Female sexual dysfunction, Orgasmic Dysfunction

Here's some information on what's called Orgasmic Dysfunction. Some of the explanations are highly "technical". I have adapted the text from LoPiccolo & LoPiccolo, which are leading authors in the areas of sex therapy.

Generally speaking, there are two types of orgasmic dysfunction in women. Primary orgasmic dysfunction applies to a woman who has never experienced an orgasm through any means of sexual stimulation. Secondary orgasmic dysfunction applies to a woman who usually cannot experience orgasm during coitus (i.e., intercourse) but who is able to have orgasm through masturbation or through manual or oral stimulation of her genitals. A woman who can have coital orgasm (i.e., an orgasm though intercourse) if she receives concurrent manual stimulation of her clitoris does not have secondary orgasmic dysfunction; she is normal. Similarly, a woman who regularly has orgasm during manual or oral stimulation, and who enjoys intercourse even though orgasm does not occur during coitus, is a candidate for reassurance about her normality rather than a candidate for sex therapy.

In addition to the primary—secondary distinction, a separation can be made between those inorgasmic women who are inhibited and, those who suffer from performance anxiety. The inhibited woman approaches the stereotype of what is oftentimes thought of as a “frigid” woman. Such a woman has a history of negative parental or religious indoctrination about sex, finds sex repulsive, does not become aroused, and enters therapy reluctantly, perhaps primarily to keep her husband from leaving her. These women need heavy exposure to the information and education and attitude change procedures. The woman with performance anxiety, on the other hand, often has an unremarkable parental and religious history, enjoys sex, becomes aroused, and enters therapy eager for the experience of orgasm for her own gratification. Alternatively, the husbands of such women often have profound doubts about their own masculinity and abilities as lovers, and put their wives under extreme pressure to have orgasms to reassure themselves on this issue. Such cases need more emphasis on the principles of eliminating performance anxiety and increasing communication and effectiveness of sexual techniques.

The role of the husband as an effective and nondemanding sexual partner for his wife is obviously crucial in orgasmic dysfunction, especially secondary orgasmic dysfunction. In one sense, it can be argued that if a woman can produce orgasm for herself through masturbation but cannot have orgasm with her husband, he is the dysfunctional one. This relates to the old maxim that “there are no frigid women, only clumsy men.” In many cases, this is true: The woman’s sexual re-sponsiveness is entirely normal, but her husband is quite inept as a lover. The principle of mutual responsibility, however, points out that such a woman has failed to train her husband to be an effective lover for her. This suggests a revision of the old maxim: “There are both frigid women and clumsy men, and they are usually married to each other.”

The treatment program for orgasmic dysfunction involves four different components. First, for the woman who has never experienced an orgasm, a program of directed masturbation is indicated. The rationale for the use of masturbation includes the fact that it is the sexual technique most likely to produce an orgasm. In prescribing masturbation, a nine-step program is usually instituted. In step one, the woman visually examines her genitals with the aid of a hand mirror and diagrams. At this time, she is also placed on a program of Kegel’s (1952) exercises to enhance her orgasmic potential through increasing strength of the pelvic musculature. In steps two and three, the woman tactually (i.e., touches) and explores her genitals to locate pleasure-sensitive areas. In steps four and five, the woman learns to intensely stimulate these areas while using erotic fantasies or explicit literature and photos to enhance arousal. She is also taught to label her physiologic responses to such intense stimulation as sexual arousal and pleasure, rather than, as often occurs, other states such as anxiety, discomfort, or tension. If orgasm has not yet occurred, in step six the woman masturbates using the electric vibrator. Steps seven through nine of this program involve the second major component of treatment for orgasmic dysfunction—skill training for the husband. In step seven, he observes his wife’s masturbation to learn what is effective for her. In step eight, he learns to manipulate her to orgasm, and in step nine this manipulation is paired with coitus.

While this program has produced good results, it should be emphasized that it is not used in isolation. Typically, the male is also placed on the same masturbation program to ensure his cooperation and support of the female. Also, throughout this program the couple has a series of prescribed mutual activities to engage in, starting with simple nondemanding body massage and progressing through kissing and hugging, breast stimulation, genital stimulation, penile insertion, and slow thrusting, and ending in full intercourse. A third major component of treatment or orgasmic dysfunction involves disinhibition of arousal. Many inorgasmic women are inhibited from reaching orgasm by fear of loss of control or embarrassment about displaying intense sexual arousal and pleasure in front of their husbands. Such a woman may be able to reach high levels of arousal (but not orgasm) in masturbation, or to masturbate to orgasm when alone but not in the presence of her husband. In such cases, the patient is instructed to repeatedly role-play a grossly exaggerated orgasm with violent convulsions, screaming, and other extreme behavior. Knowing that she is merely acting, the couple can engage in this activity quite readily. With repeated role play of exaggerated orgasm during the couple’s prescribed homework ac-tivities, the initial fear and embarrassment turns into amusement and eventually boredom (Lobitz and LoPiccolo, 1972). It has also been suggested that secondary orgasmic dysfunction is associated with a distressed marital relationship, and that it may be a symptom and result of this distress rather than a sexual problem in its own right. Such cases may respond better to a combination of sex therapy and marital counseling than to pure sex therapy.

