H. Ümit Sayin
Altered States of Consciousness
(ASC) Occuring During
H. Ümit Sayin, M.D.
Institute of Forensic Sciences,
Istanbul University, Cerrahpaşa-Istanbul
Expanded Sexual Response (ESR) is a recently defined phenomenon. It is defined as “being able to attain long lasting and/or prolonged and/or multiple and/or sustained orgasms and/or status orgasmus that lasted longer and more intense than the classical orgasm patterns defined in the literature”. During our detailed preliminary survey to investigate the claimed ESR phenomenon in some particular women, we also investigated the subjective feelings and altered states of consciousness (ASC) during very intense and prolonged orgasms in the women with ESR. During our preliminary survey 72 types of different subjective feelings and ASC patterns were described in the 47 women with ESR. Among these were: depersonalization; out of body experience; flying; dying feeling (petit morte); ecstasy; rapture; explosion feeling; quivering, earthquake feeling; flooding; absorbing; spurting; blessed; shuddering; intense love; unreal; surreal; voyage to nature; seeing light flashes, color flashes, geometric shapes, figures; peacefulness; physical and spiritual warmth; loss of control; spreading; flowing; mystical experience; unification with the partner and/or the universe; de ja vu; crying etc. It is concluded that in some particular women with ESR, some of the very intense and prolonged orgasms induce a form of ASC of which mechanism is not explained yet! Pudental, pelvic, hypogastric and vagus nerves and oxytocin pathway is involved in the development of female orgasm. We hypothesize that blended nerve activation among these four nerves during ESR may be inducing extraordinary subjective feelings and ASC during profound female orgasms. “Four nerve theory of female orgasm” may explain the ASC during ESR to some extent. Also involvement of dopaminergic, serotoninergic, noradrenergic, opioid, prolactinergic and oxytocinergic pathways may modulate the altered mood states during ESR induced ASCs. Near to our ongoing research, more research to determine the scientific basis and parameters of ESR phenomenon in some females should be carried out, as well as the research on the neurological, psychological and neurochemical mechanisms of ESR induced ASC’s in some females’ psyche.
Key Words: Expanded Sexual Response (ESR), Expanded Orgasm (EO), Altered States of Consciousness (ASC), Prolonged Orgasm, Four nerve theory of female orgasm.
Expanded Sexual Response (ESR) (Sayin, 2011 a, b, c) and Expanded Orgasm (EO) (Rhodes, 1991; Schwartz, 1999; Bodansky, 2000; Taylor, 2000, 2002; Sayin, 2010, 2012) are novel terms to define a prolonged and more intense sexual response in the human female. During the last decades many books have been written about the possibility of the enhancement of female sexual response (Rhodes, 1991; Schwartz, 1999; Bodansky, 2000; Taylor, 2002; Zdrok, 2004; Sayin, 2010, 2012). A form of ESR, Status orgasmus, a prolonged orgasm pattern lasting for 43 seconds in the human female had also been defined by Masters and Johnson, earlier (Masters & Johnson, 1966). Other incidences of prolonged and multiple orgasms in extensive numbers have been documented in the literature, such as 134 to 200 orgasms being attained in one hour in some particular cases (Sayin, 2010). After 1980’s a lot of research have been done on the limits and extents of female pleasure and orgasmic states. It has been hypothesized that orgasmic response can be enhanced and expanded in certain ways in some particular females after training sessions (Taylor, 2000, 2002; Rhodes, 1991, Bodansky, 2000; Sayin, 2010).
ESR has been defined as: ”being able to attain long lasting and/or prolonged and/or multiple and/or sustained orgasms and/or status orgasmus that lasted longer and more intense than the classical orgasm patterns defined in the literature” (Sayin, 2011 a, c). In the Eastern, Chinese, Indian and Tantric literature similar enhanced orgasmic experiences of females have been reported (Vatsyayana, 1883; Chang 1977, 1983; Schwartz, 1999; Chia 2002, 2005; Mumford, 2005; Michaels 2008).
Recently, some studies of orgasmic women also revealed a form of ASC during orgasms (Komisaruk et al, 2006; Sukel 2011). There are increasing numbers of reports of females experiencing a form of ASC during prolonged and very intense orgasms, which form a novel concept of ESR. However, in those studies no classification of the sexual response was made to address a question such that, whether these women were experiencing an enhanced orgasm pattern and ESR, or not. Most of the questionnaire that investigated the ASC during orgasms was prepared to quest an average orgasm pattern of a women.
