The word 'anorgasmia'
means lack of orgasm and describes the fact that
some women find it very hard or impossible to
experience orgasms. This is a problem for a
significant number of women, making anorgasmia the
second or third most common sexual complaint in
women. However, different surveys have struggled to
define orgasms and what exactly constitutes a lack of them. Therefore,
figures for how many women experience anorgasmia
vary widely suggesting that between 24% -
10.3% of women experience anorgasmia.
Historically, Freud
was the first to theorize about female orgasms in
the Western world. He made a distinction between
clitoral orgasms, i.e. orgasms induced through
stimulation of the clitoris, and vaginal orgasms,
i.e. orgasms achieved through stimulation of the
vagina. Unfortunately, he also suggested that a
clitoral orgasm was an 'immature' orgasm and that only
vaginal orgasms constituted 'mature', i.e. proper
orgasms for women. This has lead to many women still
feeling like there is something wrong with achieving
an orgasm through stimulating their clitoris and
that somehow their orgasms are in some way second
best. The picture is further complicated by the fact
that some women experience on orgasm through mostly
clitoral stimulation whilst having a penis inside
their vagina. Considering that most women do not achieve
orgasm through penetration and vaginal stimulation, but are much more likely
to orgasm through stimulation of their clitoris,
Freud's ideas have been very harmful to women's
experience of their sexuality. The fact that women
are more likely to achieve orgasm through
masturbation than through partner sex was discovered
by the sexologist Alfred Kinsey in the 1950s. Later,
Masters and Johnson, the first modern sex
therapists, advocated for women's right to have
orgasms. Unfortunately, this right to orgasm seems
to have developed more into a command and
has created performance pressures for women, so that many women
think that there is something wrong with them or
their sexuality if they struggle to orgasm.
However, once one
looks a bit closer it is very hard to set clear
criteria to define anorgasmia as it is very hard to
set clear criteria for what constitutes 'having
an orgasm'. An average female
orgasm involves a subjective
emotional experience as well as physiological
changes in the vagina and pelvic area. Some women
also experience sensations in their whole body or
rhythmic contractions of their uterus, vagina and
rectal sphincter. Others experience muscle
contractions all over their body and some women
ejaculate a clear fluid similar to men as they
orgasm. Orgasms are very
different form one woman to the next. Some women experience a
subjective sense of orgasm in the absence of any
physiological signs, whereas other women say they
are not experiencing an orgasm when physiologically
they show signs of doing so. Human beings and
sexologists in particular are still puzzled by the
broad range of subjective and objective experiences
we all call female 'orgasm' resulting in us being
even less clear what exactly constitutes anorgasmia,
or lack of orgasm in women.
What we do know is
that anorgasmia is an umbrella term, which describes
a range of experiences such as a complete absence of
orgasms, or unreliable or absent orgasms during
partner sex. Primary anorgasmia describes the fact
that a woman has never experienced an orgasm and
secondary anorgasmia is used when a woman can only
orgasm under certain conditions, for example only
through masturbation. Secondary anorgasmia is much
more common and often more difficult to address.
Additionally, orgasm
is only one of 4 phases in the sexual response
cycle, with the two preceding ones being first an
initial excitement phase and subsequently the
plateau phase. For a person to experience initial
excitement one needs to have an experience of libido
or feel ones sex drive. If a woman suffers from
low libido, she
may not have any problems becoming aroused and
having an orgasm if she does get interested in sex.
However, it is also possible that a woman, who
presents with low
libido may not be very interested in sex, because
she knows it will not be a very rewarding experience
due to a difficulty with orgasms.
The same is true for
female sexual arousal
disorder (FSAD), which describes problems in the
plateau phase. Therefore, a woman may solely
experience problems with getting aroused and is said
to suffer from FSAD, but when
she is aroused, she will orgasm. On the other hand
it is equally likely that a woman struggles
with orgasm, because she isn't getting aroused
enough. As each phase in the sexual response cycle
builds on the preceding one it is important to
consider whether a woman struggling with anorgasmia
is only experiencing problems with orgasms or
whether she may be experiencing problems with low
libido and sexual arousal too.
I hope that
my readers get a sense of how little we know
about the female response cycle! Not only do we not really know what an orgasm is for
women or how most of us experience them, we
also know very little about why so many
women seem to struggle having them.
Possible contributing factors for
anorgasmia
Similarly to
problems with low libido of female sexual
arousal disorder, problems with orgasms are
caused by a range of contributing factors. No
one single cause has been found for anorgasmia. It must be seen as a systemic
condition, which is affected by many
different factors in a woman's life.
