Orgasm Difficulties

Orgasm Difficulties: Do you have difficulties having an orgasm? Have you been diagnosed with primary anorgasmia, secondary anorgasmia or situational anorgasmia.   Primary Anorgasmia / Pre-orgasmia: Is where a woman has never had an orgasm under any circumstance, either by masturbation, with a partner or any other situation. Secondary Anorgasmia: Is where a woman has had at least one orgasm, but cannot do it now. Not with a partner, nor through masturbation or any other situation. Situational Anorgasmia:  Is where a woman can only orgasm in certain situations.  For example, she can have an orgasm through self-stimulation, but not with a partner.   If so, try one of the below exercises, or arrange to meet with a sex therapist located in Center City Philadelphia where we can help you overcome your specific orgasm issue .

What will I do with a Philadelphian sex therapist? For women with anorgasmia, treatment tends to focus on increasing enjoyment and stimulation. If, however, you are anxious about having an orgasm, worry about loss of control, or simply don’t like the feeling as you approach orgasm, then the therapist will work with you these issues in a systematic safe and gradual way. Expect to be given homework assignments three times a week, and imagine your therapist as a ‘tutor’ who is helping you master this new skill.

For women with secondary anorgasmia, consider yourself lucky. Half the work is already done. You already know a) what an orgasm feels like and b) at least one way of having it. Your work with a therapist will be focused on expanding your repertoire of skills to induce orgasm.

For women with situational anorgasmia, your work with a therapist will be focused a) identifying what types of situations enable you to have orgasms, and b) what types of situations prohibit them. Once the ‘problem’ has been identified, treatment strategies might include learning communication techniques, technical skills of touching, and include your partner.

Exercises you can do at home to help you have an orgasm

Learning how to orgasm through intercourse One of the most common complaints of women is failure to reach orgasm during coitus. This is not surprising. Coitus is one of the clumsiest ways to stimulate a woman. While coitus does provide an atmosphere that can be highly arousing, emotionally satisfying and erotic, the degree of stimulation to the woman’s clitoral area is nothing compared to direct manipulation. Stimulation is limited to the traction of the clitoral hood by the thrusting penis (or dildo), and some pressure by the pelvic bone to the clitoral hood. Unless the woman has a very low threshold for clitoral stimulation, it is almost ludicrous to think that mere penile-vaginal intercourse is sufficient for an orgasm.

Given the fact that most women will never orgasm through coitus alone, do not worry. Many techniques exist to facilitate a woman having an orgasm and having great sex!

To increase stimulation to a woman’s clitoral area during coitus, there are several option:

  • Increase the pressure from the male’s pelvic bone, exerted onto the female’s clitoral hood. In other words, do a little bit of grinding. Try moving up and down or side to side. During this period of experimentation, communication between the two of you will be extremely important (i.e. “too hard, too soft, ooh – I like it better this way, and yep – that sure feels good”).
  • While the woman is in the top position, assuming full control of all the movements, the man should lie flat on his back, pelvic tilted upward, stomach muscles tightened and back flat against the ground, and lie perfectly still. He then should take his right thumb (if he is right-handed) and place it approximately halfway between his bellybutton and penis. This way as his partner thrusts forward, her clitoris will rub against his finger. Many women find this extra stimulation pleasurable, especially because her thrusting motion controls the degree of stimulation that she will receive.
  • Maintaining the same positions, with woman on top, man on bottom, the woman should remain perfectly still. Please note, while she is on top, she should tense her inner thigh muscles and her vagina should fully engulf the man’s penis. In this position, the man can easily apply direct manipulation/stimulation to her clitoris with his hand. To increase the stimulation, the woman (only after 5 minutes) could SLOWLY rotate her hips, and/or move her vagina up and down along the shaft of his penis.
  • The woman can masturbate. She can masturbate from any sexual position. Probably, the easiest thing to do in the beginning is to have the man and woman both lie still, so that the woman begins her masturbation, with his penis deep inside of her – without the distraction of movements. Then as her excitement begins to increase, they both can slowly resume their coitus movements.
  • There are MANY more ways to combine manual stimulation with intercourse. But the basic gist is this: whatever sexual position the two of you are in, be it doggie-style, side-by-side, missionary, or sitting, take a moment and stop mid-position. Then take turns stimulating the clitoral area. As the two of you acclimate to this additional form of stimulation, and have figured out how to minimize the awkwardness of whatever position the two of you happen to be in at the moment, increase the pelvic thrusting motions.
  • For the more adventurous and willing to be focused on pure female pleasure . . . The woman lies on the bottom, legs tightly held together. The man lies on top, legs spread out. Instead of being directly in line with her, the man should be at a slight diagonal. In other words, one foot should be closer to her, than his other foot. In addition, his head should be 6 inches to the right (or left, depending on which diagonal he is on) and his head should be about 1 foot above her head (so that her head reaches his shoulder). This position is designed to enhance female clitoral stimulation. It does so by maximizing the rubbing potential between the male pelvic bone and the female clitoris.


