3. Cultural messages. Many of my female patients report unresolved cultural and religious beliefs that make it difficult to achieve orgasm.
Negative messages about sex often become deeply ingrained, subconsciously shaping the way we allow ourselves to respond during erotic situations. "I didn't want to be one of those 'bad' girls," a 24-year-old graduate student told me. "I denied my sexuality for so long that now I can't take it back."
More from YourTango: What Men Really Think ... Of The Male Birth Control Pill
What does it mean for a woman to achieve orgasm with a partner? It means she owns her sexuality, deserves and can allow her partner to witness her in a vulnerable state. It means she knows her own body and is not dependent on her partner for sexual stimulation and gratification. It means she can comfortably communicate with her partner about her sexual expectations and preferences.
A recent article suggested a link between EQ (emotional quotient) and a woman's capacity to achieve orgasm. The higher a woman's EQ (the ability to identify and manage emotions of one's self and others), the more likely she is to achieve orgasm. Sex Video: How Do You Keep Sex Fresh?
4. Discomfort with intimacy: "Amy," a happily married mother of three, sought treatment for the inability to achieve orgasm. "I can sing in front of my kids," she said, "but I could never sing in front of my husband. What if I sing off key? What if I look stupid?"
My response to her: "When you can sing in front of your husband, you will be able to have an orgasm in front of him, too." So how can Amy allow herself to let go during sex when she can't tolerate intimacy and vulnerability in non-sexual situations?
Shame and eroticism are commonly paired during sexual development. "Annemarie" was sexually abused by her older brother from age seven to nine. To avoid acknowledging the abuse, Annemarie feigned sleep when her abuser brother entered her room at night.
"It was easier to pretend I was asleep than to attempt to deal with all of the confusing feelings." Annemarie invariably associates sexual response with shame. She can’t allow herself to achieve orgasm because she can't bear to recall that profound shame from her past. She has not had an orgasm in 28 years.
5. Anger and resentment. Problems experienced between couples outside the bedroom are often played out inside the bedroom as well.
More from YourTango: 5 Ways Smoking Hurts Your Sexual Health
"Joan," a 42-year old, married mother of two, reported intense contempt and anger toward her husband during a recent session in my office. When I question her as to why she is unreceptive to an orgasm, she tells me "I don’t want him to think he has any affect on me."