Firstly, neurophysiological
problems can cause problems with orgasm,
just as they can do in men. It is always
advisable to see a doctor if you are
struggling with anorgasmia to get a full
health check and to rule out any possible
slow developing, long term conditions, which
can cause nerve damage such as diabetes or
multiple sclerosis. Additionally, the brain
is hugely important in experiencing orgasms
as some women can orgasm through fantasy
alone. Please also consider a full
gynecological check up screening for
STDs
or hormonal problems.
Other health issues, which
may contribute to anorgasmia are mental
health problems such as depression or
anxiety. If you are taking any medication,
please consider whether your prescriptions
may have an adverse impact on your ability
to orgasm. Anti-depressants such as SSRIs
have been shown to delay orgasm or make them
impossible. Additionally, many other
medications have been shown to affect sexual
expression adversely in men, such as
medication to control high blood pressure.
Although no clear data exists with respect
to women it may be worthwhile to discuss
your medication with your GP next time you
visit.
Secondly, psychosocial
factors are considered very important in
anorgasmia. Women, who experience
problems tend to be younger, unmarried and
have lower levels of education. Factors,
which tend to run parallel to anorgasmia,
but which may not cause it, are infrequent
sex, infrequent thoughts about sex, a
history of sexual harassment, having had an
STD or urinary tract infections, being in
overall less good health and experiencing
emotional problems.
Emotional problems could
include depression, dealing with the after
effect of sexual abuse or experiencing
general difficulties with allowing and
sustaining highly charged emotional states
and a fear of losing control.
Experiencing sexual arousal is in fact quite
a difficult task considering our normal
conditioning in Western societies and
beyond. Sexual arousal requires enough
'relaxation' to take in sexual stimulation,
therefore one needs to be open and present
in one's body and with one's partner (if one
is around). Additionally, sexual arousal
requires that one is able to build up and
sustain enough 'tension' to come to the
point of having an orgasm.
Certainly, relationship
issues will also be of great importance.
However, it has been impossible to pin down
exactly how a relationship may affect a
woman's ability to orgasm. This is due to
people in general reacting very differently
in similar situations. Some women may not be
able to open up and experience orgasms after
an argument or normally in their
relationship, whereas other women may
experience powerful orgasms even with men
they may not get on with very well. If a
male partner is experiencing problems with
sex such as rapid
orgasm or
erectile dysfunction this may have an
impact on the female partner and needs to be
addressed. Additionally, a lack of orgasms
in the woman could also be due to the fact
that the genitals of the two partners don't
quite suit each other's pressure points and
therefore don't generate enough stimulation
for the woman through penetration alone.
(The other
common male sexual dysfunction is retarded
ejaculation, which has been seen as
analogous to anorgasmia in women.)
To sum up, research has not
been able to find any clear difference
between women who are orgasmic and those who
are not, or those women who are
situationally orgasmic. This also means that
if you are a woman, who is experiencing
problems with orgasm, you are no different
from other women and that there is nothing
'wrong' about you or your experience of
sexuality. Struggling with orgasms needs
to be seen as an issue of personal
development, such as developing more inner
peace or increasing your ability to feel
joy. If you do not experience a lot of inner
peace naturally then you are not ill or
'wrong' in some way. However, you may be
able to increase your quality of life by
practicing inner peace.
Treatments for anorgasmia
There is no miracle cure or
miracle drug for curing anorgasmia. Drugs
such as viagra/sildenafil do not cure
anorgasmia in women. There are a range of
suggestions about what to do about
anorgasmia, but none of them has been proven
to work in every situation.
If you are experiencing
problems with orgasms, I would suggest that
you you see your lack of orgasms as a
problem to investigate and grow from, rather
than something that can be fixed, or indeed
must be fixed. Becoming orgasmic will be
a personal journey, which may involve many
different areas in your life, for
example your past history and childhood,
your current relationship, your body image
and self esteem and the way you manage
stress and uncertainty in every day life.
Firstly, please consider
going for a medical and gynecological check
up, just to rule out any chronic illnesses
or physical problems. Secondly, one
treatment option for anorgasmia is to go
into individual psychotherapy. This could be
relevant for you if you feel that your
childhood experiences are still affecting
you today. Early relationships with care
givers are important for how we manage our
emotions and states of arousal as well as
how to be intimate as well as separate from
another person. Some women are taught to
fear sexuality as children or adolescents,
especially if there are strong moral
prohibitions against sex, pregnancy or
physical pleasure in general. In this case,
women may not have any positive associations
with sex at all.
