We Deserve Better: The Pleasure Gap

Much More Than An Orgasm Gap!

A landmark 2015 study published in the Archives of Sexual Behavior shed important light on the persistent “orgasm gap.” Surveying more than 52,000 U.S. adults, researchers reported striking differences in orgasm frequency across sexual orientations:

• Heterosexual men: ~95%

• Heterosexual women: ~65%

• Gay men: 89%

• Bisexual men: 88%

• Lesbian women: 86%

• Bisexual women: 66%

The takeaway? In heterosexual encounters, men almost always orgasm, while women are significantly less likely to. This gap has been echoed in subsequent reporting, including Scientific American, which confirmed that about 95% of straight men usually or always orgasm during sex, compared to just 65% of straight women.

As Dr. Fenwa Milhouse—board-certified urologist, fellowship-trained pelvic surgeon, co-founder of Down There Urology, and star of TLC’s Dr. Down Below—explains, these numbers aren’t surprising. For too long, culture has pushed the myth that vaginal penetration alone should equal orgasm for women. “You would not expect a man to ejaculate by rubbing his balls,” she says in her interview on the PAUZ podcast Grab Life by the Ovaries. The clitoris, much like the head of the penis, requires direct stimulation for orgasm—yet this reality is too often ignored in heterosexual sex. If men needed clitoral stimulation to orgasm—there would be a billion-dollar gadget in every pharmacy aisle.

What About Women Struggling?

A large  U.S. population study (the National Health and Social Life Survey, NHSLS) found that 43% of women experience some form of sexual dysfunction—with low desire, arousal difficulties, or pain among the most common issues. 

For many women, menopause feels like a battle waged on multiple fronts. The steady decline of estrogen doesn’t just bring hot flashes or night sweats—it can also wreak havoc on sexual desire. The effects are both physical and psychological.

On the physical side, lower estrogen levels can lead to vaginal dryness, thinning tissue, and pain with intercourse (a cluster of symptoms known as genitourinary syndrome of menopause, or GSM). When intimacy hurts, desire naturally takes a hit.

On the psychological side, menopause often arrives in the midst of life’s most demanding years. Careers, aging parents, empty nests, or strained relationships can leave women feeling drained before they ever make it to the bedroom. Add hormonal shifts on top, and it’s no wonder that many report their interest in sex feels like it’s vanished.

But here’s the important truth: loss of desire in midlife isn’t inevitable—and it isn’t a sign that something is “wrong” with you. It’s a signal. A signal you deserve better. With the right strategies—medical treatments, pelvic health therapies, or even honest conversations—sexual well-being can absolutely be restored.

It Takes Two To Tango-But Only One Gets Help

Here’s a reality check: roughly 50% of men between ages 40 and 70 experience some form of erectile dysfunction, while up to 40% of women in menopause report sexual dysfunction—whether that’s low desire, difficulty with arousal, or pain.

But here’s the kicker: men have 15+ FDA-approved medications for erectile dysfunction (sildenafil, tadalafil, vardenafil, avanafil…the list goes on). Women? There are just two FDA-approved drugs for arousal concerns (flibanserin and bremelanotide aka Addyi and Vyleesi). 

We’ve turned men’s erections into a multi-billion-dollar industry. Meanwhile, women are too often left with silence, stigma, and a stunning lack of options. And this gap isn’t just about sex—it’s about equity, health, relationships, and quality of life.

Here’s the irony: the medical system hands out prescriptions for erectile dysfunction with ease, yet rarely pauses to ask where those erections are going. For women struggling with low desire, pain, or arousal issues, this dynamic can create yet another layer of pressure and shame. Suddenly, they’re expected to match a partner who is “ready and raging” while their own needs and barriers go unacknowledged. And to make matters worse, only 1 in 5 doctors even raise the topic of sexual health with their female patients.

 In fact, the silence is deafening.

• Only 14% of OB/GYNs routinely ask about sexual activity or satisfaction.

• Fewer than 30% inquire about sexual problems at all.

• In one survey, just 22% of women reported that a healthcare provider had ever asked them about their sexual health.

When women are asked, however, more than half report concerns. The problem isn’t the absence of issues—it’s the absence of conversation. 

What's A Woman To Do?

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