Medical Director, Cellular Medicine Association, Fairhope, Alabama
Disclosure: Charles E. Runels, MD, has disclosed the following relevant financial relationships: Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: Cellular Medicine Association Received income in an amount equal to or greater than $250 from: Cellular Medicine Association
Despite the organization’s focus on aesthetics, the unique skills of the members make them particularly suited to correct difficult problems regarding function — both urinary and sexual. These colleagues are adept at correcting conditions ranging anywhere from secondary anorgasmia to clitoral hood phimosis. At least half of their lectures focused on improving function, not aesthetics.
I had been invited to speak about the use of formal dynamic systems theory and analysis to improve surgical outcomes. Systems analysis, a framework widely used to improve function in medicine, engineering, and business, can help us understand the complex — a word which most would agree could be used to describe the female orgasm.
Understanding Systems in Medicine
A system consists of interdependent components working together to produce an effect greater than any one part can produce. Systems medicine, an interdisciplinary approach, seeks to understand and manage complex biological interactions to improve health outcomes. By this definition, all 11 recognized body systems (integumentary, skeletal, muscular, nervous, endocrine, cardiovascular, lymphatic, respiratory, digestive, urinary, and reproductive) function as dynamic networks. Disruptions in one component will limit the function of the entire system.
Of the 11, the female orgasm has a component overlap with the reproductive system — but they are not the same. A woman may conceive with anorgasmia, and a woman can also have a strong libido and enjoy multiple orgasms without conceiving a child. One may argue that the reproductive system provides offspring, but without the orgasm system there would be significantly fewer offspring. Yet, conceiving and sexual pleasure are not equal.
One may also argue that if we need systems analysis to understand how to breathe and have a bowel movement, we should use system analysis to understand what brings joy and connection and creativity — orgasm.
A 2023 study of medical education reported that out of seven medical schools in the Chicago area, only one taught the complete anatomy of the clitoris and how to evaluate female sexual dysfunction. Only one. As medical education starts to catch up with current research and women's legitimate demands for expert attention to their sexual concerns (by at least teaching physicians about comprehensive female anatomy), it may be time to acknowledge that, despite its absence thus far from traditional medical education, the female orgasm is complicated enough to warrant systems analysis, and such analysis first demands an attempt to define the system.
If a "female orgasm system" exists, it should meet the same four criteria that define other systems: 1) identifiable components, 2) interdependent interactions, 3) emergent effects beyond any single component, and 4) stability across varied conditions.
My efforts over the past 5 years to define the orgasm system and to encourage doctors and therapists to use systems analysis to treat female sexual dysfunction have not been an effort to invent anything; rather, I hope only to point out such a system exists and to offer a starting point for the work of others.
Components of the Female Orgasm System
To systematically describe female orgasm, we must first define its essential components.
Primary Components
Brain: The ultimate control center, integrating sensory, hormonal, and psychological inputs
Breasts: Responsive to tactile stimulation, contributes to arousal, and affects pituitary function
Clitoris: A sensory-dense structure that is integral to orgasm and communicates with the brain through both somatic and autonomic nerves.
Labia: Provides protective and sensory functions
Genitourinary Complex (GU Complex): Encompasses the vagina, urethra, and pelvic floor with both autonomic and somatic feedback to the arousal centers of the brain
Endocrine System: Regulates hormonal influences on arousal and sexual response
Spinal Cord and Blood Flow: Essential for neurological transmission, local engorgement, and relay of oxygen and hormones
Psychosocial Factors: Emotional, cognitive, and relational influences that modulate the function of the entire body
Secondary Components
Each primary structure comprises substructures with specific roles. For instance, the clitoris includes the glans, corpus cavernosum, and spongiosum. The GU complex involves vaginal elasticity and lubrication, while psychosocial factors extend to behavioral and linguistic influences.
Feedback Loops in the Orgasm System: A Path to Innovation
Dynamic systems operate through reinforcing and balancing feedback loops. In the context of female orgasm:
Reinforcing Loops: Positive stimulation (physical or psychological) enhances arousal, further increasing blood flow and sensory feedback, culminating in orgasm.
Balancing Loops: Psychological distress, endocrine dysfunction, or neurovascular impairment can counteract this reinforcement, inhibiting orgasmic function.
Using systems analysis to consider how the feedback loops of the autonomic nervous system play a crucial role in female orgasm (integrating somatic input from the dorsal clitoral nerve with the autonomic pathways via the cavernous nerves, ganglion innervating the vaginal wall, inferior hypogastric nerve, and the vagus nerve) triggered the idea for the Clitoxin procedure to modulate autonomic input and enhance arousal.
Clinical Implications for Treatment: A Systems-Based Diagnostic Framework
Understanding an orgasm as a system provides a structured approach to evaluating sexual dysfunction. Consider a patient presenting with dyspareunia and anorgasmia following surgical intervention.
First, surgical success does not guarantee orgasmic function. Although anatomical restoration is critical, persistent anorgasmia may stem from endocrine imbalances (eg, hyperprolactinemia, hypothyroidism), vascular limitations, or psychosocial stressors.Rather than relying solely on procedural interventions or sex therapy/counseling, comprehensive assessment and personalized, targeted, systemic corrections can optimize outcomes.
Providers also should enhance patient communication and education.A visual model of the orgasm system can aid in counseling patients, emphasizing the multifactorial nature of the sexual response and reducing unrealistic expectations from isolated interventions.
