Psychosocial and Behavioral Aspects of Women’s Sexual Pleasure: A Scoping Review

Abstract

Objectives

To clarify the psychosocial and behavioral factors related to women’s sexual pleasure.

Methods

A search was conducted on EBSCO and Web of Science databases using the key terms “female sexual pleasure” and “women sexual pleasure” and following PRISMA guidelines.

Results

76 articles were identified, referring to sexual practices, individual factors, interpersonal factors, societal factors, and ways of enhancing sexual pleasure.

Conclusions

Age, sexual experience, arousability, body-esteem, sexual autonomy, and sexual assertiveness seem to benefit women’s sexual pleasure, while sexual compliance and a gender power imbalance seem to compromise it. Additional research regarding non-western and non-heterosexual women is still required.

Introduction

Sexual pleasure is a basic component of sexual health and wellbeing and requires universal recognition and promotion (Ford et al., 2019). Acknowledging this two decades ago, Pan America Health Organization’s recommendations for the promotion of sexual health established a series of principles for promoting pleasure in sexual health. These include the need of recognizing the value of sexual pleasure throughout life in safety and respecting the rights of others (Pan American Health Organization & World Health Association, 2000). More recently, the World Association for Sexual Health (WAS) also formally committed to the goal of achieving recognition of sexual pleasure as a universal right and a component of holistic health and wellbeing in their Declaration on Sexual Pleasure (World Association for Sexual Health, 2019).

Sexual pleasure comprises physical, cognitive, emotional aspects (Boul et al., 2009), as well as social aspects (Rye & Meaney, 2007). Orgasm, a commonly described psychophysiological component of sexual pleasure, has received some attention and been the subject of several literature reviews (Alexander & Rosen, 2008; IsHak et al., 2010; Jani & Wise, 1988; Mah & Binik, 2001; Pitsouni et al., 2018). To these authors knowledge, the existing scientific evidence on psychosocial and behavioral aspects of sexual pleasure remain unsystematized. This should be of particular interest for women as they experience a pleasure gap when compared to men (Crutcher, 2012; Laumann et al., 2006; Mahar et al., 2020) and are more likely to suffer from violations of their rights than do men (Hull, 2008).

Definition of sexual pleasure

As recently outlined in WAS’ declaration of sexual pleasure, this concept is complex, diverse, and multifaceted, including many components in interplay (World Association for Sexual Health, 2019). The biological aspect of sexual pleasure (Pérez & Loving, 2017) manifests as the responses of the organs to hormones, the nervous system, and the genital blood flow (Hull, 2008). Earlier conceptualizations focused on the genital and/or physiological elements of sexual pleasure, distinguishing fore-pleasure (the erotic feelings obtained by stimulation of the genitals and/or other erogenous zones) from orgasmic-pleasure (the explosive pleasure of orgasm) (Abramson & Pinkerton, 2002). Later, sexual pleasure started being acknowledged as having emotional, cognitive, and physical components, as well as mind-body connections, such as “losing oneself” (e.g., Boul et al., 2009; Goldey et al., 2016). Sexual pleasure has been described as the overall enjoyment derived from sexual interaction (Philpott et al., 2006), including a myriad of positive feelings stemming from sexual stimulation (Abramson & Pinkerton, 2002). These feelings are subjective, a result of social constructs, and may include diverse sexual activities (De la Garza-Mercer, 2007; Rye & Meaney, 2007).

Several studies have mistakenly addressed sexual pleasure as equivalent to sexual satisfaction (Renaud et al., 1997), or achieving orgasm (Zurbriggen & Yost, 2004), but at present, research suggests that these constructs are distinct (Pascoal et al., 2016). Sexual satisfaction is described as the affective response that results from the subjective evaluation of both positive and negative dimensions of sexual relationships (Lawrance & Byers, 1995). Orgasm is the psychophysiological experience (Masters & Johnson, 1966) defined as the transient peak sensation of intense pleasure which creates an altered state of consciousness and is accompanied by involuntary, rhythmic contractions of pelvic and vaginal musculature, and by feelings of well-being and contentment (Meston et al., 2004). Although orgasm is an important aspect of sexual pleasure (Parish et al., 2007), these are not synonymous, as many women report pleasure without orgasm (Foldés & Louis-Sylvestre, 2006), and some women report non pleasurable or negative experiences associated with orgasm (Chadwick et al., 2019).

In essence, the transitory experience we call sexual pleasure (Richters, 2009), involves physical, emotional, and cognitive elements interplaying in a complex and individual response that cannot be disconnected from sexual health and sexual rights. These dimensions are well translated in the definition of sexual pleasure proposed by the Global Advisory Board for Sexual Health and Wellbeing:

Sexual pleasure is the physical and/or psychological satisfaction and enjoyment derived from solitary or shared erotic experiences, including thoughts, dreams and autoeroticism. Self-determination, consent, safety, privacy, confidence, and the ability to communicate and negotiate sexual relations are key enabling factors for pleasure to contribute to sexual health and wellbeing. Sexual pleasure should be exercised within the context of sexual rights, particularly the rights to equality and nondiscrimination, autonomy and bodily integrity, the right to the highest attainable standard of health and freedom of expression. The experiences of human sexual pleasure are diverse and sexual rights ensure that pleasure is a positive experience for all concerned and not obtained by violating other people’s human rights and wellbeing. (GAB, 2016)

Assessment of sexual pleasure

The assessment of sexual pleasure varies from one item on a Likert scale in national surveys, such as the National Survey of Sexual Health and Behavior (NSSHB) in the USA, to complex measures of sexual pleasure, such as the Female Sexual Subjectivity Inventory (FSSI, Horne & Zimmer-Gembeck, 2006). The FSSI was developed to measure five distinct factors of young women’s experiences of sexual pleasure and empowerment: sexual body esteem, entitlement to sexual pleasure from self, entitlement to sexual pleasure from partner, self-efficacy in achieving sexual pleasure, and sexual self-reflection. The Sexual Activity Questionnaire (SAQ, Thirlaway et al., 1996) comprised a dimension of pleasure from sexual intercourse along with dimensions of habit, and discomfort with intercourse. Later, the Quality of Sexual Experience Scale (QSE, Sanders et al., 2013) included the level of pleasurability in a general measure of the quality of sexual experiences. More recently, the Sexual Pleasure Scale (SPS, Pascoal et al., 2016) was validated to assess sexual pleasure on 3 items reporting to sexual pleasure experienced from sexual relationships, activities, and intimacy.

Relevance of the current review

Pleasure is a key element of the motivation for and major outcome of sexual behavior (e.g., Abramson & Pinkerton, 2002; Hull, 2008). Some studies indicate pleasure motives as more strongly related to men’s motives for sex than to women’s motives (Basson, 2002; Browning et al., 2000; Carroll et al., 1985; Leigh, 1989; Meston & Buss, 2007; Tang et al., 2012), which may stem from gender inequalities, including women's historical lack of access to pleasure and to expectations of sexual pleasure (Fahs, 2014). Social norms on sexual pleasure may be dictating what is in this case acceptable (Rye & Meaney, 2007) and explain why research has been giving primacy to men’s sexual pleasure (Higgins & Hirsch, 2007). In addition, assuming sexual pleasure and empowerment as male prerogatives discourages female sexual agency and autonomy (Pick et al., 2005), when in fact sexual autonomy and sexual pleasure should be promoted as sexual rights for every individual (Kismödi et al., 2017).

