Instead of reaching the climax, Eva* cried earlier.
From the first time she had intercourse at 17, the buildup of emotions and sensations often provoked tears. At times, she felt like the orgasm was a near-sneeze—”that very rapid mid-climax, and then it was over. When I heard about women having multiple orgasms, incredible orgasms, I just couldn’t imagine.”
Eva, now 70 and retired after a long career in the film industry, kept her inability to reach orgasm hidden in shame: “Sometimes I almost whispered it at the end of a doctor’s appointment.” For decades, she would ask friends, “‘Who are you looking at ? Who are you talking to?’ Nobody knew how to get answers or information.”
Eva may have been isolated, but she was not alone. Studies estimate that 10-15% of women have never had an orgasm, and nearly half report some degree of anorgasmia – absent, infrequent, unsatisfactory, or painful orgasm.
Despite this prevalence, female sexual pleasure hasn’t earned nearly the same limelight as male masculinity. Viagra commercials punctuate prime-time TV, but female orgasm remains a taboo subject, not just around the dinner table but even in clinical circles.
Lisa Valle, DO, is an Obstetrician/Gynecologist based in Santa Monica, California who received her medical degree in 2001. Her professors gave cursory lessons about sexually transmitted infections, but “the problems with orgasm are usually overlooked.”
In 2016, Valle opened a practice dedicated solely to women’s sexual health. Her clients range from teenage girls who can’t insert a tampon without pain, to women in their 90’s who want more sexual pleasure.
Many women, even those who know their bodies well, lack information about the physiology and psychology of orgasm, Valle says. Movies, and the porn industry in particular, often perpetuate myths about female arousal and pleasure.
“[In a movie scene], he kissed her neck and suddenly she had an orgasm. It’s just not realistic,” she says.
In truth, women need arousal, which takes time to achieve the balance of arousal and relaxation necessary for orgasm. These include hormones, lubrication, blood flow, pelvic floor muscles – they can be neither too tight nor too loose – a clitoral hood that retracts easily, and a network of vestibular bulbs and a perineal sponge behind the scenes.
It’s a common myth that orgasm is “all about the clitoris,” says Ellen Heed, PhD, a somatic psychologist specializing in sexological bodywork and a practice in Ashland, OR. In fact, it’s a “reproductive system response,” in which a woman’s erectile tissue swells, round ligaments elevate the cervix, and neurons in the brain fire in response to arousal.
“Women think that orgasm should be spontaneous,” says Heed. “It can be. But we have to learn.”
Eve tried. She used vibrators and sex toys, including “sort of like a stick with a feathery thing on it to tickle your g-spot.” She attended weekend workshops on tantric sex and massaged estrogen cream onto her clit every morning. “None of that turned into an orgasm,” she said.
She also began reflecting on her sexual, medical and social history, which included a traumatic incident at age 8 – a male relative masturbating in front of her – along with three abdominal surgeries, a series of yeast and fungal infections and a cesarean when she was 35 .
All of this, according to experts, can affect a woman’s ability to have an orgasm. For this reason, Erica Marchand, PhD, a Los Angeles psychologist specializing in sexuality and relationships, always refers clients with anorgasmia for a full physical exam.
Scar tissue from previous surgeries, cesarean sections, or episiotomy can impede orgasm. The same is true for the hormones in birth control pills and the ingredients in some psychiatric drugs. Endometriosis, urinary tract infections, and fungal infections can affect the pelvic floor muscles.
Physical therapist Stephanie Prendergast co-founded the Pelvic Health and Rehabilitation Center with locations in Northern and Southern California and New England; Her focus is on pelvic pain and sexual dysfunction.
“An orgasm is a rapid muscle contraction, a combination of voluntary and autonomous,” she explains. “In a normally functioning pelvic floor we should be able to control the muscles. We can’t do that with pelvic floor dysfunction. People don’t realize that’s why they can have orgasm challenges.”
After a thorough history and physical exam — “we’ll look at everything from the ribs down,” she says — Prendergast performs manual therapy, including transvaginal work, to restore motion and reduce pain in muscles, tissues, and nerves. Women may need core exercises to restore pelvic floor weakness or gentle stretches to relax these muscles.
“Once we see that their physiological function is in place, we need to help them get back to orgasm,” says Prendergast.
This often includes emotional work. Childhood learning and beliefs about sexuality — as well as unwanted sexual experiences, sexual violence, or trauma — play a large role in women’s ability to achieve orgasm, Marchand says. “I talk to people about their attitudes towards sex and pleasure: what did they learn about sex when they were younger? How do you feel about yourself and your body? Is pleasure something that feels okay?”
Valle surveys clients about anxiety and depression, medication and surgery, stress, and sleep patterns as part of their initial assessment. She uses the “Q-Tip test” to check for tenderness and pain in the vulva, vagina, and clitoris. She might refer women to an endocrinologist, a pelvic floor physical therapist, or a sex therapist who specializes in trauma.
And she’s working to counter the reckless advice traditionally offered by doctors who don’t understand the complexities of the female orgasm. Valle keeps a running list of the unhelpful suggestions her patients have received: Have some wine. Try lidocaine. go on vacation Relax yourself.
Shame and secrecy increase difficulty in orgasm. “If someone has been shamed or told their whole body is wrong, or that any kind of desire is ungodly or indulgent…then we have to find permission to even be embodied before we even talk about orgasm,” says head
And if a woman can’t achieve orgasm, she can further isolate herself by not talking about it, even with friends. “Women feel like they don’t belong in the orgasm club and that feels sad, intimidating, helpless and hopeless. Like they’re missing out,” says Heed.
For years, that was the case with Jennifer Anderson, a 36-year-old technology coach. Ever since she became sexually active at the age of 17, she has always focused on pleasing her male partner.
“If he was sexually satisfied, then I had done my job. When we had sex, my mind would race about things unrelated to sex. I had a mental block from excitement. I’ve struggled with partnered orgasms for as long as I can remember.”
She tried “dirty talk” while having sex with her husband. sex toy. watch porn together It wasn’t until she entered into a romantic and sexual relationship with a woman at work — and eventually split from her husband — that Anderson began to orgasm regularly.
“It was completely different with a partner,” she says. “I feel more complacent knowing this whole new world of sexuality and sexual pleasure.”
Health practitioners say there are strategies to help women with anorgasmia. Heed, the somatic psychologist, might recommend an “orgasmic meditation” in which a woman uses lube and caresses her clitoris as a mindful exercise to learn about and experience the sensations.
Marchand created the “Big O Masterclass,” a 10-week online course for women struggling to achieve orgasm. The self-directed curriculum includes work on sexual beliefs, arousal, stimulation, and partner dynamics. Since the course started in 2018, nearly 2,000 women have taken part.
Attention to the female orgasm isn’t just a matter of individual pleasure, says Marchand. Orgasm “is a matter of justice and equality. To me, it feels like a social justice issue.” The good news, she says, is that “orgasm is mostly a learnable skill.”
That goes for Eva, who has struggled with orgasm for most of her adult life. Her current partner, a man she met 2 years ago, is patient and open to trying new strategies to help both find joy in sex.
“It’s the best relationship, the most connected and sweetest I’ve ever had,” she says. And while she still faces obstacles to sexual ease — arthritis, a knee replacement, the hormonal changes that come with age — Eva is also finding a renewed sense of motivation.
“We haven’t had much intercourse, but I feel like there’s progress. I am hopefull. I’m in the thick of it. I feel like I’m on a journey that could take me there.”
*Some names have been changed to ensure anonymity.