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!

How Sex Changes in Midlife

I’m continuing to answer questions sent in by my readers. This week, I’m tackling one that comes up quite a lot: Why does sex change so much for women in midlife, and what can they do about it? First off, it’s worth acknowledging that everyone, regardless of gender, moves through different life stages that affect sexual function, connection, and desire in all kinds of ways, including in midlife. Some of the most powerful shifts involve hormone changes, and midlife is a time when hormones typically change a lot. To keep it simple(ish!) I’ll narrow my answer to the hormone changes experienced by cisgender women.

Estrogen drops substantially in midlife, and that drop has a wide range of effects on the body. Here’s a rundown of the most common effects:

  • Vaginal dryness
  • Lower sexual desire
  • Weaker orgasms
  • Decreased muscle tone and flexibility including in the pelvic floor muscles

If you want to learn more about how midlife affects sexuality, the Femani Wellness website is an excellent resource; you can start here.

It’s definitely possible to mitigate some of these shifts with lifestyle choices and specific interventions:

  • If your orgasms are weaker than they were before, it may be the result of changes in your pelvic floor muscles. Just like any other muscle, you can strengthen your pelvic floor with exercises. You might consider contacting a pelvic floor physical therapist to start; your primary care MD can give you a referral, or you can contact a PT directly.
  • If you’re not experiencing as much desire for sex, many people find that exercise helps; it increases free testosterone in the body, which often boosts desire.
  • A mindfulness practice, with a focus on perceiving and experiencing subtle physical sensations, can help a LOT with both desire and the experience of orgasm.
  • One possible effect of lower estrogen levels is vaginal atrophy, in which the skin of the vaginal walls becomes less padded and thinner, leading to pain with penetration. Thankfully, there’s an awesome treatment for that: the Vaginal Renewal Program, a non-pharmacological program that works through a combination of moisturizing, vibration, and massage. It can make a huge difference for people experiencing vaginal atrophy. Refer to the FeMani Wellness website for more information.
  • My #1 recommendation for sexual health, improved sexual function, as well as overall health, is reducing inflammation in the body. Eating an anti-inflammatory diet, doing strength training, and ensuring that you’re sweating through 30 minutes of cardio every day can make a huge difference. You could end up feeling better than ever before, and enjoying sex more too.
  • Use it or lose it. The more sexual pleasure you enjoy, the more you will have the physiological structures and neural connections to enjoy sexual pleasure. Have some orgasms, alone or with a partner. Enjoy genital massage with or without orgasm. Get the blood flowing, and learn to enter a pleasure-focused state of relaxation.

I want to emphasize one point: It is 100% possible to have awesome sex, no matter what age you are or what bodily shifts you are experiencing. The strategies I’ve mentioned above can be a huge help, but the truth is, there’s only one indispensable skill you need in order to have an awesome sexual connection over the course of a lifespan: flexibility.

By flexibility, I mean the ability to roll with the punches, respond to what’s happening in the moment, and not get dragged down by negative assumptions or meaning-making when things don’t go as planned. It’s totally fine if you’re not there yet; flexibility is something you can cultivate, and the best time to start is now!

The changes many cisgender women experience in midlife can disrupt their settled patterns of sexual connection. That can be quite distressing and scary, particularly if you haven’t yet had a lot of practice cultivating flexibility in your sexual interactions. But if you can get past that distress, and embrace flexibility, it’s also a fantastic opportunity to learn a lot more about yourself and about your partner, and possibly discover some new and exciting ways to explore intimacy together. Many people have the best sex of their lives past midlife, for exactly this reason.

Here are a few mindsets you might choose to experiment with,, which are designed to help you
cultivate flexibility:

  • It’s completely normal and expectable for things not to go as planned when you’re having sex. It doesn’t mean that there’s anything wrong with you or with your partner.
  • There are infinite ways to connect intimately, from self-pleasuring together, to sharing fantasies, to pleasuring one another with toys. If one particular activity isn’t pleasurable or possible today, this is your chance to explore some others!
  • You and your partner are teammates; your goal is to create as much pleasure and connection as you can together. Keep your eye on that goal, and let go of any sense you “should” engage in any specific activity.