In a recent study, our survey research has pointed out that some women who claim to have ESR (ESR-women) had some main characteristics compared to the women who don’t have ESR (None-ESR, NESR-women); ESR-women had at least five or more of the following characteristics of their sexual response (Sayin, 2011 a):
1) The ESR women experienced vaginal, clitoral and blended orgasms, as described by Ladas et al. (Ladas, 1982). 2) The ESR women experienced multiple orgasms in most of their sexual activities. 3) The ESR women were able to attain long lasting and/or prolonged and/or multiple and/or sustained orgasms and/or status orgasmus that lasted longer than the classical single orgasm and/or multiple orgasm patterns defined in the literature. 4) The ESR women claimed to have strong pelvic floor muscles (PFM) compared to NESR women. 5) The libido of ESR women was very high compared to NESR women. 6) ESR women described a phenomenon called G-Spot orgasms. 7) ESR women described sensitive erogenous zones in their genitalia other than clitoris. 8) ESR women masturbated more frequently compared to NESR women. 9) ESR women had erotic fantasies more frequently than the NESR women. 10) ESR women admitted to have a form of altered states of consciousness during some of their prolonged orgasms and/or status orgasmus.
We have investigated the ESR phenomenon further by using specially designed three preliminary scales in the females who have claimed to have ESR during our ongoing surveys. The main hypothesis of this article is, “during enhanced and prolonged orgasms, women may experience different forms of altered states of consciousness (ASC)”. Further statistical analysis will be carried out when the study is completed.
Preliminary SAYIN-ESR-SO scale (expanded sexual response and status orgasmus scale; containing 35 specific questions), preliminary SAYIN-PFM-ESR scale (pelvic floor muscles and expanded sexual response scale; containing 26 questions) and preliminary SAYIN-Subjective Orgasmic-ASC Experience Scale (seventy two item scale) have been used. All of these preliminary scales were designed to establish a psychometric analysis and a final scale for ESR phenomenon in future and to collect preliminary data to determine the definitions of ASC and/or subjective feelings during ESR-orgasms. Former orgasmic scale of Mah & Binik (Mah, 2010) and other reports (Fisher 1973, 1977; Taylor, 2000) were also taken into consideration during the determination of the characteristics of ASC and subjective feelings in the female ESR-orgasms. The seventy two item subjective feeling and ASC preliminary scale has been designed after many other surveys and interviews (Sayin, 2003 a, b; Sayin, 2010; Sayin, 2011 b; Sayin, 2012) since 1991 and other correspondence with women.
A total number of 47 women of different nationalities who claimed to have a form of ESR were interviewed through scientific circles, universities, former survey correspondence, internet, web site notices, and facebook communications (through facebook chat and/or gmail chat) between 2010 and 2012 (the study is still continuing). Also data from a control group of NESR-women was collected (not presented in this paper).
Before starting the survey, many interviews with the women and/or literature reviews were made to determine 72 different subjective feelings or ASC patterns experienced in a single, multiple and/or prolonged ESR orgasm. Since this is a descriptive preliminary report for the definitions of ASC in ESR-orgasms, not much emphasis is given to statistical analysis, which will be carried out in future studies and publications. All data is entered into SPSS program and frequencies of occurrences were calculated by SPSS.
In SAYIN-Subjective Orgasmic-ASC Experience preliminary Scale, 72 subjective feelings and ASC patterns were asked to be filled in a table using a 0-6 likert scale from experienced very frequently (6) to experienced very seldom (1) or to none (0) during; a) single clitoral orgasm, b) single vaginal orgasm, c) multiple orgasms, d) ESR; blended, prolonged, sustained orgasm; and/or status orgasmus. The definitions of ESR, blended orgasm, multiple orgasms and status orgasmus were given with many figures and plots for explanations in the beginning of the scales as:
The Definition of ESR: Being able to attain long lasting and/or prolonged and/or multiple and/or sustained orgasms and/or status orgasmus that lasted longer and more intense than the classical orgasm patterns defined in the literature.
