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The Elusive Orgasm—and What It Means for Healing

For many women, consistent orgasms are out of reach, which can leave both parties feeling underwhelming as lovers. Dr. Sadeghi explores what might be at the root of it, whether it’s sexual trauma, failure to be in the moment, or issues with the pelvic floor. More poignantly, he suggests that an emotional inability to reconcile all the different parts of ourselves can manifest through disease. He explains below.

What Do a Presidential Candidate and Orgasms Have in Common?

The answer to that question is probably not what you think. In order to explain, let me first tell you about my own history with a certain candidate and some of what I know about developmental challenges in the sexual realm.

I was a young medical student when I first found the lump in my left testicle. Medical students are known hypochondriacs, so my late brother, then a doctor himself, counseled me not to worry too much about it. But I just had this feeling. When I went to the doctor, he confirmed the worst: I had Stage 2 testicular cancer.

As if that news weren’t bad enough, I then learned the treatment plan my doctors had devised for me. They offered only one option: to have all the lymph nodes in my gut removed, along with the affected testicle, followed by extensive rounds of radiation and chemotherapy, accompanied by recurring prescriptions for anxiety and depression. The plan was so extreme, so invasive, I couldn’t help but wonder if it was the best one for me.

After much anxious consideration, I decided to go through with some of the suggested treatment, opting to have just my left testicle removed. I have obviously lived to tell the tale, but beyond that, the experience put me on a new path, one that taught me about myself, led me to confront past traumas, and helped me discover the kind of doctor I wanted to be.

A pivotal moment in that journey came during a psychiatry lecture my second year of medical school when I got up in front of the class to talk about what I was going through. There I was, studying to become a physician while experiencing what it was like to be a patient with a critical condition at the same time. My professor listened to my story and something about it struck a chord. After class, he approached me and recommended an article for me to read that he believed related to my case. It was called “Cancer, Disease, and Society,” by Bernard Sanders. At the time, the name was unfamiliar to me, but today he is better known as Bernie, Democratic candidate for President of the United States.

That article, published in the Vermont Freeman in 1969, may have been several decades old at the time, but it offered a perspective on disease that was new to me. It led me to look beyond a person’s physical symptoms and the various tests, medicines, and treatments that Western medicine had to offer. It inspired me to wonder what else in a person’s life might be contributing to his or her condition. As Sanders asks at the beginning of the article: “Can disease be understood solely by looking into test tubes and microscopic slides, while ignoring the emotional lives of the people who succumb to them? Is disease just a tumor, or an ulcer, or a headache, or are those merely symptoms and manifestations of a person’s whole state of being?”

A New Perspective on Healing

“A person’s whole state of being”…that phrase resonated with me. If I really wanted to heal myself, and go on to be of service to others, could I just treat symptoms in isolation or did I need to look at a person’s whole state of being? That question led me to look more closely at the works referenced in Sanders’ article, including the writings of Dr. Wilhelm Reich, a psychoanalyst who came to the U.S. from Austria in 1939, and then the work of my teacher, Dr. Morton Herskowitz, author of Emotional Armoring. I came to understand that there was no separation between mind and body when it came to health and healing. True healing meant taking into account a person’s emotional well-being, their sexual health, their past experiences and traumas, as well as their physical symptoms. It meant looking at anything and everything that might impact someone as a whole.

So, what does this have to do with orgasms? Sanders’ article was essentially an exploration of the link between emotional and sexual health and cancer. He even cited a 1952 study of breast cancer patients, which found that a high percentage of the study’s cancer sufferers “had never experienced orgasm, did not enjoy intercourse, and considered it a distasteful, wifely duty.”

I don’t mean to suggest that an inability to achieve orgasm causes cancer. The link is not that simple or direct. What I am suggesting, however, is that our minds and our bodies are merely different parts of the same whole, and what affects one affects the other. I came to view my own cancer from this perspective after reading Reich and Herskowitz. Their work helped me see how I’d donned emotional armor years before to cope with the physical and sexual abuse I’d experienced as a child. Based on everything I was learning, it suddenly seemed like no coincidence that years of sexual abuse, repressed emotions, and struggles with my masculinity created negative energy that manifested as cancer in my sexual organs.

To some, this idea and its sources may sound controversial (Reich’s work was even burned by the government during this lifetime), but to others they are likely to resonate even if they aren’t sure why. Anyone suffering from sexual dysfunction, for example, is likely to understand that the problem is a lot more than just a set of physical symptoms.

