One of the biggest concerns I hear from women in my clinic is about the lack of orgasm or inability to have one at all.
Orgasm is often people's one and only goal when it comes to sex, but I encourage my patients to take a different approach. We work toward changing the motivation behind sex from performance, to pleasure. The idea is that letting go of the orgasm goal makes you more likely to have one. I know, easier said then done.
Webster's defines orgasm as: intense or paroxysmal excitement; especially: an explosive discharge of neuromuscular tensions at the height of sexual arousal that is usually accompanied by the ejaculation of semen in the male and by vaginal contractions in the female.
Most people get that it's a physical reaction, but what is “intense excitement?” How do you know you've reached that level? Well, it's subjective.
Women have often seen too many movies and talked to too many friends about what an orgasm should look and feel like. Think about sex in the media or pornography – the couple climaxes together in this beautiful, choreographed dance of movements and sounds. Women think it's supposed to be loud and noisy, but the reality is, it only has to be as loud as you feel comfortable with.
Many people also believe men and women can't orgasm at the same time. Blood does flow differently to the genitals, and many women take longer to reach that level of arousal. But climaxing simultaneously isn't impossible. If one of you needs to take a break mid-act, that's OK. Just keep the communication open so both of you know where you stand, what level of excitement you're at, etc.
According to the book “Principles and Practice of Sex Therapy” by Sandra Leiblum, 5-10 percent of women have primary anorgasmia, which is the inability to orgasm with any form of stimulation. Secondary anorgasmia is the ability to orgasm through oral or manual stimulation but not through intercourse.
Certain medical conditions can prevent orgasm, and having a baby can change things, too. Childbirth places strain on a woman's pelvic floor muscles, which are the primary muscles that flex during orgasm. This can be treated with the help of a pelvic floor physical therapist.
Taking antidepressants or other psychological medications can affect a woman's blood flow, also affecting her ability to orgasm. If you think this applies to you, just be sure to talk with your doctor before going off any medication.
Once a medical factor is ruled out or been treated, the psychological treatment can begin. Here is what I recommend to patients who would like to either have an orgasm for the first time or yet again.
1) Stop trying! Seriously, focus on what sensations in your body feel good during sexual activity and what your mind-body connection is.
2) Consider if you have body image issues. Sex is about empowerment, and it helps to feel good about your body.
3) Think about your expectations for sex. Are they realistic? Are they yours or someone else's? Ignore everyone/everything else, and find what works for you and your partner.
4) Educate yourself about sexual response cycles, hormones and sexual development in general.
5) Try Sensate Focus, an activity taught by sex therapist to help couples learn to enjoy sexual touch and connect the mind and body.
6) Spend some time getting to know your body through self touch and exploration. If you have moral or religious objections to masturbating, think of this as self-exploration of one's body and temple, as opposed to sexual pleasure.
7) Think about sexual triggers. Not just what kinds of touch you like, but what kinds of smells, sounds, sights and tastes are also sexually exciting to you.
8) Remember, it's just an orgasm! If you can experience one, great. But if your sex life starts to revolve around them, it's time to reassess and work toward pleasure over performance.