Do you or did you have such a sexual response?
Definition of Status Orgasmus:
Status orgasmus is the continuous form of blended orgasms and/or clitoral/vaginal orgasms that last for starting from 1 minute to 10-15 minutes (or more). During status orgasmus a continuous orgasmic state is experienced and very few women are believed to achieve status orgasmus state. Status orgasmus can be seen in vaginal and clitoral orgasms, however mostly it is seen as an expanded/extended form of blended orgasms, in which both clitoral and vaginal orgasm reflexes are triggered at the same time. Similar orgasmic states and full body orgasms are also defined in Tantric literature. The duration may change from woman to woman. Status orgasmus was first defined by Masters & Johnson as lasting for 43 seconds in a woman in 1966. Today it is estimated that status orgasmus continues for 1 to 2 minutes, while it may last for 10 to 15 minutes, a prolonged and extended orgasmic state which ends by a giant orgasm (Big-O) that gives a big relief and satisfaction at the end. In most of the status orgasmus experiences there is usually a refractory period of 10 to 15 minutes. The number of minor orgasms in a status orgasmus may exceed from 5-10 to 20-30 (some women claim that this quantity goes up to around 50). In status orgasmus it is thought that pudental, pelvic, hypogastric and vagal nerves mediate the triggering mechanism at the same time. In the following graphs the physiological changes and pleasure/satisfaction is depicted. Status orgasmus is a continuous form of tetanic orgasms of blended, vaginal or clitoral origin.
According to this information answer the following:
Have you ever had status orgasmus?
Single Female Orgasm: Clitoral or vaginal orgasms. Clitoral orgasm is mediated by pudental nerve, vaginal orgasm is mediated by pelvic nerve. It has long been debated that some vaginal orgasms are triggered by Grafenberg’s Spot (G-Spot) (Ladas, Whipple, Perry G-Spot, 1982). Clitoral orgasm is generally perceived in a local genital area, as bursting; 80 to 90 % of women have experienced it. Vaginal orgasms are said to be more satisfactory and more radiating.
Multiple Orgasms: Multiple orgasms can be either clitoral or vaginal or induced by both. There is a successive train of orgasms, generally increasing in amplitude and intensity gradually.
Blended Orgasms: Blended orgasms can be mediated by the orgasm triggering mechanism of both clitoris and spots of vaginal origin (such as G-Spot, A-Spot, O-Spot or Cervix). A blended orgasm is much more intense than a clitoral or vaginal orgasm alone. Both pudental and pelvic nerves mediate the triggering of blended orgasm. Blended orgasms are much more satisfactory and they are multiple orgasms. (Ladas, Whipple, Perry, the G-Spot, 1982; Komisaruk, Beyer-Flores, Whipple, The Science of Orgasm, 2006)
The survey correspondents were also questioned about their medical history and the women who had had some psychiatric background such as bipolar disorder, persistent genital arousal syndrome, hyperthyroid disorder, obsessive compulsive disorder, or sexual compulsive disorder etc. were not taken into the study, since the enhanced sexual response in those women could be related with the psychopathology or metabolic pathology. Also the women were questioned about their psychiatric background and whether they used any drugs of abuse, such as hallucinogens. The women who were diagnosed as alcoholic, psychotic, bipolar disorder, manic disorder, schizophrenic, paranoid disorder, etc. and the women who used any drugs of abuse were not taken into the study.
Further detailed analysis of the results with proper statistics compared with the control group will be published when the study is completed. This article is only a preliminary report to support the hypothesis that enhanced and prolonged orgasms may induce many different forms of ASC in the human female.
The results from SAYIN-Subjective Orgasmic-ASC Experience preliminary Scale are given and discussed in this article. The results are given in the following tables as the occurrence frequencies are pointed out as A, B, C and D which depict the following frequencies of the ASC and/or subjective feeling to be seen and recorded in the female subjects during a multiple orgasm and/or an ESR induced orgasm:
A) Recorded in between 76-100 % of the subjects B) Recorded in between 50 to 75 % of the subjects C) Recorded in, between 25 to 49 % of the subjects D) Recorded in between 1 to 24 % of the subjects.
Our preliminary comparison of these results showed that some NESR control women also experienced ASC during clitoral or multiple orgasms; however the variety and frequency of their experience of ASC was significantly much lower compared to the ESR women. The detailed statistics of the data will be published when the study is completed.
