We live in an orgasm-focused society. Orgasms are perceived as the proverbial icing on the already tasty sexual cake.
Millions of women feel "gypped" or "broken" if they are unable to achieve the coveted climax. We are so invested in the notion of orgasms that faking orgasms is common; most women admit to having done so at some point. And, during a recent session of sex therapy in my office, a wife disclosed to her husband that she has been faking orgasms throughout their entire 43-year marriage.
Despite our misguided notion that having an orgasm is the primary reason to have sex, when it comes to women, it is no sure thing. There are many obstacles that can undermine a woman's capacity to achieve orgasm. I will focus on five today:
1. Illness and/or medication. A wide range of illnesses, including diabetes, multiple sclerosis, cancer, and spinal cord injuries can damage physiologic processes necessary to achieve orgasm. These illnesses may also affect a woman's sense of femininity, disrupting her sexual confidence.
Medication can also affect the orgasm phase of sexual response. Blood pressure medications, antihistamines, and certain psychotropic drugs can make it difficult to achieve climax. In particular, selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed class of anti-depressants and certain antipsychotics, which raise prolactin levels and are common culprits of orgasm disorders.
2. Aging. The normal aging process can also take a toll on a woman's ability to achieve orgasm.
As we age, we have fewer hormones, especially estrogen. This can affect our neurological and circulatory functioning. As estrogen levels decline, sensations in the clitoris and nipples are decreased, causing limited blood flow to the genitals. As vascular efficiency decreases, orgasm difficulties increase.
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."
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.
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.
"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."
And what about the woman whose husband threatens her? "You better be fun in bed," he says, "Or else!" If you don't loosen up and enjoy yourself, I'm going to divorce you."
"Laney," who suffers from Generalized Anxiety Disorder, is already distracted by intrusive thoughts during sex. Now she has the added pressure to "be fun." Imagine trying to achieve orgasm under these conditions. And what of the many women who were taught that sex is dirty?
The good news? A little education goes a long way! Simply sharing statistics or debunking myths can have significant therapeutic value.
It is comforting to hear that less than 20 percent of women can reliably achieve orgasm from intercourse alone. Providing women an opportunity to explore their shame, anger, fear, or other negative emotions can be extremely liberating.
Most women appreciate the chance to gain insight into their sexuality. Centuries of stigma around female sexuality will not disappear overnight, but we are starting to see subtle shifts in the pendulum toward a healthier outlook.
Let me know what gets in your way of achieving orgasm and I'll try to help!