Most men with an inhibited ejaculation problem are able to ejaculate with masturbation if they want to, but are unable to ejaculate in their partner’s vagina during intercourse. Or maybe a man has the ability to ejaculate during intercourse with one woman but not with another. Like other sexual problems, inhibited ejaculation usually builds up gradually. As a man experiences the inability to ejaculate more and more often, and as he withdraws to masturbate outside the vagina, the problem worsens. He needs to reverse the process and move closer and closer to ejaculating in a vagina rather than further and further away from doing so.
A short-term case of inhibited ejaculation, in which the problem has occurred for less than a year, can usually be treated quickly with sex therapy techniques and will respond extremely well to the exercises described in Chapter 25. Along-standing case of inhibited ejaculation, as I have said, can be one of the most difficult sexual problems to deal with. I have seen it take a long time (sometimes years) for a man to learn to ejaculate in his partner’s vagina. It is particularly difficult to heal a problem that has been going on for a long time (twenty years or more) and that is fueled by anger toward women in general or toward a specific female partner. A man may not experience this anger on a conscious level. When I worked with men who had this type of problem, I often saw that the anger had become such a part of their personality that they were unaware of it; most of them denied that they were angry with their partners and insisted that they liked women and liked sexual activity. If you are unable to ejaculate because of repressed anger, you may still be able to learn to ejaculate through the exercises described in this book, because they are quite powerful. The healthiest way to deal with long-standing anger, however, is to work on the underlying issues with a competent therapist.
In my practice, I have noted two specific types of inhibited ejaculation. Some men experience difficulty ejaculating due to their having worked to control their ejaculations, generally over a period of years. In other words, they tried to avoid premature ejaculation and overdid it. Dealing with this type of problem is a relatively straightforward matter, for which the treatment options described in Chapter 25 work very well. In other cases, a man has developed a problem with ejaculation as a result of anger against women or against a specific woman. This anger, which may be of long duration, destroys the intimacy in their relationship. While the man may maintain an erection for long periods of time, his feelings are so dulled that his penis has literally “numbed out.”
If you are experiencing inhibited ejaculation, you may have some of the following experiences. You may accept that you have a problem but rationalize it by saying, “Well, most women like a guy who can last a long time.” You may even be proud of yourself for lasting longer than you perceive that other men last. You may have intercourse steadily for over an hour and yet still have to leave the room and masturbate in order to ejaculate. You may feel that you have lost the sensation in your penis or that it is no longer a part of you. You may or may not be aware that you are angry, or you may be unaware of the source of the anger you feel.
If you are experiencing the first type of inhibited ejaculation I described (holding back), it should be a fairly easy and enjoyable process for you to relearn how to ejaculate during intercourse, though it may take a few weeks. If you are experiencing the type of inhibited ejaculation related to anger, you may need to consult a qualified therapist to help you deal with the psychological aspects of the problem.
For example, you will have to confront the fact that, while some women do enjoy prolonged intercourse, few women like intercourse without intimacy, and that may be what they have been experiencing with you. You will have to confront the fact that instead of thinking what a great lover you are, the women you have been with may have been thinking, “Isn’t he ever going to come?” If you are willing to confront and deal with these issues, you have an excellent chance of learning to experience intimacy, learning to feel your body again, and learning to ejaculate during intercourse, though you may require the help of a qualified therapist. You will have to decide whether learning to ejaculate during intercourse is worth truly sharing yourself with your partner in such intimate behaviors as kissing, talking, and passively accepting stimulation.
I’m not trying to discourage you, but I want you to have realistic expectations. As I’ve said, in my experience this type of inhibited ejaculation is the most difficult sexual problem to deal with. In fact, many clients quit therapy rather than face up to their problems. For some men, remaining unable to ejaculate with a partner is preferable to experiencing vulnerability and intimacy. But if you are motivated to deal with your problem and are willing to do the sensate-focus exercises, your chances of learning to ejaculate with a partner are good and the outlook is positive.
Don
I have treated many men with inhibited ejaculation. One of them was Don, thirty-eight. Don’s inhibited ejaculation was of the first type that I described, the result of consciously holding back ejaculations for a number of years to avoid impregnating his wife. In therapy, Don learned sexual activities that promote intimacy, such as kissing and sharing feelings. He learned to relax his body when he felt close to ejaculation, and he began to feel sensations in his penis again.
Steve
Steve, age sixty, had a more severe problem with inhibited ejaculation, worsened by other factors in his relationship with his wife. He had never forgiven her for an extramarital relationship she’d had in the early years of their marriage, and his inability to ejaculate with her dated from that time. By the time he sought sex therapy, more than twenty years later, his wife had refused to have sexual relations with him for five years, and she had developed a number of psychosomatic illnesses. Steve developed problems with his erections in addition to his difficulty with ejaculation. However, he could masturbate to ejaculation in front of a partner, and there was an excellent chance that he could have learned to ejaculate again during intercourse. But he decided to quit therapy, saying that sex with his wife was just not worth being intimate with her in other ways.
chapter 11
Female Orgasm Disorder
Female orgasm disorder is currently defined in the DSM-IV as “persistent delay in, or absence of, orgasm following a normal sexual excitement phase.” Another name for this condition is inhibited female orgasm. Older terms include inorgasmia and anorgasmia. The problem has also been called preorgasmia, reflecting a belief that all women are capable of having an orgasm, even if they haven’t yet had one.
