Grace Marie Wetzel

Sexual strangulation (also referred to as choking during sex) has become increasingly prevalent among young adults and disproportionately affects females. Epidemiological studies indicate that more than half of college-aged women report a lifetime history of being strangled during sex, and it is most often described as consensual. Despite its widespread occurrence, little is known about the acute and cumulative neurological consequences of this behavior. Pilot studies suggest associations between frequent sexual strangulation and elevations in blood biomarkers of neural injury, alterations in brain structure and connectivity, and increased mental health symptoms; however, existing evidence is limited by cross-sectional designs, short-term follow-ups, and small sample sizes. This prospective cohort study is designed to characterize both the acute and longitudinal neurological effects of sexual strangulation using multimodal assessments. A total of 200 young adult females (100 with frequent sexual strangulation exposure and 100 controls with no lifetime strangulation history), along with a pilot cohort of 40 males, will undergo comprehensive evaluations including blood-based biomarkers of neural injury and inflammation, multimodal MRI, cognitive and oculomotor testing, retinal imaging, and mental health assessments. Acute neurological responses will be assessed approximately 24 hours following a sexual event involving strangulation (or non-strangulation sex in controls), while longitudinal follow-up will occur every six months over 30 months to examine cumulative exposure effects. Semi-structured interviews conducted at each time point will characterize strangulation practices, contextual factors, consent dynamics, and associated symptoms. The primary objectives are to (1) examine baseline group differences in neurological health between individuals with frequent sexual strangulation exposure and non-strangulation controls, (2) identify acute neurological alterations following sexual strangulation, (3) determine associations between cumulative strangulation exposure and neural cellular, physiological, and functional integrity over time, and (4) characterize young adults’ experiences, contextual factors, and perceptions of sexual strangulation through semi-structured interviews. Collectively, this study aims to establish temporal relationships between sexual strangulation and neurological health outcomes and to inform clinical guidance, sexual health education, and harm-reduction strategies related to this increasingly common sexual practice.

Across three experimental studies using hypothetical scenarios, we investigated under what circumstances, and to what effect, women and men devalue women’s orgasm. In Studies 1 and 2, women reported their orgasm value in response to a hypothetical scenario that varied their imagined orgasm history and current orgasm frequency with a new partner (low vs. high). In Study 2, orgasm value was compared to a baseline, pre-manipulation measure of orgasm value. In both studies, we found that women devalued orgasm only when they imagined they had a history of infrequent orgasms and were not orgasming with their current partner. When current orgasm frequency was low, women who valued orgasm less (or devalued orgasm) imagined better sexual and relationship outcomes than women who valued orgasm more. Men (Study 3) valued a hypothetical female partner’s orgasm less under the same circumstances and reported similar impacts of women’s orgasm absence on their own and perceived partner’s imagined sexual and relationship outcomes.

Research has found that bisexual women expect clitoral stimulation and orgasm more when hypothetically partnered with another woman versus a man, which is consistent with the widely documented heterosexual orgasm gap. The current research aims to (1) investigate “perceived partner orgasm pursuit” (i.e., the participant’s perception that her partner is pursuing her orgasm) as a novel mechanism to explain this difference in orgasm expectations, and (2) demonstrate that manipulating the interpersonal sexual script with a male partner to include sufficient clitoral stimulation can increase orgasm expectations when women have sex with men. In Study 1, we found that bisexual or pansexual women (N = 457) partnered with a woman in a hypothetical scenario expected greater clitoral stimulation, partner pursuit of her orgasm, and likelihood of orgasm than those partnered with a man. In Study 2, bisexual or pansexual women (N = 362) who were partnered with a man in a hypothetical scenario that specified (1) clitoral stimulation or (2) opportunity to orgasm via her most reliable route expected her partner to pursue her orgasm and expected orgasm, at similar rates to women who were partnered with a woman whose sexual behavior was unspecified. On the contrary, women partnered with a man in a hypothetical scenario which specified vaginal intercourse only expected the lowest likelihood of orgasm. In both studies, condition predicted expected clitoral stimulation, which predicted perceived partner orgasm pursuit, which predicted orgasm expectations. This research suggests that sexual scripts explain differences in orgasm expectations by partner gender, and these expectations can be changed by shifting the sexual script at the interpersonal level to include sufficient opportunity for (and pursuit of) women’s orgasm via clitoral stimulation. Findings are discussed in the context of contributors to and solutions for the orgasm gap.

