In this, the very first episode of The Referral, Dr Karan is joined by Married At First Sight’s sex and relationship expert Charlene Douglas. Karan gets down to the science behind the big O, the climax, the ultimate high everyone's looking for......the orgasm, and more specifically 'the orgasm gap' between women and men. Is it a patriarchal society problem? Are men really the problem here – or is it the female anatomy?! Science or psychology?! Find out here!

Karan also brings you ‘What The Health’, the latest mind-blowing health news you’ll love, and he answers YOUR questions in ‘Crowd Science’.

If you’d like to get in touch and ask Karan a question about all things health and science, get in touch at TheReferralPod.com. 



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Welcome to this brand new, shiny episode of The Referral.

I'm a surgeon in the NHS and I want to bypass and swerve all of that nonsense, misinformation and pseudoscience that plagues the internet and online spaces, especially when it comes to health, science, medicine, all of that stuff.

I'm not going to prescribe you blueberries and kale and doing yoga on your head.

I'm going to give you actual science based information to hopefully save money, live better, live happier and just actually follow the science instead of crap.

Your intestines are basically noodles that cause constipation and your batteries need recharging for 8 hours every day.

Now I'm going to show you how to counteract all that and improve your health and get your own back on the body.

All the answers you need in this podcast.

Every week I'm going to be joined by an expert.

It could be some boffin from Oxford or Cambridge University or it could be a celebrity who has a specific medical condition, an expert in their own right.

Today is going to be a juicy topic, orgasms.

Why are women not having enough orgasms compared to men?

Is it the patriarchy or badly behaved men?

And in this episode, I'm delighted to be joined by Charlene Douglas.

She's a sex and relationship expert, and you probably recognize her face and that name because she was on Married at First Sight in the UK.

get is that men will then rub the clip for England like and doing all the stuff they see in porn.

And then wonder why it's not happening for the woman.

We'll also play a quick round of Ask Me Anything.

This is really dangerous for me because it allows Charlene to ask me anything she wants.

What's the most bizarre thing that you've ever seen or heard from a patient?

Make sure you stay tuned for, If It Ducks Like A Quack.

This involves me debunking the most outrageous myths about orgasms.

A juicy burning question you want me to answer, get in touch at thereferralpod.com.

But first to kick off, what the health is going on?

What is going on in the world of health, medicine, science around the world?

A university professor has lived underwater for over 74 days and he doesn't plan to stop.

Now he's not just floating in the water hoping he doesn't rise to the surface.

He's actually inhabiting a tiny little undersea lodge that's 30 feet at the bottom of a lagoon in Florida.

The difference is, this is no ordinary lodge.

It has no technology that depressurizes it, so he's feeling the full pressure of being 30 feet underwater.

You're probably wondering why the hell is he living underwater for so long?

Truth is, the researchers are looking at how the human body and the human physiology reacts to extremes of pressure.

Now, in addition to assessing the human physiology being affected by these extremes of pressure, there's another thing that might happen.

The psychology of being isolated underwater.

I mean, bear in mind that he's going to have very limited human contact, which is 1 thing, and it's well known and well documented in the scientific literature that prolonged periods of isolation, which you'll obviously have when you're living underwater in a 30-foot deep lagoon, you'll also have some significant impacts on your mood, on your stress levels, and who knows, you might break.

Additionally, you need a bit of sun exposure for vitamin D synthesis and underwater you're probably not going to be getting enough sun.

Now I have no idea what it is with people spending time on their own with no contact in weird places.

Beatrice Flamini, a Spanish extreme athlete, has emerged after spending 500 days in a cave in Grenada, again with no human contact.

Just to give you some context, when Beatrice Flamini entered the cave, Russia hadn't invaded Ukraine and the world was still in the middle of the COVID pandemic.

She was 48 when she entered the cave and she was 50 when she came out.

When she emerged, she was obviously very happy, but at the press conference she was being held by people who had to support her because in the cave, in the darkness, she lost a sense of balance and she also lost her perception of time somewhat.