TABLE 1. Subjective perception and ASCs. Experiences during a single clitoral or a single vaginal orgasm are not included and presented. Category explanation for A: 76-100%, B: 50-75 %, C: 25-49% and D 1-24%.
During a multiple orgasm AND
During a prolonged orgasm with ESR (prolonged orgasms, blended orgasms, status orgasmus)
TABLE 2. Subjective perception and ASCs. Experiences during a single clitoral or a single vaginal orgasm are not included and presented. Category explanation for A: 76-100%, B: 50-75 %, C: 25-49% and D 1-24%.
During a multiple orgasm AND
During a prolonged orgasm with ESR (prolonged orgasms, blended orgasms, status orgasmus)
TABLE 3. Subjective perception and ASCs. Experiences during a single clitoral or a single vaginal orgasm are not included and presented. Category explanation for A: 76-100%, B: 50-75 %, C: 25-49% and D 1-24%.
During a multiple orgasm AND
During a prolonged orgasm with ESR (prolonged orgasms, blended orgasms, status orgasmus)
TABLE 4. Subjective perception and ASCs. Experiences during a single clitoral or a single vaginal orgasm are not included and presented. Category explanation for A: 76-100%, B: 50-75 %, C: 25-49% and D 1-24%.
During a multiple orgasm AND
During a prolonged orgasm with ESR (prolonged orgasms, blended orgasms, status orgasmus)
Some of the psychological changes during female “intense orgasms” had been well documented by Fisher such as depersonalization, flying, rapture and ecstasy etc., however Fisher observed such ASC’s in a group of women he called “high orgasmic”, who could have been named as women with ESR if interviewed today (Fisher, 1977). Similar psychological changes of female mood during intense orgasms have been cited in the literature during the last decades (Swartz, 1994; Taylor, 2000; Sayin, 2010; King, 2010; Sukel, 2011). In French language, one of the terms used for female orgasm is “petit morte” (little death), trying to articulate the flying, out of body, dying, dispersion of consciousness experiences during an intense orgasm.
During our surveys in 1993, 2003, 2010-2012, we have interviewed with similar ASC cases of “high orgasmic” women (Sayin, 2010; Sayin, 2011; Kocatürk, 2011). We are not presenting the comparison of the ASC frequencies, averages of likert scaling, and statistics between ESR and NESR women in this article, since this is a preliminary report of some of the definitions and this study is still continuing.
It was Mah & Binik’s study first opened a typical discussion on such altered mood states during female orgasms (Mah, 2001, 2002, 2005, 2010; King, 2010). King, Mah & Binik categorized subjective feelings of female orgasms in 10 dimensions as building sensations, flooding sensations, flushing sensations, shooting sensations, throbbing sensations, general spasms, pleasurable satisfaction, relaxation, emotional intimacy, and ecstasy (King 2010). However, in Mah & Binik’s studies there was no classification of women in terms of the properties of orgasmic response, such as clitoral, vaginal, blended and/or ESR.
It is problematic if the quality and details of orgasmic response (whether it is clitoral, vaginal, multiple or enhanced/prolonged orgasm) is not recorded and reported; and if ASCs during an enhanced orgasm is mixed with a traditionally accepted form of orgasm; because it is not easy to decide then, whether this form of ASC is a result of a very powerful and prolonged orgasm or not! For instance, in our groups mystical experience was never recorded in NESR women, but some women with ESR reported to have a form of mystical experience. Also, the average scoring of “flying, out of body experience” was below 2 in likert scale in NESR women during multiple orgasms; however it was above 4 during ESR women’s multiple orgasm experience. Near to this, NESR women did not experience prolonged and ESR orgasms that lasted very long and intense, so there was no control group data to compare ESR women’s prolonged orgasm experience with anyone in the whole study group!
In our group, we have used a similar scale including King’s orgasmic dimensions, although we have not classified the feelings in certain categories yet, we have found similar patterns in female orgasmic response as King, Mah & Binik did. We have not divided the subjective feelings and sensations into ASC and none-ASC subjective feelings, because it is not for sure at what point a subjective feelings turns into ASC or can be accepted as ASC, further analysis in our series will be carried out. Among King’s classifications some of the reported feelings were obviously a form of ASC, such as flooding, spreading, shuddering, soothing, unifying, ecstatic, rapturous etc.
