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Treatment is directed at: eliminating the causative illness, and substituting offending medication if possible, removing inhibitions and possible causes that maintain the problem, and enhancing physical and emotional pleasure, and responsiveness without making orgasm a goal, by reducing the pressure to perform and increasing effectiveness of stimulation and communication.
Treatment requires the understanding and co-operation of both partners.
Medical: no medications have yet been proved to be beneficial in enhancing orgasm in women [2].
Sex Therapy: it is important to deal with: sexual inhibitions, poor body image and self esteem, performance anxiety, and previous or existing physical or emotional abuse.
Most women who have orgasmic problems can learn to achieve orgasms by self stimulation, and they can then proceed to orgasm in the presence of the partner or by manual stimulation by her partner.
For situational orgasmic disorder [orgasms with masturbation but not with partner], the focus of treatment is on the relationship especially regarding trust and safety for the woman to be sufficiently safe when feeling vulnerable. Her partner needs information regarding women’s sexual function and she needs support to guide her partner.'
For lifetime orgasmic disorderm a 'masturbation program' is recommended. Treatment consists of information and masturbatory exercises, this involves self discovery and self stimulation, sensate focus, Kegel’s, genital and intercourse exercises [See Sexual Assignments]. Once women have experienced orgasm they find it increasingly easy to repeat and especially to tolerate the feeling of being out of control, and they are then able to approach sexual arousal with an expectation of success rather than failure [1].
Sensate focus exercises: enables you to give each other pleasure without worrying about orgasms, and dispels a lot of tension.
Genital exercises: are an extension of sensate focus, to include mouth, breast and genitals, extending from sensual to erotic sensations. Gentle slow teasing stimulation heightens erotic arousal and reduces ‘goal orientation’ [struggling for the ‘goal’ of orgasm].
This is followed by intercourse exercises: using positions that make it possible to maximise clitoral stimulation, because 70% of women need clitoral stimulation before, during or after intercourse in order to have an orgasm. With the 'woman above' or 'side by side' positions, the woman herself [or her partner] can apply clitoral stimulation during intercourse, and this should enable her to experience orgasm.
Role playing: ’letting’ go, calling out and making funny faces and moving in an uncontrolled way [as seen on the TV!!] allows you to deal with problems of control, and reduce performance anxiety.
Erotica, fantasy, vibrator or a clitoral device may be recommended. The United States Food and Drug Administration [FDA] has recently approved a device designed to improve female sexual function. This is known as EROS clitoral therapy device [EROS-CTD], which is designed to treat female arousal disorder and is approved for women who experience reduced sensations and lubrication and inability to achieve orgasm. It is available on prescription in USA. It is a small vacuum pump that is placed over the clitoris to apply gentle suction to that area and increase blood flow, aiding sexual arousal [3].
Male dysfunction: low libido, erectile dysfunction, or premature or inhibited ejaculation should be treated as this can affect the woman’s response and ability to experience orgasms.
Relationship therapy: is indicated, as sex therapy is unlikely to be effective in a hostile relationship.
The combination of short foreplay, little clitoral focus and short intercourse would doom even uninhibited and sexually responsive woman to no orgasm, so a better understanding of the need for effective stimulation and the need to communicate this to your partner are vital to deal with this problem
Treatment usually results in a tremendous improvement in response, the relationship, intimacy and self esteem, and this may prove to be even more important than orgasms!
If you are not able to consult a therapist who deals with sexual problems then the following book is recommended for women with orgasmic problems: “Becoming Orgasmic, A Sexual and Personal Growth Programme for Women” by J. Heiman and J. LoPiccolo, Piatkus, 1998.
Don’t just read it through, but do the exercises as they are recommended.
