quarta-feira, 6 de junho de 2012

Why no “O”?

by Dr. Maureen Whelihan

This post will address orgasm disorders in women.  Let’s begin by describing it.  This definition by an International Collaborative Group gathering in 2004 to discuss orgasm defined it as this; “a variable, transient peak sensation of intense pleasure creating an altered state of consciousness, usually accompanied by involuntary, rhythmic contractions of the pelvic striated circumvaginal musculature, often with concomitant uterine and anal contractions and myotonia that resolves the sexually induced vasocongestion with an induction of well-being and contentment”.  Now that I have your attention, I suspect you can almost feel it based on this detailed description!

It is well-known that women can be multi-orgasmic.  But many are unaware that women can achieve orgasm without genital stimulation through visual or fantasy and more often by breast stimulation.  I have seen patients that could easily reach orgasm with nothing but breast stimulation.  The problem was that her husband had not even gotten her undressed before getting her to climax and she would then decide she had no energy for intercourse and was not interested!  Not good.

Orgasm disorders are a close second behind arousal disorders, however hypoactive sexual desire disorder still prevails as the number one complaint.  The general feeling is that PRIMARY ANORGASMIA (never had an orgasm) is more an anxiety condition and a sex therapy consult should begin.  However, SECONDARY ANORGASMIA is where she has reached orgasm previously and cannot now.  The etiology of this is a broad range of things.

Keep in mind that in the initial evaluation, one needs to address lack of adequate stimulation as this is the number one cause of secondary anorgasmia.  Many women (as high as 70-90%) report an inability to reach orgasm with penetration only.   Clitoral stimulation in whatever form preferred by the woman is necessary.

Ok, so we are clear that clitoral stimulation should always occur.  When, you ask?  My recommendation is always – FIRST!  For several reasons this is beneficial.  One of the most common causes of sexual pain is vaginal dryness.  This can be due to inadequate arousal, among other things.  Women climaxing first will engorge the vulva, lubricate the introitus, expand the vagina and make it a happy place to penetrate.  Furthermore, many men are concerned about firing too soon; they will have NO WORRIES, because she has already had at least one orgasm.  Everyone is happy.  I have had this very discussion with male clinic patients who are concerned that they have premature ejaculation.  Many last 4-10 minutes on average – plenty of time.  HOWEVER, they never made sure their wives climaxed first.  So now, when he quickly gets soft after 4 minutes, she has no time to get there.  Angry woman….not good.

Often the women are to blame, here, because when they are not interested in trying to get aroused, they simply give him a “pass” to dive in and go for it while they create the grocery list and choose new wallpaper for the bedroom in their head.  By doing this, they plant a message of “sex is no fun for me” in their own brain and a vicious cycle begins.  I strongly encourage women to figure out how they get to orgasm the fastest or easiest and make sure this happens nearly every time.

I posted previously on bringing vibration into a partnered sexual encounter and this is generally a home run for all.  She gets her “O”, he feels that he has done his job and can enjoy penetration without guilt and she stays focused on the moment rather than the cobwebs on the ceiling.  Everyone is happy.

Chronic illness such as multiple sclerosis, chronic renal failure on dialysis, diabetes, atherosclerosis, smoking and depression are some of the most frequent conditions interfering with orgasm.

Medications, especially antidepressants (SSRIs), and antipsychotics, are culprits; however serotonin-norepinephrine reuptake inhibitors (SNRI’s) may be less negative in these patients.  Some are better than others.

Estrogen deficiency and testosterone deficiency can play a role either directly due to atrophy of the tissue or indirectly due to lack of arousal and desire.

Although the general thought is that anxiety/mood disorders, shame, guilt, poor body image, past abuse, and poor genital image are the some causes of PRIMARY anorgasmia, some recent studies suggest genetic factors.  One study suggests that a single nucleotide polymorphism in glutamatergic receptor genes has been found in those with difficulty achieving orgasm.

This discussion is too long to post here, but modify the medications as needed by adding buspirone (Buspar) or bupropion (Wellbutrin XL) or even yohimbine (Yocon).  I have mentioned milnacipran (Savella) as my new favorites for this if tolerated.

