Female Orgasmic Disorder: 'I'm Not Able to Climax'

In the final phase of lovemaking - after desire and sufficient arousal - a woman often achieves orgasm. But a persistent delay in, or complete absence of, orgasm that causes the woman marked distress has been labeled "female orgasmic disorder" (FOD).

The condition can be primary, meaning that the woman has never reached an orgasm, or secondary - the woman can no longer achieve orgasm.

Primary FOD is the most challenging of all female sexual dissatisfactions to treat, says Jennifer Berman, M.D., a urologist and one of the nation's leading experts on sexual health.

Both primary and secondary FOD can be caused by:

• Emotional trauma or sexual or physical abuse: There is no doubt that women with a history of abuse are at greater risk for all sorts of emotional and physical problems - especially depression and anxiety - that can ruin their sex lives. "Feelings of guilt, shame, anger, fear anxiety, and isolation" are quite common for these women, write the Bermans in their book, For Women Only: A Revolutionary Guide to Overcoming Sexual Dysfunction and Reclaiming Your Sex Life. For some, the feelings manifest in an inability to be present or connected while making love. Other women report being on the verge of orgasm and then hitting a wall.

• Medications and surgery can contribute to FOD: Excessive amounts of alcohol, drugs that reduce blood pressure, the class of antidepressants know as selective serotonin reuptake inhibitors Prozac(Fluoxetine), Paxil(Paroxetine)) and anti-anxiety drugs like Xanax and sedatives such as Halcion can delay or impede orgasm. Severed pelvic nerves as a result of surgery can inhibit the engorgement of the genitals - a precondition for building to a climax.

• Inadequate Sex: You simply can't talk about orgasm without mentioning sexual techniques. Making love is not something we are born knowing; we have to learn how to give and receive sexual stimulation and satisfaction. Due to a variety of reasons - cultural, religious and personal - some women are uncomfortable discussing and exploring the sexual techniques that might bring on or intensify an orgasm.

• Pelvic floor prolapse: This condition occurs with the loosening of the muscles that support internal pelvic organs. Prolapse can result from childbirth, aging, surgery and spinal cord injury. Women suffering from prolapse often experience an urge to urinate and complain of pressure in the vagina or rectum, report the Bermans.

Overcoming Female Orgasmic Disorder

We are conditioned to believe in sex = intercourse = orgasm. Such high-pressure expectation alone can prevent orgasm from occurring. Furthermore, as the Bermans frequently acknowledge, there is much more to sex than orgasm.

"For many couples, the intimacy, exploration, sensuality and connection of sex can be lost when it becomes goal-oriented, focusing on orgasm as the ultimate experience," they write. Nonetheless, there is no need to "grin and bear" sex without orgasm if you can do something about it. Possible solutions include:

• Counseling: The Bermans prescribe counseling for victims of sexual abuse. The treatment process is long and arduous, but it can help an abused woman reclaim her sexuality. "The first step is acknowledging what happened, the second is acknowledging that it wasn't your fault and the third is purging the shame," they write. All three steps are crucial to recovery.

• Changing meds: You may need to switch or even eliminate prescription drugs that have a negative impact on sexual function. Of course, you must work with your doctor before making any changes to your medication regimen. Depending on a woman's history, the Bermans generally advise taking antidepressants known to have less sexual side effects, including the medications marketed as Celexa, Wellbutrin, BuSpar, Serzone or Effexor. Sometimes, you can also change the way you take the drug to reduce side effects. For instance, there is now a version of Prozac that can be taken weekly instead of daily.

• Communication:: To have satisfying sex, you and your partner have to become experts in arousing each other, which requires honest communication. "Every woman is different," say the Bermans, and as such, it is every woman's "responsibility to tell a partner what she likes." If you feel uncomfortable talking about you want, the Bermans suggest introducing erotic books or videos to start the conversation. Stay on a positive track with statements like: "I would really love it if you would do more ________."

• Kegel exercises: Toning your pelvic muscles with Kegel exercises can help you achieve more intense orgasms. To strengthen these muscles, start and stop your stream of urine several times. The Bermans recommend working up to five sets of 10 contractions a day. The longer you hold the contractions, the stronger your muscles will become. Think of all the fun you can have at boring meetings and standing in line at the grocery store!

• Hormones: In their book, the Bermans describe a 38-year-old patient whose ability to reach orgasm improved after she began taking methyltestosterone, a synthetic form of testosterone sold by drug companies. The patient did not have any medical problems, but she did have very low levels of testosterone available for use by her body.

• How do the Bermans comfort a woman who has never been able to have an orgasm? Because "there is no orgasm pill at this time," says Jennifer Berman, you have to be "sensitive and supportive and explain the limitations of what is available now. We also explain our working knowledge of anatomy and attempt to provide alternatives toward sexual fulfillment."