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.