Can’t Orgasm? Here’s Help for Women

About 10% of women have never had an orgasm -- either with a partner or during masturbation. And quite a few of them have found their way into my therapy practice. That's when I tell these women the good news: It is possible to learn to be orgasmic.

The first and most important lesson is to practice developing a balance of tension and relaxation during sexual activity. But, my women clients ask, how can they be both tense and relaxed at the same time? It's a good question, and here is my two-part answer:

How to Have an Orgasm Step 1: Tense Up

The type of tension that helps women reach orgasm is muscle tension (myotonia). Many women have the mistaken impression that they should relax and "just lie there" because they've heard that relaxation during sex is important. But it turns out that muscle tension is often necessary for an orgasm. In my experience, the majority of women learn to have their first orgasm by incorporating a fair amount of leg, abdominal, and buttock tension.

Not surprisingly, women report that the most orgasm-inducing muscle contractions are in their lower pelvis. These are the same muscles you squeeze to stop the flow of urine midstream (a conscious contraction of this group is called a Kegel exercise).

What is the connection between tensing muscle groups and having an orgasm? Arousal. Contracting (or tensing) certain muscles increases blood flow throughout the body and often to the genital area. And arousal, of course, is the road map that helps lead most women to orgasm.

How to Have an Orgasm Step 2: Wind Down

So, where's the relaxation part of this equation? In the brain. During sex, a woman should be focused simply on feeling the sensations of the stimulation.

Have a hard time relaxing? Think of a Times Square billboard in which words stream into view from the left-hand side to the right edge, and then disappear off the screen. During sex, many women find it helpful to program their own Times Square news crawl with a repetitive mantra such as "I can take as long as I want" or "This really feels great" on their mental silent radio. It keeps the brain occupied -- but with a thought that will encourage sexual arousal rather than with a nervous, negative thought that might decrease arousal.

After this first lesson, I send my clients away with a homework assignment. During sex, they are to tense up their muscles and let their minds go silent. This technique takes practice, but it can work over time. And more often than not, my clients return to a future session with their own good news to report.

Can't Orgasm? The Problem Could Be Medical

Therapy can help some women having difficulty with orgasm. For others, a medical condition or side effects from a medication may be causing the problem. Visit your doctor to rule out these causes. Options for treatment include the following:

• An FDA-approved device called Eros helps increase blood flow to the genitals.
• Over-the-counter creams may increase sensitivity and help a woman reach orgasm, although these are not FDA-approved. As always, talk to your doctor before starting any treatment.

Originally published in the March/April 2008 issue of WebMD the Magazine.