Although it is common for women to be unable to reach orgasm, you must keep in mind that women have wide variability in the type and intensity of stimulation that triggers orgasm for them. The clinician has to judge that the woman’s orgasmic capacity is less than would be expected for her age, sexual experience, and the kind of stimulation she receives.
What’s Normal?
This is a difficult question to answer, because, in theory, all women with intact genitals and no injuries to the nervous system or other physical problems should be able to have orgasms. In addition, women on average have a more diffuse orgasm ability than men—that is, they have the potential to experience orgasm from the stimulation of sites on the body other than the genitals. This means that many more women than men are able to have orgasms through psychological stimulation alone, or through touch to parts of the body that we don’t normally think of as erogenous zones. In fact, there have been reports that even women with spinal-cord injuries have been able to have orgasms.
But the reality is that many women do not experience orgasm at all, with any kind of stimulation. This is the most common female sexual complaint after low sexual desire. In my view, it is normal to be able to have an orgasm with manual stimulation, a vibrator, oral sex, or intercourse with a partner you care for. If this is not happening for you, I believe that it is a serious enough problem that you should look for solutions. Notice that I qualified my statement by saying “with a partner you care for.” I think it would be unreal
istic to expect to have orgasms with a partner you don’t really care for or trust, or with one who is selfish. I also think it would be unrealistic to expect to have orgasms if you are not receiving adequate levels of stimulation. The fact is that many women are orgasmic with one partner but not with another simply because one partner functions better sexually or because of feelings of love for a certain partner.
Types of Female Orgasm Disorder
In lifelong female orgasm disorder, a woman has never had an orgasm. In acquired female orgasm disorder, a woman has had orgasms in the past but is unable to have them now. In generalized female orgasm disorder, a woman cannot have an orgasm with any type of stimulation or with any partner. In situational female orgasm disorder, a woman can have an orgasm with some types of stimulation but not others, or with some partners but not others.
Some women have never experienced orgasm. Others may be able to reach orgasm—even multiple orgasms—through masturbation but not through intercourse. Some may have been able to reach orgasm through intercourse in the past but can no longer do so, or are orgasmic with one partner but not another. Some women who are able to reach orgasm feel they are trying too hard or taking too long. Still others realize that as they approach orgasm they consciously shut down.
Dr. Ruth Westheimer conceptualizes female orgasms in a slightly different way. Here is a list of the various definitions she uses:• Primary anorgasmia occurs when a woman has never had an orgasm by any means.
• Situational anorgasmia is a condition in which a woman can only have an orgasm by means of very limited patterns of stimulation. The situation must be perfect or the orgasm won’t happen.
• Random anorgasmia occurs when orgasms do not happen regularly or in any predictable pattern. Sometimes they happen and sometimes they don’t, and there’s no way to predict it.
• Secondary anorgasmia occurs when a woman had a previously reliable orgasm ability, but now enters the plateau phase of the sexual response cycle and can’t go any higher.
In my experience, there are two very common types of female orgasm problems. The first is lifelong or primary female orgasm disorder. A woman who has this problem believes that she has never had an orgasm in her life with any kind of stimulation. The fact is that most women who believe they have this problem had orgasms when they were children or adolescents. These orgasms probably occurred either during sleep or as a result of unintentional clitoral stimulation. It’s difficult to remember whether you had orgasms as a child because children feel pleasure when they touch their genitals but they don’t equate the pleasurable sensations with sexuality in any adult sense.
A second very common type of problem is secondary, or situational, female orgasm disorder, in which a woman can have an orgasm (or several) with masturbation, manual stimulation, a vibrator, or oral sex, but is unable to have an orgasm with intercourse. Surveys on human sexual response indicate that many women either do not have orgasms at all, or do not have them during intercourse. In some cases, studies they have read or heard about may have convinced some women that they are unable to have orgasms. Certain temporary physiological states can also interfere with the ability to reach orgasm. For example, alcohol and certain prescription drugs can interfere with orgasm.
I believe that, in the absence of nerve damage or other physiological injury or defect, any woman can have an orgasm. If you can reach orgasm through masturbation, you can also do so through intercourse, because this means your body is physically capable. If you can have one orgasm through intercourse, you can have as many as you want through intercourse.