Taylor also described similar alterations of the mood in her PhD thesis (Taylor, 2000). In Taylor’s study, the expanded orgasm (EO) or ESR duration was 0.2 to 60 minutes and even more in some particular cases in 22 female subjects (a total of 44 subjects or 22 couples). Taylor had classified her cases into four dimensions as physical, mental, emotional and spiritual. Taylor’s cases described a deep experience of ASC such as, more pleasure; deep relaxation; heightened sensations; increased energy; temporary pain relief; energy expanding out of body; deep relaxing abdominal breathing; increased clarity and creativity; acceptance of the self and others; extra sensory perception; ecstasy; mystical experience; divine feelings; increased awareness of the body; mind connection and integration; psycho-spiritual birth and death experience; loss of illusion of spatial separation; loss of spatial dimensions, loss of sense of time; personal boundaries dissolving and merging with the divine; cosmic emptiness and void; sharing with the partner; compassion; sense of fulfillment etc. (Taylor, 2000).
Our final psychometric scales for assessing the mood changes and ASC during ESR may contain more than 72 items; however this is a preliminary report of a preliminary study that concludes that enhanced and expanded female orgasmic response (EO) may alter the consciousness and induce many extraordinary mood states which is not defined in the literature clearly yet. We have also classified these alterations in clitoral, vaginal, multiple and ESR-prolonged orgasms. Our data (not shown) also suggests that there can be an alteration of consciousness and ASC in some single clitoral or vaginal orgasms alone, without any ESR; however, it is more likely to experience many of those proposed 72 subjective feelings and ASCs during ESR orgasms. Our data supports Fisher’s, Taylor’s and King, Mah & Binik’s findings (Fisher, 1977; Taylor, 2000; Mah, 2001, 2002, 2005, 2010, King 2010).
The neurological, psychological and neurochemical mechanisms of emerging of ASC during an EO and an ESR are not investigated and explained thoroughly yet. The main mechanisms of ASC can be correlated with the abruptly released neurotransmitters in certain parts of the brain and the activation and/or deactivation of different parts of the brain.
It is reported that during a single orgasm developing by masturbation or by intercourse, dopamine (Stahl, 2001; Brown, 2007; Passie, 2005; Kruger, 2002, 2005, 2006), prolactin ( Passie, 2005; Kruger, 2002, 2005, 2006), oxytocin (Stahl, 2001; Argiolas, 2003; Passie, 2005; Krüger, 2002, 2005, 2006), melanocortin (Brown, 2007), serotonin (Stahl, 2001; Brown, 2007) norepinephrine (Stahl 2001) and endogenous opioid peptides (Argiolas, 2003) are released and involved in the mechanisms of orgasmic and post orgasmic mind states. Acute dopamine release is a pleasure inducing factor during the female orgasm (Stahl, 2001; Brown, 2007, Kruger 2002, 2005, 2006). It is also reported that the ASC inducing hallucinogen MDMA (ecstasy) mimicked a post orgasmic state of mind which is induced by the release of prolactin (Passie, 2005). It is well documented in the literature that dopamine, serotonin, norepinephrine, endogenous opioid peptides induce changes in the mood and consciousness. The extraordinary subjective feelings during female orgasm cited in this paper (or more of them which are not investigated yet) can be caused by the abrupt robust changes in the neurotransmitter concentrations at the synaptic clefts at certain parts of the brain, mainly in the sensory cortex and limbic system. Namely, the powerful and longer the orgasmic state, the considerable and substantial, the alterations will be. Subjective feelings and ASC recorded in our study group mimic the acute effects of some hallucinogenic drugs studied in the literature. Our ongoing survey and orgasmic ASC study will be revealing more data and insights about a possible future research on the subjective consciousness alterations during a classical or ESR female orgasm. It was obvious that in ESR, those cited ASCs were more frequently experienced compared to a single clitoral or vaginal orgasm.
