One of the most gratifying experiences I can have is when I help a patient solve what he or she thought was an insolvable problem. In my experience, teaching a determined woman how to achieve an orgasm is almost always successful. But of course, the operative word is determined.

Most important goals we set for ourselves take a huge amount of time, work, focus, and perseverance. Becoming orgasmic is no different.

Inability to orgasm is a common problem among women in the United States and internationally. The common feelings engendered by not being able to have an orgasm are shame, frustration, and a profound feeling of being defective. Almost all of the women I see for this problem are convinced that they have tried everything and that they are somehow, mysteriously, broken.

But the blocks to female orgasm I see are a varied as the outlines of clouds or the shapes of trees. The patient needs to be willing to turn her sexual life over to our care. If she could have figured the problem out, it would have already happened. It’s the therapist’s job now.

The patient needs to be honest and curious about her own sexual history and her experiences trying to acheive orgasm and to turn herself over to our guidance. 

To begin with, we take a detailed history of each woman’s experiences with sex, be it partnered or solo. We always review whether medical factors might be involved. I personally put a lot of focus on whether the woman has an understanding of what kinds of touches give her sensual and/or sexual pleasure. Even if you never have had a partner, you can still use my BodyMap technique to explore what kinds of touches you do and do not like.

If she does not know what feels good to her, she has to first explore this on her own. How can you ask someone else to touch you in a way that will feel good if you don’t know the answer to this question yourself?

We look at what she learned about whether it is okay to ask for what she needs in a relationship. I review what lessons, overt or subtle, she has learned in her family of origin about whether “nice” girls have sexual feelings at all.

We look at how she feels about her body, particularly her breasts, stomach, and genitals. We assess her ability to be mindful and stay focused on sensation. Problems with ADHD and general anxiety have to be conquered, because the ability to stay focused on what does feel good long enough for the sensual and sexual feelings to build is critical.

A seasoned sex therapist’s basic understanding of the mechanisms of orgasm and the experience of guiding patients toward helpful actions (for her) and away from her specific unhelpful tendencies and patterns will do the trick. Sometimes it’s a long journey, but so worth it.

The really satisfying part is a patient’s astonishment when she has an orgasm, even though she worked hard, focused on some difficult issues, explored some formerly forbidden feelings, and followed our instructions.

Happily, I am never surprised when she succeeds.