It's important to note that our sense of time, or our sleep-wake cycles, our circadian rhythm, the internal biological clock that we have, is dictated by environmental cues, the light and the dark.

She mainly only had the dark, no light, so there was no way to reset her internal compass.

This has multiple consequences because the sleep-wake cycle isn't just so we know when to go to bed, when to wake up.

It's actually involved in every single body process from what time you go to the toilet, when you're hungry, your immune system, your heart health, your biological clock.

They have these biological clocks in every cell of your body.

So it's not just your sleep that's affected, but every single system in the body.

And it's proven that extended periods of isolation, especially when we're talking 500 days, that's gonna have significant impacts on your mental health and possibly contribute to neurodegeneration as well.

I'm Cameron Esposito, and I have a lot of jobs.

I'm an actor, You've seen me on ABC's A Million Little Things.

I'm a stand-up comic, best-selling author, but I am no expert at survival.

On my new podcast, Survivor Die Trying, we're gonna learn together.

From shark attacks to tsunamis and bad breakups, this is your one-stop shop to prepare for the absolute worst-case scenario.

Join me and some special guests on Survivor Die Trying, a comedy podcast that prepares you for anything.

Listen and follow wherever you get your podcasts.

Why is there an orgasm gap between men and women?

Doesn't matter if you're heterosexual, homosexual, polysexual, bisexual, there is a clear gap between men and women.

I'm joined by sex and relationship expert, Charlene Douglas, also known as the intimacy coach.

You might've seen Charlene on Married at First Sight, where she's been smashing it with her intimacy advice to relationships and couples.

Charlene, before we get started into the nitty gritty of the big O, tell us a little bit about what you do.

I suppose my official title is a psychosexual therapist.

I work with individuals and couples, pretty much with any issue they've got linked to sex and relationships.

From a science anatomical point of view, I had a couple of ideas as to why there might be this gap.

I mean, clearly 1 thing which shocked me was that it was only in 1998 that a urology surgeon, Professor Helen O'Connell, actually mapped the clitoris.

Before then, it wasn't really acknowledged as a larger-than-life piece.

People thought it was a tiny little button that you could see, but it was Helen O'Connell, which they actually mapped it and studied it using MRI.

But also I thought, looking back throughout history at the orgasm gap, you know, men have always thought, and probably society has always thought, that it's more of an issue for men.

If a man can't ejaculate and suffers from erectile dysfunction or premature ejaculation, that could affect fertility.

But in a female sense, the ejaculation isn't a biological function that affects fertility and reproduction.

So maybe that's also a reason it was suppressed and the knowledge of that gap was suppressed.

But rather than from a scientific anatomical point of view, day to day, what do you think it is from a psychological, physical point of view, that gap?

Well, I think for a lot of women in particular, we are sort of naturally maternal people so we want to make sure that, you know, in heterosexual relationships we want to make sure that our partner is looked after and cared for.

And so there isn't that focus then on what we need in order to orgasm.

You know, we're so used to making sure that our partner is protected and supported and that their needs are being met.

I think society has a big part to play as well.

You know, we're taught how to help a man to feel sexually stimulated, and then women just have to fit into that somehow.

And I think it's only recently where women have actually started to have conversations with themselves, with others, where they're saying, you know, actually, we'd like to have an orgasm too.

You know, we'd like to experience pleasure.

And I think the more people talk about it, the more you realise that actually, women really do want to have an orgasm.

Well, I find fascinating about what you've just said.

In men, you know, I'm a man, so it's a relatively straightforward phenomena.

You know, There's some genital stimulation, the pudendal nerve, which sort of controls the orgasm in men.

That reflex arc goes up the spinal cord to the brain and you've got an orgasm, ejaculation, climax, whatever you want to call it.

But in women, actually looking at the science, there's so many different routes to orgasm.