In closing, sexual pleasure is the result of the interaction of biological, psychological, relational, and social factors. In the absence of an ecological model of sexual pleasure it seems relevant to systematize previously acquired knowledge on the several systemic levels at interplay. A scoping review of literature on the psychosocial and behavioral aspects of sexual pleasure of women could minimize the structural disadvantage of women in what concerns sexual pleasure, as well as facilitate the creation and/or expansion of existing models of sexual pleasure. Thus, impacting clinical practice and overall promotion of sexual health, sexual rights, and wellbeing.

Aim

Feminist scholars highlight the importance of women asserting their sexual agency and sexual power for better sexual and interpersonal outcomes (Bay-Cheng & Zucker, 2007), as gendered scripts lead to women prioritizing partner sexual needs instead of their own (Fahs, 2014). However, there seems to be an erasure of sexual pleasure in sexual science research (see Jones, 2019). Although this seems to be changing, as there are several scientific publications on the psychosocial and behavioral dimensions of women’s sexual pleasure, these did not receive the same systematization as their psychophysiological counterparts, such as orgasm. A review of literature focused on these aspects will contribute to inform on the current state of sexual health, systematize knowledge acquired so far and to guide further research and health programs. The aim of this study is to clarify which psychosocial and behavioral factors are related to female sexual pleasure in past research by conducting a scoping review of the literature by answering the following research questions: Which psychological, behavioral, and social factors are related with sexual pleasure in women with no disabilities or known illnesses?

Methods

This systematic review followed the Preferred Reporting Items for Systematic Reviews (Moher et al.) guidelines (Moher et al., 2009, 2015).

Search strategy

EBSCO and Web of Science databases were searched using the key terms “female sexual pleasure” and “women sexual pleasure.”

Eligibility criteria

This systematic review examined articles presenting empirical results concerning the sexual pleasure of self-identified women from 2000 to 2020. In 2000 sexual pleasure was recognized as part of overall sexual health (Pan American Health Organization & World Health Association, 2000), an important landmark for the study of sexual pleasure and the rationale for establishing our review’s timeframe. Papers to be included had to be written in English language, be published in peer-reviewed journals, and specifically target sexual pleasure, either using qualitative tools such as interviews or focus groups, or quantitative tools such as the several sexual pleasure scales described earlier. We excluded theoretical papers, reviews of the literature, case studies, editorials, conference abstracts, and book chapters. Studies pertaining animals, children or adolescents, and men only were not considered for this review. In addition, studies referring to women with physical disabilities or illnesses (e.g., cancer, spinal cord injuries, multiple sclerosis, HIV, and epilepsy) and genital mutilation were also excluded. Moreover, research that solely measured orgasm or sexual satisfaction, was further excluded from this review as they do not match current definitions of sexual pleasure. Finally, we did not include research referring solely to the biological aspects of sexual pleasure as this review focuses on psychosocial and behavioral aspects.

Study selection

The first author screened titles and abstracts of the total papers to be able to extract those meeting eligibility criteria. In a second phase, the first and second authors reviewed the full texts of these articles to verify if these were illegible and relevant to the purposes of this review. This led to the further exclusion of additional articles. Following this stage, the remaining articles were scrutinized by these authors for data collection. Data was stored in a word document by themes. These themes were later refined and organized to produce the narrative results that follow.

Results

An initial search of our key terms identified a total of 1,911 articles, of which only 1,352 remained after removing duplicates. These titles and abstracts were screened to extract the 118 articles meeting this review’s inclusion criteria. Based on full-text reviews of the 118 remaining studies, 42 were further excluded due to irrelevance or due to not meeting eligibility criteria. We chose to include 8 studies that used samples with some individuals aged under 18, as these were part of larger samples of most adults. Excluding these articles would result in the loss of important data. A total of 76 studies from 18 different countries¹ comprises this review. Figure 1 illustrates each step of the search process.

Figure 1.

Flowchart with study selection.

This review found 35 quantitative studies, 33 qualitative studies, and 8 mixed methods studies. Twenty-seven studies used mixed samples (women, men, and others), 47 used women-only samples, and 2 studies used samples of heterosexual coupled individuals. Of the total 76 studies, 14 used samples that were exclusively heterosexual, and 2 studies used samples with lesbians and bisexuals. The remaining studies were either mostly heterosexual or did not provide information on sexual orientation. Only 8 studies were carried out with non-western samples. Study general characteristics are described in Table 1.

Table 1.

Sexual pleasure research by date.