Another option for treatment
is go find a specialist
psychosexual
psychotherapist. In psychosexual
psychotherapy, you would focus more directly
on your sexuality and how to develop it.
Your psychosexual therapist may suggest
books for you to read to find out more about
female sexual anatomy and sexual health
issues such as
safer sex. Your therapist will want to
hear about your past sexual history, current
expression of sexuality, frequency and level
of your libido and arousal and how
distressing your current situation is to
you. Often women are encouraged to do a
visual and tactile exploration of their
genitals at home in private to acquaint
themselves more with their own bodies. Quite
often this leads on to directed masturbation
exercises as homework assignments between
sessions. About 80% of women learn to orgasm
through masturbation, but only 20- 60% go on
to have orgasms with their partners. Quite
often women find it difficult to transpose
their new found skills to partner sex.
An important other avenue for
consideration is the relationship a woman
might be in. There is of course the clichéd
possibility that the woman doesn't
experience an orgasm either because she
feels emotionally neglected by her partner
or because he or she is such a bad lover.
This may indeed be the case some of the
time, but quite often things will be much
more complex. In couples therapy the focus
is not on the person with 'the problem', but
more on the overall functioning of the
couple as a team. From that perspective one
might ask how does it serve both partners
that she is anorgasmic, or what do both
partners contribute to maintaining the
problem? Often communication between
partners needs to be improved. Couples
can engage in the structured
sensate focus
exercises devised by Masters and Johnson to
gradually increase their level of physical
intimacy and ease with each other. Sensate
focus is a program of stepped physical and
sexual contact, which helps to defuse
anxiety and build up connection with ones
own physical sensations whilst in the
presence of your partner.
Tips for couples, which apply
to both partners include:
Initiate
sex only if you want it.
Say no to
sex being initiated if you are sure you
don't want it.
During
sex, try to get something out of it for
yourself
Allow
yourself to give feedback that would
maintain or increase your own enjoyment.
It is important for each
woman to consider what becoming orgasmic
would mean to her, her relationship and her
partner. What emotions are attached for you
to not being orgasmic or having orgasms only
some of the time? Do you want to have
orgasms to keep your partner happy so as not
to dent his self esteem, (It is completely
impossible to try and have orgasms for
somebody else's sake!) or do you feel you
should be having orgasms to be 'a real
woman'? (Nobody has the right to define how
you are experiencing your sexuality as
'wrong' or 'deficient', whether you have
orgasms or not!) It is important that you
feel comfortable and save in your own body
and experience ownership of your sexuality
and orgasm. However you experience
your own sexuality just now, it is yours,
your own unique way and as such ok. You
may be able to develop and expand your
experience of sexuality, but it needs to be
for your own sake, because you enjoy it,
rather than for external reasons.
If you do want more help in
becoming orgasmic, you can work through the
standard psychosexal self help manual on the
topic
Heiman, J.R., LoPiccolo, J. (1988)
Becoming orgasmic: A sexual and personal
growth program for women (rev. and
expanded ed.). New York: Simon and
Schuster. Also, read our pages on tips
to improve
low sex drive and
female sexual
arousal disorder. If you are
experiencing problems with a male partner
recommend to him to read Zilbergeld, B. (1999)
The
New Male Sexuality. Revised edition, Bantam
Books. In fact it may help for you to read
it too. And:
Except your
sexuality as it is for now. It is yours
and ok the way it is. Learn to enjoy
your own body as it responds right now
and see whether you can develop from
there.
Learn how to
be more independent emotionally and how
to
deal better with any anxiety you may
be experiencing in your life.
Take time to
masturbate by yourself and learn to
enjoy your body in other ways.
If you are
feeling adventurous, check out books on
tantric sex or female orgasms such as
Sundahl, D.
(2003)
Female ejaculation and the G-spot.
Hunter House Publishers. Have fun
learning new stuff about your body.
Work on
your communication with your partner.
Talking helps!
References:
Bartlik, B., Goldberg, J. (2000) Female
Sexual Arousal Disorder. In Leiblum,
S. and Rosen, R. (Eds.) (2000) Principles
and Practice of Sex Therapy. Third Edition,
The Guilford Press
Heiman, J.R., LoPiccolo, J. (1988)
Becoming orgasmic: A sexual and personal
growth program for women (rev. and
expanded ed.). New York: Simon and
Schuster
Sundahl, D.
(2003)
Female ejaculation and the G-spot.
Hunter House Publishers
Written by Anna, 01.02.2008
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