“Maybe we’re not doing it right.” “He feels so bad he can’t satisfy me that it’s hurting our relationship.” “He said he’s never had a problem satisfying other women, so what’s wrong with me?” These are just some of the things I’ve heard from patients who are having trouble achieving orgasm. Depending on the severity of the problem, it can lead to depression and feelings of isolation. At the same time, a woman’s partner may feel sexually inadequate and the relationship suffers. Difficulty experiencing sexual pleasure can negatively impact a person’s emotional well-being, sense of self, intimate relationships, and more. If we consider a person’s “whole state of being” and how the different parts of ourselves—mental, physical, emotional, spiritual—are intimately intertwined, is it that much of stretch to think that a person’s inability to engage in a satisfying sex life can, if left unchecked, contribute to the development of other issues, including a disease like cancer?

When It Comes to Orgasms, What’s Normal?

Before I talk more about this link and what you can do about it, it’s important to clear up a few things about female orgasm in general. Research shows that about 10% of women are anorgasmic, or have never had an orgasm (1), and another 10% can easily reach orgasm (2). That means that 80% of all women require some work to reach climax or may occasionally not reach orgasm during sex. Despite what many women and their partners may think, this is completely normal. In fact, women within the normal range reach orgasm only about 50%-70% of the time (3).

It’s also important to know that, in spite of what we see in Hollywood and adult films, 75% of women cannot reach orgasm through intercourse alone and require the help of sex toys or oral/manual manipulation (4). This has far less to do with a woman’s desire or the skill of her partner than it does with her physical anatomy. The closer a woman’s clitoris is to her vaginal opening, the more likely she is to be able to climax from intercourse alone. For this to happen, the clitoris to vagina measurement, or C-V distance, should be no more than 2.5 centimeters or about one inch. Any further separation will prevent the clitoris from receiving adequate stimulation during penetration. Many women needlessly worry because they’ve never had an orgasm through intercourse, but can easily reach one through masturbation. This, of course, is also normal. I encourage partners to educate themselves about C-V distance so there’s no pressure that a woman’s orgasm has to come from the penis alone because it very rarely does.

In contrast to women, 98% of men say they always reach orgasm during sex (5). In her book, The Case of the Female Orgasm, Elisabeth Lloyd, professor of biology at Indiana University, gives her theory as to why there is such a difference between women and men when it comes to reaching orgasm from sexual encounters. According to Lloyd, the male orgasm is essential to continuing the human species so it is directly connected to ejaculation. One might say that the consistent male orgasm has been highly selected by evolution. Because the female orgasm isn’t central to propagating the human race, women overwhelmingly don’t orgasm during intercourse. This is evidenced by the fact that a woman’s ability to orgasm has no effect on her fertility. In much the same way, nipples are highly sensitive in women as opposed to men because they are also crucial to carrying on life on earth.

So, if it takes you a bit of time to work up to an orgasm, if you have never had an orgasm from intercourse, or if you don’t make it over the top once in a while, congratulations, you’re normal. If, however, you have never experienced an orgasm (known as primary anorgasmia), have experienced orgasm but never again after a certain time period (secondary anorgasmia), or suffer from any other sexual dysfunction outside of what is medically considered to be the normal range of experience, it might be time to look deeper into what’s going on. Because all women possess the proper anatomy to have an orgasm, there is no reason why all women can’t eventually achieve one with relative consistency.

This is a topic that’s often uncomfortable for women to talk about, even with their doctors. If the promise of a satisfying sex life isn’t enough to convince them to do so, then perhaps the ideas put forth in Bernie Sanders’ article will. There may be more than just good sexual health at stake. An issue in any part of your being can affect the whole. Sexual problems may be a signal that it’s time to look more closely at your life and consider what in your past or present experience could be contributing to your condition.

With that in mind, let’s take a look at some of the common reasons why women have trouble achieving orgasm and what you can do about them.

Abuse Issues

Many women discover that their inability to achieve orgasm is connected to some form of emotional, physical, or sexual abuse from their past. Sex may be seen as dangerous causing them to hold back. They may feel it’s wrong to enjoy sex or low self-esteem may convince them that they don’t deserve the enjoyment. Negative body image issues may also come into play, as well as religious and social taboos. All of this leads to a woman’s inability to remain present during sex, often being distracted by sudden feelings of fear, guilt, shame, anger, or isolation. These women often report experiencing the build-up of sexual tension and then hitting a wall.

