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15 Dec 2002

Unable to orgasm
My husband and I have been married for 5 years
In the early stages of our relationship i could reach an orgasm.
I havent been able to for the past two years.
Please advise
Answer 412 views

01 Jan 0001

Anorgasmia is usually categorised or specified in one of three ways; as primary, secondary, or situational. Primary anorgasmia means that the diagnosed woman has never been able to achieve orgasm at any point in her life. A diagnosis of secondary anorgasmia means that the woman was consistently able to have orgasms at one time, but is no longer able to achieve them. Situational anorgasmia refers to women who can achieve orgasm in certain sexual situations, but never orgasm in other specific situations. For example, a woman who can orgasm through masturbation but never during sex in the man-on-top position. By now you may see yourself fitting into one of these categories and you may be asking yourself, "am I sexually dysfunctional and in need of immediate psychological care?" The answer is most likely, "no". Like many sexual dysfunctions, diagnosis of anorgasmia is somewhat subjective and depends a great deal upon the thoughts, emotions, and desires of the individual experiencing it. Some women may never achieve orgasm through intercourse with their partner and yet live active, fully satisfying sex lives by achieving orgasm in other ways such as partners stimulation of her clitoris manually. Other women may be able to achieve orgasm through manual stimulation, yet still feel depressed, inadequate and unfulfilled because they can not reach orgasm during intercourse. Studies show that women who identify with the latter group are not alone. It is estimated that between 10% and 40%of adult American women have problems achieving orgasms.

Many possible causes for anorgasmia have been proposed, but all are inconclusive or inadequate at explaining the problem as a whole. Proposed explanations have included lack of sexual education, strong religious upbringing, lack of strength in the woman’s pubococcygeus muscle, past sexual abuse, impotence or early ejaculation in male partner, and high levels of anxiety associated with sex. Although some of these explanations have shown a correlation with anorgasmic women, no one factor has been shown to significantly contribute to the problem any more than another. Therefore, anorgasmia is most often treated as a complex combination of many, or all of the previously listed variables.

Counseling for anorgasmic women will most likely focus on three areas. First, Women are usually encouraged to attend sex therapy with their primary sexual partner. There are several reasons for this, but the primary one is that anorgasmia, like many sexual dysfunctions, can not be seen solely as the woman’s problem- there are many relationship variables which effect the symptom and, therefore, need to be treated in couples therapy. Counseling often begins with an element of sexual education for the couple. The couple is taught the mechanisms of sexual arousal in women and, most importantly, they are taught the differences in the male and female sexual response cycles.

Female inhibited orgasm is often treated with specific therapeutic techniques. Couples will often be taught to use sensate focus exercises at home, and females will often be taught and encouraged to use systematic desensitization, Kegel exercises, and directed masturbation to treat their orgasm problem. Directed masturbation is a technique whereby the woman is educated as to how she can bring herself to orgasm. The hope is that through her increased body-awareness and comfort with orgasm, the woman can transfer this knowledge and take charge in directing her partner during intercourse, thereby achieving orgasm with her partner. Beyond education and techniques, counseling will likely focus on the emotional or situational factors of both the individual and the couple that are contributing to the lack of orgasm in the woman. How these sensitive and all-important issues are dealt with in therapy will depend a great deal on the theoretical orientation of each individual counselor.

If the problem of anorgasmia is treated by a qualified sex therapist who takes time to consider the many variables which can contribute to the problem, than the couple can expect a positive outcome. And although successful treatment of this condition depends a great deal on the specific nature of the diagnosis (primary vs. secondary, age of woman effected, willingness of partner to attend counseling, depth of emotional cause, level of anxiety associated with becoming orgasmic, etc.), research has shown a success rate of 80-90% for treatment of primary anorgasmia; and between 10-75% success rate for treatment of secondary anorgasmia. These successful treatment rates are encouraging for the millions of women who live with the frustration of not being able to reach orgasm in their sexual lives. It appears that our society has finally come to the realization that women too are sexual beings, beings who desire, need, and deserve similar pleasure from the act of sex as men have enjoyed for centuries. Fortunately, sex therapists have evolved along with society in their ability to help women live fully satisfying sex lives if they so desire.

Contact SA Sexual Health Association for a referral to a sex therapist in your area. 0860 100 262
Dr Mac
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