Almost all women are able to experience orgasm, whether through masturbation or through plenty of foreplay followed by penetrative sex. There are, however, a number of reasons why a woman might find she is unable to experience orgasm. The problem is often psychological, but there might be physiological causes.
Medication and physiological causes
Some drugs can adversely affect sexual response. These include: anti-hypertensives, such as beta-blockers; antidepressants, such as Anafranil; sedatives, such as Xanax, diazepam or Valium; neuroleptics, such as Largactil; anticonvulsants, such as phenobarbitones; anti-cancer drugs, such as Tamoxifen, prescribed to delay recurrence of breast cancer and which can cause vaginal bleeding, discharge, genital itching and depression; and, finally, some birth control pills, particularly progestogen-dominant pills, which can cause vaginal dryness and loss of libido.
The cause could be vasculogenic: somehow the blood flow to the clitoris is inhibited, a condition which is linked to heart-disease, high blood pressure and high cholesterol or smoking.
Or the cause could be hormonal. This is linked to the menopause, endocrine disorders, after-childbirth hormone deficiency and diabetes.
Vaginal or urinary tract infections can inhibit orgasm, notably interstitial cystitis, a chronic inflammatory condition of the bladder.
There might be pelvic floor disorders, such as prolapse of the womb or bladder, often due to ageing, menopause, childbirth or trauma.
More drastically, there might be neurogenic problems, where the nerves in the clitoris aren’t connecting. This, though, is exceptionally unlikely, except in cases of spinal-cord injury and clitoradectomy, a primitive, third world practice designed to control women by depriving them of sexual pleasure.
It makes sense to see your GP and discover if the reason for not experiencing orgasm could be medication, blood flow or hormonal – or, less likely, a physical condition.
Sexual function disorder
Sexual function disorder is a reason why women might fail to reach orgasm. The categories of sexual function disorder include:
- Hypoactive Sexual Desire Disorder – which is loss of sexual desire to the point of personal distress, and the causes of which can be medical, emotional, menopausal or related to sexual abuse;
- Sexual Arousal Disorder – which causes inadequate genital lubrication, lack of clitoral and/or nipple arousal and sensitivity, and which is often psychological but also linked to poor blood flow to the genital area;
- Sexual Pain Disorders (SPD) – which cause persistent genital pain, sometimes resulting from medical problems such as vaginal infections, the complications of menopause, or resulting from some vaginal surgical procedure;
- Vaginismus is a sub-category of SPD – where there are involuntary constricting spasms in the vaginal musculature inhibiting penetration. This is usually a conditioned, Pavlovian response to painful penetration but can also be induced by emotional or relationship problems. One form of it is Vestibulitis, a recurring inflammation and burning sensation around the vaginal opening.
A good GP or a visit to a GUM clinic should resolve what the cause is.
Technique
The problem can simply be technique, which is to say, not really knowing where the clitoris is and so not stimulating it properly. Usually, though, the failure to experience orgasm is a psychological issue. It may seem strange, but masturbation is partially about releasing sexual tension. It’s about being able to relax and let go sufficiently to slide down into the waves of orgasm.
This inability to let go can be caused by: depression; dysthymia, a hard to diagnose but depressive condition associated with feelings of sadness, isolation and feeling overwhelmed or under-appreciated; stress; early or ongoing sexual or emotional abuse; drug and/or alcohol abuse; the menopause, in which case, hormone replacement therapy can help; body image; self-esteem problems; or relationship issues.
Some of these conditions can be alleviated with drugs. Testosterone is the key hormone that affects sexual desire in both men and women. It comes in pill form and also as a cream. A new drug called Prostaglandin E-1 is being developed for local (genital) application to aid arousal. Some also suggest that Viagra can have as strong an effect on female arousal as it does on men – a targeted female version is under development.
Some women can’t get over propaganda given in their childhood that sex is ‘wrong’ or ‘dirty’. However hard they try, this mental block will not allow them to climax. It can be a lengthy process, sometimes possible as self-help, though more usually with counsellors, to allow one’s self to find being fully sexually aroused physically and psychologically acceptable.
This involves sensate exercises to accept and develop the responsiveness of one’s own body and to accept and develop one’s capability to get lost in sexual thoughts and fantasies. It can often help to read good erotica or watch sexy films, such as the Lovers’ Guide series, and train oneself to relish their contents.
In short, if you have problems experiencing orgasm, your first stop should be your doctors or a GUM clinic. Then a good sex therapist might be useful.