Ask Alex,
First of all, thank you for the services you provide. Your emails are extremely informative. I have a few letters/questions for you. I live with my boyfriend and we have such a lovely relationship. We are very much in love and I believe we will eventually get married if our path follows the same way it’s going. We have a special relationship that you just can’t find anywhere. I do have a few dilemmas though. I love making love to him, and it is very enjoyable. He gets me very excited, but I hardly ever orgasm. When we first started making love I was always on bottom. Then I switched to top, and now he always wants me to be on top. I like both, but I like variety. I want to try a different position every time we make love if not a few different positions each time. Also, I go down on my boyfriend all the time, and he loves it. But, I can’t seem to make him cum with oral sex. He says that it is very y hard for him to cum through oral sex, and only one person has ever made him cum, but he says she was a real “whore”. My boyfriend has gone down on me only twice. I don’t know if he doesn’t like oral sex or if he doesn’t like how I taste. I love my boy with all my heart, I wouldn’t trade him for anything. But, how do I fix these dilemmas? I feel comfortable talking to him about anything, but I don’t want to hurt his feelings. He has said before how unhappy he is that I rarely cum. He always asks if I do or don’t…with me it’s hard to tell because I’m very vocal. Please help, Alex!
Chicago, IL

Dear Samantha,
I am wondering what stops you from being direct with your partner? Why not simply tell him exactly what you told me. After showing him this letter, continue by suggesting a few ways that he could stimulate you that could bring you to orgasm. In some ways it is your responsibility to teach him about your body. Of course, you can not make anyone interested in learning, but from the sounds of your letter, it sounds like he wants to learn.

If you are having trouble imagining how this conversation might go ask him to participate in the following exercise with you:

Take ten minutes and answer the following questions (set A). After you and your partner have finished answering the questions, read your answers to each other. Then answer the following questions (set B).

Set A

  • The fastest way to make me orgasm is to _________
  • The thing that you do that turns me on the most is _________
  • My sexual fantasy is ____
  • I find it difficult to talk about what turns me on because _________
  • The one thing that you could do to help me talk about my sexual likes/dislikes is _________
  • My favorite type of oral sex is _________
  • My favorite sexual positions are _________
  • The best sex we ever had was _________
  • Orgasm means _________ to me
  • When you touch me like _________ I generally respond _________

Set B

  • The one thing that I am most struck by is _________
  • The hardest thing for me to hear is _________
  • This has been helpful for me in the following ways _________
  • If it is ok with you, I would like to try _________
  • When can we practice?

This tip was originally written by Alex Robboy, CAS, MSW, LCSW

HTHGS: How do I know if I am having an orgasm?

Ask Alex,
I need your help. Currently, I am having good sex. I know this because it feels good. My question is, how will I know if I am having an orgasm? During orgasm, will the ‘cum’ flow out?

Dear Amy,
I am glad to hear that you are having ‘good’ sex and that it is pleasurable for you. Having good sex is important! Many people can not say that. It goes without saying that the point of sex, contrary to popular belief is not having an ‘orgasm,’ but rather the process of being sexually intimate with yourself and/or others. Remember the days when you first kissed a boy or a girl and you were TOTALLY satisfied? During that first kiss, or first ‘heavy petting’ experience, the world felt like it was going to stop. There was no orgasm, yet you were completely satisfied. Ok, so if you want to be ‘goal’ oriented, how will you know if you have ‘achieved’ an orgasm. During an orgasm you will experience a series of PC (puboccygeal) muscle contractions. To locate the PC muscle, try stopping your urine, mid-flow. The muscle that you use to stop yourself from urinating mid-flow is called the PC muscle. Some women report that these contractions feel like you are sneezing, except that this sensation stems from your genital area and not your nose. The contractions will feel out of your control. In the moment, like a sneeze, you will be unable to stop the contraction. In regard to your second question, will the ‘cum flow out,’ the answer is yes and no. A small percentage of the population during orgasm will experience, what is called, Female Ejaculation. During female ejaculation fluid is expelled from the urethra. This fluid is not to be mistaken for urine, because it is made from a different substance. However, the majority of women will not experience this. They may merely experience an increase in vaginal lubrication.