The ASC in ESR may also be related with the activation and deactivation of certain areas of the brain. Komisaruk's team, who have been doing fMRI studies during female orgasm, recently found heightened activation in the prefrontal cortex (PFC) during female climax - something not seen in the previous studies of female orgasm (Komisaruk, 2004, 2005, 2011). Surprisingly, this was also the case in the individuals who can achieve orgasm by thought alone, a recently defined case of ‘brain orgasms’. With fantasy and self-referential imagery often reported as being part of the sexual experience, Komisaruk et. al. investigated if the PFC might be playing a key role in creating a physiological response from imagination alone. According to Komisaruk, female orgasm is also a different form of consciousness (Sukel, 2011).
Georgiadis et. al., performed similar experiments in which they found that the some brain regions “switched off” during orgasm. Specifically, they saw significant deactivation in an area of the PFC called the left orbitofrontal cortex (OFC) (Sukel, 2011). Giorgiadis found that during sexual stimulation and arousal, left (L) inferior parietal lobule and L postcentral gyrus were activated in both men and women; however right (R) amygdala, R and L fusiform gyrus, R middle temporal gyrus, L inferior temporal gyrus were deactivated. During orgasm, L cerebellar vermis of anterior lobe were activated in both men and women, while R gyrus rectus, L inferior frontal gyrus, L middle frontal gyrus, L superior frontal gyrus, L medial frontal gyrus, L inferior frontal gyrus L middle frontal gyrus were deactivated in both sexes. In females R insula was more activated than males during orgasm (Giorgiasis, 2009). Giorgiadis also reported that regional cerebral blood flow (rCBF) increased in the left secondary and right somatosensory cortex during arousal by means of clitoral stimulation. During clitoral orgasms however rCBF was decreased in the neo cortex, particularly in the left lateral orbitofrontal cortex, inferior temporal gyrus and anterior temporal lobe. Giorgiadis found that orgasm related increases of rCBF occurred in the deep cerebellar nuclei, right caudate nucleus (Giorgiadis, 2006). No fMRI or other studies on the correlation of orgasm related mood changes and brain activation/deactivation have been reported yet.
Komisaruk et. al. reported that clitoral, vaginal and cervical stimulation differentially activated the regions of the sensory cortex (Komisaruk, 2011). Komisaruk & Whipple also reported some orgasms of none-genital origin, coining the term “brain orgasms”, where there was no genital stimulation, orgasm might occur in some women (Komisaruk, 1998). Vagal nerve involvement in the development of female orgasms was also reported, defining that vagus nerve innervating uterus and cervix, supplying a by-pass pathway distant from the plexuses related with spinal cord (Komisaruk, 2003, 2004). Komisaruk and Whipple reported that during a female orgasm induced by vaginal-cervical stimulation, hypothalamic paraventricular nucleus (where oxytocin is released), amygdala, hippocampus, pre-optic area, basal ganglia, cerebellum, anterior cingulate, lower brain stem and insular-parietal-frontal cortices were activated in the female brain (Komisaruk, 2005). It is hypothesized that pudental, pelvic, hypogastric and vagus nerves are involved in the development of female orgasm (Komisaruk, 1998, 2003, 2004, 2005, 2006, 2011).
Most probably, primarily dopaminergic pathways may be involved in the alterations of mood as the studies cited above point out. Also acute releases of oxytocin and prolactin may be responsible of some of the mood changes and ASC patterns during prolonged orgasms.
Four Nerve-Six Pathway Theory of Female Orgasm
In most of the studies of fMRI, MR and PET, investigating female orgasms, single stimulus from only one locus is studied, as it is mostly the clitoris. However today we know that female orgasm develops through different pathways and the stimulations of different loci (Komisaruk, 2006) (Figure 1). For the explanation of prolonged, enhanced and expanded orgasms, “the blended orgasm theory” seems to be the most plausible one (Ladas, 1982). It is also reported that female orgasms can develop through the stimulation of nipples and hence through intercostals nerves-(T2-T5 vertebrae, particularly T4)-hypothalamus-pituitary-oxytocin pathway (Komisaruk, 2006; Magon, 2011). Oxytocin has an effect as a neurotransmitter in the brain and it is also released from the pituitary to the bloodstream (Argiolas, 2003). Thus forming a double fold pathway system (Figure 2).
Besides pudental, pelvic, hypogastric and vagus nerve pathways, the two oxytocin pathways may also contribute to the development of female orgasms, forming a four nerve-six pathway module for the explanation of female orgasmic response.