	Author(s)/Year	Study type	Sample (size, gender, sexual orientation, mean age)	Assessment of sexual pleasure	Results
1	Thirlaway et al. (1996)	Quantitative	447 Women with family history of breast cancer, M = 48.7, age range [35–65] 81 Women without family history of breast cancer, M = 45.5, age range [35–65]	Validation studies of SAQ (by the authors)	The SAQ comprised dimensions of pleasure from sexual intercourse, discomfort with intercourse, and habit. Pleasure from sexual intercourse (desire, enjoyment, and satisfaction) contributed to the variance of sexual functioning. Pleasure dropped and discomfort increased in women with age over 55.
2	Slosarz (2000)	Quantitative	100 Women, 100 men, age range [25–40]	Ratings of sexual pleasure per sexual interactions	Penile-vaginal intercourse rated as very pleasurable, especially if both partners achieve orgasm
3	Ferguson et al. (2003)	Quantitative	20 Women, M = 43.2, age range [31–57]	1 item in a 5-point Likert scale from questionnaire (by the authors)	Zestra for Women enhances female sexual pleasure and arousal when applied to the vulva
4	Pinkerton et al. (2003)	Quantitative	145 Women, 78 male, M = 22.2, age range [19–40]	Ratings of sexual pleasure per sexual activity in a 5-point scale	Women rated vaginal intercourse, receiving oral sex, and being masturbated by partners as highly pleasurable.
5	Zurbriggen and Yost (2004)	Mixed methods	85 men, 77 women (heterosexuals), age range [21–45]	Sexual pleasure assessed by open-ended questions regarding sexual fantasy	Women tended to have more sexual fantasies concerning their own sexual desire and sexual pleasure than sexual fantasies concerning their partners’ sexual desire and pleasure
6	Sanchez et al. (2005).	Quantitative	309 Heterosexuals (117 men, 192 women)	SPS (by the authors)	Less sexual autonomy impacts sexual pleasure negatively.
7	Horne and Zimmer-Gembeck (2006)	Quantitative	Study 1: 192 women (90% heterosexual), M = 17.4, age range [16–19] Study 2: 449 women (85% heterosexual), M = 17.9, age range [16–20] Study 3: 214 (85% heterosexual), M = 19.9, age range [17–22]	Validation studies of FSSI (by the authors)	The FSSI contains 5 factors: sexual body-esteem, entitlement to sexual pleasure (self), entitlement to sexual pleasure (partner), self-efficacy in achieving sexual pleasure, and sexual self-reflection. The 3 sexual pleasure subscales were positively correlated with sexual consciousness, safe sex self-efficacy, self-esteem, resistance to sexual double standards, and negatively correlated with self-silencing in intimate relationship.
8	Randolph et al. (2007)	Quantitative	80 Women (89.8% heterosexuals), 35 men, M = 22.29, age range [20–40]	Questionnaire (by the authors)	Male condom use impacts negatively female sexual pleasure.
9	Sanchez and Kiefer (2007)	Quantitative	320 Heterosexuals (122 men,198 women), M = 31.01, [17–71]	SPS (Sanchez et al., 2005)	Body-shame linked to less sexual pleasure and greater sexual problems. These relationships were mediated by sexual self-consciousness during physical intimacy. Women’s arousability was a stronger predictor of sexual pleasure than men’s.
10	Higgins et al. (2008)	Quantitative	189 Women, M = 24.5	Questionnaire (by the authors)	Male condom use impacts negatively female sexual pleasure whether used alone or in conjunction with hormonal methods.
11	Maynard et al. (2009)	Qualitative	28 Women, M = 30, age range [18–55]	Interviews	Physical sexual pleasure and pleasing partner were reasons to engage in anal sex.
12	Carter et al. (2010)	Mixed methods	Quantitative study: 180 men and 220 women, M = 21, age range [18–25]; Qualitative study: 70 (men and women)	Questionnaire (by the authors); diary and interview.	Sexual pleasure was a main reason to engage in anal sex
13	Hinchliff et al. (2010)	Qualitative	12 Heterosexual women, M = 54.2, age range [48–60]	Interviews	These women in the menopause described privileging male sexual pleasure and that male erectile dysfunction impacted their own sexual pleasure.
14	Schick et al. (2010)	Quantitative	1974 (972 men, 1002 women), M = 60, age range [50–107]	1 Item from NSSHB in a 5-point Likert scale	Men and women over 50 years old indicated high rates of arousal and pleasure in their last sexual encounter.
15	Weinberg and Williams (2010)	Mixed methods	121 Heterosexuals (69 women, 52 men), M = 20.7, age range [18–30]	Questionnaire (by the authors) and interviews	Comfort with one’s body was associated with sexual behavior and pleasure among women.
16	Vannier and O'Sullivan (2010)	Qualitative	63 Committed heterosexual (31 men, 32 women), M = 20.4, age range [18–24]	Interviews and diaries	Sexual compliance was common in young adults in committed heterosexual relationships, which reported that 17% of their sexual activities were sexually compliant, albeit these were rated as less pleasurable.
17	Herbenick et al. (2011)	Quantitative	2453 Women (86.5% heterosexuals), M = 32.69, 18–68	Sexual pleasure with events assessed in 4-point Likert scale	Lubricant use was associated with higher sexual pleasure and reduced pain in women in both solo sex, penile-vaginal sex, and anal-sex
18	Kaestle and Allen (2011)	Qualitative	72 (56 female, 16 male), age range [18–24]	Written answers to open-ended questions	Many women described to struggle with the contradiction between stigma and sexual pleasure when narrating their perceptions and feelings around masturbation.
19	Backstrom et al. (2012)	Qualitative	43 Women (27 heterosexuals), M = 21, age range [21–23]	Interviews	Cunnilingus was taken for granted in relationships and a source of pleasure for women who enjoyed it but not for women who did not.
20	Lorvick et al. (2012)	Mixed methods	Quantitative study: 322 Women [18+] Qualitative study: 34 Women [18+]	Questionnaire and interviews	Women using methamphetamines indicate these women describe feelings of power and agency related to sexual pleasure while high on drugs
21	Tambling et al. (2012).	Qualitative	150+ Women, victims of domestic violence, age range [16–60]	Interviews	The intervention program addressed these women’s right to experience pleasure and received good feedback from participants
22	Kısa and Özdemir (2013).	Quantitative	281 Married women, age range [40–65]	Questionnaire (by the authors)	Vaginal dryness negatively impacts women’s sexual pleasure. 54.4% reported trouble receiving sexual pleasure.
23	Sanders et al. (2013)	Quantitative	1474 women (93.27 heterosexual), M = 39.9, age range [18–60], 877 men, M = 40, age range [18–60]	QSE (by the authors)	The QSE included the 1 item pertaining the level of pleasurability in a general measure of the quality of sexual experiences. Most participants engaging in sexual activities rate their pleasure positively.
24	Štulhofer and Ajduković (2013)	Mixed methods	Quantitative study: 1893 women, M = 27.85, age range [18–60]; Qualitative study: 68 women, M = 31, age range [18–60]	Questionnaire (by the authors) and interviews	Masturbatory frequency and orgasm ability predict pleasure during intercourse.
25	Bowman (2014)	Quantitative	765 Women (67% heterosexuals), age range [18–61]	FSSI (Horne & Zimmer-Gembeck, 2006)	Sexual pleasure was identified as a reason to masturbate and leaded to sexual empowerment.
26	Fahs (2014)	Qualitative	20 Women (60% heterosexual), M = 34, age range [18–59]	Interviews	Best orgasm experiences occur during non-penile vaginal intercourse. Sexual pleasure was dependent of the women’s ability to communicate their desires.
27	Fahs and Gonzalez (2014)	Qualitative	20 Women (60% heterosexual), M = 34, age rage [18–59]	Interviews	Pleasure with anal eroticism was identified as theme in women’s narratives about receptive anal sex.
28	Herbenick et al. (2014)	Quantitative	1559 Women (93.6% heterosexuals), M = 46.8, age range [18–91]	NSSHB	Lubricant use was associated with higher sexual pleasure and reduced pain in women.
29	Opperman et al. (2014)	Qualitative	119 (81% female; 92% heterosexuals), M = 20	Qualitative survey	“Orgasm: the ultimate pleasure?” was a theme identified by participants. Partner’s orgasm was a source of pleasure for women.
30	Fennell (2014)	Qualitative	30 Heterosexual couples, age range [18–36]	Interviews	Male condom use impacts negatively female sexual pleasure.
31	Smith et al. (2014)	Quantitative	1101 Women, age range [18–51]	Questionnaire (by the authors)	Hormonal contraceptive use was linked to decreases in sexual pleasure and orgasm.
32	Fiaveh et al. (2015)	Qualitative	20 Women, 16 men, age range [22–79]	Interviews	Women expressed pleasure as romantic erotic sensuality, foreplay, and physical attractiveness.
33	Fileborn et al. (2015)	Qualitative	43 Partnered women (1 bisexual), M = 64.4, age range [55–81]	Interviews	These women voiced the silence around older women’s sexuality entrenched the idea that they do not desire sexual pleasure
34	Hoel (2015)	Qualitative	12 Women, age range [21–63]	Interviews	Women posited sexual pleasure a religious right and emphasized the sacrality of sex as an intrinsic component of human experience.
35	John et al. (2015)	Qualitative	192 (69% female), age range [18–50]	Focus groups	Changes in sexual pleasure affected method choice and use among married Malawi. Women’s perceived role of providing pleasure were intertwined gender norms.
36	Katz and Schneider (2015)	Quantitative	258(72.5% women), age range [18–23]	Questionnaire (by the authors)	Sexual compliance is disproportionately higher in women having casual sex, which are more likely to comply with a form of sex that promotes partner sexual pleasure, rather than their own sexual pleasure. More women than men complied to giving oral sex to a casual sex partner.
37	Mastro and Zimmer-Gembeck (2015)	Quantitative	209 (61% women), M = 19.28, age range [17–21]	Two subscales from FSSI (Horne & Zimmer-Gembeck, 2006)	Pleasure self-efficacy was linked to assertiveness.
38	Muhanguzi (2015)	Qualitative	Focus groups: 71 women; Interviews: 40 women; heterosexual	Focus group and interview	Sexual pleasure was dependent of these married women’s ability to communicate their desires.
