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I’m Actually Fine! You’re Too Far Away and I’ve Lost My Nerve!

by Wendie Trubow, MD, MBA March 29, 2016
woman-grasping-sheet

(Warning, contains explicit language)

Two weeks ago, we explored libido, and last week we explored response. So now we’ve arrived at the peak of this series! (Sorry, couldn’t resist). Let’s explore orgasms: what’s normal, what’s concerning, and what needs a consult.

This is something most providers are completely comfortable discussing; so while it may feel uncomfortable for you, please know that your functional medicine provider will be happy to work with you on this!

I have a particular bone to pick with Hollywood. Hollywood is great for escapism, for fantasy, for creating romantic scenes, and particularly for portraying the “ideal” or “ultimate” orgasm. You know the scene, right? The woman has the most mind-blowing orgasm on screen, and she and her partner are left speechless at the magic that just occurred. And if you’re like the majority of women in my office, you’re sitting there thinking “I don’t have orgasms like that.” and “What’s wrong with me?”

Forgetting completely, of course, that you went to the movies to escape, not get a reality check.

So let’s dive in. Orgasmic dysfunction falls into three major categories. Take Josie, for example, who falls into what is the most common category I see as a clinician. Josie told me she had a concern about her orgasms, since she thought maybe she wasn’t having them. So here’s what I asked her:

Josie, do you experience sexual desire? Her answer: Yes.

OK during your sexual experience, do you experience some sort of difference between the way you feel at the outset, and the way you feel at the end? Her answer: Yes, actually.

Last question: Josie, are you satisfied at the end of your sexual encounter? Her answer: Yes.

Josie’s problem is NOT that she doesn’t have orgasms. Her problem is that the way her orgasms occur don’t match Hollywood’s portrayal of them! Josie doesn’t actually have a medical problem—she has a perception problem. Her perception was that an orgasm had to look a certain way in order for it to be a satisfying sexual experience. But when we got real about HER experience, she saw clearly that she was having orgasms. Your orgasms will not (and SHOULD NOT) look like anyone else’s!

The second type of orgasmic dysfunction falls into a thoroughly separate category. Take Orly, for example. Her concern was that she was not able to orgasm during intercourse. This my favorite issue to work with, actually, and also involves a Hollywood rant. Interestingly, the introitus (the entry to the vagina) and vagina (where a woman has intercourse) are GEOGRAPHICALLY REMOVED from the clitoris (the largest source of an orgasm). Some women can and do orgasm during vaginal intercourse. However, most women need clitoral stimulation. If your partner is concentrating on the vagina, that’s nice, but is not likely going to bring you to orgasm. So, Orly and I got to talking, and she shared her concern with me. As we explored, we were able to uncover that she was easily able to orgasm with other stimulation, just not solely from vaginal stimulation.

The last category of orgasmic dysfunction stems from an underlying medical or psychiatric cause. Thankfully, it’s much less common than the other two categories! Over time, medical issues such as diabetes can cause peripheral nerve damage, and this nerve damage can affect the nerves leading to the vagina, clitoris, and bladder. Women with diabetes are at risk, and any woman who has diabetes and also experiences orgasmic difficulties should absolutely come in for evaluation, as should any other woman who feels that the sensation in her vagina is decreased. The second cause within this category is trauma.

All types of trauma (emotional, physical, and sexual) can inhibit a woman’s ability to orgasm if the abuse is linked in some way to her sexuality. This also deserves a consultation. There are many phenomenal therapies and support available for women with issues in this category.

The take home message? While there are a few instances in which you really do need to seek medical help, your chances are pretty high that your orgasms, and responses, are perfect just the way they are.

Have a topic you’d like me to cover? Email me directly at info@fivejourneys.com.

Originally published by Huffington Post.