We hypothesize that during ESR orgasms, multiple pathways and cerebral centers contribute to development of prolonged female orgasms. When multiple pathways are involved, a lot of different cerebral loci and immense changes in many neurotransmitter systems may take part in the development of female orgasms acutely, thus inducing an extraordinary mood and consciousness change.
ESR induced orgasms have been defined recently in the medical literature (Taylor, 2000; King, 2010; Sayin, 2011, 2012). More emphasis should be given to an extended and further research on ESR and ESR induced prolonged female orgasms to understand the neuroanatomical, neurochemical and psychological mechanisms of ESR to unveil female orgasmic response.
Bodansky S, Bodansky V, Extended Massive Orgasm, CA: Hunter House Pub, 2000.
Chang J. The Tao of Love and Sex : The Ancient Chinese Way to Ecstasy. New York: Dutton, 1977.
Chang J. The Tao of the Loving Couple: True Liberation Through the Tao. New York: Dutton, 1983.
Chia M, Chia M, Abrams M, Abrams RC. The Multi-Orgasmic Couple: Sexual Secrets Every Couple Should Know. New York: Harper One, 2002.
Chia M. Healing Love through the Tao: Cultivating Female Sexual Energy. New York: Destiny Books, 2005.
Fisher S. Understanding the Female Orgasm, London: Pelican Books, 1977.
Fisher S. The Female Orgasm: Psychology, Physiology, Fantasy. New York: Basic Books, 1973.
Giorgiadis RJ, Kortkaas R, Kuipers R, Neiuwenburg A, Pruim J,Simone Reinders AAT, Holstege G. Regional cerebral blood flow changes associated with clitorally induced orgasm in healthy women. Eur J Neurosci 2006; 24:3305-16.
Giorgiadis RJ. Men versus women on Sexual Brain Function: Prominent differences during tactile genital stimulation, but not orgasm. Hum Brain Map 2009; 30(10):3089-101.
King R, Belsky J, Mah K, Binik YM. Are there different types of female orgasms? Arch Sex Behav 2010; 40(5):865-75.
Kocatürk A, Sayin U, Baş GY, Kocatürk C, Ocakçı AF. Sexual behavior patterns of Turkish females at two universities of İstanbul in 2011: Marmara and Bogaziçi universities pilot survey studies. 33rd NACS Conference 2011, Oslo-Norway, Nordic Association for Clinical Sexology 33rd Congress Abstract Book (33):15.
Komisaruk BR, Whipple B. Love as a sensory stimulation: Physiological Consequences of its deprivation and expression. Psychoneuroendocrinology 1998; 8:927-944.
Komisaruk BR, Sansone G. Neural pathways mediating vaginal function: The vagus nerves and spinal cord oxytocin. Scandinavian J Psych 2003; 44:241-250.
Komisaruk BR, Whipple B, Crawford A, Grimes S, Liu WC, Kalnin A, Mosier K. Brain activation during vaginocervical self stimulation and orgasm in women with complete spinal cord injury: fMRI evidence of mediation by vagus nerves. Brain Res 2004; 1024:77-88.
Komisaruk BR, Whipple B. Functional MRI of the brain during orgasm in women. Annu Rev Sex Res 2005; 16: 62-86.
Komisaruk BR, Beyer-Flores C, Whipple B. The Science of Orgasm, Baltimore: John Hopkins University Press, 2006.
Krüger TH, Schiffer B, Eikermann M, Haake P, Gizewski E, Schedlowski M. Serial neurochemical measurement of cerebrospinal fluid during the human sexual response cycle. Eur J Neurosci 2006; 24(12):3445-52.
Ladas AK, Whipple B, Perry JD, The G-Spot and Other Discoveries About Human Sexuality. New York: Henry Holt Co, 1982.
Mah K, Binik YM. The nature of orgasm: A critical review of major trends. Clin Psych Rev 2001; 6:823-56.
Mah K, Binik YM. Do all orgasms feel alike? Evaluating a two-dimensional model of the orgasm experience across gender and sexual context. J Sex Res 2002; 39:104113.
Mah K, Binik YM. Are orgasms in the mind or the body? Psychosocial versus physiological correlates of orgasmic pleasure and satisfaction. J Sex & Marital Ther 2005; 31:187-2005.