39	Satinsky and Jozkowski (2015)	Quantitative	237 Women, M = 28.85, age range [18–71]	FSSI (Horne & Zimmer-Gembeck, 2006)	Entitlement to pleasure predicted verbal consent to oral sex as a function of self-efficacy in achieving sexual pleasure
40	Schick et al. (2015)	Quantitative	121 Lesbian and bisexual	1 item from NSSHB in a 5-point Likert scale	Lubricant use was associated with higher sexual pleasure and reduced pain in women.
41	Goldey et al. (2016)	Qualitative	73 Women (55%heterosexual), age range [18–64]	Focus groups	Solitary pleasure was characterized by eroticism (genital pleasure and orgasm) and autonomy and partnered pleasure by nurturance, trust, and giving pleasure.
42	Barnett and Melugin (2016)	Quantitative	861 Heterosexuals (71.2% female), M = 20.46, age range [18–30]	Ratings of sexual pleasure per sexual activity in a 7-point scale	Study assessed pleasure with specific sexual activity, showing masturbation and anal sex as the least pleasurable activities, and penile-vaginal sex as the most pleasurable.
43	Hewitt-Stubbs et al. (2016)	Quantitative	295 (112 men, 183 women), M = 19.5, age range [17–25]	8 items from FSSI (Horne & Zimmer-Gembeck, 2006)	Entitlement to partnered sexual pleasure increased significantly with increased self-efficacy in achieving sexual pleasure.
44	Jozkowski et al. (2016)	Quantitative	974 women (733 bisexual, 241 lesbian), M = 27, age range [18–62]	Questionnaire (by the authors) with 6 items assessing sexual pleasure	Sexual inhibition, but not sexual excitation, was positively correlated with sexual problems and negatively correlated with sexual pleasure.
45	Pascoal et al. (2016)	Quantitative	279 (54% women), M = 32, range [18–88]	SPS (by the authors)	Sexual pleasure was correlated with sexual satisfaction and with sexual functioning.
46	Shepardson et al. (2016)	Qualitative	262 Women, M = 18.1, age range [17–18]	Written interviews	Sexual pleasure was the most common benefit of hooking up.
47	Wood et al. (2016)	Quantitative	899 Heterosexual (512 women), M = 20.94, age range [18–24]	1 item in a 4-point Likert scale	73% of men and 69% reported receiving oral sex was very pleasurable. Participants reported higher pleasure in giving and receiving oral sex with committed partner when compared to casual partners.
48	Fahs and Plante (2017)	Qualitative	20 Women (60% heterossexual), M = 35.5	Interviews	Physical pleasure, wanting an orgasm’ was a theme identified by participants as good sex.
49	Kelly et al. (2017)	Qualitative	94 Women, age range [16–49]	Interviews	Women tended to focus on enabling their male partner’s pleasure while ignoring their own sexual desires, wishes and interests
50	Thomas et al. (2017)	Qualitative	15 Women (12 heterosexuals), M = 21.53, age range [19–28]	Interviews	Women frequently feigned exaggerated sexual pleasure to end troubling sexual encounters.
51	Blunt-Vinti et al. (2018)	Qualitative	30 Heterosexual women, age range [18–25]	Interviews	Communication with sexual partners, sexual self-awareness and acceptance, and sources of information and education emerged as themes in improving sexual pleasure and satisfaction
52	Bowling et al. (2018)	Qualitative	50 Women, 19 men, M = 32.7, age range [21–50]	Focus groups and interviews	Sexual pleasure increased with female condom use, consent, and privacy.
53	Brown et al. (2018)	Qualitative	5 Women, 4 men, age range [18–19]	Focus groups	Heterosexual women described that their attempts to dismantle the expectation of female sexual passivity resulted in a greater burden, as these women felt responsible for their own pleasure as well as their partners’
54	Grower and Ward (2018)	Quantitative	365 Heterosexual women, M = 31.39, age range [18–40]	Entitlement to sexual pleasure assessed by 4 items on a 5-point Likert scale (Day, 2010)	Women with greater body appreciation had greater more feelings of sexual satisfaction, sexual assertiveness, and entitlement to sexual pleasure
55	Hargons et al. (2018)	Qualitative	18 Black students (16 heterosexuals), M = 19.11, age range [18–24]	Interviews	Themes concerning meanings around pleasure included: monitoring mutual pleasure, relegating pleasure to men’s performance, and positioning pleasured possibilities as hope for women or expectation for men. Women linked sexual pleasure to having an orgasm.
56	Herbenick et al. (2018)	Quantitative	1055 Women, age range [18–94]	Questionnaire (by the authors)	Study assessed experiences related to orgasm, sexual pleasure, and genital touching. 18.4% reported intercourse alone was sufficient to orgasm and 36.6% reported clitoral stimulation was necessary for orgasm during intercourse. Another 36% stated clitoral stimulation benefited orgasm, although was not needed. Women attributed better orgasms to partner familiarity, and emotional intimacy.
57	Khalaf et al. (2018)	Qualitative	20 Women, M = 25, age range [21–29]	Interviews	Malayan religious women acknowledged women’s right to sexual pleasure but regulated sexual pleasure by the religious and social rules of purity and social dignity
58	Rigo and Saroglou (2018)	Quantitative	Christian tradition: 276 heterosexuals (58% women), M = 24.46, age range [17–77] Muslim tradition: 170 (71%women), M = 25.31, age range [18–53]	4 items from the Pleasure subscale of the YSEX? inventory (Meston & Buss, 2007)	Christian and Muslim religiosity predicted decreased pursuit of sexual pleasure
59	Benson et al. (2019)	Qualitative	20 Heterosexual women [18–50]	Interviews	Sexual pleasure (self and partner) was a reason for women to engage in anal sex.
60	Ashton et al. (2019)	Qualitative	27 Women, age range [18–30]	Interviews	Qualitative studies suggest pornography may enhance sexual pleasure through solo pleasure, shared viewed with partners, discovering new sexual preferences, and reassurance about body appearance. On the other hand, pornography may interfere with sexual pleasure through misrepresentation of bodies, sexual acts, and expression of pleasure.
61	Carter et al. (2019)	Quantitative	382 Women, age range [18–49]	1 Item from NSSHB in a 5-point Likert scale	Communicating openly about painful sex was linked with greater sexual pleasure, whilst no communication was related to little or no sexual pleasure.
62	Chadwick et al. (2019)	Mixed methods	389 Women in quantitative (41.2% heterosexuals), M = 28.42, and 162 women in qualitative. 60 transgender women in quantitative and 33 transgender women in qualitative	Questionnaire (by the authors) and interviews	Having orgasms lead to negative outcomes, and orgasm was described as less pleasurable than other partnered sexual experiences.
63	De Santis et al. (2019)	Mixed methods	49 Heterosexual couples, M = 37.37 (Horne & Zimmer-Gembeck), M = 39.24 (men)	Open-ended questions	Prescribed sexual activity with sex toys in a 6–8-week intervention program improved sexual pleasure.
64	Guitelman et al. (2019)	Mixed methods	50 Women (56% heterosexual), M = 20.04, age range [18–26]	FSSI (Horne & Zimmer-Gembeck, 2006)	Bibliotherapy intervention combining feminist analysis and self-help for women’s orgasm difficulties showed increase in self-efficacy in achieving sexual pleasure
65	Herbenick et al. (2019)	Quantitative	7.032 Undergraduate students (48% men, 51% women, 1% transgender)	1 Item from NSSHB in a 5-point Likert scale	Undergraduate college students only reported higher levels of sexual when having sober consensual sex.
66	Katzman and Tuchman (2019)	Qualitative	26 Women, M = 43.2, age range [22–63]	Interviews	Women using injectable drugs report feelings of power and agency related to sexual pleasure during use.
67	Marques (2019)	Qualitative	26 Women, age range [25–36]	Focus groups and interviews	Qualitative studies suggest pornography may enhance women’s sexual pleasure by providing sexual self-actualization and corporal validation.
68	Rowland et al. (2019)	Quantitative	2059 Women, M = 28.8, age range [18–90]	Questionnaire (by the authors)	Women with orgasmic difficulties viewed masturbation as equally or more satisfying than partnered sex.
69	Stahl et al. (2019)	Qualitative	16 Women, age range [57–91]	Interviews	Sexual pleasure is supported by novel contexts, cultivating intimacy with partners and oneself, creativity with sexual activities, and maximizing sexual possibilities.
70	Waskul and Anklan Waskul and Anklan (2020).	Qualitative	78–147 Women, M = 25.2, age range [18–67]	Written open-ended questions	Vibrators were a tool for great pleasure as well as a shameful taboo.
71	Alarie (2020)	Qualitative	55 Women, age range [30–60]	Interviews	Women sexual relationships with younger men allowed higher sexual assertiveness and greater sexual pleasure compared to their experiences with men of their age and older.
72	Bond et al. (2020)	Quantitative	209 Women who have sex with men (75% heterosexual), M = 22	FSSI (Horne & Zimmer-Gembeck, 2006)	Women with greater body-esteem seem to have more sexual behaviors and sexual pleasure. Entitlement to sexual pleasure from self and self-efficacy in achieving sexual pleasure were correlated positively with increased orgasm frequency.
73	Milstein et al. (2020)	Quantitative	379 (76.6% women), age range [18–29]	Questionnaire (by the authors)	Young individuals in emotionally committed sexual relationships presented higher sexual pleasure than those having casual sex
74	Pascoe (2021)	Qualitative	21 Heterosexuals (8 women), age range [26–39]	Interviews	Women’s sexual pleasure was facilitated by men and compromised female sexual autonomy. Sexual pleasure presented more challenging to negotiate than sexually transmitted infections prevention.
75	Warshowsky et al. (2020)	Quantitative	271 Women, M = 19.10, age range [18–30]	FSSI (Horne & Zimmer-Gembeck, 2006)	Students attending a Human Sexuality University course improved on all measures of sexual functioning, including entitlement to sexual pleasure and orgasm quality
76	Weitkamp et al. (2020).	Quantitative	36 Women in the intervention group, 25 women in control group, M = 32.53	SAGASF-F (Schober et al., 2004)	Guided self-massage and mindfulness techniques resulted in increased sexual pleasure and reduced pain in women

