Editor's Note: (Ian Kerner is a licensed couples therapist, writer and contributor on the topic of sex for CNN.)
(CNN) Many of us equate "sex" with "intercourse" and use those words interchangeably. Yet highly satisfying sex doesn't have to be limited to penetration -- and doesn't even have to include it at all.
According to a recent study, many women report that they require clitoral stimulation to have an orgasm.
For the study, Debby Herbenick, director of the Center for Sexual Health Promotion at Indiana University and a research fellow and sexual health educator at the Kinsey Institute, and her colleagues assessed data from 1,055 women ages 18 to 94 who answered a detailed online survey about their sex lives. "Our purpose was to understand more about women's experiences with ... the kinds of touch they find pleasurable and how clitoral and vaginal stimulation contribute to their orgasms," she explained.
In reading her results, I'm struck by the idea that the majority of women report that they often don't reach orgasm through intercourse alone. This flies in the face of the stereotype of intercourse as the be-all and end-all of sexual activity -- and suggests that couples should explore the whole range of pleasurable options for achieving climax. The study contained a few compelling findings worth enumerating.
This study found that only about 18% of women reported being able to climax during intercourse from vaginal penetration alone. About 36% said they needed clitoral stimulation in order to orgasm during intercourse, and another 36% said it enhanced the experience. Yet, many women still fake orgasm during intercourse, according to therapist Laurie Mintz, author of the new book "Becoming Cliterate."
"The main reasons they give for faking is that they want to appear 'normal' and want to make their male partners feel good," she said.
"This is one of the saddest and most common problems I deal with in my clinical practice," added Anita Hoffer, a sexuality counselor and educator. "Women who either are uninformed or insecure and therefore easily intimidated by ignorant partners bear a great deal of shame and guilt at being unable to climax from intercourse alone. Many are greatly relieved when they learn that they are among the majority of women who engage in sexual intercourse."
Do some orgasms feel better than others? According to 78% of the survey respondents, the answer is yes. These so-called better orgasms aren't necessarily dependent on the length of an encounter. In fact, fewer than one in five women surveyed believed that longer sex contributed to better orgasms.
Instead, the most common contributors to orgasmic bliss included spending time to build arousal, having a partner who knows that they like, emotional intimacy and clitoral stimulation during intercourse, said Herbenick. "A woman's general mood and stress level -- including the degree to which she is able to mindfully immerse in the sexual encounter -- can have an impact on orgasm quality too," Mintz explained.
This term "outercourse" refers to sex that isn't intercourse and doesn't involve penetration. It can include kissing, touching, erotic massage and using sex toys, just to name a few options.
"When we equate intercourse and sex and call everything that comes before intercourse 'foreplay,' we are buying into the cultural script that sex should proceed as follows: foreplay (just enough to get her ready for intercourse), intercourse (during which both women and men orgasm), and game over," Mintz said. But sex doesn't have to involve intercourse at all. Even when it does, other forms of stimulation can add to the experience and may improve the odds of reaching orgasm.
Herbenick suggested that couples take a lesson from the early days of their relationship. "Sometimes, when people are first getting together, they spend time making out and touching each other's genitals long before they start having oral sex or intercourse with each other," she explained. "All too often, once oral sex and intercourse become part of their routine, the rest fades away -- which is too bad, considering how powerful genital touching can be."
The study found that 41% of women prefer just one style of touch. "This underscores how important it is to have conversations about sex and pleasure or even to show your partner what you like, since otherwise, the chances of just stumbling upon that one preference are pretty low," Herbenick said. "Couples should be having conversations about what they like, what they don't like, what feels good and leads to orgasm, as well as what feels good but doesn't necessarily lead to orgasm."
One good source of information about women's sexual pleasure that can help you get the conversation started is the website for OMGYES, which sponsored the study. The site, which states it's for 18-year-olds and older, contains a series of videos that demonstrate different types of touch that real women find pleasurable, including techniques labeled "edging," "layering" and "orbiting." There is a free preview but a cost to access all of them.
I've found this site very helpful to my female patients and their partners who want to learn more about female pleasure. "It tastefully and unselfconsciously names, describes and normalizes behaviors that are universal and, by example, invites the viewer to experiment and learn," Hoffer said. "As Leonore Tiefer (sex researcher, therapist and activist) has said, 'Sex is not a natural act,' and good lovemaking is an art that must be learned and practiced."