HTHGS: My wife doesn’t think she is having an orgasm through intercourse

Ask Alex,
My wife doesn’t think that she is having orgasms through intercourse. I think she is. I give her reasons and mine. I have tried to be as specific as I can. She thinks this for 2 reasons:
___1st-When she has had an orgasm from hand stimulation, the hand stimulation orgasm feels different. She can’t explain very well what different means. She did say that hand stimulation orgasm feels tingly from her feet to her head, whereas intercourse does not.
___2nd-When reading about, or talking to other women about orgasms most do not have orgasm very frequently through intercourse. She think that it would be weird if she is having orgasms 75% of the time through intercourse.

I think that she is having orgasms they are just different. I think this for varying reasons:
___1st – when I have an orgasm through had stimulation it is different too, the hand stimulation is more physical and tingly from the feet to my head where as the orgasm intercourse is more emotionally satisfying.
___2nd – when we have intercourse she will make uncontrollable loud noises, and contort her body in ways that she never does during hand stimulation. We tried have had intercourse after she brought up the issue and she said that she is not faking these reactions.
___3rd – I have asked her if she is satisfied after she “orgasms” through intercourse and she says that she is, I will ask her if I could stimulate her the rest of the way with my had and she would not want to. Times when it does not seem to me that she orgasms she acts very much different afterward that when I think she does, and if I offer to simulate her the rest of the way she is much more willing to let me do so.

Basically what I want to know is: for women are intercourse orgasms different than hand orgasms. If you could explain the differences if there are any I would greatly appreciate it. If from the information I have provided you think that there is something else that I am not just getting feel free to tell me. Mostly I just want my wife to be happy & to think that she is enjoying sex. I have been a member of your email newsletter for the 2 years that we have been married.

Just recently she has brought this to my attention, and I am having a hard time dealing with this because I have always tried to please her before I please myself. When I asked her she would tell me that she had an orgasm, because she didn’t want to tell me she wasn’t when her body would react the way it does. Basically its seems to me that she has been very confused. Sorry If I have rambled on. Thank you so very much for any help.

Dear Ramble,
First, your wife is right! She is not having an orgasm. Thus, to facilitate her ability to have an orgasm during coitus, my suggestion is that you encourage her to masturbate during coitus. This could look like you placing her hand on her genitals. For many women this is the permission that they need to touch themselves. Others, will need you to tell them how much it turns you on to watch (even if it’s not true). Lastly, other women will enjoy your manually stimulating their genitals during coitus. To find out what your wife will like best, try all three options.

Second, regardless of whether or not your wife is right, your wife is communicating to you a very important message. She believes that something is missing from her sexual experience and she believes (has hopes) that sex will get better (even if it is already fantastic). Thus, I am wondering why you are bothering to focus on the issue of orgasm (that is her concern) your mission is to explore her body and discover all the different ways to make her sexually aroused / pleased. This means spicing things up with different positions / new ways to touch, and possibly exploring the finer points of sex, such as delving into the realm of fantasy, seduction and game playing. Instead of focusing on whether or not she had an orgasm, use this discussion that you are having as a wake-up call. For her to tell you this it a) took courage b) means she wants to work on it with you — eg. Wants to practice having more sex with you c) has hope and d) trusts you. What more could you ask for?

Lastly . . . according to Masters and Johnson there is only one type of orgasm… however more recent research suggests that there are multiple types. Again, this information is neither here nor there. It really does not matter. What counts is whether or not both people feel satisfied, feel free to let themselves go, are in tune with ones own likes and dislikes, and enjoy sex for sex sake and not as a way to ‘gain’ something else.

HTHGS: How to have an orgasm

Tips on how to have an orgasm.

