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When Meg Ryan faked an orgasm at the deli in When Harry Met Sally, audiences were embarrassed and a little shocked. That was 1989. Today? Orgasms -- real ones --are everywhere. The interns on Grey's Anatomy seem to have them regularly, and Sex and the City's Samantha thrashes and moans two nights a week -- in prime time! It's enough to make the average woman feel like a bit of an underachiever. While we all suspect that endlessly orgasmic Samantha isn't entirely "normal," we're not sure we are, either.

The truth is, only one in four women regularly has an orgasm during intercourse, and a third rarely or never do. This news may be reassuring -- or depressing. But what's healthy when it comes to orgasms, anyway? To find out, Health went in search of a sexual reality check and uncovered everything (well, almost everything) you'll ever want to know about the Big O.

It isn't all easy

It's true that the female orgasm is definitely "hot," says Dorian Solot, a sex educator and co-author with her partner of the forthcoming "I Love Female Orgasm: From 'Right There' to 'Oh, Yeah!' and Everything in Between." "Once upon a time," says Solot's partner, Marshall Miller, "a 'real man' cared only about his own pleasure and ignored female satisfaction entirely." No more. And not a moment too soon, right? After all, there's no question that orgasms are part of a healthy sex life. When the Earth moves, you're working those muscles, releasing tension, and bonding with your partner -- all good things.

Yet even as Top 10 lists and titillating TV shows give women's orgasms the importance they've lacked for years, sexperts including Solot contend that pop culture doesn't quite get it. For starters, women aren't built like men (that's no surprise). And when it comes to orgasm during intercourse, it can be quite a challenge getting all the right parts (the clitoris, in particular) lined up for pleasure. Kind of like Jupiter aligning with Mars. "The myth of the century is that all women should have orgasms from intercourse," Solot says.

Julie Kasperson, 46, of Las Vegas, Nevada, knows the challenge firsthand. She can climax during oral sex or when being touched, but not during intercourse. "I used to talk endlessly with my girlfriends about it," she says. "I'd wonder if there was something wrong, or if I wasn't doing the right things."

There's nothing wrong with Kasperson, who, like 70 percent of women, isn't regularly orgasmic during intercourse. Most women need clitoral stimulation to climax, and that's not automatic. "You can get it if the sexual position allows for friction," says Laura Berman, Ph.D., assistant clinical professor of psychiatry and OB-GYN at the Feinberg School of Medicine at Northwestern University. But it can take time and practice to find that position. And if you don't? Berman, who's also the director of the based Berman Center, a health-care facility in Chicago, Illinois, that helps women improve their sex lives, recommends using a vibrator during intercourse to help you reach orgasm or trying other tricks to boost your sexual satisfaction.

It's also no secret that some women, some of the time, are satisfied with non-orgasmic sex. "Orgasm is not the pinnacle for all women," says psychologist Dennis Sugrue, Ph.D., a past-president of the American Association of Sex Educators, Counselors, and Therapists. "The usual model suggests that if the orgasm doesn't occur, somehow the sexual experience got derailed. I don't think this does us service in terms of understanding women and their sexuality."

In fact, many women tend to want intimacy and a sense of connection just as much as an orgasm or even more so. "That is very true," says sex researcher Beverly Whipple, Ph.D., author of "The Science of Orgasm." "You have to remember that whatever is pleasurable and satisfying can be an end in itself."

The upshot: You don't have to have an orgasm to be satisfied. But if it's an orgasm you want, expect the unexpected. "Orgasms are like snowflakes; every one is unique," Solot says. "They can be more or less intense de-pending on a zillion factors, everything from the kind of stimulation to how long the buildup to how connected you're feeling." The goal is to find out what you like and how to have it your way.

Pressure: A big turn-off

The pressure that women feel to be orgasmic isn't just coming from all the hot sex in the media, Miller says. It's also a response to the urging of partners, some well-intentioned and some not. And that can add up to a lot of pleasure-killing pressure. "Today, many guys measure their worth" by whether they can make their partner climax, Miller explains.

Toni Ann Johnson, a 38-year-old writer from Los Angeles, suffered from having an overzealous partner.

"Sex was all about him showing off," she says. "I felt like he wanted me to have an orgasm to show how great he was that he could do that." The power play backfired, though. Johnson was anxious, frustrated, and distracted by his narcissism. The result of all the stress? She broke up with the guy and is happier with her current partner. With him, her orgasm, she says, is "as important to him as it is to me. Sometimes it's not important to me. I don't always need to have one." But when she does, he's at the ready.

Johnson's solution was more honest than how some women deal with the pressure. "There's an epidemic of women who, for whatever reason -- perhaps mercy for an overenthusiastic partner -- are faking," Northwestern's Berman says. "Men are getting a legacy of fakers in their path, so that with every new relationship, a guy says, 'Every woman I've been with has reached orgasm with me, so what's wrong with you?'"

Maybe that sounds a little far-fetched, especially for committed couples who think they can talk openly about sex. But even if you're happily married, there may be a level of honesty that can bring you closer, a level that only makes sex better. Sexologists say talking to your partner about orgasm -- what works, what doesn't, why having one may not matter -- is an essential part of a healthy sex life.

Johnson used to be really shy about opening up with her partner when it came to her intimate needs. But she discovered that talking with other women really helped. In fact, Johnson went so far as to talk about sexual satisfaction on "The O Tapes," a documentary scheduled to air on Showtime next year that features women's first-person stories about female orgasm. "Being part of a forum where there are so many women with similar experiences validated my own," she says. "And a lot of men and couples can benefit from hearing so many women talk about what they need sexually."

The most important sex organ

Let's assume that orgasm is a part of life you don't want to live without, whether or not you have one every time. The key to unlocking your potential, sexologists say, may be what's happening between your ears, not elsewhere. "Orgasm can be more a mental response than a physical one," says Yvonne K. Fulbright, M.S., a sex educator and author of "Touch Me There! A Hands-On Guide to Your Orgasmic Hot Spots." Indeed, recent research suggests that how emotionally connected you are with your partner can affect the quality of your orgasm. So whether you're going to have an orgasm -- and whether you're actually going to feel good about the one you have -- may have as much to do with how you feel about your partner and yourself as it does with whether everything's caressed and coddled in the proper fashion (although that doesn't hurt, either).

Feeling badly about yourself and your sexuality can be a self-fulfilling prophecy. Let's say, for instance, you think you peaked sexually in your 20s or 30s and your body will never achieve the same level of satisfaction. Those negative thoughts can sabotage your brain and body so that you miss out on decades of pleasure. "Orgasm is the most vulnerable you can be in front of someone else," Berman says. "If you don't feel safe, if you feel bad about your body, or guilty, it can be difficult for you to let go and release yourself to experience orgasm." But if you think of orgasms as something important and wonderful regardless of your age or whether they're earth-shattering explosions or just tiny blips, then ooh la la. Even a 2006 Swedish study backs it up: Women of all ages who thought sex was important actually had orgasms more often.

Wendy Olvin (not her real name), 40, of Portland, Oregon, is much happier now that she understands sexual satisfaction isn't all about the mechanics of the act. When Olvin's had trouble achieving orgasm, it was because "my head wasn't along for the ride," she says. But now she knows that experimenting with erotica, talking to her husband, and having a lot more foreplay can make a difference.

Olvin's orgasms have gotten better as she's gotten older. "Maybe it's because I know my body so much better," she says. "I am no longer afraid to ask for what I need because I know what I need. How fabulous is that?" Very.

Kara Jesella is freelance writer living in New York.