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.

Mindfulness: A “Magic Bullet” for Building a Healthy Sex Life

Nothing kills arousal like anxiety. Whether you’re worrying about the argument you had over breakfast, listening for sounds of trouble from the kids downstairs, or mulling over a big project at work or school, it’s hard to think about sex when you’re pumped full of nervous energy.

These anxieties may be well-founded, and good reasons not to have sex in this moment. You can always decide that this is the not the time, not the situation, or not the person for you. If something in particular about this situation is pinging your anxiety radar, listen to your gut and do what feels right for you.

But what about regular, day-to-day free-floating anxiety? Type A worries, or “being wound too tight?” Any kind of anxiety can get in the way of desire, but this latter type can last for years. Assuming you might want to experience desire even before becoming a less anxious person, mindfulness is the ticket.

Learning strategies to quiet your mind and settle into a place of awareness is key. You can begin to build this ability in literally countless ways but here are a few:

  • You might practice tuning in and being present when you’re doing the dishes. Slow down. Breathe. Notice the sensations in your body. Don’t rush. Just be with it.
  • Be present in your body and notice the sensations of being in the shower. Check in with all of your senses; what do you smell? Hear? Are there different textures? Can you feel your feet where they touch the floor?
  • Notice the sweet moments in the day. The sun on your cheek, a moment of quiet, or any other moment you experience as pleasant. Instead of letting it pass in a millisecond, be with it and see if you can stay with it for maybe 3 seconds. Then you can expand to not just lovely moments, but just any moment. Take a look around and take a breath. That’s being in the moment.
  • Take a few minutes to sit or stand still and pay attention to your breathing, to the in and out flow of air. Just notice it, don’t try to change it. See if you can stay with your body and your breath for 5 breaths. Don’t try to control your breathing, and don’t worry about your mind wandering, just be there.
  • If you WANT to control your breathing, put some very light attention on lengthening your exhale in a really relaxed way. Don’t worry about the inhale at all; it will happen automatically. Aim for your exhale to be twice as long as your inhale.

Aside from lowering anxiety, reducing stress hormones in your body, and about a million other positive effects, being present in the moment and in your body can make the difference between ok sex and great sex. You can practice mindfulness alone, and you can also practice being present in the moment, and in your body, with your partner.

  • Next time you’re holding hands, notice what it feels like in the place where your hands meet.
  • Next time you’re making out, see if you can be right there with your whole self. When you find your mind wandering, just refocus; look right at your partner, and say “hi”. Notice that connection, and stretch it out a little longer, just like the sun on your cheek.
  • When you experience arousal, don’t reach for a goal, even if that goal is orgasm. Stay with your body sensations, and try floating in that space for a little while. Sex can be a perfect distraction from anxiety, and is great for your body and mind. But it might take practice not to hurry, not to reach, not to pressure yourself. Just enjoy it. Start with just a few minutes; work your way up. Soon you can enjoy an hour or an afternoon of lovely, embodied, spa-like sex.

When you feel yourself tensing up during a sexual encounter, or feel your mind spinning out into an obsessive worry when you want to be focusing on your or your partner’s experience of pleasure, with practice, it will feel intuitive to draw on that practice of mindfulness, to take a moment, feel what you are feeling, and come back to the present.

Note: you can’t do mindfulness wrong!! Don’t make this another thing to worry about. Practice being in the present moment, which might be quite “imperfect” with all its thoughts and sensations and feelings. It’s all ok. It’s all your life, and this isn’t about changing it. It would be too bad if you missed it because you didn’t take a moment here and there to notice it, though. Take a moment here and there. It’s worth it.