Humans have a tendency toward essentialization or tend to believe that group differences are biological and immutable (i.e., unchangeable). In the current study, we assessed biological explanations for a well-established gender disparity in the sexuality domain: the orgasm gap. Across three studies, we found that laypeople commonly endorsed biological explanations for the orgasm gap. Furthermore, biological beliefs about the orgasm gap were correlated with greater immutability beliefs about the orgasm gap (Studies 1–2) and greater gender essentialism (Study 2). In Study 3, we found that gender disparities in the sexuality domain were viewed as more biological and immutable than gender disparities in another domain. Thus, we conclude that some gender disparities are conceptualized differently than others. We identify a need to further investigate biological beliefs for gender disparities across domains and identify the sexuality domain as a potentially useful target for interventions to reduce essentialism.

Previous research has established that gendered sexual scripts shape sexual behavior. This study seeks to expand prior work on orgasm disparities for women across sexual orientations by exploring the role of partner gender. Across two studies, we examined how the gender of women’s sexual partners influenced their orgasm goal pursuit. We compared lesbian and heterosexual women’s experience with their most recent partner in Study 1, and experimentally compared bisexual women partnered with a woman or a man in a hypothetical sexual encounter in Study 2. In both studies, women reported higher clitoral stimulation and orgasm expectations when partnered with a woman compared to a man. Moreover, partner gender had a significant indirect effect on women’s orgasm goal pursuit through clitoral stimulation and expectations for orgasm. These results suggest that sexual scripts associated with partner gender play a key role in the orgasm gap for women who have sex with men.

Orgasm gaps between heterosexual men and women, and for women across sexual orientations, are well-established in research. However, no large-scale assessments of orgasm frequency by race/ethnicity exist. Here, we analyzed 10 years of cross-sectional Singles in America survey data between 2011 and 2021 to investigate the orgasm gap at the intersection of gender and racial/ethnic identity (i.e. White, Black, Hispanic/Latino, and Asian) for heterosexual participants (N = 27,347). White and Hispanic/Latino men reported greater orgasm frequency than Black and Asian men. Hispanic/Latino women reported the greatest orgasm frequency, and Asian women reported the lowest, with White and Black women's frequencies in between. The orgasm gap between men and women was largest for White (d = 0.89) and Asian (d = 0.86) groups, although Asian participants reported a lower orgasm frequency than White participants overall. The orgasm gap was smaller for Hispanic/Latino participants (d = 0.66), because Hispanic/Latino women reported a greater orgasm frequency than other racial/ethnic groups of women. The orgasm gap was smaller for Black participants (d = 0.61), because Black men reported a lower orgasm frequency than some other racial/ethnic groups of men. This descriptive study serves as an important starting point for future research on orgasm experiences across racial/ethnic groups.

The “orgasm gap” for women who have sex with men remains a pressing gender equity issue. Recent research found that women who pursued orgasm as a goal were more likely to have one. The current research replicated this relationship between orgasm goal pursuit and orgasm frequency for heterosexual women, and found that this relationship did not exist for heterosexual men (Study 1). Then, across two experimental studies, we examined how heterosexual women vary their orgasm goal pursuit across sexual encounters. In Study 2, women who read that a hypothetical sexual encounter would be “quick” reported less intent to pursue orgasm than women who were told they could “take their time” or received no time information. In Study 3, women who read that their hypothetical sexual partner seemed selfish reported less intent to pursue orgasm than women who were given a non-selfish partner or no partner information. Importantly, these effects were mediated by women’s perceived orgasm likelihood in the scenario. These results suggest that women shift their pursuit of orgasm depending on cues which signal whether orgasm will be feasible. This research used self-regulation theory to understand women’s motivations for pursuing orgasm during sexual encounters with men, with implications for reducing the orgasm gap.