FSSI: Female Sexual Subjectivity Inventory; NSSHB: National Survey of Sexual Health and Behavior; SAGASF-F: Self-Assessment of Genital Anatomy and Sexual Functioning; SAQ: Sexual Activity Questionnaire; SPS: Sexual Pleasure Scale; QSE: Quality of Sexual experience.

This review’s outcomes are highly heterogeneous and at times conflictive. We identified several areas of research which included psychosocial and behavioral aspects of women’s sexual pleasure. We grouped these into major themes: sexual practices (masturbation and genital stimulation, penile-vaginal sex, oral sex, anal sex, and contraception), individual factors (age/experience, body and self-esteem, sexual satisfaction and sexual functioning, sexual autonomy, and drug use), interpersonal factors (sexual assertiveness and sexual compliance, relationship, and partner factors), societal factors (gender and religion), and ways of enhancing sexual pleasure. Although these themes do not represent closed categories, we believe presenting results for each theme separately, in systemic levels, will help structure knowledge and identifying gaps in research. In the following sections we include information retrieved from each single paper reviewed. When papers offered insight referring to more than one theme results from the same paper are presented under the different themes.

Sexual practices and sexual pleasure

Different sexual activities were rated as pleasurable (Sanders et al., 2013), but not necessarily reaching consensus on the sexual practices which are more pleasurable for women. Below we provide a description of sexual pleasure correlates for each sexual practice.

Masturbation and genital stimulation

There was at least one study suggesting masturbation as one of the least pleasurable activities for women (Barnett & Melugin, 2016), although other studies suggest differently. For instance, in a study with women who struggled to reach orgasm they viewed masturbation as equally or more satisfying than partnered sex, whilst women without this difficulty found orgasmic pleasure was higher during partnered sex compared to masturbation (Rowland et al., 2019). In this study, pleasure during masturbation was associated with older age, masturbation experience and efficacy in reaching orgasm. Another study with women, identified sexual pleasure as a reason to masturbate, which in turn resulted in sexual empowerment through sexual efficacy and higher genital self-image (Bowman, 2014). As for younger women, although some accepted masturbation as normal and pleasurable, many still seem to be struggling with the contradiction between stigma and sexual pleasure, unlike the young men in this qualitative study (Kaestle & Allen, 2011).

Studies also indicated genital/clitoral stimulation was highly pleasurable for women (Barnett & Melugin, 2016; Pinkerton et al., 2003) and that benefited pleasure during penetration (Herbenick et al., 2018).

Penile-vaginal sex

Research documented penile-vaginal intercourse as very pleasurable (Pinkerton et al., 2003), or as the most pleasurable sexual activity (Barnett & Melugin, 2016), specifically, if both partners achieve orgasm (Slosarz, 2000). However, some women’s best orgasm experiences occurred most often during non-penile-vaginal intercourse activities (Fahs, 2014).

Oral sex

A qualitative study exploring women’s attitudes and experiences of cunnilingus found that receiving oral sex was viewed as central to sexual pleasure and orgasm by some women, although some viewed it as uncomfortable or less intimate than intercourse (Backstrom et al., 2012). In a quantitative study, 69% of women reported receiving oral sex was very pleasurable, whilst only 28% considered giving oral sex was very pleasurable (Wood et al., 2016). The same study found higher pleasure ratings for giving and receiving oral sex to a committed partner than to a casual partner. Receiving oral sex was rated as one of the highest sexually pleasurable activities for women (Barnett & Melugin, 2016; Pinkerton et al., 2003). In another study, entitlement to pleasure predicted verbal consent to oral sex as a function of self-efficacy in achieving sexual pleasure (Satinsky & Jozkowski, 2015).

