Orgasm Difficulties - Treating Common Sexual Problems: Womens Sexual Health
Content provided by the Faculty of the Harvard Medical School
Orgasm difficulties
Few aspects of human sexuality have incurred the intense debate that has surrounded orgasm. As scientists struggle to quantify this holy grail of sexual experience, certain questions come up repeatedly: Are orgasms the same for women and men? Is an orgasm primarily a psychological or physiological experience? Do women have more than one kind of orgasm, and which type is better? The frenzy of speculation on these points will no doubt continue, but the highly individual and subjective nature of orgasms forces another important question: When does an orgasm difficulty become a dysfunction? As with other sexual problems, an orgasm that is premature, delayed, or absent warrants special attention only when it causes you or your partner distress.
Problems in men
The amount of penile and other stimulation a man needs before ejaculating varies greatly. A young man who is highly aroused may feel the urge to ejaculate very quickly after entering his partner. With experience, most men learn to anticipate the moment of ejaculation and employ techniques to slow their orgasm.
As a man ages, several changes take place. An older man ejaculates less semen, so the fluid may release less forcefully. Having less ejaculate translates into less intense pressure for release. This allows a mature man to enjoy a longer period of stimulation before feeling an overwhelming urge to ejaculate.
Often, men can adjust lovemaking routines to accommodate natural age-related occurrences. However, some of the following conditions can disrupt a man's sexual pleasure and that of his partner.
Premature ejaculation. Premature ejaculation is a common problem in which a man ejaculates as soon as intercourse starts or even before he enters his partner. It often leads to anxiety that the problem will occur again. The woman may become frustrated as she finds her sexual arousal continually thwarted, and she may lose interest in sex as a result.
Rarely, early ejaculation can be traced to a medical problem. Your doctor will want to rule out urologic conditions, diseases, or an injury to the nervous system.
If an underlying physical problem isn't to blame, treatment usually involves medication, sex therapy, or both. Ironically, an adverse side effect of certain antidepressants can be put to positive use in treating premature ejaculation. In several studies of paroxetine (Paxil), sertraline (Zoloft), and clomipramine (Anafranil), men reported having more time before ejaculation and greater sexual satisfaction for themselves and their partners.
In sex therapy, the therapist will help you and your partner explore and address the issues that may be contributing to the dysfunction. In addition, you'll learn behavioral exercises such as sensate focus and a start-stop technique that is often very helpful. You'll also be encouraged to adapt your foreplay and lovemaking style to increase your sexual enjoyment.
Delayed ejaculation or orgasm. Delayed ejaculation occurs when a man is able to have an erection but isn't able to ejaculate. There's no "right" amount of time for a man to take to reach orgasm. An older man will generally need more prolonged stimulation for arousal and orgasm. Also, some men reach orgasm much more easily through manual and oral stimulation. Because the urge to ejaculate lessens with age, an older man may be able to enjoy intercourse without needing to ejaculate every time. However, if the urge is present but orgasm fails to occur after a lengthy period of intercourse, he may give up trying. Alternately, the man's partner may need to halt lovemaking because of vaginal discomfort. Delayed ejaculation is a relatively rare problem, affecting only 3%–8% of men.
When assessing the problem, one of the first things your doctor will do is ask you which medications you take. Many antidepressants, blood pressure medications, and medications for obsessive-compulsive disorder can produce orgasm difficulties. To correct the problem, your doctor may recommend reducing the dosage of the drug, changing the frequency at which you take it, or switching to a different drug altogether. Don't stop taking a medication or alter your dose without speaking to your doctor first, though. Another possibility is to take bupropion or the herb yohimbine; both may counteract the sexual side effects of other medications.
Much more rarely, the inability of a man to come to orgasm has a psychological origin. This may be the case if the problem has persisted throughout life. A sex therapist can explore the emotional issues at the core of your inability to have an orgasm. He or she can also help you relax and focus on letting go so you can fully experience pleasure during sex.
Problems in women
A common complaint from women is a complete lack of orgasms or an inability to have an orgasm with a partner. In a 2004 survey of 862 sexually active older women, about 13% of the women reported that they had never or had rarely experienced orgasms during the past six months. As with other sexual dysfunctions, female orgasm difficulties can stem from physical and emotional causes, as well as issues involving the couple's relationship or sexual practices. Often, it's the result of a combination of factors.
If you've been able to have orgasms with your partner in the past, your doctor will investigate possible physical causes. These might include insufficient hormone levels, nerve damage from pelvic surgery (such as a hysterectomy) or even long-distance bicycle riding, vaginal pain, depression, or side effects of medications such as antidepressants.
If no physical problems are uncovered, the next step is sex therapy. The therapist will first ask whether you've ever been able to have an orgasm — either through masturbation or with a partner.