Let's Start Recognizing the Female Orgasm as a System
When analyzed through the lens of systems medicine, the female orgasm provides a useful framework for refining surgical, medical, and psychosocial therapeutic strategies and for innovating new ideas. Recognizing orgasm as an emergent property of interconnected biological, neurological, and psychosocial factors fosters a more effective and sophisticated patient-centered approach and facilitates communication across specialties. Future research should continue refining this model to improve clinical applications and optimize sexual health outcomes. It is time for the twelfth body system — along with clitoral anatomy — to become part of our medical education.
COMMENTARY
The Female Orgasm Should Be Considered the Twelfth Body System
DISCLOSURES
| April 08, 2025When I spoke at the International Society of Cosmetic Gynecology 2025 World Congress on March 21, I did not mention "cosmetics".
Despite the organization’s focus on aesthetics, the unique skills of the members make them particularly suited to correct difficult problems regarding function — both urinary and sexual. These colleagues are adept at correcting conditions ranging anywhere from secondary anorgasmia to clitoral hood phimosis. At least half of their lectures focused on improving function, not aesthetics.
I had been invited to speak about the use of formal dynamic systems theory and analysis to improve surgical outcomes. Systems analysis, a framework widely used to improve function in medicine, engineering, and business, can help us understand the complex — a word which most would agree could be used to describe the female orgasm.
Understanding Systems in Medicine
A system consists of interdependent components working together to produce an effect greater than any one part can produce. Systems medicine, an interdisciplinary approach, seeks to understand and manage complex biological interactions to improve health outcomes. By this definition, all 11 recognized body systems (integumentary, skeletal, muscular, nervous, endocrine, cardiovascular, lymphatic, respiratory, digestive, urinary, and reproductive) function as dynamic networks. Disruptions in one component will limit the function of the entire system.
Of the 11, the female orgasm has a component overlap with the reproductive system — but they are not the same. A woman may conceive with anorgasmia, and a woman can also have a strong libido and enjoy multiple orgasms without conceiving a child. One may argue that the reproductive system provides offspring, but without the orgasm system there would be significantly fewer offspring. Yet, conceiving and sexual pleasure are not equal.
One may also argue that if we need systems analysis to understand how to breathe and have a bowel movement, we should use system analysis to understand what brings joy and connection and creativity — orgasm.
A 2023 study of medical education reported that out of seven medical schools in the Chicago area, only one taught the complete anatomy of the clitoris and how to evaluate female sexual dysfunction. Only one. As medical education starts to catch up with current research and women's legitimate demands for expert attention to their sexual concerns (by at least teaching physicians about comprehensive female anatomy), it may be time to acknowledge that, despite its absence thus far from traditional medical education, the female orgasm is complicated enough to warrant systems analysis, and such analysis first demands an attempt to define the system.
If a "female orgasm system" exists, it should meet the same four criteria that define other systems: 1) identifiable components, 2) interdependent interactions, 3) emergent effects beyond any single component, and 4) stability across varied conditions.
My efforts over the past 5 years to define the orgasm system and to encourage doctors and therapists to use systems analysis to treat female sexual dysfunction have not been an effort to invent anything; rather, I hope only to point out such a system exists and to offer a starting point for the work of others.
Components of the Female Orgasm System
To systematically describe female orgasm, we must first define its essential components.
Primary Components
Secondary Components
Each primary structure comprises substructures with specific roles. For instance, the clitoris includes the glans, corpus cavernosum, and spongiosum. The GU complex involves vaginal elasticity and lubrication, while psychosocial factors extend to behavioral and linguistic influences.
Feedback Loops in the Orgasm System: A Path to Innovation
Dynamic systems operate through reinforcing and balancing feedback loops. In the context of female orgasm:
Using systems analysis to consider how the feedback loops of the autonomic nervous system play a crucial role in female orgasm (integrating somatic input from the dorsal clitoral nerve with the autonomic pathways via the cavernous nerves, ganglion innervating the vaginal wall, inferior hypogastric nerve, and the vagus nerve) triggered the idea for the Clitoxin procedure to modulate autonomic input and enhance arousal.
Clinical Implications for Treatment: A Systems-Based Diagnostic Framework
Understanding an orgasm as a system provides a structured approach to evaluating sexual dysfunction. Consider a patient presenting with dyspareunia and anorgasmia following surgical intervention.
First, surgical success does not guarantee orgasmic function. Although anatomical restoration is critical, persistent anorgasmia may stem from endocrine imbalances (eg, hyperprolactinemia, hypothyroidism), vascular limitations, or psychosocial stressors.Rather than relying solely on procedural interventions or sex therapy/counseling, comprehensive assessment and personalized, targeted, systemic corrections can optimize outcomes.
Providers also should enhance patient communication and education.A visual model of the orgasm system can aid in counseling patients, emphasizing the multifactorial nature of the sexual response and reducing unrealistic expectations from isolated interventions.
Let's Start Recognizing the Female Orgasm as a System
When analyzed through the lens of systems medicine, the female orgasm provides a useful framework for refining surgical, medical, and psychosocial therapeutic strategies and for innovating new ideas. Recognizing orgasm as an emergent property of interconnected biological, neurological, and psychosocial factors fosters a more effective and sophisticated patient-centered approach and facilitates communication across specialties. Future research should continue refining this model to improve clinical applications and optimize sexual health outcomes. It is time for the twelfth body system — along with clitoral anatomy — to become part of our medical education.
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
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