Anal sex

Research identified sexual pleasure as a motive for women to engage in anal sex (Benson et al., 2019; Carter et al., 2010; Fahs & Gonzalez, 2014), even when this was painful (Maynard et al., 2009; Štulhofer & Ajduković, 2013), although some studies indicated that anal sex was rated as the least pleasurable sexual activity (Barnett & Melugin, 2016). The pleasure derived from anal intercourse was predicted by masturbatory frequency and orgasmic ability (with sexual intercourse) (Štulhofer & Ajduković, 2013).

Contraception use

Research indicated male condom use impacted negatively female sexual pleasure (Fennell, 2014; Higgins et al., 2008; Randolph et al., 2007). Hormonal contraceptives were also linked to decreases in sexual pleasure and orgasm (Smith et al., 2014). However, for some women, using hormonal contraceptives (Higgins et al., 2008), or female condoms (Bowling et al., 2018) increased their sexual pleasure by decreasing worries about pregnancy or sexually transmitted infections. Method choice and consistent use were also affected by perceived decreases sexual pleasure (John et al., 2015).

Individual factors

Findings pertaining individual factors showed that age, sexual experience, arousability, body-esteem, and sexual autonomy favored sexual pleasure. However, findings concerning the link between sexual pleasure and sexual function were very limited.

Age/experience

Age and/or sexual experience of heterosexuals were positively related to sexual pleasure in several sexual activities regardless of gender (Barnett & Melugin, 2016; Pinkerton et al., 2003), but inexperienced men reported having more pleasure than inexperienced women in most sexual activities (Barnett & Melugin, 2016). Having more sexual partners (Pinkerton et al., 2003) and more frequent partnered sexual activity (Rowland et al., 2019) were related to higher sexual pleasure.

Some studies focused on aging populations. A study indicated that pleasure from sexual intercourse dropped in women after age of 55 whilst their discomfort with intercourse increased (Thirlaway et al., 1996). Also, British women in the menopause described privileging male sexual pleasure and that male erectile dysfunction impacted their own sexual pleasure (Hinchliff et al., 2010). In a qualitative study with Australian women aged 55–81 years old, the silence around women’s sexual desire and agency in older age seemed to entrench the belief that older women do not desire sexual pleasure (Fileborn et al., 2015). On a different note, findings from interviews in women between 57 and 97 years old suggested sexual pleasure is supported by novel contexts, cultivating intimacy with partners and oneself, creativity with sexual activities, and maximizing sexual possibilities (Stahl et al., 2019). As well, findings concerning the last partnered sexual event from a nationally representative sample of men and women over 50 years old in the United States, indicated most respondents presented high rates of arousal and pleasure (Schick et al., 2010).

Body and self-esteem

Women with greater body-esteem reported having more sexual behaviors and sexual pleasure (Bond et al., 2020; Weinberg & Williams, 2010), and more feelings of entitlement to sexual pleasure (Grower & Ward, 2018). Contrarily, women experiencing body shame and sexual self-consciousness presented more sexual problems and reported less sexual pleasure from physical intimacy (Sanchez & Kiefer, 2007). Entitlement to sexual pleasure (self and partner) and self-efficacy in achieving sexual pleasure were related to self-esteem (Horne & Zimmer-Gembeck, 2006)

Sexual satisfaction and sexual functioning

Sexual pleasure was correlated with sexual satisfaction and with sexual functioning overall (Pascoal et al., 2016). In a psychometric study of Sexual Inhibition and Sexual Excitation Scales (Janssen et al., 2002) for women with a sample of lesbian and bisexual women, sexual inhibition, but not sexual excitation, was positively correlated with sexual problems and negatively correlated with sexual pleasure (Jozkowski et al., 2016). In another study, however, women’s arousability was a stronger predictor of sexual pleasure (Sanchez & Kiefer, 2007). As for orgasm, qualitative studies found the words “pleasure” or “pleasurable” were used to describe orgasm (Opperman et al., 2014), that for some young black women attending university, pleasure meant having an orgasm (Hargons et al., 2018), and that physical pleasure and orgasm were aspects of “good sex” (Fahs & Plante, 2017). Despite this, one study reported some women testimony having “bad” orgasms and that these may be less pleasurable compared to other aspects of sexual experiences (Chadwick et al., 2019). The same study found these bad experiences were relevant for some trans women, which described orgasm as an unwelcome reminder of unwanted genitals.

Sexual autonomy

Research found that when sexual autonomy, the feeling that one’s behaviors are self-determined (cf. Deci & Ryan, 1987), is undermined, sexual pleasure is negatively impacted (Sanchez et al., 2005). Sexual autonomy was defined as a feature of solitary sexual pleasure in a qualitative study (Goldey et al., 2016). In addition, entitlement to sexual pleasure from self and self-efficacy in achieving sexual pleasure were correlated positively with increased orgasm frequency (Bond et al., 2020), and with sexual consciousness, the tendency to attend to the individual sexual feelings, motivations, desires, tendencies, awareness of arousal, and turn-ons (Horne & Zimmer-Gembeck, 2006). At the same time, sexual autonomy was related with relationship/partner aspects as well. In a study held in South Africa with heterosexuals, men were identified as the facilitators of women’s sexual pleasure, compromising their female sexual autonomy (cf. Pascoe, 2021). A longitudinal study with Australian women ranging from 17 to 25 years old, indicated entitlement to partnered sexual pleasure increased significantly over the year of the study related with increased self-efficacy in achieving sexual pleasure (Hewitt-Stubbs et al., 2016).

Drug use

Qualitative studies with women using methamphetamines (Lorvick et al., 2012) and injectable drugs (Katzman & Tuchman, 2019) indicated they described feelings of power and agency related to sexual pleasure while high on drugs. Contrarily, undergraduate college students reported higher levels of sexual pleasure only when having sober consensual sex (Herbenick et al., 2019).

Interpersonal factors and pleasure

Findings concerning interpersonal factors identified that sexual assertiveness benefited sexual pleasure and that sexual compliance constrained sexual pleasure. Data on sexual pleasure in hookups versus committed relationships was inconclusive.

Sexual assertiveness and sexual compliance

Qualitative research suggested pleasure depended on heterosexual women’s ability to communicate their desires (Fahs, 2014; Muhanguzi, 2015). Pleasure self-efficacy was also linked to assertiveness in young individuals from 17 to 21 (Mastro & Zimmer-Gembeck, 2015). However, research indicated sexual pleasure was more challenging to negotiate than sexually transmitted infections’ prevention (Pascoe, 2021). Furthermore, communicating openly about painful sex was linked with greater sexual pleasure, whilst no communication was related to little or no sexual pleasure (Carter et al., 2019). In addition, entitlement to sexual pleasure (self and partner) and self-efficacy in achieving sexual pleasure were positively correlated with safe sex self-efficacy, and negatively correlated with self-silencing in intimate relationships (Horne & Zimmer-Gembeck, 2006).

