If you have never had an orgasm, you’re not alone. The statistics show that many women fail to experience an orgasm or have orgasms that don’t always feel the same. Dr Careen Rascher shares the ins and outs.
Dr Rascher explains that it is important to note:
Inability to experience an orgasm or long delays in reaching orgasm is called anorgasmia. There are different types of anorgasmia:
• Lifelong anorgasmia. You’ve never experienced an orgasm.
• Acquired anorgasmia. You used to be able to orgasm but can no longer do so.
• Situational anorgasmia. You are only able to orgasm under certain circumstances such as during oral sex or with a certain partner.
• Generalized anorgasmia. You aren’t able to orgasm in any situation or with any partner.
It has long been argued that vaginal and clitoral orgasms are different.
Dr Rascher shares: “Freud referred to clitoral orgasms as immature, and vaginal orgasms as mature in nature. In fact, the clitoris is an organ about the same size of the penis. In addition, it’s only the tip of the clitoris called the clitoral head that we can see externally.”
She continues: “The body of the clitoris lies below the skin surface, furthermore the bulbs of the clitoris are found on either side of the vagina. So direct stimulation of the clitoris leads to a ‘clitoral’ orgasm, and a vaginal orgasm is caused by indirect stimulation of the clitoris.”
The existence of the G spot is also much debated:
Dr Rascher explains: “Some women say they can ejaculate with massage of this area found on the anterior vaginal wall. These are most likely secretions from glands which lie on either side of the urethra. However, this does not apply to all women.” Not sure where you fall? Don’t worry! There are books for this.
So What Are The Causes of Anorgasmia?
There are many potential causes of anorgasmia in women. Some of the most common causes include:
Medical causes include:
Psychological causes include:
• Past sexual abuse, rape, incest, or other traumatic sexual experience;
• Fear of loss of control during orgasm;
• You have relationship problems with the partner;
• Fear of contracting a sexually transmitted infection;
• You feel guilty about sexual pleasure;
• Fear of becoming pregnant; and
• You have mental health problems such as major depression or anxiety.
Anorgasmia is most often curable:
Dr Rascher explains that the first step is education of the couple: “We need to ensure that sexual stimulation is appropriate and continues for an adequate duration of time. A combination of counseling, psychotherapy, and sex therapy are used, either for the individual or for the couple.”
In couples’ therapy, therapists often assign “homework” that focuses on:
• Relaxation techniques;
• Sexual exploration;
• Improving sexual communication;
• Decreasing inhibitions;
• Increasing direct clitoral stimulation;
• The use of a suitable vibrator with lubrication;
• Individually, a woman might be encouraged to masturbate either through self-stimulation or with a vibrator; and
• Pelvic floor physiotherapy is a very useful intervention.
Dr Rascher shares: “When failure to reach orgasm is caused by a medical problem such as diabetes, we need to optimize the management of the illness to ensure that no further damage to pelvic nerves and blood vessels occur.”
She adds: “In those cases of anorgasmia thought to be caused by medication such as antidepressants, a few options exist. If an SSRI (selective serotonin reputable inhibitor) such as fluoxetine (Prozac) is being used, bupropion (Wellbutrin) can be added.”
She continues: “Bupropion is a commonly prescribed antidepressant which works on the dopaminergic system in the brain. In suitable cases, the SSRI can be switched to bupropion or another orgasm-friendly antidepressant under the guidance of a psychiatrist.”
It is important to note that bupropion is also sometimes prescribed in women who are not depressed because it facilitates orgasm by its dopaminergic effects.
“Women suffering from low oestrogen levels may become orgasmic simply by using a local oestrogen cream. We also routinely test women’s testosterone levels and if these are found to be low local testosterone cream is prescribed,” Dr Rascher explains.
The Final Word
Dr Rascher shares her final advice on anorgasmia:
• Orgasmic difficulties are common among women;
• Medical and psychological causes may contribute; and
• Ideally treatment is multidisciplinary including a doctor trained in sexual health, a psychologist or sex therapist, and a pelvic floor physiotherapist.
And if all else fail, don’t be too embarrassed to explore your own sexual pleasure for yourself!
About Dr Careen Rascher
Dr Careen Rascher is a Sexual Medicine expert and Psychiatrist. She recently became a Fellow of the European Committee of Sexual Medicine, and has started consulting patients with sexual problems at the Wits Donald Gordon Medical Center. Her practice is called My Sexual Health. Here she works with a multidisciplinary team which includes doctors who are specialists in sexual medicine, pelvic floor physiotherapists and psychologists or sex therapists.