It’s important to remember that memories of abuse may be subconscious and just beyond a person’s immediate awareness. A physical disorder or illness can be an attempt by the subconscious to get our attention about a much deeper issue. In these cases, Reichian therapy might be of service, as is a loving, patient partner. With courage and the right support, many women have overcome their past and achieved the joy of orgasm.

Lack of Intimacy

Physical touch is very important for building momentum during sex, especially for women, but it has to be the right kind of touch. Most couples already touch, hug, and kiss during sex, but is intimacy involved? Is it loving? How long does it last? How a woman receives and perceives touch makes a great deal of difference in whether her body is primed for orgasm or not. This isn’t to imply that a man is solely responsible for a woman’s orgasm, but touch is where every sexual encounter begins. It is a powerful form of communication that resonates in every cell of the body. When a woman feels loved, safe, adored, and even worshipped by the kind of touch she’s experiencing, her mind will quiet and her body will relax and open into a receptive state that’s primed for pleasure.

As we get older and hormone levels change, intimate touch becomes an invaluable tool to help women build up to an orgasm that we used to achieve in only minutes when we were in our 20’s. In fact, a study from the University of Chicago found that women in their 50’s and older were nearly three times less likely to achieve orgasm when there was little or no intimate touching involved (6).

Another study found that the optimal amount of time for sexual intercourse was between 3 and 13 minutes, with the average being 7.3 (7). Sadly, this amount of time accounts for the entire sexual encounter for some people, not just penetration. During the rest of the time you might want to consider slow or prolonged kissing, spooning, touching the face while keeping eye contact, kissing the forehead, kissing down the length of the arms, legs or torso, laying your head on your partner’s chest to hear the heartbeat or playing with their hair.

I can’t stress enough how important building intimacy in this way is to a woman’s orgasm. This means taking time and slowing things down, sometimes way down. Letting go of goal-oriented sex where orgasm is the prize greatly reduces sexual expectations and stress and allows the body to progress at its own pace. The reward will be a deepening of your relationship and the opportunity to have experiences that are in many ways even more satisfying and longer lasting than a fleeting orgasm.

Imbalance Between Relaxation and Tension

As the body approaches orgasm, it requires the perfect balance between relaxation and tension, but how can we be relaxed and tense at the same time? In this case, the body must be in a state of tension while the mind is relaxed or silent. Because the male orgasm is highly selected for sex by evolution and the male thought process is generally linear in nature, it’s not very difficult for a man to get his mind into the orgasm zone during sex. Odds are very good that in the heat of the moment, he’s not thinking about that business proposal he has to present at the end of the week. Some research suggests that women, however, can have a bigger challenge keeping their mind in the moment.

To minimize distractions, I usually recommend giving yourself enough time to have longer, more intimate sex. The time to have sex isn’t 30 minutes before you have to leave the house for an appointment. Make sure the kids are taken care of so you don’t have to think about them. Even holding back during sex because you’re afraid the noise will wake them up is enough distraction to prevent orgasm. Meditation can be helpful in learning to quiet the mind as is visualizing an abstract concept like white light. If religious or sexual taboos are a distraction, Reichian-based counseling can be helpful. Regularly introducing new positions, toys, and so on can be a good way to keep your mind in the moment and stop it from zoning out because sex has become routine.

While the mind relaxes, the body needs to be tense. For women, this means the buttocks, thighs, and pelvic floor muscles, the ones you use to stop the flow of urine. Consciously tensing these muscles during oral or manual masturbation and even penetration helps increase physical tension, brings additional blood to engorge the genitals, increases sensitivity, and assists the body in building to orgasm. A condition known as pelvic floor prolapse is a loosening of these muscles that support the pelvic organs, and can be caused by pregnancy, childbirth, straining from constipation, chronic coughing, or aging. If you leak a few drops of urine when you sneeze, laugh, or cough, this might be an issue for you.

Kegel exercises help tone the pelvic floor muscles and are easy to do. Simply tense the muscles you use to stop urine flow, hold the contraction for five seconds and then release for five seconds. Repeat for a set of ten. Try to get three sets in during the day. Eventually, you’ll want to work your way up to contracting for ten seconds and releasing for ten. Remember, this is an internal exercise, so there should be no movement of the abdominals or any other visible muscles.