Inability to have an orgasm during certain activities probably has more to do with the nature of the activities than with any deficiency on a woman’s part. There are many sites in the female genital region in which an orgasmic response can be triggered. I discussed these sites in Chapter 2, and in Chapters 26 and 27 I describe exercises that provide strong stimulation to these areas.
Physical Causes of Female Orgasm Disorder
It’s rather rare for female orgasm problems to stem from a physical cause. However, brain damage, spinal cord damage, or other nerve damage could cause an inability to reach orgasm. So could diseases of the nervous system, such as multiple sclerosis, or complications due to pelvic surgery.
The most common physical cause of female orgasm disorder is drug use. Alcohol slows down a woman’s reflexes and makes it difficult for her to have an orgasm, but by far, the most common culprits are the SSRIs—antianxiety agents like Prozac, Paxil, and Zoloft.
Psychological Barriers to Orgasm
Given that women have many different sites in their genitals that can trigger orgasm, and given that women on average have a more diffuse orgasm ability than men, why is it that so many women have difficulties with orgasm, especially during intercourse? Here are some of the most common reasons.
The number-one reason why some women have difficulty with orgasm is lack of experience with self-touch. In order to learn to be orgasmic—predictably orgasmic whenever you want to be—it is essential that you learn to touch your genitals and learn which genital areas arouse you the most.
A second reason why some women have difficulty with orgasm is expectations. Expectations can short-circuit your orgasm ability in one of two ways: They can be either too low or too high. A woman with low expectations usually thinks she won’t be able to have an orgasm or that it will be too much trouble, so either she doesn’t ask for the stimulation she needs, or she doesn’t even try to become aroused. A woman with expectations that are too high has an idealized view of orgasm. She thinks that when she has an orgasm, the heavens will open and she’ll hear violin music and live happily ever after. It doesn’t happen that way. The first few times you have an orgasm, it may feel like a small shiver in your PC muscle, accompanied by rapid heart rate. It’s easy to get a little discouraged and think, “That was it? That was the Big O?” You have to give it some time. The PC muscle spasms and rapid heart rate of orgasm are reflexes, but other enjoyable parts of orgasm (like full-body muscle spasms and making noise) can be learned and practiced. Trust me, it all gets better.
Another aspect of problems in reaching orgasm, as I’ve said, is that women don’t remember the orgasms they had as a child or adolescent and can’t connect with those feelings in adulthood. In Chapter 27 I show you how to access those feelings using sleep and fantasy.
Probably the most common reason why women have difficulty with orgasm during intercourse is that their PC muscle isn’t strong enough to spasm when they have something inside their vagina. In Chapter 18, on self-touch, and again in Chapter 27 I’ll explain how to exercise your PC muscle to make it strong enough so that you can have an orgasm when something is inside your vagina.
Another common reason why women have difficulty with orgasm during intercourse has to do with the difference between typical male and female arousal responses. The average man typically gets sexually aroused more quickly than the average woman. If you adhere to a very common sexual script in this culture, when you have sex, your male partner typically does oral sex with you first, then you do oral sex with him, then you have intercourse. This means that when you start to have intercourse, your arousal level has probably decreased. If you think of arousal on a 1-to-10 scale, with a 10 being orgasm, this means that when you start intercourse your male partner is probably up around arousal level 8, while you’re probably closer to a level 2. Unless your partner has an excellent ability to last during intercourse without ejaculating, it’s going to be very difficult for you to have enough time to become aroused to the point of orgasm.
If you have experienced a problem reaching orgasm, here are some questions you should ask yourself:• Do you feel that your partner is pressuring you to have an orgasm? (It may be more than just a feeling—he may actually be pressuring you.)
• Do you feel defensive if your partner asks, “Did you have an orgasm?”
• Do you feel there is something wrong with your body and the way it re
sponds sexually?
• Do you feel you may not be built like other women?
• Are you distracted during intercourse by thoughts such as, “I wonder if I’m going to have one this time?”
• Do you engage in frenzied activity during intercourse such as vigorously rubbing your clitoris rather than slowly and sensuously enjoying the feelings of intercourse?
• Do you get close to an orgasm with a partner and then feel yourself shut down?
• Do you let your partner define whether or not you have had an orgasm without correcting him if he is wrong?
• Do you allow your partner to continue activities that bother you or that you do not enjoy?
• Do you fake orgasm?
In order to reach orgasm through intercourse whenever you want to, you will have to make some changes! You must take responsibility for the fact that you are not reaching orgasm now. (At the sex therapy clinic where I worked for many years, we said, “Everybody is ultimately responsible for his or her own orgasm.”) You will need to learn to stimulate yourself to orgasm before you can show your partner how to do it. If your partner has been pressuring you, you may need to bring this issue out into the open. You may need to discard stereotypes about women’s roles during sexual activity and adopt sexual positions that are stimulating rather than “ladylike.” You can learn how to communicate with your partner explicitly during sexual activity, even if the idea of doing so seems embarrassing for you now.
Sexual Healing Page 12