Questions to ask yourself

  1. Do you masturbate? Many women find it easier to have an orgasm from solo-sex (masturbation), than from two-person sex. Have you ever tried the Jack Rabbit? The Jack Rabbit is an excellent type of vibrator for women with difficulties having an orgasm. The Jack Rabbit vibrator combines vaginal and clitoral stimulation. Each form of stimulation has it’s own separate control system to more specifically fit your bodies needs. The Jack Rabbit, can be purchased at most sex toy shops or online.
  2. When you are with a partner, what does your communication with him/her look like? When something does not feel good how do you let your partner know this? How do you let your partner know when something feels particularly good? Or you would like to experiment with something new? Often, women have difficulties having an orgasm with a partner because they are not sure how to communicate to a partner their likes & dislikes. Try being direct. Remember, most men do not touch you because it feels good to them, they touch you, because they enjoy giving you pleasure.
  3. Do all your past lovers know that you have never had an orgasm? And if so, how have the two of you tried to work on it? Often, the pressure of having an orgasm is so great, that women (and men) find themselves telling their partner’s that they have had an orgasm when they really didn’t just to make the other person feel good, or stop. Unfortunately, sometimes when partners are told about the ‘orgasm’ issue, they shut down because they feel like you do not want them sexually (ie. You are not turned on by them, or you would have had an orgasm).
  4. Partners, have the unique ability of doing sexual things to you that you could never do for yourself. Not only can they give you oral sex, while touching your g-spot with their finger, but they can ‘keep going’ even when you might have stopped.
  5. How good are you at being ‘selfish’ and receiving pleasure? Do you feel like you are always needing to give? Could you comfortably have an entire evening where you never (or almost never) touched your partner and she/he did all the giving? Women sometimes experience difficulties with having an orgasm because they feel uncomfortable receiving. Learning how to relax and enjoy the moment can be difficult.
  6. How do you know when you are relaxed? Having an orgasm is a physical response to stimulation. Thus, if one can learn to relax enough, your body will naturally take care of itself. To relax some women have found that two forms of stimulation is necessary. One of the types of stimulation is what will make you excited enough to have an orgasm, while the other form of stimulation is designed to ‘distract’ your brain long enough to let your body take over. For example, some women who are very uncomfortable with anal stimulation have found that anal stimulation combined with oral sex will allow them to orgasm. Some alternative healers recommend getting high on marijuana specifically to learn how to have an orgasm. Marijuana, they report is operates as a relaxant. However, with this being said, Marijuana is an illegal substance and considered by many to be a ‘gate-way’ drug to very addictive substances.
  7. What makes you so sure you have never had an orgasm? In my practice, I have found that many women who initially complain that they have never had an orgasm are indeed orgasmic. The problem is that they do not have realistic expectations of what an orgasm is. Contrary to popular opinion, orgasms do not always ‘rock your world’ and make you see stars.
  8. Lastly, what will be different once you have had an orgasm? How will your sex life be improved? What do you imagine will happen?

Once you address these specific questions, you will be in a better position to further address your needs. Sometimes simply naming the ‘problem’ makes the solution obvious.

How I had my first orgasm (written by a satisfied website user)

In regards to the article in which a fellow reader mentioned her difficulties in having an orgasm, I would like to share how I eventually was able to enjoy them. I started having sex about a year and a half ago. I unfortunately had not had an orgasm until about 6 months ago…which I was still only able to have them when I did it myself.

When I told my boyfriend that I realized I had not had one until then, I found that he was constantly putting me first and trying everything he could think of to get me off. Although nothing happened the first few times, he eventually got to the point where he could do wonders for me, but orally stimulating my clitoris while fingering both holes.

Once that got boring…I decided to figure out ways that I could have an orgasm while we were actually having intercourse. Although it took a while, I have found 2 positions that always work. The first position is girl on top, leaning over enabling us to kiss one another, and having a pillow underneath the guy’s tailbone, therefore pushing his pelvis upwards. The second position is when again the female is on top, and the guy is on bottom, however this time the guy is sitting in a chair, or if not, at least sitting in that position. These positions create enough friction between the area directly above his shaft, and the girl’s clitoris and then it also allows him to have deeper penetration.

Sex therapy can help individuals and couples address a variety of sexual concerns, such as low libido, sexual dysfunction, and difficulties with intimacy. It can also help individuals work through past sexual trauma, body image issues, and other psychological factors that may be impacting their sexual well-being. Through sex therapy, individuals and couples can gain a better understanding of their sexual desires and needs, improve communication and intimacy within their relationships, and ultimately enhance their overall sexual satisfaction and well-being.

Sex therapy can help individuals and couples improve sexual intimacy by addressing any underlying psychological, emotional, or relational factors that may be impacting their sexual relationship. Through therapy, individuals and couples can learn how to better communicate their desires and needs, understand each other’s perspectives, and work through any conflicts or issues that may be causing distance or disconnection in their sexual relationship. Additionally, sex therapy can help individuals and couples address any physical or medical issues that may be impacting their sexual function, such as erectile dysfunction or premature ejaculation.

In sex therapy, couples can learn how to communicate effectively, how to understand their partner’s sexual desires, how to express their own sexual desires, how to overcome any sexual problems, how to overcome any sexual guilt, shame, and how to feel more comfortable with their own bodies. It can also help couples to address any past sexual traumas that may be impacting their sexual relationship.

Moreover, sex therapy can help individuals and couples to explore and expand their sexual boundaries, and to create a more satisfying and fulfilling sexual relationship. Through therapy, individuals and couples can learn how to express themselves sexually, how to understand their partner’s sexual needs, and how to meet those needs in a way that is comfortable for both partners.

In summary, sex therapy can help improve sexual intimacy by addressing the underlying psychological, emotional, and relational factors that may be impacting the sexual relationship, and by providing couples with the tools and skills they need to communicate effectively, overcome sexual problems, and create a more satisfying and fulfilling sexual relationship.