You can, you know, vaginal, clitoral, cervical in some women,

there's loads of other erogenous zones as well.

And for me, this was really mind-blowing for me.

They did a study on women who had spinal cord injuries, where they had no sensation to the genital area, so they couldn't feel anything on the vagina or labia.

But still, if they stimulated that area, they still had orgasms via different routes via the vagus nerve, which sits outside the spinal cord and still gave them an orgasm, which suggests that actually it's not a one-way road as it is for men.

There's actually so many different routes to orgasm, which actually isn't really talked about from a scientific point of view or even a cultural point of view.

No, I think there isn't that focus on giving women the space to explore their bodies, to work out what works for them.

You know, oftentimes there's this whole myth that women are very complex.

Now, I'd say that we're not complex at all.

I'd say that we just need to be understood.

And I think for a lot of women, they do the same things that men need in order to orgasm.

You know, the 5 seconds of foreplay and then let's penetrate and, oh, orgasm should happen.

And we know that the statistics show that a lot of women, I think over the statistics, like over 75% of women require clitoral stimulation in order for orgasms to happen or like, you know, fertile or sexually aroused, enough to orgasm.

But in saying that, you know, I've said that to quite a lot of people, and then what you'd get is that men will then rub the clit for England, like patting it and doing all the stuff they see in porn.

So there's still more exploration that's required for, you know, when you're in a relationship with a, when a guy's in a relationship with a woman where you need to think about like, what does she need?

You know, it's not just touching the clitoris, rubbing it, throwing lubricant on it.

And like you rightly said, there are other parts of the body that may be erogenous for people.

Yeah, a lot of women spoke about the lower back as well, it's quite sensual.

But also the way they're touched as well.

know, the pressure, you know, if it's, you know, are you doing it in a very slow, gentle way?

I remember speaking to a woman who'd once said that she was with her partner and her partner was going down her, so I suppose the official term is, you know, performing oral sex, going down her very colloquial term.

And she said that midway through, he turned around to watch football, because someone had just scored.

Now, She then wondered why it was that she was struggling with staying in her body and really getting into the vibe or having an orgasm.

And it's like, well, already you're worrying about a partner who looks like they're getting bored.

So how are you expecting your body to orgasm in that space.

So, seeing these couples often, you know, who are having marriage difficulties, relationship difficulties, a lot of that might boil down to issues in the bedroom.

What tips would you give someone who's struggling in the bedroom?

How can an orgasm save a relationship or save a marriage?

Well, first of all, I'd say that to take the focus off having an orgasm, because I think oftentimes what happens with couples is there's such a focus on we need to have

an orgasm that they miss out on the journey.

They miss out on the fun of exploring each other's bodies, of being playful.

And so for me, I'd say that when you take the focus off, I need to have an orgasm, and instead focus on sensation, slowing things down, connecting with 1 another, thinking about what you need to feel sexually stimulated.

That's when oftentimes you will then notice that your body will feel more relaxed and then your orgasm.

Women often come to me and say, I really struggle to have an orgasm when I'm with my partner.

But then they will play with sex toys like a clitoral stimulator, a vibrator, and then they can orgasm within minutes.

So that would then suggest it's not something maybe medically that's taking place there that's not working.

It's something psychological that's happening there where when you're by yourself you feel really safe.

You're not going to be judged, you're not going to be criticised, you can take your time, your body is not on a timer.

You've not got your partner watching you and saying, have you come yet?

Almost like a trophy that they need to claim.

You know, as opposed to just allowing the body to naturally just do what it's supposed to do.

And I think with anything, and you know, obviously you're the medical expert, but I'd say with so many things when it comes to our bodies, when we put pressure on it, we're waiting for it, then maybe sometimes our body's a little bit stubborn.

It's like, I guess almost, you know, if you're trying to get to sleep and you are constantly clock watching, thinking what time is it?

You probably suffer from insomnia or some degree of alertness that night because you're constantly clock watching or you're looking at your alarm and you're doing all these sleep tracking devices.