I'm kind of curious about this. I've never had a problem with being aroused although, I survived a rape as my first sexual experience. However, I get more excited by kissing than actual intercourse. I get more excitment out of fantasies than reality. Am I weird? Ummm, I know this is kind of personal but, what can I do to rectify this? I'd appreciate any insights at all. Thanks!

~Aztec

Hello, Aztec

Well, I don't think you're that unusual. Many females need time to get warmed up...and, part of that process, is kissing and touching. Might the prior rape hav something to do with this? Perhaps, but I don't really have that sense.

Not that you'd want to reply here, but I think the clinical issue would be whether you could achieve orgasm in both instances, only through manual stimulation, or through intercourse alone. Each answer would be indicative of something a little different.

There could also be "other" issues at work here, such as sexual position, mutual attraction & desire, length of relationship, and so forth. All of those things would contribute to arousal level and perception of pleasure.

As for fantasies, I think you're pretty normal...the ideal is ALWAYS better than the reality! Our mind is a great thing, really.

Hope this helps...if you'd like to explore this a little more, feel free to PM me.

Dr. Dave

Reading all of the above there is the implication that women can all achieve orgasm eventually if they follow the right steps - and the vibrator seems to be considered the magic wand in the equation. I have had a vibrator for 5 years and have stil never had an orgasm. Sometimes it feels 'nice' but I know I haven't even come close. And of course this means I would never be able to tell a man and thus will never be able to have a real relationship. So I find it annoying for people to assume that the road to results is simple a matter of following the manual or that if I was in a loving relationship it would all fall into place.

Hi, Gemma,

Thanks for your input...you're correct...oftentimes a "manual" is seen as a solution...rather, it is really nothing more than a guide. There were some things you did not mention, such as your age, number of relationships, sexual activity, and so forth.

I have a different thought on wether you achieving orgasm will hinder a relationship...it will not. Sex/orgasm is a physiological response to a mental perspective...in other words, sex/orgasm is as mental as it is physical.

Depending on your age, you might consider getting checked out by an OB/GYN and then get a referral to a sex therapist. I am highly confident that a solution exists for you...I think others may be able to help you find that answer.

Please feel free to PM me if you want more feedback privately.

Dr. Dave

It's amazing how prevalent female sexual dysfunction is(statistics are high). Why do you think that is?

I am one of the many females with secondary sexual dysfunction. And I know some of the reasons why which include 1) having sex before I'm ready(I guess because I feel it is the only way they will stay interested) which causes me to feel used and resentful, never knowing if the person really likes me, and also makes me feel bad for not sticking to my convictions; 2) feeling pressure about orgasm from the man; 3) general lack of communication with my partner about sexual needs(for various reasons).

But it was interesting to read that men's need for women to orgasm can be based on their own feelings of inadequacy. I have never really thought about it like this, which seems odd but true. I have always hated whenn this happens and it has been this way with every sex partner I've ever had. As soon as they start talking about me orgasming (before or during sex) I lose interest in sex completely. I just don't want to deal with it. If I don't orgasm, they feel bad and then I feel worse. It sucks. I've tried to tell some of my partners that I can enjoy sex immensely even if I don't orgasm but they don't seem to buy it. I've had guys leave me because I didn't orgasm during sex. Honestly, I don't ever look forward to sex anymore because of this and I know it keeps me from relationships. Sometimes I feel so overwhelmed by the pressure to perform sexually that I feel I'll never be able to be in a long term relationship and it is depressing.

Well, this is my personal opinion, but I think female sexual dysfunction being prevalent may be due to the way we socialize females (i.e., young girls are encouraged to do everthing little boys do) and then about when puberty hits, females are suddenly told to cross their legs, be more lady-like, not do certain things, are told be seductive, but not slutty, and so forth. I think these mixed messages about sex, sexuality, good girls don't, and so forth cause many women not to experiment with sexual pleasure. Therefore, I believe, many women do not know how to be selfish enough with a partner to reach orgasm. That's my personal opinion and I have no research to base that upon. I'd be interested in hearing what females think. Thanks for an interesting question.

Dr. Dave