Sexual compliance, defined as willing consent to unwanted sex, was disproportionately higher in women having casual sex, which are more likely to comply with a form of sex that promotes partner sexual pleasure, rather than their own sexual pleasure (Katz & Schneider, 2015). Sexual compliance was also common in young adults in committed heterosexual relationships, which reported that 17% of their sexual activities were sexually compliant, albeit these were rated as less pleasurable (Vannier & O'Sullivan, 2010).

Relationship and partner factors

Research indicated young individuals in emotionally committed sexual relationships had higher sexual pleasure than those having casual sex (Barnett & Melugin, 2016; Herbenick et al., 2019; Milstein et al., 2020). Contrary to this, one study found that sexual pleasure was the most common benefit of hooking up for 17- and 18-year-old women (Shepardson et al., 2016). On the other hand, women reported less sexual desire and pleasure in their first partnered sex experiences when compared to men (Katz & Schneider, 2015).

Partners perceived as generous, giving, and concerned about women’s pleasure benefited women’s orgasm quality (Fahs, 2014), so did men’s sexual competence (Hargons et al., 2018). Partner’s orgasm also presented as a source of pleasure itself, as most women reported they felt happy and good about giving their partner’s orgasm and felt sexual pleasure themselves (Opperman et al., 2014). Moreover, many women attributed better orgasms to partner familiarity, and emotional intimacy (Herbenick et al., 2018). In the same line, trust, giving pleasure, and closeness were described as important elements of partnered pleasure (Goldey et al., 2016). As well, in a study with women and men from Ghana, pleasure was attached to romantic erotic sensuality, foreplay, and to physical attractiveness (Fiaveh et al., 2015). Age of sexual partner also impacted sexual pleasure: women aged 30 to 60 reported that their experiences with younger men allowed for greater sexual assertiveness and greater sexual pleasure when compared to their experiences with men of the same age or older (cf. Alarie, 2020).

Societal factors

Research concluded that women tended to favor male partner’s pleasure with losses for their own. Findings on religion and sexual pleasure were inconclusive.

Gender

Recent findings suggested women tend to focus on enabling their male partner’s pleasure while ignoring their own sexual desires, wishes and interests (Kelly et al., 2017). Research found women faked orgasms to reinforce their partner’s sexual skills (Fahs, 2014) or feigned exaggerated sexual pleasure to end troubling sexual encounters (Thomas et al., 2017). In another study, heterosexual women described to feel responsible for their own pleasure as well as their partners’, which they conceived as a burden (Brown et al., 2018). On a different note, research found women had more sexual fantasies concerning their own sexual desire and sexual pleasure than sexual fantasies concerning their partners’ sexual desire and pleasure (Zurbriggen & Yost, 2004). Moreover, entitlement to sexual pleasure (self and partner) and self-efficacy in achieving sexual pleasure were correlated with resistance to sexual double standards (Horne & Zimmer-Gembeck, 2006).

Religion

Christian and Muslim religiosity predicted decreased pursuit of sexual pleasure (Rigo & Saroglou, 2018). In line with this, young adult religious women from Malaysia (Muslim, Christian, Buddhist, Hindus, Sikh, and agnostic) stated to regulate sexual pleasure by the religious and social rules of purity and social dignity, although acknowledged women’s right to sexual pleasure (Khalaf et al., 2018). Contrarily, in a qualitative study with South African Muslim women, sexual pleasure was posited as a religious right, emphasizing the sacrality of sex as an intrinsic component of human experience, and sexual satisfaction as vital to the unity with God (Hoel, 2015).

Ways of enhancing sexual pleasure

Findings indicated lubricants enhance sexual pleasure but offered inconclusive data on the benefits of using sex toys and pornography for sexual pleasure. Research on interventions concluded education favored sexual pleasure.

Lubricants

Vaginal dryness negatively impacted women’s sexual pleasure (Kısa & Özdemir, 2013), while lubricant use was associated with higher sexual pleasure and reduced pain in women (Herbenick et al., 2011, 2014; Schick et al., 2015). A study also indicated that Zestra for Women, a botanical feminine massage oil, enhanced female sexual pleasure and arousal when applied to the vulva (Ferguson et al., 2003).

Vibrators

Vibrators were seen as a tool for great pleasure as well as a shameful taboo (Waskul & Anklan, 2020). In addition, prescribed sexual activity with sex toys in a 6–8 week intervention program improved sexual pleasure (De Santis et al., 2019)

Pornography

Pornography, the material deemed sexual with the primary intention of sexually arousing the consumer, interfered with sexual pleasure through misrepresentation of bodies, sexual acts, and expression of pleasure (Ashton et al., 2019). On the other hand, another study suggested sexually explicit materials boosted women’s sexual pleasure by providing sexual self-actualization and corporal validation (Marques, 2019).

Interventions

Educational programs improved sexual pleasure in diverse contexts. An intervention program for women victims of domestic violence which addressed these women’s right to experience pleasure received good feedback from participants (Tambling et al., 2012). Another study examining the effectiveness of a bibliotherapy intervention combining feminist analysis and self-help for women’s orgasm difficulties increased self-efficacy in achieving sexual pleasure (Guitelman et al., 2019). Furthermore, students attending a Human Sexuality University course improved on all measures of sexual functioning, including entitlement to sexual pleasure and orgasm quality (Warshowsky et al., 2020). Finally, an online intervention focused on guided self-massage and mindfulness techniques resulted in increased sexual pleasure and reduced pain in women (Weitkamp et al., 2020). In addition, young heterosexual women (18–25) identified communication with sexual partners, sexual self-awareness and acceptance, and information/education improved pleasure (Blunt-Vinti et al., 2018).

Discussion

This review identified several areas of research with mention to psychosocial and behavioral aspects of women’s sexual pleasure, including sexual practices (masturbation and genital stimulation, penile-vaginal sex, oral sex, anal sex, and contraception), individual factors (age/experience, body and self-esteem, sexual satisfaction and sexual functioning, sexual autonomy, and drug use), interpersonal factors (sexual assertiveness and sexual compliance, relationship and partner factors), societal factors (gender and religion), and ways of enhancing sexual pleasure. These studies are heterogeneous and often present conflicting or inconclusive data, providing additional evidence on the multifaceted nature of sexual pleasure (World Association for Sexual Health, 2019), and on importance of considering sexual pleasure in the ecological context of sexual health (Ivankovich et al., 2013).

Some studies on women’s sexual pleasure partially support the gendered notion that women privilege the relational aspects of sex (e.g., Fahs & Plante, 2017), as they report to have higher sexual pleasure with committed or familiar partners comparing to casual partners (e.g., Herbenick et al., 2018; Milstein et al., 2020), and elect penile-vaginal intercourse the most pleasurable sexual activity, relegating masturbation as one of the least pleasurable activities (Barnett & Melugin, 2016). These findings are in line with the notion of coital imperative, which places all other sexual activities as merely foreplay (Kelly et al., 2017).

