What's wrong with me? Gail thought. Why won't my body do what I want it to?
When Gail came to see me, with some embarrassment she confessed, "I have trouble having an orgasm."
She said her husband was also frustrated because he wanted her to enjoy sex as much as he did. Neither of them knew what was wrong. His feelings of frustration and inadequacy only made Gail feel more pressure to perform and less able to do so.
Gail suffers from Female Orgasmic Disorder (FOD), a persistent or recurrent delay in, or absence of, orgasm, following normal sexual excitement. The Hite Report, a nationwide study of female sexuality, reported recently that 79 percent of women have, at some time, suffered from FOD. In my practice as a psychotherapist and sex therapist, I frequently hear this complaint.
Many women don't realize that orgasm is an inborn capacity; it's God-designed. Just as orgasm is natural for men, it's also natural for women. It's an instinctive, God-given response he wants married women to experience.
Yet "blockages" can occur that hinder a woman's sexual experience with her husband. Orgasm involves the mind and the body, so "blockages" can be physical or psychological.
Perimenopause or low testosterone. If you think testosterone is found only in men, guess what? Testosterone gives women sexual desire and orgasmic ability as well.
When clients come to me with FOD, the first thing I do is rule out the possibility of physical problems by asking them to get a full gynecological checkup. Gail, 35, reported that she'd been having intermittent periods and that her mother had had an early menopause. Indeed, Gail's gynecologist found she was perimenopausal, within three or four years of full menopause, and had low testosterone.
The gynecologist prescribed a testosterone topical gel that Gail could apply daily. After two months on the new hormone, Gail was able to enjoy all the benefits of intimacy with her husband, and was grateful for the intervention.
Pain. This is one of the most common complaints about sex reported to gynecologists. Pain can be caused by a vaginal or urethral infection, estrogen depletion, muscle spasms at the opening of the vagina, the formation of a supersensitive bundle of nerves after an episiotomy, or by the penis "bumping" the cervix or uterus.
Vaginal and urinary infections are easily cured with antibiotics, and it's important to have estrogen and testosterone levels checked. About 15 percent of women experience muscle spasms at the vagina opening. The best way to treat these spasms is to desensitize the vagina. Sex therapists use graduated dilators to gently stretch the vagina's opening. With a patient husband, these spasms can be cured 80 percent of the time.
If the pain is caused by a neuroma, an extraordinary sensitivity near the vaginal opening caused by a supersensitive bundle of nerves after an episiotomy, most women can be treated with creams or ointments—such as Vitamins A & D, cortisone ointment, and lidocaine gel. If that doesn't help, the next option is minor surgery.
Jane came to see me nine months after having a baby. She complained of severe pain each time she and her husband had intercourse. She'd tried various creams and ointments, but nothing removed the pain. When I sent her to her gynecologist with my suspicions of the problem, her physician agreed she had a neuroma, and removed it with minor surgery.
After six weeks Jane could stand touching without pain and after four months she was orgasmic and pain-free.
Other physical problems. Feeling that bumping sensation during sex can usually be corrected by finding a different sexual position that changes the direction of thrust, since some women have turned cervixes or some men are very large.
An eating disorder, such as anorexia, may also hinder the ability to climax. A 10 percent loss of ideal body weight can cause a woman to stop ovulating and menstruating, thereby producing less estrogen and testosterone. If you're underweight and experiencing these symptoms, see your physician.
Lines of defense for physical blockages
Have a thorough exam by a gynecologist, preferably one who specializes in sexual dysfunctions.
Monitor your lifestyle choices:
Don't smoke. Smoking can damage blood vessels throughout the body, including the genital area. Constricted blood flow to the genitals can block orgasm.
Limit alcohol intake. While a glass of wine can help you relax, anything after that can dampen arousal and impair orgasm.
Check out medications. Blood pressure medication, tranquilizers, narcotics, antidepressants, even anticholesterol agents can cause low desire, arousal difficulties, diminished genital sensitivity, and hinder orgasm. If you're taking these medications, check with your physician to see what changes you can make.
