked and linked only to sex when, in truth, pleasure is an incredibly important part of our lives. It’s a complex emotion that allows you to experience feelings like enjoyment, satisfaction, and gratification. As a sensory experience, pleasure happens when you take a bite of your favorite food, you enjoy the warmth of a gentle breeze on your face, or you feel a sense of peace when you look at a beautiful, clear-blue sky. Think about that smile that comes to your face when you hear your favorite song or the exhilaration you feel after working out. All those things invite pleasure onboard…but only if you take the time to notice and enjoy them. Experiencing pleasurable activities increases your “happy hormones”, like dopamine, serotonin, endorphins, and oxytocin.1 The more pleasure you’re able to experience throughout the day, the higher those levels go. The fuller your “pleasure bucket” gets, the better you feel! Sensuality’s joy comes to us when we pay attention. On the other hand, when it comes to participating in intimacy, we have to choose whether we want to be sexual. And that, at times, can be messy and often hard to do.
That’s because sexuality is a bit more complicated. It’s complex and multifaceted and includes a range of feelings, behaviors, and identities, and how they relate to things like sexual attraction and expression. Sexuality is certainly about physical attraction and activity, but it also embodies your emotional and romantic being. Depending on your preference and situation, you may be totally content to “just have sex”, whatever that looks like for you. But, on the other hand, maybe you’re game to begin a new sexual journey. What about integrating more sensuality into your sexuality, but with a better understanding of how your anatomy really works?
Maybe you’re someone who found your clitoris at a young age. If so, lucky you! If everything comes together, it works, and you’re okay with that, right on! But again, what if you don’t know what you don’t know? What if it doesn’t work? Then what?
Many times, those of us with vulvas need to work to find our own physical pleasure. That pleasure, by the way, is ours to find, own, and cherish. There’s not a lot of conversation about how the whole clitoris (the female sex organ) looks or works. Truth be told, the full anatomy of the clitoris wasn’t published until 20052 with a full 3D image not published until 2010. Since that time, studies have been done and books written on the topics of clitoral anatomy and function.3
News flash! The clitoris isn’t just that little “nub” above your vaginal opening. The two pictures below show the labeled clitoral anatomy4 and the newest, most up-to-date model of the clitoral structure.5 The clitoral organ straddles the urethra (in orange) and the opening of the vaginal canal (in green). The clitoral body and crura, shown in pink, are analogous to the penis in that it takes on a stiffness with arousal and increased blood flow, but does not become erect. The “nub” or glans, shown in yellow, is home to over 10,000 nerve endings,6 making it quite sensitive with arousal. What you see in purple are the vestibular bulbs extending down from the clitoral glans. They, too, respond to arousal by filling with blood and becoming tumescent. Though the glans win in having the most nerve endings, the whole of the clitoral structure, when aroused, is sensually pleasurable to both touch and vibration.
Hopefully the picture below will help you understand where the clitoris lives. I’ve used my pelvic model along with an unaroused clitoris model (thanks to the amazing Anita Brown-Major.) 7
I hope you’ve gained a better understanding of the anatomy in order to head in the right direction. Exploring and learning how your own body works is important and something that needs to happen when you’re safe, alone, and maybe quietly playing your favorite music and burning lovely, scented candles. If you’re not big on using your fingers for stimulation or it’s not working for you, I’d highly recommend that you get a vibrator (my fave is the We-Vibe TouchX ). Starting with your favorite lube, use your fingers to spread it all over down there between your legs. Using your fingers and/or vibrator, explore the area (but don’t go inside yet), taking inventory of how it feels. Is it nice? Warm? Bumpy? Be patient. It might take awhile to get used to your touch or vibration. There likely will be some areas that feel better than others so make a mental note. After abit, go just inside your vagina on either side with your fingers and/or vibrator where the vestibular bulbs live. That’s where they’re easily stimulated. The more blood flow and aroused you get, the better the sensation will feel. Once you’re back outside, try going up higher and above the clitoris where the pubic hair grows. The body of the clitoris is right in the middle (see photo above). Try moving the fingers and/or vibrator gently back and forth across the clitoral body. Then, going lower, bit by bit and back and forth, see if you can feel something happening inside (If you do, don’t worry! It’s just your pelvic floor muscles getting warmed up for more arousal and orgasm! If not, no worries for now.). If it feels good, gently go to the glans and let your body do what it wants to do. Whether you have an orgasm or not – but it felt good – your time has been well spent!
If you’ve gotten through this for the first time, you’ve begun your personal discovery process! I hope you’ve been enlightened in a way that has ignited your sensual and sexual pleasures enough to do it again. When sensuality and sexuality work together, sex is the best ever! But it takes time, patience…and lots of practice. Remember – your pleasure depends on you! Take the lead and let it happen. Enjoy!
Dee is an internationally recognized author, teacher, and speaker on the treatment of chronic vulvar pain who spent over 27 years devoting her private practice to treating women with chronic vulvar pain, sexual dysfunction, chronic pelvic pain, and bowel & bladder disorders. A pioneer in her field, Dee is currently or has been a member, fellow, president, or board director for a vast array of organizations dedicated to women’s sexual health and pelvic health, including the The American Physical Therapy Association (APTA), The International Pelvic Pain Society (IPPS), The International Society for the Study of Vulvovaginal Disease (ISSVD), The International Society for the Study of Women’s Sexual Health (ISSWSH), The European Society for Sexual Medicine (ESSM), The International Society for Sexual Medicine (ISSM) and The World Association for Sexual Health (WAS). Her research and findings are widely published in journals and books, and she has been a lecturer and instructor at numerous schools, universities, workshops, and conferences around the world. As a sole practitioner in the Chicago metro area for over 27 years, Dee used a functional perspective to help patients decrease pelvic pain and restore health. After closing her clinical practice in 2017, she co-founded the Center for Genital Health and Education, where she continues to develop research on sexual pain with business partner Elizabeth Wood. With an added focus on pleasure, Dee brings much needed, progressive insight into educating people through Vulva Love as well as Pleasure Movement. She and Elizabeth co-authored the book, The Pleasure Prescription: A Surprising Approach to Healing Sexual Pain written to help women find a path from pain to pleasure.
References
- https://www.health.harvard.edu/mind-and-mood/feel-good-hormones-how-they-affect-your-mind-mood-and-body
- O’Connell H, Sanjeevan KV, Hutson JM: Anatomy of the clitoris. In: The Journal of urology, 2005, page 1189-1195.
- Anatomic Study of the Clitoris and the Bulbo-Clitoral Organ. Vincent Di Marino and Hubert Lepdi. Springer, 2014
- The Pleasure Prescription: A Surprising Approach to Healing Sexual Pain. Dee Hartmann and Elizabeth Wood. Luminaire Press. Oregon. 2021
- Dr. D. Haag-Wackernagel. Medintim
- Uloko M, Isabey EP, Peters BR. How many nerve fibers innervate the human glans clitoris: a histomorphometric evaluation of the dorsal nerve of the clitoris. J Sex Med. 2023 Feb 27;20(3):247-252. doi: 10.1093/jsxmed/qdac027. PMID: 36763957.
- clitorate.com.au



