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Photography Ashley Armitage, via @ladyist

‘Why can’t I come?’: Women and experts on why you’re struggling to orgasm


TextAmelia Abraham

According to experts, there are many reasons why, including anorgasmia and anti-anxiety medication – here’s what you can do about it

“I started having sex when I was 18, but I didn’t have my first orgasm until I was 23,” says Lola*, from Melbourne. “It was a mix of things: men being incredibly selfish, me not knowing how to get there mentally with someone else – even though I could do it alone – and because for the first few years of sex I was so subscribed to a fake idea of what sex should be like that I was just focussed on performing and pleasing the guy I was with.”

On some levels, it feels like we’re living in a time when there’s more conversation than ever around women and queer people’s sexual pleasure (rather than men’s for a change). Take the show Sex Education, which literally (and yet subtly) educates us about a different sexual issue someone might be having in each episode. Or young sex educators using social media, like Eileen Kelly of Killer and A Sweet Thang. On top of that, from September, same-sex relationships will be compulsorily taught about in UK schools.  

Yet, despite these improvements, sex for a lot of people is still shrouded in anxiety and even pain – both of which are rarely discussed. Studies suggest that five to ten per cent of sexually active women are unable to orgasm, while another suggests that 75 per cent cannot reach orgasm without the help of sex toys, hands, or oral sex. The medical term for regular difficulty reaching orgasm after ample sexual stimulation is “anorgasmia”, and it can happen for any number of physical or psychological reasons.

London Gynecology clinic explains that one big reason is painful intercourse – a common problem that affects almost three out of four women during their lifetime. It may be because of illness, or infections like thrush, or STIs such as chlamydia, gonorrhoea, and herpes, or else skin disorders. Another cause is vulvodynia – which is a pain disorder that affects the vulva, or vaginismus – a reflex contraction (tightening) of the muscles at the opening of the vagina, or else hormonal changes during the menopause, childbirth, pelvic inflammatory disease, cystitis and painful bladder syndrome, which are all associated with pain during sex. 

Trauma or body confidence can similarly create a challenge, with emotions such as fear, guilt, shame or embarrassment potentially making it harder to relax. “Stress and fatigue can affect desire to have sex,” adds Saurabh Phadnis, one of the oncologists at London Gynecology clinic. “If one cannot relax, arousal is difficult, and pain may result.”

Isobel, who is 28, from London, explains that struggling to reach orgasm was an issue she never had until she went on anti-anxiety medication at 24. They gave me Prozac, otherwise known as fluoxetine, and it really helped to quell the anxiety. I remember the first few weeks, as I was acclimatising – I would feel like I was rushing on pills, my hands would sweat, but something else I noticed was that my sex drive dropped. From then on, I found it really difficult to not just to get turned on, but to come. I guess the two go hand in hand.” Whether with herself or with a partner, what followed for Isobel was an “overthinking” of it. “As someone disposed to anxiety, albeit medicated for, I became really worried about the problem, or about taking too long with a partner, and that just made things worse. Very occasionally, I’d have a breakthrough, but this period lasted for a year and a half.” 

“Body-wise, maybe someone or their partner doesn’t know how to stimulate themselves in a way physically that’s going to feel good. With the mind, it could be that they’re getting distracted, almost watching, which is what we call “spectatoring”, rather than actually being in the moment. The emotional side could be if someone doesn’t feel comfortable or safe in the sexual situation.” – Miranda Christophers, sex and relationship therapist 

Lola meanwhile, believes that difficulty in climaxing came from her surrounding culture: “I honestly think it stems from the group of girls I was friends with when I first started having sex, who’d had sex before me and gave me a very narrow narrative of sex and how it was meant to please the man. I guess this was only exacerbated by what I was consuming culturally, like movies and porn. I felt quite self conscious in bed always thinking about how I looked or if my partner was pleased.” 

According to the sex and relationship therapist Miranda Christophers, it’s common for there to be a combination of reasons like this for why a person can’t orgasm. Three things need to connect; the body – in terms of actual physical stimulation, the mind, and the emotions. “Body-wise, maybe someone or their partner doesn’t know how to stimulate themselves in a way physically that’s going to feel good. With the mind, it could be that they’re getting distracted, almost watching, which is what we call “spectatoring”, rather than actually being in the moment. The emotional side could be if someone doesn’t feel comfortable or safe in the sexual situation. Other things might be trust – are there any infidelities? – or attraction.”