If all physical and lifestyle areas check out, then I usually look at areas of psychological difficulty such as stress, anger, depression, guilt, and body image.
Anita thought her marriage was ideal—until she discovered her husband, John, was having an emotional affair with his coworker. Suddenly, Anita lost the ability to have an orgasm. Even though she tried, she was unable to feel complete openness in sex and no longer could respond.
In therapy we dealt first with her anger and mistrust. Thankfully John was open to therapy and was remorseful, even changing jobs to prove the affair was over.
But it wasn't over for Anita. Every time she had sex with John, she wondered whether she was meeting his needs, would he betray her again, and where had she gone wrong? She had to get past her denial of the "idealness" of their relationship and look at some of the problems in their marriage. Next we worked on her devastation.
It took months of counseling for her to believe her husband was repentant. Yet slowly they rebuilt trust, and she was again able to become orgasmic.
Depression can result in a lack of sexual interest, and must be treated before that interest can return. A combination of prayer, therapy, medication, and patience are prescribed, and after the person's mood elevates, her sexual drive usually returns.
When Alexis started taking an antidepressant, she was unable to have an orgasm. Her physician told her, "You have to choose, be depressed or be orgasmic." That just isn't true.
When Alexis became my client, I asked her physician to allow Alexis to take a lesser dose on weekends so she could experience a fulfilling physical relationship. He agreed. Alexis cut her dose by half on the weekends, her orgasms returned, and her mood stayed stable.
Guilt from misbeliefs or a rigid upbringing can cause a great deal of fear. Sarah was reared in a legalistic Christian home in which she was taught nothing about sex, except to avoid it before marriage. Marriage didn't change those years of ignorance and fear of sex. She'd go to bed early, hoping her husband would think she was asleep and not "bother" her for sex. She couldn't enjoy lovemaking because she could never relax and let herself become aroused.
When Sarah came to me, I began slowly with sex education and Scripture to help her realize sex was good, not bad or dirty. We worked on relaxation exercises to decrease her anxiety. I gave her a tape I'd made with Scriptures read to soothing background music that she used daily to teach her body how to relax. Sarah and her husband's first homework assignment was to massage each other, without touching genitals, until she could be comfortable just being unclothed and giving and receiving massage. Step two was massage with genital touching but no climax. She began to relax and feel which touches she liked and which she didn't. She also began to lubricate and sense some erotic feelings. Eventually, she was able to enjoy the entire lovemaking session. While it was a slow process of more than six months, she finally had her first orgasm.
Lines of defense for psychological blockages
Identify and resolve emotions of sadness, anger, and fear. The apostle Paul instructs us to "speak the truth in love" (Ephesians 4:15). In marriage, this is crucial for maintaining intimacy. If you are struggling with your marriage, see a Christian counselor or talk with trusted Christian friends and family.
If you're on antidepressants, make sure your medication is "orgasm friendly." If not, check with your physician or pharmacist for other meds that can do the same job without sexual side effects, or ask your doctor about smaller doses on weekends.
Make sure you know what God says about sexuality and spirituality. Check out some good books on the subject and don't just believe everything someone else told you. I suggest one of these to get you started: Sexual Intimacy in Marriage by William Cutrer and Sandra Glahn, Intended for Pleasure: Sex Technique and Sexual Fulfillment in Christian Marriages by Ed Wheat, or The Gift of Sex by Clifford and Joyce Penner.
Learn to relax and let your body do what God intended it to do.
In my 20 years working as a sex therapist, I've observed that most women suffer silently with not being orgasmic for three to five years before they seek treatment. Ecclesiastes 3 says there is a time to mourn and a time to dance. If you've had intimacy problems, you've had your mourning time. Don't wait any longer, try some of these ideas, reclaim your sexual birthright, and dance!
Dr. Shay Roop, psychotherapist and sex therapist, lives with her husband in Florida. Check out her website at www.drshay.org. Adapted from for Women Only: God's Design for Female Sexuality and Intimacy (Living Inc. Books), due June 2004.
Copyright © 2003 by the author or Christianity Today/Marriage Partnership magazine. Click here for reprint information on Marriage Partnership.