This article originally appeared on Tonic.
“Other girls started talking about how good orgasms felt when I was around 12 or 14 and I never understood, because no matter what I did I couldn’t find anything that felt good,” says Sarah Redell, a 19-year-old telephone captionist from Texas. “It really made me feel broken and ostracized to have girls talk about how good this sensation felt, but when they looked to me to see my experiences, I had nothing to contribute.”
This continued through Redell’s teenage years and into adulthood. In clinical terms, the continued inability to orgasm is known as anorgasmia. Between 16 and 25 percent of adult women and 1 to 4 percent of adult men experience it at some point in their lives. There are a number of ways in which people might struggle to climax. Some might have never had an orgasm, whereas others can experience difficulties after previously having had orgasms for years, a subset known as acquired anorgasmia. The broad inability to orgasm can affect an individual regardless of how they sexually stimulate themselves, or can be restricted to specific sexual situations—they might only be able to come when masturbating alone, for example.
There are diverse reasons for why someone might be unable to climax. Antidepressants are one of the major causes of acquired anorgasmia, affecting (at some capacity) up to 73 percent of all men and women who are prescribed SSRIs. Psychosocial factors—including cultural and religious backgrounds that promote guilty or negative attitudes towards sex—as well as anxiety, depression, negative body image, and experiences of sexual abuse or trauma have also been associated with anorgasmia. People with certain disabilities are more likely to experience anorgasmia—especially those with spinal cord injuries, women who have experienced genital mutilation, and some men who have been circumcised, says Cyndi Darnell, a New York-based sex and relationship therapist.
“Beyond that, the pressure to orgasm can be part of the problem,” Darnell says, citing scenarios where one partner might express they want the other to come, or where someone might become worried that they’re taking too long and their partner is becoming bored or physically tired. Sociocultural expectations around gender can also play a role. “Women have significant disproportionate amounts of body shame,” Darnell continues, adding that heterosexual women are often expected to please the man rather than themselves. The pressure to conform to expectations of masculinity can affect men of all sexual orientations too.
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The so-called ‘death grip’—experienced by both men and women—might also impact the ability to orgasm. “Hyperstimulation caused by masturbation makes a penis less sensitive for intercourse,” explains Lawrence Jenkins, assistant professor at Ohio State University’s Department of Urology. “The vagina, and to a lesser degree, the anus, cannot replicate the amount of pressure and friction that is produced with aggressive or variant masturbation styles.” This is why, for some men who have gotten used to masturbating, it can be really challenging to climax during intercourse.
Darnell expands this idea across all genders: “If they know their own speed, their own pressure, they’re accustomed to a particular toy, they’re accustomed to a particular move or a particular position, that can become an ingrained habit.” Women might, for example, become used to climaxing with a vibrator or from masturbating lying on their stomach, making it more difficult to orgasm during partnered sex, she says.
Darnell suggests a number of strategies to try before visiting a sex therapist. For people who regularly masturbate with a vibrator or to porn, she recommends reducing that frequency or taking a break from those methods until there’s a noticeable difference in erotic sensations. “Toys become really useful allies for everyone during sex,” she continues, explaining how sex toys can relieve physical exertion on mouths, hands, and bodies, providing novel sensations along the way. “It is also a matter of making sure that you’re slowing down, that you’re connecting with your partner, that you are giving them feedback about what feels good, and recognizing that pressure is probably one of the number-one enemies of orgasm.”
If someone is having trouble have an orgasm and is actively seeking a way to address this, Darnell emphasizes the importance of patience. “It’s a good thing to pause, stop, reflect, slow down, and not panic if orgasm is not present in your sex life for now,” she says. “It will come. I believe absolutely everybody is capable of orgasm unless there is some serious clinical reason why they cannot.”
There can be surprising outcomes, even for individuals with complex medical conditions. “I know anecdotally of a case of someone who is paralyzed from the chest down who experiences orgasmic sensations in the back of his ear,” she adds. “Anything is possible.”
Moreover, Darnell suggests that there are multiple ways in which we can experience orgasm and sexual pleasure that go beyond society’s strict definitions of what "real" sex is. “There are very few people for whom [anorgasmia] is actually a true diagnosis, because there are so many variables that constitute what an orgasm is.” And finally, it’s worth remembering that the spectrum of human sexual experience is incredibly varied—orgasms are simply one form of sexual pleasure, and sex can be just as satisfying without them.
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This article originally appeared on Tonic.