Similar, I don't know what it would be, orgasm, orexia or whatever, where you're obsessed with orgasm at the forefront of the thing.

But you mentioned about obviously that's when women take their own time or masturbating on their own, they find they can orgasm with increasing frequency.

But it's interesting to note in the study done by Laurie Mintz of all of these women and men, homosexual, heterosexual, it looks like there is an increased percentage of homosexual women and bisexual women who achieve orgasm rates almost equivalent to heterosexual men.

Because does that suggest that women know what they're doing so they'll know what other women want?

But I think there is something about there not being any expectations when it comes to lesbian sex, for example, right?

So with heterosexual sex, we're taught that, you know, based on the movies or porn, that your guy comes home from work, and then you should want sex straight away, you should rip off each other's clothes, you should want sex so quickly and spontaneously.

And then you need to groan like Harry Met Sally type groaning, right?

And then without, you know, without much sexual stimulation at all, no more than just seeing your partner and the excitement of seeing your partner, then you just come in a way that's amazing and so unreal.

In your expertise on psychology in relation to its sex interlink there, you may have come across stuff by Sigmund Freud.

Everyone's probably heard of Sigmund Freud.

People sometimes see him as this expert in developmental psychology.

But what I read about him is that he had this notion that when a woman has a clitoral orgasm, that's kind of derived from the clitoris and that's the main source of stimulation, that woman would be seen as immature.

But vaginal orgasm, which is incredibly uncommon for women, I mean, I think it's a very small percentage of women can orgasm via purely penetrative sex alone.

He thought that was a mature orgasm, a sign of a mature woman, which seems ridiculous for someone that society holds on a pedestal as the kind of, you know, the expert on developmental psychology.

I think it's clear to say that, you know, Freud was great in his time and he's obviously supported and helped a lot of psychologists of today to do what we do.

But we know so much more now about the body and about the mind.

And we know that that isn't the case anymore.

You know, that the clitoris does need stimulation in order for orgasm to take place, usually.

And I'd say that, you know, for those women that are having penetrative sex and their orgasm in that way, some might say it's the kind of the internal clitoris that's been stimulated and some of what you described some of that kind of the internal sexual organs.

It goes round the vagina and it's got these kind of arching bulbs as well.

So the penetrative sex might be stimulating the body of the clitoris.

I know you said you wanted to sort of take the pressure off orgasm when it comes to sexual relationships and sexual acts, but if you know there was a heterosexual couple or any couple and the woman was failing on a regular basis to achieve orgasm or even never achieved orgasm, what sort of practical life tips in terms of sleep habits or things that they would do during, before, after, would you actually advise so they actually orgasm more and enjoy sex?

So the first thing I'd say is to understand what your body needs separate from the sexual space of your partner.

It's really difficult to work out what turns you on sexually, when your partner's staring at you.

So away from that, you need to have a think about what turns you on.

And I'm not just talking about sexual stimuli, I'm talking about things like your partner, like what your partner says or does.

1 thing that I think we don't talk about enough is if the relationship isn't where it needs to be, then that can have an impact on how relaxed your body is and how connected you feel to your partner.

So that then impacts you having an orgasm.

So for example, if your partner is disrespectful to you or critical of something you've done, it may not even be related to sex.

It might have been something that happened early on in the day, linked to something completely different, But if you've internalised that as something that feels, that makes you feel less than, would you then want to connect with that person?

Because if what you're saying is that you're expecting your body and your mind to be vulnerable with someone you don't really feel safe with.

I think it's about being really honest about that.

So I would say explore what's going on in the relationship to make sure that you feel safe physically and emotionally safe with your partner.

You know, remember, there are lots of ways to turn ourselves on.

It's not just porn, as people often sort of just go to that.

So if you're someone that likes to listen to a sexy scenario, then that can be a turn on as well.

So look at what you need and then have a discussion with your partner about it.

