Once a month, I attend a luncheon gathering for local members of the American Association of Sexuality Educators, Counselors, and Therapists (AASECT). Some of us who attend are not official members, but we all work within this general field. We are Sexologists, Psychologists, Psychotherapists, and Coaches of various specialties, and we have the most fascinating discussions!

October's discussion centered around working with clients who have difficulty becoming orgasmic, and I learned so much that I thought I'd share it with you.

Some of the challenges that we discussed involved male clients (no names ever mentioned) who could achieve an erection alone, but not with a partner; female clients who feel arousal but just can't reach orgasm; and female clients who can't seem to identify anything that arouses them. One of the challenges identified for clients who cannot reach orgasm is the intense desire TO reach orgasm, and the part that societal expectations play in nourishing that anxious desire.

In a culture where we are reinforced from an early age, through media and popular dialogue, that successful sex ends in orgasm (preferably simultaneous) for both partners, the person unable to reach orgasm can experience a lot of pressure. Not only may there be external pressure - EX: a reflected sense of self from the other partner, such as 'my partner feels like a poor lover if I do not cum' - but also internal pressure - EX: 'there's something wrong with me if I do not cum.'

Add to this a culture in which the mental, emotional, and spiritual aspects of sex are not often openly discussed, particularly during our youth, when our bodies and expectations are rapidly developing, and you've got a recipe for misunderstanding and anxiety. Any thoughts of how sex Should Be, beyond 'consensual and enjoyable for all partners', is limiting. What to do?

Some of the discussed solutions involved embracing a focus on Pleasure... on enjoying the process rather than chasing a particular outcome. This is, of course, easy to say, but perhaps not as easy to actualize when one has never had an orgasm. Some questions we might ask such a client are, "When are you IN your body?" or "What is a successful sexual experience to you?" As a relationship coach, I would also want to ask, "What do you perceive as a successful sexual experience for your partner?" and then determine if there was an open two-way channel of communication about that perception.

Therapist David Reed's model of the erotic pathway was raised, which includes the following four stages: Seduction, Sensation, Surrender, and Reflection. To quote an article on Human Sexual Response Cycles, "During the stage of surrender we can experience orgasm. According to Reed, orgasm requires momentarily surrendering and giving up control. It requires us to take our mind off our performance or to stop "spectatoring." To experience orgasm requires us to stop worrying about how we look or smell, or about making too much noise, or about whether we are going to have a bowel or bladder accident. It also requires trust of ourselves and of our partner if we are with a partner."

For those of us who live largely in our minds rather than our bodies, this can pose an additional challenge. Although still illegal, marijuana has been known to help people get out of their heads and into their bodies, thus facilitating such a release of control, and this raises the topic of the biochemistry of an orgasm.

Apparently, orgasm is dependent on a spike in the neurotransmitter Serotonin. Anxiety is known to crash serotonin levels, so it's no surprise that worrying makes an orgasm less likely. Marijuana use facilitates the output of serotonin, but, if used daily, can establish a new "normal" within the brain. This is not unlike the Selective Serotonin Re-uptake Inhibitor (SSRI) family of drugs, such as Prozac, Paxil and Zoloft, among others, which create an even level of serotonin in the brain, and which may point to why so many people self-medicate for depression and anxiety with marijuana.

The problem here is that we need a serotonin spike to achieve orgasm, which is simply not possible when the brain's level of serotonin has been artificially raised. Et voila - SSRIs and chronic marijuana use often lead to loss of libido and/or sexual dysfunction.

Regarding clients challenged with basic arousal, we might ask them to speculate on the wide variety of arousal vectors - visual, audible, taste, smell, tactile, fantasy, and/or contextual, among others. At this point we must also consider the common differences between the ways in which men and women gain access to arousal. While my husband may merely need to look at me as a sexual object to find something arousing, I need to experience an emotional and physical connection in order to even begin to get into 'the mood.' Breathing, energy and connection-based exercises such as those found in Tantric practices can help women and men who first need that kind of experience to gain access to their physical arousal.

Additionally, for a client who just can't seem to get there, and for whom the mental/emotional process is healthy, many of us would recommend experimentation with various types of stimulation. Fingers are great, and there's so much more. Sex toys, dildos of different densities, vibrators, G-spot and prostate stimulators, butt plugs... until you've tried them, who knows which one might suddenly light your fire?!

Lastly, there's the importance of drilling down to the underlying issue or concern. Many a client who states, "I want to have an orgasm," may have a deeper desire that is more directly addressed. With such a client we might ask, "What would make an orgasm possible for you?" Perhaps it's trust, safety, anonymity, or another aspect that, if not distinguished, could continue to make that very orgasm an uncomfortable impossibility.

Wishing you great orgasms!

Additional Reference: Betty Dodson, Orgasm Doctor

Article of Interest: HBO options a controversial book about one young woman's quest for an orgasm.