If you've never had an orgasm, the therapist will explore issues in your past such as sexual abuse or negative messages about sex or masturbation. The therapist will also encourage you to become more familiar with your body and what pleases you sexually. Books and videos are often helpful; the therapist may suggest that you buy a vibrator and experiment with using it to stimulate yourself, eventually in front of your partner if you're comfortable doing so. This technique is often successful in helping a woman learn to have orgasms. The orgasm rate is somewhat lower when these women have sex with their partners, but most report that after therapy, they enjoy sex more and have a more relaxed attitude about it.
In some cases, women enter sex therapy being able to have orgasms through masturbation, but not with a partner. The therapist will approach this situation by exploring how the couple stimulate each other. He or she will also delve into emotional issues that may be getting in the way, such as how you and your partner relate to each other and what your orgasms mean to both of you. Another important element of treatment is sensate focus exercises. If difficulty communicating your sexual needs is at the root of the problem, these exercises can help the two of you develop these skills. By placing the emphasis on enjoyment rather than reaching orgasm, a woman can relax and focus on her own pleasure.
Sex therapy underscores that orgasmic responses vary. At one extreme are the rare reports of women having orgasms from fantasy alone or just from having their breasts caressed. Somewhere in the middle are women who can, in one position or another, reach orgasm during intercourse. However, still more women find they need direct clitoral stimulation. A good therapist will reassure couples that there is no one right way to experience sexual pleasure and encourage them to adapt their lovemaking style to best suit their needs.
Alternative therapies for sexual problemsCan an herb or supplement improve your sex life? The market is flooded with herbal products whose manufacturers claim they can, but consumers should treat these claims with skepticism. Most of the creams and herbal supplements available over the counter and sold on the Internet have not been studied rigorously. Since the FDA doesn't regulate the use and dosage of herbal products, their safety and effectiveness are unknown. Dosages can vary widely from product to product and even pill to pill. Keep in mind, too, that "natural" doesn't mean harmless. Herbal products can cause side effects and interact with other medications. Also, what's listed on the label is not necessarily what's inside the bottle. This is illustrated by a 2006 FDA warning that urged consumers to avoid the following dietary supplements that claim to treat erectile dysfunction and improve sexual performance: Zimaxx, Libidus, Neophase, Nasutra, Vigor-25, Actra-Rx, and 4EVERON. The FDA found that these products contained sildenafil, vardenafil, or substances that are nearly identical to these medications. But none of these chemicals were listed on the products' labels. In fact, the packaging was misleading. According to the FDA, the packaging claimed that the products were "all natural" and did not contain the active ingredients used in FDA-approved erectile dysfunction drugs. This poses a serious health risk to consumers who might take such a product unaware that it could interact with other medications. Like sildenafil or vardenafil, the chemicals in these supplements can interact with nitrates (which are commonly used to treat angina and congestive heart failure) and cause blood pressure to drop to dangerously low levels. There is a dizzying array of other products marketed for improving sexual function. The chart below examines a handful of commonly known alternative therapies. But medical experts agree that it's best to opt for well-tested, FDA-approved medications. If you do decide to use an alternative therapy, tell your doctor about it so he or she can watch for possible side effects and drug interactions. | |||
Common alternative therapies | |||
| Name | What is it? | How does it work? | Is it safe? |
| Yohimbine (Yocon) | Oral treatment for erectile dysfunction. Derived from the bark of a West African evergreen. | Opens blood vessels in the skin and mucous membranes. May be helpful for men who can't take Viagra, Cialis, or Levitra, although its effectiveness has not been clearly established. | Side effects include anxiety, insomnia, increased heart rate and blood pressure, tremors, nervousness, irritability, and dizziness. |
| Ginkgo biloba | Chinese herb said to improve libido and erectile function. Available in pill form. | Opens blood vessels and increases blood flow. May be helpful if your erectile problems are the result of inadequate blood flow. | Can cause headache, stomach upset, dizziness, diarrhea, and skin reaction. Has a blood-thinning effect, so should not be used with anticoagulant medications or before surgery. |
| DHEA | A dietary supplement that is converted into testosterone and estrogen in the body. Said to improve libido, female arousal and orgasm, and erectile dysfunction. | Increases body's testosterone and estrogen levels. May improve libido and erectile function in isolated cases, but little reliable evidence on its effectiveness exists. More information is also needed on long-term effects. | May cause growth of facial hair and acne in women. High doses could cause depression, jaundice, and an increased risk for liver cancer. |
| Zestra | A plant-based arousal oil for women made from a blend of borage seed oil, evening primrose oil, vitamin E, and other herbs. This topical treatment is applied to the clitoris and labia during foreplay. Shown in a small clinical study to help enhance sexual function in women with sexual arousal disorder. | The makers of the oil claim that it increases genital blood flow and improves the workings of the genital sensory nerves. Contains large amounts of a fatty acid that the body converts to prostaglandin, which helps increase blood flow and nerve conduction. | When used as directed, few side effects have been reported thus far. Some women who had yeast infections at the time of usage developed mild skin irritation. |
| Last updated: | January 23, 2007 |
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Medical content reviewed by the Faculty of the Harvard Medical School. Harvard Health Publications, Copyright © 2007 by President and Fellows of Harvard College. All rights reserved. Used with permission of StayWell.
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