Women: I can't orgasm

I can’t orgasm, difficulty having an orgasm, why can’t I orgasm, all about orgasm, sex therapy Brisbane

What orgasm feels like

The orgasm is usually defined as changes occurring in the vagina and pelvic region as recorded by both subjective and physiological methods. Descriptions that women have applied to the feeling of orgasm include:

Tension building in the vaginal and pelvic region followed by a release of pressure
A heightening then a letting go of excitement
Genital contractions or twitchingHigh excitement followed by a flooding feeling of release
Intense pleasure in the genitals

The orgasm experience is highly subjective with women reporting little to extreme feelings of heightened sensation, with some reporting vaginal contracting while others experience no contracting at all.

Disorder definition

The DSM-5 definition is the presence of either of the following symptoms in 75% - 100% of sexual occasions (in identified situational contexts of, if the condition is generalised, in all contexts):

Marked delay or absence of orgasm
Markedly reduced intensity of orgasmic sensations
The symptoms must persist for a minimum duration of approximately six months
Must cause significant distress (e.g. frustration or anger)
Must not be better accounted for by a nonsexual mental disorder, severe relationship distress, other significant stressors, substance / medication or another medical condition.

If you can’t orgasm the issue will either be:

Lifelong (has always been an issue from the first sexual experience
Acquired (has developed the issue at some point during the lifespan)
Generalised (occurring in all situations
Situational (occurring only in some situations and / or with some partners but not in others)
Mild (causing a mild level of distress)
Moderate (causing moderate distress)
Severe (causing severe distress)

Possible cause

If you are finding reaching an orgasm difficult or impossible, there may be one main driving factor or a combination of many. Possible factors to consider include:

previous sexual assault
negative past or current sexual experiences
depression, stress and anxiety
irrational concerns about potential loss of control
physiological problems (ie inadequate supply of arterial blood to the genitals, congenital issues, arthritis, hypertension, chronic pain, thyroid problems, asthma, diabetes and coronary heart disease etc)
medications including anti-depressants
inadequate foreplay
relationship issues
the meaning associated with sex and orgasm
inadequate sex education/knowledge

The other complexity is that there appears to be a substantial variation in the interpretation of what an organism actually is. This is difficult to define as the orgasm is such a subjective experience. Many women record different physical experiences and some women lacking information, may feel they are not orgasmic when in fact they are.

Some women may only experience orgasm caused by clitoral stimulation and are not sufficiently aroused from G-spot stimulation. They may record a lack of orgasm believing that they should be experiencing the other or both types of orgasm.

Treatment

If the issue is physiological, a GP and/or gynaecological assessment should uncover the driving causes.

However if the issue is psychologically driven, research offers good evidence that psychological interventions are particularly helpful for female orgasmic problems. Assessment usually consists of establishing:

a timeline of when the problem first started
the situations when it presents
what experiences look like (adequate stimulation etc)
thoughts pertaining to sex
any past trauma
current relationship quality
levels of sexual knowledge
psychological and emotional wellbeing
general health and medications

Depending on these assessment outcomes, a therapeutic plan can then be established to address each problematic factor.

So, if you’re asking yourself, why can’t I orgasm, stop asking and start seeking answers because there are many things you can do to improve the situation and go on to enjoy a fulfilling and rewarding sex life.

Why can some women achieve orgasm and others find it difficult or even impossible to reach? If you’re asking yourself… why can’t I orgasm?... read on. There are many reasons for this variance in individual women.

Past ideas

Over the past centuries the female orgasm has taken on a range of meanings for women, her partner and the relationship, considered as both good and bad at different historical points. According to Thomas Laqueur in his book Making sex: The body and gender from the Greeks to Freud, in the 1700s and early 1800s it was thought that a woman required an orgasm to be able to conceive but by the 1830s conception was then believed possible without sexual pleasure or orgasm. Historical views saw women’s orgasm as something that needed to be controlled and inhibited.

Sigmund Freud linked the orgasm to a woman’s personality maturity, espousing that clitoral orgasms were superficial and immature whereas vaginal orgasms, authentic and mature. Contrary to this view, Alfred Kinsey in the 1950s made no distinction between the different types of orgasm. His view was that women were more likely to be orgasmic with masturbation rather than sex with her husband. This view caused significant controversy at the time.

In the 1970s, the Master and Johnson approach offered that, a woman’s sexual response cycle was based on the same physiology of the nervous system functioning as men, therefore the female orgasm was not too dissimilar to the male orgasm. They promoted a plan for making orgasms possible for never or rarely-orgasmic women by removing the idea of pathology. Their belief was to remove the anxiety and natural sexual response would follow. The current view appears to be that a woman’s orgasm is linked to her personal history, relationship and culture interacting with nervous system functioning.

Evolution

Different theories have attributed various functions to the female orgasm. One theory is that the female orgasm evolved to protect offspring by strengthening long term sexual pair bonds due to oxytocin excretion during orgasm.

Another theory is that female orgasm is designed to reward sexual intercourse and create sexual motivation to maximise procreation and survival of the species. Some argue that this theory would indicate that higher rates of orgasm produce a higher libido.

These theories however do not explain why women still orgasm who: a) are not seeking a long-term relationship, b) do not wish to conceive, c) do not have off-spring requiring protection, or d) do not have a partner at all. Evolutionary theory does not also explain why orgasm rates are higher with masturbation than with partnered sex.

A large-scale study of 2914 Australian female twins evidenced that 35% of women never or rarely had orgasms during partnered sex. This result appears to contradict the evolutionary view that orgasm supports pair bonding. If orgasm is related to strengthening pair bonding we could expect to see higher orgasm rates for partnered sex, more commitment to monogamous relationships, fewer sexual partners in a lifetime and long-term relationships would be correlated to higher orgasm rates.

Physiology

The areas of the female physiology that are most sensitive to touch are the labia, the entrance of the vagina and the clitoris. These areas have a high amount of nerves and have vasocongestive capability. The inside of the vagina is thought to have relatively low sensitivity with the exception of deeper stronger pressure that stimulates the pubococcygeus (PC) muscle.

The PC muscle is a hammock-like muscle, found in both sexes, that stretches from the pubic bone to the coccyx (tail bone). It forms the floor of the pelvic cavity and supports the pelvic organs. It is known to not only control urine flow but contracts during orgasm. It is thought that strength and tone of the pubococcygeus (PC) muscle relate to orgasm capacity.

WOMEN: I CAN'T ORGASM?