However, a split in research highlights women derive pleasure from casual sex (Shepardson et al., 2016), and from masturbation as a function of higher self-efficacy in reaching orgasm and sexual pleasure (e.g., Bowman, 2014; Rowland et al., 2019). Pleasure self-efficacy also seems to be involved in women’s enjoyment of oral sex and anal sex (Satinsky & Jozkowski, 2015; Štulhofer & Ajduković, 2013), and is specifically related to their entitlement to sexual pleasure (e.g., Bond et al., 2020; Hewitt-Stubbs et al., 2016). These findings could potentially mean that women report less sexual pleasure from casual sex or from sexual activity other than intercourse simply because they are not autonomous and efficacious in reaching pleasure in those circumstances. Yet, these assumptions need to be addressed in further research.

Age, sexual experience, arousability, body-esteem, sexual autonomy and sexual assertiveness are other individual and interpersonal factors favoring women’s sexual pleasure (e.g., Barnett & Melugin, 2016; Bond et al., 2020; Mastro & Zimmer-Gembeck, 2015; Rowland et al., 2019; Sanchez & Kiefer, 2007). One should consider as well that sexual pleasure may lead or predispose to more sexual experience, higher arousability, better body-esteem, and to sexual assertiveness, i.e., that these relationships may be bidirectional. Nonetheless, women seem to start off their sex lives in disadvantage, as inexperienced women report having less pleasure than inexperienced men (Barnett & Melugin, 2016). This potential means sexual pleasure can be learned but we are not teaching women to effectively pursuit sexual pleasure from young age.

On the other hand, women are expected to have less pleasure as they get to older age, as well as to privilege their male partner’s sexual pleasure (Fileborn et al., 2015; Hinchliff et al., 2010), though being difficult to determine if this is linked to aging, conservative sexual beliefs, or to other aspects of long-term relationships. Furthermore, sexual compliance with men’s sexual pleasure is disproportionately higher in women throughout the life span, negatively affecting women’s sexual pleasure (Katz & Schneider, 2015; Vannier & O’Sullivan, 2010). In some instances women might even fake orgasms to bolster their partner’s sexual skills or strategically end unpleasurable sexual interactions (Fahs, 2014; Thomas et al., 2017). Other studies found the percentage of women faking orgasms is remarkably high (Fahs, 2011) when compared to men (Muehlenhard & Shippee, 2010). This accounts for what was already discussed in the literature as the pleasure gap (Crutcher, 2012; Laumann et al., 2006; Mahar et al., 2020), a symptom of mismatched sexual rights and equity between women and men. On the other hand, sexual assertiveness may be an element counteracting these outcomes as it seems to enhance women’s sexual pleasure and sexual self-efficacy (e.g., Alarie, 2020; Mastro & Zimmer-Gembeck, 2015), drawing attention to the need to further promote the rights to sexual autonomy and sexual pleasure (Kismödi et al., 2017).

Research also indicates male condoms and hormonal contraceptives have a negative impact on women’s sexual pleasure (e.g., Fennell, 2014; Smith et al., 2014), while lubricant use was associated with higher sexual pleasure and reduced pain (Herbenick et al., 2011, 2014; Schick et al., 2015). These should not be read as grounds for sexual pleasure or lack thereof and rather as aspects that need to be understood in the bio-psycho-social landscape of sexual pleasure. In fact, in some cases, contraceptive use may increase sexual pleasure by decreasing concerns with pregnancy or STDs (Bowling et al., 2018; Higgins et al., 2008), indicating safety too can be pleasurable. Thus, using condoms and lubricants might be an effective way of combining pleasure and safety.

In addition, methamphetamines and injectable drugs seem to enhance women’s sexual pleasure (Katzman & Tuchman, 2019; Lorvick et al., 2012), emphasizing the need of including sexual pleasure in the discussions involving sexual risk taking and sexual health promotion. Furthermore, educational programs have shown to improve sexual pleasure and pleasure self-efficacy in diverse contexts (e.g., Guitelman et al., 2019; Weitkamp et al., 2020).

From the overall findings on women’s sexual pleasure, one may conclude that women tend to prioritize men’s sexual pleasure, even if that means decreasing their own. Beyond that, sexual compliance to men’s desires is higher when women are younger or from an older age group, or if they have little body-esteem. Conversely, as women get sexually experienced, might become more able to facilitate pleasurable sexual encounters, which in turn could empower them to seek sexual pleasure. So, although women face a power disadvantage in sexual pleasure, when they indeed experience sexual pleasure, they might also experience sexual empowerment through gained sexual self-efficacy and entitlement. These outcomes emphasize the need of further advocating for sexual pleasure as a sexual right and as a crucial aspect of sexual health. Likely, women enhanced sexual autonomy and sexual assertiveness, perhaps through masturbation training and/or communication enhancement, might suppress or diminish the sexual pleasure gap.

Limitations and future directions

There are a few limitations of this work worth naming. The first concerns the fact we did not use intercoder reliability scores to determine which articles were to be included in the review. In addition, we have chosen not to include a quality assessment tool, due to the high heterogeneity in methodology and findings. Our highly heterogeneous and often conflicting results can also be partially explained by the heterogeneity of definitions and operationalizations of the construct of sexual pleasure. Some studies assess sexual pleasure with one-item measures, whilst others apply complex instruments of sexual pleasure. There are few studies using robust measures of sexual pleasure, which we identify as a gap in research that should be addressed in future studies.

The current body of research regarding women’s sexual pleasure concerns mainly western heterosexual women, which emphasizes the need to further investigate sexual pleasure in non-western countries and communities as well as in lesbian, bisexual, and pansexual women. This review meant to include self-identified women, including transwomen, but because our search terms did not include “transgender” this may have accounted for the limited findings which included transwomen (1 study). Moreover, there are aspects of the literature that require clarification, namely regarding the pleasure derived from certain sexual practices, as some studies indicate that women privilege penile-vaginal intercourse, while others suggest women privilege masturbation. Finally, future research should aim at describing the potential underlying mechanisms of sexual pleasure, including the role of sexual autonomy and sexual assertiveness, as well as the relationships with sexual dysfunctions and problems.

Conclusions

This review systematized the knowledge acquired from previous research on the psychosocial and behavioral aspects of women’s sexual pleasure and identified gaps in the literature. The empirical studies on these topics refer to sexual practices related to sexual pleasure, individual, interpersonal, and social factors impacting sexual pleasure, and ways of enhancing sexual pleasure. These findings highlight the importance of a multilevel approach to sexual pleasure, which considers its bio-psycho-social components in ecological interaction. Age, sexual experience, arousability, body-esteem, sexual autonomy, and sexual assertiveness benefit women’s sexual pleasure, while sexual compliance, and gender power imbalance seem to compromise it. Findings pertaining sexual practices, sexual functioning, religion/religiosity, and some relationship aspects presented inconclusive and require further exploration. This review provides further evidence of the mismatch sexual rights and equity between women and men. By highlighting topics and trends within the research of women’s sexual pleasure, this review may facilitate the creation and/or expansion on existing models of sexual pleasure, thus impacting clinical practice and overall promotion of sexual health, sexual rights, and wellbeing.

Disclosure statement

No potential conflict of interest was reported by the author(s).