Mah K, Binik YM. The Orgasm Rating Scale. In T.D. Fisher, C.M. Davis, W.L. Yarber, & S.L. Davis (Eds.). Handbook of Sexuality-Related Measures (3rd ed.) (pp. 500-502). New York: Routledge, 2010.
Mamfurd J. Ecstasy through Tantra. Minnesota: Llewellyn Pub, 3rd ed., 2005.
Masters W, Johnson V. Human Sexual Response. Missouri: Little Brown Company, 1966.
Michaels AM, Johnson P. Tantra for Erotic Empowerment. Minnesota: Llewellyn Pub, 2008.
Passie T, Hartmann U, Schneider U, Emrich HM, Krüger TH. Ecstasy (MDMA) mimics the post-orgasmic state: impairment of sexual drive and function during acute MDMA-effects may be due to increased prolactin secretion. Med Hypotheses 2005; 64(5):899-903.
Rhodes R, Brauer AP, Brauer DJ. ESO Ecstasy Program, N.Y.: Grand Central Pub., 1991.
Sayin Ü, Ziyalar N, Kahya İ. ‘Orgasmic behavior in educated Turkish women’. Proc. 3rd European Academy of Forensic Science Triennal Meeting, Istanbul, Turkey, September 2003. Forensic Science International 2003; 136 (Suppl. 1):186. (a)
Sayin Ü, Ziyalar N, Kahya İ. ‘Sexual behavior in educated Turkish women’. Proc. 3rd European Academy of Forensic Science Triennal Meeting, Istanbul, Turkey, September 2003. Forensic Science International 2003; 136 (Suppl. 1):287. (b)
Sayin Ü. Derin Seks (Deep Sex), İstanbul: Klan Publications, 2010.
Sayin Ü, Ramstadius M. Expanded Desire: The Main parameters and new definitions of enhanced and expanded sexual response (ESR).33rd NACS Conference 2011, Oslo-Norway, Nordic Association for Clinical Sexology 33rd Congress Abstract Book 2011; (33):21. (a)
Sayin Ü, Can G, Ramstadius M, Kocatürk A, Kahya İ. Desire in Turkish women: orgasmic behaviour patterns in 2240 educated Turkish women which improves with education. 33rd NACS Conference 2011, Oslo-Norway, Nordic Association for Clinical Sexology 33rd Congress Abstract Book 2011; (33):22. (b)
Sayin Ü, Ramstadius M, Kocatürk A. Pelvic floor muscle strength is correlated with attaining vaginal orgasms in human female as measured by Kegel Perineometer. 33rd NACS Conference 2011, Oslo-Norway, Nordic Association for Clinical Sexology 33rd Congress Abstract Book 2011; (33):22. (c)
Sayin Ü, Artırılmış Cinsel Doyum:ESR, Kadınlarda Ultra Orgazm (Expanded Sexual Response: ESR, Ultra Orgasm in Women), İstanbul: Okyanus Publications (in press), 2012.
Schwartz L, Schwartz B. The One Hour Orgasm. New York: St. Martin’s Griffin, 1999.
Sukel K. Sex on the brain: Orgasms unlock altered consciousness. New Scientist 2011; 2812. http://www.newscientist.com/article/mg21028124.600-sex-on-the-brain-orgasms-unlock-altered-consciousness.html?full=true.
Swartz LH. Absorbed states play different roles in female and male sexual response: hypothesis for testing. J Sex Marital Ther 1994; 20 (3) 244-53.
Taylor P. PhD Thesis: An Observational and Comparative Study of Practitioners of Expanded Orgasm: An Investigation of an Effective and Accessible Path to Transcendent States of Consciousness, Submitted in Partial Fulfillment of the Requirements for the Degree of Philosophy in Transpersonal Psychology, International University of Professional Studies, Maui, Hawaii, 2000.
Taylor P. Expanded Orgasm: Soar to Ecstasy at your Lover's Every Touch, Illinois: Sourcebooks, Casablanca, 2002.
Vatsyayana, Kama Sutra, Trans. by Burton R., London: Private, 1883.
Zdrok V. Anatomy of Pleasure, Philadelphia: Infinity Pub., 2004.