American Medical Association Family Medical Guide - American Medical Association [260]
Desensitizing creams and condoms can diminish the amount of sensation you experience during intercourse, but they do not provide a long-term solution to the problem and can cause irritation in your partner. Trying to concentrate on something else during intercourse generally does not help.
Inability to Achieve Orgasm
Many women have never experienced an orgasm, but lack of orgasm is rare among men. Only about 20 to 30 percent of all women regularly reach orgasm through vaginal penetration alone, without additional stimulation of the clitoris. Up to 10 percent of women cannot reach orgasm even with stimulation of the clitoris by themselves or their partner.
The inability to reach orgasm may be lifelong or can begin at any time. A common factor contributing to the inability to achieve orgasm (medically known as anorgasmia) is lack of adequate sexual information. Reaching orgasm requires sufficient stimulation of the clitoris, and many women may never have learned how to get enough stimulation to reach orgasm. Some women have never allowed themselves to be fully sexual, possibly because of a strict or religious upbringing. They may consider their sexuality embarrassing, making sex difficult because of their beliefs and feelings. A lack of sexual awareness, self-exploration, and self-stimulation is a common characteristic of women who are seeking treatment for anorgasmia.
The inability to achieve orgasm also can result from a lack of sexual interest that began with a physical problem such as damage to the vagina after childbirth, thyroid disease, or a side effect of drugs such as antidepressants.
Diagnosis and Treatment
If you are unable to achieve orgasm during sexual activity, talk about the problem with your doctor. He or she will perform a physical examination and will probably order a variety of tests to rule out a physical cause of your problem.
Treatment of an inability to achieve orgasm depends on the underlying cause. If your doctor cannot identify an underlying physical condition, he or she may be able to suggest ways to help you achieve orgasm or may refer you to a sex therapist for treatment. Sex therapy usually requires both partners to participate in therapy sessions and perform recommended exercises at home.
The most successful treatment prescribed by sex therapists for anorgasmia is sexual self-exploration through masturbation, combined with sexual fantasy. Masturbation is a normal, healthy activity that can help a woman learn how to become aroused and find the kind of sexual stimulation she needs to reach orgasm. Then she can use self-stimulation to reach orgasm when she is with her partner, showing her partner the techniques that work best.
Sometimes trying a new position during intercourse can help. If your partner is willing, experiment with some new positions. Many women find it easier to attain orgasm when they are on top, astride their partner. In this position, a woman can control the intensity and exact location of her clitoral and vaginal stimulation.
Painful Intercourse
Pain during sexual intercourse, also called dyspareunia, can affect both men and women and is usually caused by a physical condition. In women, causes of frictional pain at the vaginal opening include inadequate vaginal lubrication, a vaginal or bladder infection, a sexually transmitted disease (STD) such as genital herpes (see page 482), or soreness after childbirth. Deep pelvic pain can result from conditions such as endometriosis (see page 870), a disorder of the ovaries, or allergic reactions. Chronic pain in the lower back also can cause deep pelvic pain during intercourse.
Common causes of painful