Orgasm as a State-Dependent Process

Female orgasm has been described in the scientific literature as involving an altered state of consciousness. An altered state of consciousness involves a shift away from ordinary waking consciousness, in which executive control, self-monitoring, evaluation, threat monitoring, cognitive distraction, and performance monitoring become less dominant, while sensory, emotional, imaginal, and bodily experience become more prominent. Many of these inhibitory processes are also commonly associated with orgasmic difficulty.

Neuroimaging and neurophysiological research demonstrates substantial changes during orgasm across brain systems involved in attention, sensory processing, emotional processing, reward, autonomic regulation, inhibition, and executive control.

These findings support a state-dependent understanding of orgasm, in which orgasm depends not only on stimulation, but also on the nervous system's capacity to transition into and sustain an orgasm-supportive neurophysiological state.

The Neuroregulatory Model of Female Orgasm

A Neuroregulatory Model of Female Orgasmic Function: A State-Dependent, Multi-Pathway Framework

Developed by Suzanne Mulvehill, PhD, the Neuroregulatory Model proposes that orgasm emerges through coordinated progression across five neuroregulatory phases:

Safety → State Transition → Absorption → Sensory Amplification → Orgasmic Release

The model proposes that multiple pathways may converge upon shared regulatory conditions and shifts the focus from stimulation alone toward the nervous system's capacity to access and stabilize the conditions in which orgasm becomes possible.

Research Status: Currently under peer review.

Orgasmic Learning

Orgasmic Learning as a Treatment Framework for Female Orgasmic Disorder/Difficulty: A Review Using Perelman's Sexual Tipping Point® Model

This review introduces Orgasmic Learning as a proposed state-dependent treatment framework for female orgasmic disorder/difficulty, examining how orgasmic access may be developed, strengthened, expanded, and transferred through experience and learning.

The framework shifts the therapeutic target toward state transition: inducing or facilitating entry into an altered, absorbed, or otherwise orgasm-supportive state in which orgasmic response becomes accessible. Across the pathways reviewed, this state transition is proposed as the shared therapeutic target of Orgasmic Learning.

The review evaluates six evidence-supported orgasmic learning pathways, described in the research section below.

Research Status: Currently under peer review.

Foundational Research Supporting Orgasmic Learning

Beyond the research supporting the individual pathways, a broader scientific literature examines mechanisms that may help explain how different pathways can facilitate orgasmic access.

Attention & Absorption

Research suggests that attentional organization plays an important role in female sexual response.

Sheen & Koukounas (2009) found greater subjective sexual arousal under immersive, participant-oriented conditions than under spectator-oriented conditions. Swartz (1994) proposed that absorbed states may play a particularly important role in women's sexual response. Cuntim & Nobre (2011) identified cognitive distraction as an important factor in female orgasmic difficulty.

Together, these findings support the importance of movement away from evaluative self-monitoring and toward sustained experiential immersion.

Altered States of Consciousness

Female orgasm has been formally described as involving an altered state of consciousness, and research suggests that greater capacity to enter altered states may be associated with greater sexual responsiveness.

Costa, Pestana, Costa, & Wittmann (2016) reported an association between altered states of consciousness and higher sexual responsiveness. Research involving meditation, hypnosis, psychedelic states, trance, and sexual absorption provides additional evidence for states characterized by changes in attention, self-monitoring, sensory processing, and experiential immersion.

Inhibition & Excitation

Orgasmic response is influenced by the interaction between processes that facilitate sexual response and those that inhibit it.

Komisaruk & Rodriguez Del Cerro (2022) proposed that orgasm and related disorders depend upon the interaction of neural inhibition and excitation.

Orgasmic Learning incorporates this balance by examining how different pathways may reduce inhibition, increase sensory salience, facilitate absorption, and shift the excitation-inhibition balance toward orgasmic access.

Interoception & Sensory Processing

Interoception refers to awareness and processing of signals arising from within the body.

Dixon, Poerio, Rieger, & Klabunde (2024) found associations between interoceptive awareness and female orgasm frequency and satisfaction. Neuroimaging research further demonstrates increasing activation across distributed sensory systems leading toward orgasm and convergence of sensory inputs within centrally mediated orgasmic processing.

Experience-Dependent Neuroplasticity

The nervous system changes through repeated experience.

Kleim & Jones (2008) describe principles of experience-dependent neural plasticity through which repeated activation can strengthen neural processes over time.

Orgasmic Learning proposes that repeated engagement with orgasm-supportive states or conditions may increase their stability, flexibility, and accessibility over time.

Research Supporting the Six Orgasmic Learning Pathways

The six pathways represent different routes through which orgasmic access has been documented or facilitated in women. The strength and type of evidence differ across pathways, ranging from observational studies and systematic reviews to clinical reports, physiological studies, neuroimaging research, and historical psychotherapy literature.

1. Cannabis-Assisted Pathway

Research supports cannabis as a pathway associated with improved orgasmic response, including among women experiencing orgasm difficulty.