It might be the case that it doesn't feel very private for you when you're having sex with your partner.

So for example, if you've got kids next door or you'd feel like the neighbour can hear you downstairs, yeah, that will impact your ability to really connect with your partner and to orgasm.

There aren't like 2 or 3 things that you need to look at and think about.

be explored to include your relationship to sex in the very first place.

Because for some people, we've grown up in a household in our younger years where sex was told, we were told sex is bad.

Yeah, or you don't speak about it, or that's disgusting or whatever it may be.

Or there might be some religion, religious thoughts around sex being maybe just for reproduction and not for pleasure.

So we're now in 2023 and you're expected to enjoy sex and to let loose and swing from the chandeliers, but deep in your head you're like, but my Catholic mum or my Muslim mum or my Christian mum has said, that's dirty.

Thank you so much for chatting about orgasms.

I know a lot of people probably won't be comfortable talking about it, but hopefully they're comfortable listening and using some of the tips that you gave to improve their own relationship with sex.

Yeah, I've always wondered whether, as a doctor, what's the most bizarre thing that you've ever seen or heard from a patient?

I could probably write you an entire book of some of the stuff I've seen.

I think that, it's wrong to say highlights because it's not like a tour, I'm seeing all these things, but 1 of the, probably 1 of the scariest things I've seen when I first started out in surgery was a patient who had their intestines hanging out of them.

They just had an operation, a big abdominal surgery, so they had a big cut in their tummy.

Their tummy began to swell after the operation and it just burst the stitches and their intestines were sticking out, which was a very visceral sight.

But in terms of weird things that, or bizarre things that patients have said, there was a very confused, delirious patient on 1 of the elderly care wards in my first year as a doctor.

And obviously in elderly care, in geriatric wards, you have very sick patients who some of them may be at the sort of end of their life passing away with urine, severe urine infections, heart problems, lung problems, all sorts.

There was a patient in 1 of the side rooms that was palliated, so they were kept comfortable.

They had a really horrible chest infection which didn't respond to antibiotics and the patient and family wanted to, you know, just stop any antibiotic care and all care.

So they were just kept comfortable in the side room.

1 of these confused patients on the main bay, I was seeing them, and they started getting increasingly agitated and started shouting and named that patient in the side room, so and so is dying.

And immediately after that happened, there was some noise that was heard in that side room and me and my colleague who were there, we went there straight away and the patient was really struggling in the last few moments and passed away.

So for me, obviously, you know, healthcare professionals sometimes can be a superstitious bunch when it comes to, you know, don't work on full moons or don't say the Q word, don't say it's quiet, all these sort of things.

I mean, surely my science brain is thinking that's a coincidence.

But also on 1 hand, I'm thinking, wow, that's a bit creepy.

Well, basically, if you've seen a myth online, chances are I've probably heard it and some of them are terrible.

Today we'll be tackling some orgasm myths.

There's actually a very small percentage of women that will orgasm via penetrative sex.

The vagina does not have anywhere near the number of nerve endings that you'd see in the periurethral erectile tissue or even in the clitoris as well.

And most women would see orgasm preferentially via clitoral stimulation because, contrary to popular opinion, the clitoris isn't just a tiny button that you can press and that you see on the outside, it actually extends behind and around the vaginal wall.

So even if someone does orgasm via penetrative vaginal sex, chances are there's actually a significant stimulation of the internal body of the clitoris and the clitoral bulbs as well.

Now the second myth, women only enjoy sex if they climax.

Now again this is probably down to some degree of personal preference, but most sex experts agree that sex isn't all about the act of climaxing, that's only 1 component of sex and a sexual relationship.

Sex actually starts outside the bedroom, all sorts of sensory stimulation that needs to occur as well.

That's all part of the greater arousal around sex.

And our third myth, masturbation ruins sex with your partner.

See all The Referral with Dr. Karan transcripts on Applepodcasts

Why Women Aren't Having Enough Orgasms with Charlene Douglas