Medications and Surgery

Drugs for depression, anxiety, regulating blood pressure, and sedatives all delay or impede orgasm by preventing the muscles around the vagina and clitoris from becoming adequately engorged with blood, which is necessary for sexual pleasure. Consult your physician about the possibility of reducing your prescription or taking a trial period off the medication to see how your body responds. Sometimes switching to a different medication can make a difference, as some drug companies are now promoting brands that they claim come with minimal or no sexual side effects. A clitoris vacuum pump, which draws extra blood into the clitoris, used in conjunction with a medication change, can provide added support.

Significant scarring from injuries or surgeries often blocks one or more of the energetic pathways in the body, called meridians. The result is a condition known as reverse polarity. When energy travels down a meridian and hits scar tissue, it either pools up and stagnates in this area or ricochets off this roadblock and flows down another meridian where it doesn’t belong. In either case, it can create physical problems in the vicinity of the scar or in remote areas of the body. For many women who used to have orgasms but can no longer achieve them, the culprit is often a scar from a C-section birth.

A procedure known as integrative neural therapy (INT) injects Procaine into the scar tissue. This generates a release of some of the rigidity and stagnate energy through the miasmatic process. Homeopathic agents are added to accelerate the release and reopen the pathway. Results are often immediate and dramatic. It sounds incredible, but many women have had sexual pleasure restored to their lives through INT, never suspecting that their C-section scar could have anything to do with the fact that they lost the ability to orgasm shortly after they had their babies. INT has also been effective in alleviating dyspareunia (painful intercourse) after C-section birth. Interestingly, the Japanese use a vertical incision for C-sections to avoid disrupting the energy meridians of the body.

Hormonal Imbalance

Testosterone is the hormone of desire, even in women, not estrogen. Although women only need a small amount of testosterone for sexual health, the slightest imbalance is enough to create a big problem, such as lack of libido or inability to orgasm, which is why it can be a good idea to get hormone levels checked by a physician if you are experiencing a problem. Bio-identical testosterone is available in a number of different applications, and testosterone-based creams are available that may be applied directly to the clitoris to heighten sensitivity.

Letting the Body Lead

Our cells can’t speak to us, but our bodies still send us messages all the time if we are only willing to listen to them. Whether it is a lack of sexual pleasure, or another physical problem, understanding the factors that may be contributing to the condition is essential.

Inability to orgasm doesn’t necessarily mean something is wrong with your relationship or that either partner is inadequate. The best prognosis is to be open to what your body is trying to tell you and to communicate with a loving partner about what you’re experiencing. In other words, consider using this as a way of creating a deeper level of intimacy. It’s important to remember that every woman is different and that orgasm isn’t always an earth-shattering experience. Let go of your expectations. Better yet, just let go, and let your body reveal what orgasm is for you.

I’d like to dedicate this article to my teacher, Morton Herskowitz, author of Emotional Armoring, who taught me so much about the emotional armor that was weighing me down.

For more health and inspirational insights from Dr. Sadeghi, please visit Behiveofhealing.com to sign up for the monthly newsletter, as well as an opportunity to purchase the annual health and well-being journal, MegaZEN. For daily messages of encouragement and humor, follow Dr. Sadeghi on Twitter at Behiveofhealing.

(1) Female Orgasms: Myths & Facts. The Society of Obstetricians and Gynaecologists of Canada.
(2) Thacker, Holly. (June 4, 2014). There’s Help for Women Who Can’t Achieve Orgasm. Cleveland Clinic: Health Essentials.
(3) Thomas, Lisa. (November 19, 2011). Help! I Can’t Have an Orgasm: Anorgasmia or Inability to Achieve Orgasm or Anorgasmia is a Fairly Common Problem. Psychology Today.
(4) Donaldson, Susan James. (September 4, 2009). Female Orgasm May Be Tied to ‘Rule of Thumb’. ABCNews.
(5) Ibid
(6) Galinsky, Adena. (2012). “Sexual Touching and Difficulties with Sexual Arousal and Orgasm Among U.S. Older Adults.” Archives of Sexual Behavior, 41(4), 875-890.
(7) Corty, Eric. Guardiani, Jenay. (2008). “Canadian and American Sex Therapists’ Perceptions of Normal and Abnormal Ejaculatory Latencies: How Long Should Intercourse Last?” The Journal of Sexual Medicine, 5(5), 1251-1256.

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