• Banbury, S., Tharmalingam, H., Lusher, J., Erridge, S., & Chandler, C. (2024). A preliminary investigation into the use of cannabis suppositories and online mindful compassion for improving sexual function among women following gynaecological cancer treatment. Medicina, 60(12), 2020.
• Kasman, A. M., Bhambhvani, H. P., Wilson-King, G., & Eisenberg, M. L. (2020). Assessment of the association of cannabis on female sexual function with the Female Sexual Function Index. Sexual Medicine, 8(4), 699–708.
• Lynn, B. K., López, J. D., Miller, C., Thompson, J., & Campian, E. C. (2019). The relationship between marijuana use prior to sex and sexual function in women. Sexual Medicine, 7(2), 192–197.
• Mulvehill, S., & Tishler, J. (2024). Assessment of the effect of cannabis use before partnered sex on women with and without orgasm difficulty. Sexual Medicine, 12(2), qfae023.
• Mulvehill, S., & Tishler, J. (2025). Cannabis for female orgasmic disorder/difficulty: A systematic review. Sexual Medicine, 13(4), qfaf061.

2. Fantasy & Imagery Pathway

Fantasy- and imagery-based evidence includes historical behavioral treatments using fantasy training, guided imagery, and orgasmic reconditioning for orgasm difficulty; clinical trial evidence that guided imagery and music improved overall sexual function and the orgasm dimension of sexual function; and contemporary randomized evidence that structured sexual fantasy exercises may increase sexual desire and pleasure while reducing sexual distress and sexual worries.

• Campos, P., Leal, I., & Costa, R. M. (2026). The role of sexual fantasy on sexual desire, distress, and sexual worries: A randomized controlled study. Journal of Sexual Medicine, 23(5), qdag097.
• Marquis, J. N. (1970). Orgasmic reconditioning: Changing sexual object choice through controlling masturbation fantasies. Journal of Behavior Therapy and Experimental Psychiatry, 1(4), 263–271.
• Mohammadi, E., AbdiShahshahani, M., Noroozi, M., Mohammadi, A. Z., & Beigi, M. (2023). Improving sexual dysfunction through guided imagery music (GIM): A clinical trial study. Journal of Education and Health Promotion, 12(1), 442.
• Wish, P. A. (1975). The use of imagery-based techniques in the treatment of sexual dysfunction. Counseling Psychologist, 5(1), 52–55.

3. Hypnotic Induction Pathway

Hypnosis-assisted evidence includes historical clinical reports of hypnosis-assisted treatment for orgasm difficulty, anorgasmia, and conditions historically described as frigidity, together with contemporary physiological evidence that hypnotically induced orgasm is associated with increases in plasma prolactin consistent with orgasmic response. Hypnosis may facilitate orgasmic access through focused attention, reduced ordinary cognitive monitoring, increased suggestibility, and enhanced sensory and imaginal experience.

• Cheek, D. B. (1976). Short-term hypnotherapy for frigidity using exploration of early life attitudes. American Journal of Clinical Hypnosis, 19(1), 20–27.
• Chernenkoff, W. (1972). Regressive hypnosis in treatment of temporary anorgasm. Canadian Family Physician, 18(3), 56–57.
• Pfaus, J. G., Nerenberg, A., Sonshine, M., Kosařová, A., Nováková, M., & Novák, J. (2025). Hypnotic induction of orgasm increases plasma prolactin in women. Journal of Sexual Medicine, 22(Suppl. 1), qdaf068.054.
• Richardson, T. A. (1968). Hypnotherapy in frigidity and para-frigidity problems. Journal of the American Society of Psychosomatic Dentistry and Medicine, 15(3), 88–96.
• Ward, W. O. (1975). Successful treatment of frigidity through hypnosis. Virginia Medical Monthly, 102(3), 223–228.

4. LSD-Assisted Psychotherapy Pathway

LSD-assisted evidence includes historical reports of LSD-assisted psychotherapy for women's orgasmic difficulties and conditions historically described as frigidity, including reports in which orgasmic response emerged during treatment.

• Ling, T. M., & Buckman, J. (1960). The use of lysergic acid in individual psychotherapy. Proceedings of the Royal Society of Medicine, 53(11), 927–929.
• Ling, T. M., & Buckman, J. (1964). The treatment of frigidity with LSD and Ritalin. Psychedelic Review, 1(4), 450–458.

5. Pelvic Floor & Somatic-Motor Pathway

Pelvic floor and somatic-motor training may function as a trainable orgasmic learning pathway by increasing awareness of pelvic floor sensations, coordination, contraction and relaxation capacity, voluntary muscular control, sensory access, and excitatory input without requiring direct genital stimulation.

• Pfaus, J. G., Erez, R., Erez, N., & Novák, J. (2026). Non-genitally stimulated orgasms increase plasma prolactin in a menopausal woman. International Journal of Sexual Health, 38(2), 404–408.
• Riccetto, C., Lanza, A., Pereira, S., Pereira, L., Silva, J., & Palma, P. (2010). Pelvic floor muscle training in the treatment of women with secondary anorgasmia: Functional and electromyographic valuations. International Urogynecology Journal, 21.

6. Tantra & Breath-Based Altered-State Pathway

Yoga-, tantra-, and breath-informed practices may support orgasmic learning by facilitating transition into altered or absorbed states and training attentional absorption, autonomic regulation, interoceptive awareness, enhanced sensory access, and whole-body orgasmic capacity, thereby increasing excitatory access while reducing cognitive and autonomic inhibition.

• Lousada, M., & Angel Reyes, B. E. (2011). Tantric orgasm: Beyond Masters and Johnson. Sexual and Relationship Therapy, 26(4), 389–402.
• Pfaus, J. G., & Tsarski, K. (2022). A case of female orgasm without genital stimulation. Sexual Medicine, 10(2), 100496.