Problems with orgasm
The general impression that men have far fewer problems reaching orgasm than women is supported by statistics. Various surveys have estimated that, although only about one to four per cent of the general population of men have trouble with orgasm, the figure is up to 40 per cent for women.
Up to 26 per cent of women report that they never achieve orgasm through intercourse, and up to 80 per cent are able to achieve orgasm during intercourse only ‘with assistance’, i.e. foreplay involving clitoral stimulation.
Sex therapists have largely come round to the idea that it is actually ‘normal’ for a woman to have trouble reaching orgasm without clitoral stimulation. However, about 10 per cent of women never reach orgasm by any means.
In the same way that young men need to learn to control orgasm, young women often have to learn how to achieve one.
Although female masturbation is still widely considered less acceptable than male masturbation, many women learn about how they like to be stimulated by touching themselves. Once they know what they like, it becomes much easier to communicate their needs to their sexual partner.
Even if a woman knows how to bring herself to orgasm, many positions adopted in sexual intercourse do not provide sufficient clitoral stimulation for the woman to orgasm. The process may therefore have to be ‘re-learned’ with each new partner, and couples need to take their time to work out a pattern of foreplay that satisfies them both.
CAUSES OF FAILURE TO REACH ORGASM
In all cases, poor technique and inadequate stimulation may be the main problem.
Physical causes
A little alcohol can be relaxing, but too much has a deadening effect on sexual performance. Men may find it harder to maintain an erection, whereas women find it harder to become properly aroused to climax.
Drugs, prescribed or otherwise, may also have this effect, and any drug that lowers libido (sexual urge) can also inhibit orgasm. Drugs include cocaine, barbiturates, thioridazine, some medications for high blood pressure, oestrogens, antidepressants and occasionally the oral contraceptive pill.
Surgery can also interfere with sexual satisfaction, although in many cases the cause is more psychological than physical, i.e. resulting from a reaction to mastectomy, colostomy or genital surgery. There is some evidence that hysterectomy can lead to less satisfactory orgasm in some women. Prostate surgery decreases sexual functioning in only a small proportion of men.
Any serious or long-term illness can lead to lowered sexual urge and difficulty with orgasm. Painful intercourse, for whatever cause (see pages 25–34), may make a person too tense and anxious to achieve orgasm. Only in rare instances is the failure to have an orgasm caused by a neurological problem.
Psychological causes
Orgasm is a reflex that occurs when there has been enough sexual stimulation for the person to reach ‘the point of no return’. Getting enough stimulation for long enough may be the main problem, especially for women, but other factors can make it harder to reach that ‘point’.
Women especially need to feel secure and relaxed before they can abandon themselves to sexual arousal. Unresolved worries about pregnancy, the relationship, etc. can interfere with excitement.
If orgasm has not been achieved several times, performance anxiety and fear of failure make the problem worse, and a pattern of behaviour called ‘spectatoring’ can take hold. Instead of allowing their bodies simply to enjoy erotic sensations, the importance of reaching orgasm means that the person is always asking herself: ‘Is this how I’m meant to feel? Am I near orgasm yet? Why not? What’s wrong?’ This kind of anxiety clearly dampens arousal and inhibits orgasm.
Studies of women who are unable to have an orgasm also reveal a variety of other factors – fear of loss of control, competitive or aggressive feelings, unrealistic worries about urinating if they have an orgasm, etc. These should be explored further with a psychosexual therapist.
TREATMENT FOR DIFFICULTIES WITH ORGASM
This is best discussed with a psychosexual therapist, who can help decide what the basic problem is. If it is one of sexual technique, the therapist can help the couple explore new ways of stimulating each other, and perhaps teach the woman exercises to maximise clitoral stimulation during intercourse. In other cases the emphasis may be more on psychological issues.
If ‘spectatoring’ is a problem, the therapist may encourage distraction by fantasy, aided if necessary by erotic literature or film, and sex aids such as vibrators. Specific exercises to help a man or woman achieve orgasm may include the steps in the box on page 54.
When the use of fantasy is second nature, the vicious cycle of anxiety and fear of failure, leading to ‘spectatoring’, will hopefully be broken.
OUTLOOK
The outlook for failure of orgasm is usually very good, with sex therapists quoting success rates of around 90 per cent within 20 sessions.
A step by step guide to overcome ‘spectatoring’
1 Self-stimulation with fantasy, alone
2 Self-stimulation as above, but with the partner present; nitially the partner can be present but with his or her back turned
3 Mutual pleasuring, using sensate focus exercises
4 Mutual foreplay to orgasm, without intercourse, again using fantasy and distraction
5 Full intercourse
KEY POINTS
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Women have more problems reaching orgasm than men
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Masturbation is an important way for women to learn what they like
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Failure to reach orgasm may have physical and psychological causes
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Fantasy and self-stimulation are good ways to overcome ‘spectatoring’