Orgasm problems (also called anorgasmia)

Many women suffer from difficulties in reaching an orgasm during sex at some time in their life. There are two different categories of orgasm difficulties – primary and secondary.

Primary anorgasmia means that the woman has never experienced an orgasm, either in masturbation or in sex with a partner.

Secondary anorgasmia means that the woman has experienced orgasm at least once before – perhaps in a previous relationship or through masturbation – but does not have an orgasm during sex now.

Some kinds of anorgasmia depend on the particular situation that the woman is in. For instance, she may be able to have an orgasm through foreplay, but not during penetration, or she may be able to masturbate to orgasm but does not reach orgasm with a partner.

Common causes of orgasm problems include:

• Particular diseases In their advanced stages, diabetes and multiple sclerosis may lead to the inability to achieve an orgasm. If the woman suffers from these diseases and has experience of orgasm problems, she should consult her GP.

• Alcohol abuse Sustained drinking may prevent the woman from being able to respond sexually. Alcohol is also a depressant so that sexual drive may also be absent, leading to arousal and orgasm problems in the woman.

• Some gynaecological operations Although rare, complications of some gynaecological operations can cause orgasm problems. But these might also be linked to psychological issues rather than physical concerns. If the woman has concerns about her orgasmic response after a surgical procedure, she should seek help from a GP.

• Some drug treatments Some drugs (eg antidepressants) may inhibit sexual desire and this can lead to a loss of orgasm. The woman should check any possible side effects of drug treatments with her GP.

• Psychological or relationship problems The majority of orgasm difficulties are probably psychological or due to relationship concerns. A lack of trust in a partner, poor sexual education or unhelpful messages from parents and others in childhood about sex (i.e. ‘sex is dirty’) can all prevent a woman from experiencing orgasm. Tiredness and stress can also contribute to the inability to achieve an orgasm.

Treatment

• Psychosexual Therapy - Psychosexual therapy offers real help for orgasm problems. If the woman has never had an orgasm, the therapist can guide the woman through a series of exercises, undertaken at home, in order to achieve orgasm through masturbation. If the woman is in a relationship, similar exercises may be undertaken with a partner. Couple psychosexual therapy may also help the woman and her partner to tackle any relationship problems that contribute to the problem. See the Relate web site.

• Relaxation - Tiredness and stress can prevent a woman from feeling sexually aroused. Learning to relax, and taking time to focus on personal needs, can help to restore normal sexual functioning.

• Vibrators - Some women find that a vibrator is an excellent aid to reaching orgasm. They can also enliven foreplay with a partner, allowing the woman to reach an orgasm easily.

Dyspareunia (or painful sex)

Dyspareunia means the experience of pain during intercourse, and sometimes discomfort during stimulation of the labia and clitoris. Women often describe the pain differently.

It can be a general soreness, a sharp or pulling pain on penetration, stinging discomfort or a dull ache. It is crucial to have any pain of this kind checked by a GP.

Common causes of dyspareunia include:

• Problems after childbirth - If the woman has experienced a tear or episiotomy during childbirth, penetration may be painful due to soreness around the scar. If pain or soreness continues some months after the birth, the woman should seek advice from her GP.

• Vaginal dryness - During sexual arousal, a woman should experience natural lubrication in the vagina. A lack of lubrication can be the result of a number of concerns, such as lack of arousal, anxiety about a sexual relationship and the onset of the menopause. Tiredness and stress can also prevent a woman from lubricating naturally.

• Some gynaecological concerns - Dyspareunia can occur as the result of a number of diseases. Menstrual difficulties or bowel problem can contribute to dyspareunia. A GP should be consulted if painful sex seems related to this kind of condition.

• Infections - Some common vaginal infections, like thrush, can cause great discomfort. Check with a GP to ensure that these easily treated problems are not the underlying cause for dyspareunia.

• Vaginismus - for details, see below. Vaginismus is an important cause of dyspareunia. In women suffering from vaginismus, the muscles surrounding the entrance of the vagina contract to prevent penetration of the penis and trying to have sex may be painful.

Treatment

• Resolution of an underlying difficulty - If dyspareunia is caused by a medical condition – like thrush – resolving the difficulty can often eliminate dyspareunia.

• Help for vaginal dryness - Lubricants are available at most chemists for use during sexual activity. If the woman is menopausal, other treatments (like HRT) may also be helpful so it is wise to consult a GP in these circumstances.

• Psychosexual Therapy - Where dyspareunia is not caused by a medical condition, therapy can help the woman to feel more relaxed and to enjoy sex more, which usually boosts natural lubrication. Where dyspareunia is caused by a medical condition, therapy can also help to improve the woman’s confidence about sexual matters as she recovers from the physical problem.

Vaginismus

The term vaginismus refers to the involuntary spasm of the muscles surrounding the entrance of the vagina. Penetration by a penis is usually impossible during sex, and in the worst cases, the woman may not be able to use tampons or to insert her own finger into her vagina. Women with vaginismus usually find it distressing, especially if she wishes to have a family.

Vaginismus is usually caused by:

• Physical problems - A tough hymen, which cannot be broken by intercourse or a swollen gland inside the vagina, can cause penetration to be impossible. Although very rare, these difficulties may be overcome through medical treatment.

• Psychological or couple difficulties  -Women suffering from vaginismus may be suffering from a form of post-traumatic stress disorder as a result of experiencing childhood sexual abuse, rape or some other kind of abuse. The muscle spasm may be caused by a deep-seated desire to block memories of a painful event in the past. Alternatively, there may be a lack of trust in a partner or a fear of further abuse if intercourse succeeds.

Treatment

• Psychosexual Therapy -  Vaginismus can be very responsive to therapy. The woman (and her partner, if desired) are guided through a set of specially designed exercises that help her to become more comfortable about her body and encourage her to relax in order to allow intercourse to take place. See Relate web site.

• Medical treatment for an underlying physical cause - If vaginismus occurs because of a physical problem, treatment for the concern usually resolves the vaginismus.

Loss of desire – a sexual problem experienced by both men and women

Loss of desire for sex is fast becoming one of the most common sexual difficulties experienced by both men and women. Tiredness, stress, anxiety and the fast pace of life for couples and families can all contribute to a loss of interest in sex.

It is possible to regain an interest in sex by taking time to relax more as well as making an effort to put time aside for sex rather than going through the motions of an intimate relationship late at night when both partners are exhausted.

Psychosexual therapy can help to boost sexual libido by encouraging the couple to spend quality time together as well as offering new ways of enjoying sex.