"I demand that I climax. I think women should demand that. I have a friend who’s never had an orgasm in her life. In her life! That hurts my heart. It’s cuckoo to me." —Nicki Minaj
According to Rowland, Cempel, and Tempel, as reviewed in their recent study "Women's Attributions Regarding Why They Have Difficulty Reaching Orgasm," reports of difficulty or inability to orgasm in women range from 10 to 40 percent. Many factors can impede orgasmic capacity: age, hormonal status, sexual experience, physical stimulation, general health, type of stimulation, the kind of sexual activity (e.g., masturbation or not), and whether the relationship is a brief encounter or longer term. Further studies show that while the majority of women can masturbate to orgasm, up to 50 percent of women do not orgasm during sexual intercourse, even with additional stimulation.
Why do women have difficulty with orgasm? There are many possible factors, ranging from reduced sexual desire, pain during intercourse, difficulty becoming sexually aroused, and psychological and relationship factors, including anxiety and post-traumatic symptoms. Researching sexuality is difficult because of complex and inter-related factors, including statistical challenges as well as social stigma and taboos around discussing sexuality. Yet, given the scope of the problem, research is required to guide clinical interventions for women and couples for whom decreased sexual satisfaction is a source of individual distress and relationship problems.
In order to better understand what women themselves attribute orgasmic difficulties to, Rowland and colleagues surveyed 913 women over the age of 18, including 452 women who reported more severe problems achieving orgasm on initial screening. For women with more severe difficulty, 45 percent reported problems with orgasm during half of sexual experiences, 25 percent in three-quarters of sexual experiences, and 30 percent during almost all sexual experiences. Researchers first formed several focus groups to develop a set of commonly reported factors and then developed an online survey gauging demographic information, lifestyle, relationship status, how often they had sex, relationship quality, use of medication, sexual responses, physiologic factors (e.g., arousal and lubrication), and orgasm.
Finally, they looked at the level of distress from difficulty with orgasm, which is not necessarily perfectly correlated with actual difficulty, as some women are not bothered by it or prefer to abstain from sexual activity for various reasons. Three groups were identified for comparison: women who had orgasm difficulty, but were not distressed by it, women who were distressed, and women who did not have orgasm difficulty. They were all asked about why they thought they had difficulty with orgasm, using 11 categories identified during the original focus group and study development, including a 12th “Other” category:
1. I am not interested in sex with my partner.
2. My partner does not seem interested in sex with me.
3. I do not enjoy sex with my partner.
4. My partner does not seem to enjoy sex with me.
5. I am not sufficiently aroused/stimulated during sex.
6. I am not adequately lubricated during sex.
7. I experience pain and/or irritation during sex.
8. We do not have enough time during sex.
9. I am uncomfortable or self-conscious about my body/appearance.
10. I feel that medication or a medical condition interferes with having an orgasm.
11. I feel that my stress and/or anxiety make it difficult to have an orgasm.
The most common overall reasons given by women were stress and anxiety, reported by 58 percent; lack of enough arousal or stimulation by nearly 48 percent; and not enough time by 40 percent. Moderately common issues were negative body image, reported by 28 percent; pain or irritation during sex from 25 percent; insufficient lubrication by 24 percent; and medication-related problems by almost 17 percent. The other factors were less commonly reported, by less than 10 percent of respondents.
Some of these factors go together. For example, a lack of arousal was associated with stress and anxiety, not enough time for sex, lubrication issues, and genital pain or irritation. Women with a negative body image tended to also report stress and anxiety. A lack of lubrication, unsurprisingly, was associated with a lack of time and genital discomfort.
When distressed women were compared to non-distressed women, researchers learned that more distressed women experienced anxiety and stress around sex and believed their partners did not like having sex with them. More distressed women, when asked to identify the single most important contribution to decreased orgasm, reported anxiety and stress, while non-distressed women reported less interest in sex and not having enough time to reach orgasm during actual sexual encounters.
Many of these factors are seemingly straightforward to remedy and are likely reflective of relationship quality and partner inattentiveness, among other reasons. There are simple ways to improve the frequency and quality of orgasm via changes in technique and specific communication strategies, which improve overall sexual and relationship satisfaction. While many of these approaches to improving orgasmic and sexual satisfaction sound like common sense, barriers such as poor relationship quality, inadequate or dysfunctional communication styles, unaddressed individual issues, such as depression, anxiety, trauma, and sexual and medical disorders, are often difficult to actually address.
Sexuality remains infused with pressure and shame for many people, in spite of greater positive and open attitudes. On personal and couple levels, people often rely on avoidant coping to deal with the anxiety and shame surrounding sex and sexual problems, solidifying pessimistic views, confirming negative self-image and amplifying low self-esteem, and reducing belief in their ability to make positive changes. Fortunately, by providing "esteem support," partners can help one another with self-esteem and self-efficacy, making it easy to tackle challenges.
In some cases, as with medications and medical conditions, making changes that would improve sexuality is more complicated. Nevertheless, quite often there are ways of modifying medications and treating medical conditions which can improve or restore sexual enjoyment. Even modest improvements in sexual satisfaction over time can greatly improve quality of life and are worth pursuing.
In therapy and through self-help, individuals and couples can address psychological and emotional issues, improve communication and relationship difficulties, and thereby directly work on intimate behaviors to achieve better sex for both partners. Restoring self-esteem and self-efficacy, practicing more adaptive, active coping, cultivating realistic optimism, and modifying relationship behaviors provides relief of underlying issues and improves overall relationship quality and sexual enjoyment. Rather than setting unrealistic short-term goals, which leads to chronic failure and hopelessness, approaching challenges with investment in compassion for oneself and others, gratitude, curiosity, and patience paves the way for long-term gains.
Please send questions, topics or themes you'd like me to try and address in future blogs, via my PT bio page.
David L. Rowland, Laura M. Cempel & Aaron R. Tempel (2018): Women's
Attributions Regarding Why They Have Difficulty Reaching Orgasm, Journal of Sex & Marital
Therapy, DOI: 10.1080/0092623X.2017.1408046