We don’t often think about what needs to happen to go from arousal to a satisfying orgasm. Your mind needs to stay clear and focused, your nerves sensitive and then blood needs to flow to all the right places. There’s a mental, emotional and physical aspect to sex, and unfortunately a variety of problems can interfere.
Many women find they cannot climax during penile-vaginal sex. If a woman has never climaxed in her adult life, we call it primary orgasmic dysfunction. If she had been able to climax in the past, but now finds it difficult or impossible, we call it secondary orgasmic dysfunction.
Only 10 percent of women easily climax. Most women are in the remaining 80-90 percent. I see many women in my practice who feel relief just to know they are “normal” when they have trouble climaxing with just vaginal sex but can climax with direct clitoral stimulation. It’s unfortunate that many women think they are not normal if they cannot climax solely through vaginal intercourse. Most women can not! It is important to relax and know that you are normal.
Do you know where your erogenous zones are?
To help with being able to climax, it is important for a woman to know where her erogenous zones are. She should also communicate about them with her partner. Various parts of a woman’s body respond to touch and stimulation, such as the face, lips and neck.
A woman’s most sensitive erogenous zones include:
- “G-spot,” the anterior part of the lower vagina
- “ClitGVa,” the clitoris, G-spot and the vagina
Women who have been able to climax without difficulty in the past but now are having trouble need an evaluation. I take their history and then I do a physical and a hormonal and medication evaluation.
Often, one or more of the following is a culprit:
- Medicines, including antidepressants/selective serotonin reuptake inhibitors (SSRI)
- Hormonal deficiency (This is very common, especially after menopause)
- Partner issues
- Medical problems, such as diabetes and hypertension
- Lack of exercise
- Sleep disorders
Treating orgasmic dysfunction
To treat orgasmic dysfunction, off-label oral prescription bupropion can help. Viagra may also work. In particular, it can work as an off-label treatment to help women who are on SSRI antidepressants.
Some doctors will also prescribe off-label “Scream Cream” made by a compounding pharmacy. This cream includes a variety of topical medications. When a woman applies it to the clitoris, it increases blood flow and helps promote an orgasm.
Women can use this cream alone or they can use it along with a stimulating device, such as the Intensity™ device, which is an FDA-approved pelvic electrical stimulating device. It stimulates the pelvic muscles that contract with climax and also provides direct clitoral stimulation. There is another device that is FDA-approved to treat orgasmic dysfunction, called the Eros device, which is only available through a doctor’s prescription.
It’s important to note that there are other problems, besides orgasmic dysfunction, that can affect women sexually and cause female sexual dysfunction. They include low libido, painful sex, difficulty being aroused and even sexual aversion.
All of these issues are real. They can cause women a lot of distress and affect their relationships. But the good news is that treatments are available, which many women don’t realize.