Miranda says that often, you need all three of these areas to be positively working and connected “for the arousal circuit to really get going” and “to create the right experience for someone”. If one thing is going wrong, it can also have knock on effects on the other areas. 

So, what do people do when they can’t come? One person I spoke to went to a sex shop and spoke to staff there about toys that might help them spend more time working on orgasming alone for the first time, eventually finding a vibrator that did the trick. Another I talked to in the US, went to the (expensive) workshop that appears in Gwyneth Paltrow’s show The Goop Lab on Netflix, The Betty Dodson method; first, they teach you that vaginas come in many shapes and sizes (to eradicate shame), then teach a masturbation method that mixes a special weighted dildo, a Magic Wand vibrator, and deep breathing techniques. 

The Betty Dodson method has reportedly been found to help 93 per cent of women reach orgasm, but many other fixes may exist, explain the experts, like lubricant, changing partner (to someone you have more sexual chemistry with), to simply making more time for sex, so that neither partner is tired or anxious. Talking with your partner more can help, discussing what causes plain, and what causes pleasure. However, the advice goes that if pain during intercourse persists, or these measures aren’t helping, you should seek medical advice.

The Havelock Clinic in London offers a team of “doctors, psychologists, and pelvic health physios who are experts in sexual medicine”. One of them is Dr Ali Mears. She says that many women come in to talk about pain or other medical issues, and only mention that they have anorgasmia when probed. On the other hand, some do say they have inorgasmia, and it turns out that pain is preventing them from reaching orgasm. Another common situation is women saying they can’t come, but it turns out they just can’t come from penetration. “The majority of women do not climax through penetration alone,” says Mears, “but many people expect that they'll come from some vaginal thrusting as what happens in the movies.” 

When people come in with pain Mears will ask a series of questions; whether it’s a lifelong issue or acquired, whether it applies alone or with a partner, and about their medical history (“SSRIs can affect reaching orgasm, but so can alcohol and drugs, or even conditions like diabetes or Parkinsons”). She will try to get to the root of the pain. Sometimes, it is neurological, the body misfiring pain signals – that’s valid, says Mears: “I hate the phrase ‘it’s all in your head’.” She will suggest a course of action depending on the diagnosis, from physiotherapy to medication for more physical conditions, through to suggesting CBT. 

When it comes to accessing psychological help, Miranda Christophers finds that women can sometimes be reticent to talk about their problems, while research shows that it’s likely that queer, trans, or non-binary people may feel some shame in talking about their sex, partly through encountering barriers with healthcare professionals who are not versed in queer sex and relationships. Working with men and women from ages 16 to 80, Christophers has also noticed that men are more likely to seek help for sexual dysfunctions than women. “I don't like to say it but women can fake it and men can’t, so a lot of women do.” She finds that men are more motivated to try and overcome sexual dysfunctions – especially as women are taught that sex is about male pleasure. When men do seek help, it tends to be more to do with themselves, and women when they feel it’s having an impact on a relationship. 

One thing she sees a lot is people who say they can only come in certain situations – with a particular kink, in a certain setting, or thinking a specific thought. “People will say ‘I can only orgasm with a vibrator, or on my own, on my back, on a chair, or with men it might be a death grip,” she explains. “I would look at widening that out. With women, for example, I really get them to experiment with different things, go on sites like OMGyes and look at the different techniques that they can be trying and maybe even for a while maybe not use the vibrator at all.” It can be about breaking psychological habits, deprogramming yourself. Christophers also encourages a kind of sexual mindfulness with her clients, so if the problem is performance anxiety she works on helping them to catch anxious thoughts, to “let go”.

“The funny thing is that I was able to give myself orgasms the entire time that I couldn’t come with a partner, so it was definitely a mental block just being with another person” – Lola*

While help is out there then, not everyone finds they need it. Lola’s situation improved naturally: “The funny thing is that I was able to give myself orgasms the entire time that I couldn’t come with a partner, so it was definitely a mental block just being with another person,” she says. “As I got older, I noticed my partners started to focus on me more and the balance started to even out. I was less self conscious in bed and started following what I wanted. I began to lose those negative thoughts and ideas on sex to really unlock my body.” 

For Isobel, it took coming off medication and managing her anxiety in other ways to reach orgasm again, but she says that the experience led to many conversations with her friends about anorgasmia, and she realised just how common it is. “Some of them, in their thirties, still haven’t come. If we all talked about it more, we’d realise it’s so much more common than you think.”

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