Other things to be studied in the future are midodrine, oxytocin and bremelanotide for women.

Without saying, behavioral or sex therapy as needed is a mainstay to the approach of this topic.  Happy hunting….
Dr Whelihan can be reached at www.BestSexualAdvice.com   or 888 569-3374


8 Responses to “Why no “O”?”

  1. 1
    Why no “O”? - Palm Beach Post (blog) May 17th | newhealthreport.com Says:
    [...] Why no “O”? – Palm Beach Post (blog) [...]
  2. 2
    Dave Right Says:
    A lot of women don’t have a positive attitude about sex. Their grandmother or mother told them that they are going to hate sex but it is their marital duty or that reproductive organs are repulsive. Their religion told them that it is a sin for a woman to enjoy sex. Society says sex is dirty. Governments and churches make rules and laws against it. Most are afraid of diseases. Some women use sex to get what they want, in or out of marriage. Making it a business transaction takes all the fun out of it. I feel sorry for the ladies that have been forced. That could ruin sex for the rest of their lives. All of these women have been poisoned against sex and will never enjoy it and will never have and orgasm. Dr. Oz said that only 37% of women over 60 like sex.
    Then you have guys that are minute men or don’t care enough or don’t know what to do to please a lady. Sex was such a taboo subject that everyone had to learn by trial and error. Now info is easy to find but you have to know enough to go looking for it. Society hasn’t done women any favors.
  3. 3
    Brad Lead Says:
    Every man is born with premature ejaculation, so having it is perfectly normal to start with. Controlling ejaculation is something you have to learn just as you had to learn to control your bladder as a child. We get taught to control our bladders but no one teaches us how to control ejaculation.
    The American Academy of Family Physicians confirms that: Behavioral methods are helpful for more than 95 percent of men who have premature ejaculation. So, if you have tried exercises and they have not helped it is because they have not been explained properly to you. Many of the treatment programs offered online have not been written by professionals.
    Do not waste time or money on sprays, vitamins, herbs, dietary supplements or drugs. This is a learning problem and these things will not help you learn to control ejaculation any more than they can help you to learn to speak another language.
    There are a lot of high-priced programs advertised online but all you need is an inexpensive little book written by a doctor and sex therapist that has been used successfully around the world for more than 32 years.
    It is called “Lasting Longer: The Treatment Program for Premature Ejaculation” by Dr. Sy Silverberg M.D.
    For free preview chapters from the book visit the website.
  4. 4
    Dr Whelihan Says:
    Brad, You are absolutely correct! Behavioral training and exercises help men improve this. Sometimes however, it is secondary to “rushing” because of concerns of erectile function. So all avenues must be discussed. Thanks for your thoughts and insight!
  5. 5
    Dr Whelihan Says:
    So true! So many things negatively influence women (and men) regarding their sexuality. Our clinic takes time to “discover” these influences and educate the patient about sexual practices that will work in their relationship. We do a lot of “permission-giving” and urge women NOT to withhold sex for punishment. This is a large portion of what we do in the clinic. Thanks for your thoughts.
  6. 6
    Connie Says:
    My long time problem is climaxing in some other way than through direct clitoral stimulation. I don’t think Ive ever had an orgasm otherwise. And when I stimulate myself, I find I can achieve orgasm very quickly, however, with my husband, it can sometimes take up to 10 minutes :( I am extremely attracted to him, sexually, that’s not the issue… We always include a decent amount of foreplay…. I just wish that I could climax during sex. It FEELS good…. I just never get the ending result :(
  7. 7
    Dr Whelihan Says:
    Hey Connie,
    Don’t put so much pressure on yourself! Find that orgasm whatever way is the easiest! Your partner wants you to be satisfied and does not care about timing or method. It is all good. I am sure you try simultaneous clitoral stim while he is penetrating, right? This will helf you reach your goal and YOU are in control!
  8. 8
    Why No “O”? | | Boulder Sex TherapyBoulder Sex Therapy Says:
    [...] Read the full article here:  Why No “O”? [...]

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