Troubleshooting Orgasm Problems (Part Two)

Recently, I wrote about troubleshooting orgasm problems, and described one strategy for improving orgasmic response by increasing arousal. Today, I’m describing another strategy, which you can use in combination with the increasing arousal: improving the ability to sustain arousal.

Orgasm is a reflex response to a sustained high level of arousal. “Sustained” is the key word here. Anxiety kills arousal; you can’t reach orgasm if your process of building arousal is being constantly deflated by worries like “do I look bad?”, “are the kids about to bust into this room?”, “am I turning my partner off?”, “did I remember to turn off the stove?”,  “do I have enough money in my bank account to pay the rent tomorrow?”, and so on. 

That’s not to say that people who are experiencing stressful things can’t ever have satisfying sex. They can and do, all the time. In fact, sex can be a lovely stress-reducer for some! What I’m getting at is that being able to experience arousal, and sustain that experience for long enough to reach orgasm, takes some anxiety-management chops. 

So, when you’re working with a client who is not reaching orgasm when they would like to, along with considering what kinds of stimulation work for them and how to increase arousal, consider what might be disrupting the sustaining of that arousal. 

If one of the things disrupting arousal and interrupting pleasure is intrusive thoughts, which it often is, you can help your client build the skills to handle that. As a therapist, this is probably squarely within your wheelhouse: they can develop the ability to let emotions come and go, stay in the moment and in their body, and choose connection with their partner over a negative thought-feeling spiral. Developing these skills will help them with every aspect of their relationship, not just sex. 

Another thing to assess any time you’re working with sex issues in the therapy room is sex pain. Pain, like anxiety, can kill arousal in a snap–and more than that, it can be immensely damaging to bodies, minds, and relationships, if left untreated. Sex pain can be caused by all kinds of things, from vaginal atrophy to endiometriosis to undiagnosed STIs to sex positions that just happen to bump the cervix and many other things. The best thing to do if your client reports sex pain is to get them a medical evaluation ASAP so that a team of health care providers can start sorting out exactly what’s causing the problem. Meanwhile, you can help with the relational dynamics and personal thoughts/feelings/meanings that tend to surround the experience of painful sex. 

A combination of those two strategies–helping your client increase pleasure, and thereby arousal, by increasing sensory input and experience; and helping them effectively managing anxiety and other thought/emotion spirals that may disrupt arousal–is a wonderful two-pronged approach to tackling the vast majority of orgasm issues.

Troubleshooting Orgasm Problems (Part One)

Orgasm is a reflex response to a sustained high level of arousal. Many different kinds of stimulation can lead to orgasm; whether you’re talking about an orgasm from direct stimulation of erectile tissue, or a “g-spot orgasm,” or a “braingasm,” that definition binds them all together. That means that you have two strategies you might use to increase orgasmic response: increasing arousal, or improving the ability to sustain arousal. For best results, you’ll probably want to explore both. 

Strategy One: Increasing Arousal

To increase arousal, look at adding more stimulation or different kinds of stimulation. Consider, say, a cis male client who experiences “delayed ejaculation” in partnered sex–in other words, he doesn’t reach orgasm as quickly as he would like to. Using a hand or adding oral stimulation is likely to provide more stimulation than penetration alone. You can also fold in other sensual experiences, like stimulating other parts of the body,  talking dirty, looking at something sexy, or playing with fantasies. Think about adding multiple senses (touch, sound, imagination), multiple types of touch (soft, firm, light, vibrating) and multiple areas of the body (inner elbow, vulva, prostate, lips). 

I find it much more useful to make my focus be helping people attain as much pleasure and connection as possible, rather than helping them figure out how to achieve orgasm in the “right way” or at the “right tempo” (because there is no “right way,” nor is there a right amount of time to get there)! 

Generally speaking, people have one or two pathways to orgasm that have been strengthened by repeated practice, and they will have a much easier time reaching orgasm through those familiar pathways. For our hypothetical client who doesn’t reach orgasm as quickly as he would like to, perhaps he has a frequently-used pathway to orgasm that is derived from his self-pleasure style, and the way that he’s having partnered sex does not provide the same kind stimulation. The quickest and easiest way to help is simply to normalize building in some of the same kind of stimulation that easily brings him to orgasm into his partnered sex routine. There’s really nothing wrong with touching yourself in order to reach orgasm when you’re with your partner! 

You can help quite a bit by simply normalizing your client’s orgasmic pathway and helping them develop a little more flexibility and openness to incorporating different kinds of stimulation into their partnered sexual patterns. The prescription here is to be creative and open-minded, and get outside of rigid ideas about what partner sex should and shouldn’t include. 

On the other hand, it’s always good to have multiple routes to orgasm, since it allows for more flexibility if one of your well-practiced pathways isn’t possible. Possibly our hypothetical client would like to be able to achieve orgasm with penetration alone; if so, it’s possible to build a new neural pathway that will allow for that, although it will take some time and practice. The process of building a new neural pathway to orgasm generally involves moving between the easy, well-practiced pathway and the desired new pathway. I’ve written before about the process of building a new neural pathway to orgasm; you can check out that post here.

Stay tuned for part two, where I’ll describe the other half of my two-pronged approach to trouble-shooting orgasm issues!

Having A Satisfying Sex Life On Antidepressants

SSRIs, or selective serotonin reuptake inhibitors, are a common class of antidepressants. They’re also known for inhibiting sexual desire and making it more difficult to reach orgasm. Often, I see patients who feel like their sex lives have taken a hit after starting a course of antidepressants, and who want to get back in touch with their sexual selves. The good news is that, while it can be an adjustment, it’s still very possible to have a satisfying sex life while taking an SSRI.

If you’re trying to reconnect with your libido or experience some satisfying sex while on an SSRI, or if you have a client who’s in that boat, these are my recommendations.

  1. Let go of “shoulds.” You want to have a satisfying sex life. Part of that is recognizing that there’s no one “normal” level of sexual desire. Some people have very little desire, or no desire at all, and that’s ok. Your goal here is not necessarily to bring your desire up to a “normal” level; there is no “normal” level of desire. Rather, think about this process more in terms of what it is that you hope to gain from having more desire or more sex. Are you looking for more fun, more pleasure, more exploration, more intimacy, something else, all of the above?
  2. Recognize that willingness can be enough to begin a sexual interaction. If you’re typically the initiator in a sexual encounter, or if you usually wait until you’re really, really turned on to start a sexual interaction, it makes perfect sense that your sex life would take a hit if your libido decreases. Changing up that pattern can help. If you know that you want to have more sex, consider initiating an encounter even if you’re not feeling it quite yet. You may find that your arousal begins to pick up once the encounter is underway.
  3. Invest in a vibrator. SSRIs don’t generally stop you from reaching orgasm–rather, they raise the orgasmic threshold, making orgasm take longer to reach. Sometimes people give up on reaching orgasm because it’s harder to achieve–but investing in a toy like a vibrator, that can cut time to orgasm in half, can make a huge difference. Vibrators aren’t just for female-bodied people, either–there are plenty of vibrators designed specifically for male-bodied people. Nor does it have to be a vibrator; any kind of toy that feels good to you and reduces the time and effort necessary to reach orgasm will help.
  4. Explore. Now is a time to learn more about what turns you on. Explore widely: consider different kinds of stimulation, different activities, erotica, fantasy…explore a broad repertoire of pleasurable and stimulating things to do or imagine, so that you have a wider menu of options to choose from when you’re having trouble accessing desire. This can be an opportunity to discover something new about yourself.