“I just can’t orgasm. My doctor said that nothing is wrong with me and that I just need to relax.”

Experiencing the lack of, or inconsistent orgasm is a common sexual issue shared by women in sex therapy.

As we continue our session, she shares that she’s bought books like The Joy of Sex, tried different sexual positions, has shown patience with her body that it will ‘eventually happen’ and has a considerate partner who sympathizes with her frustrations. Nonetheless, she hasn’t experienced that mind-blowing orgasmic phenomenon described by her closest female friends.

“I’d rather not have sex and I fear that every time he touches me it will lead to sex so I avoid his affection.”

Weeks turn into months and eventually she begins to withdraw. She withdraws from herself and she withdraws from her partner. The sympathetic partner begins to feel lonely, insecure and unloved. At the same time, she feels a sense of failure in her relationship for not sexually turning towards her partner, and is deeply saddened by the betrayal of her own body branding her genitals as broken.

What once was a passionate erotic exchange shifts into personal narratives of obligatory or dutiful sex, sex to keep him happy and affirm his masculinity, sex to avoid arguments, and sex as a relationship maintenance chore.

A study recently published by The Journal of Sex and Marital Therapy found that only 18% of women experience orgasm with penetration. And a report published by the Journal of Sex Research found that close to 70% of women pretended to have an orgasm during penile-vaginal intercourse.

Consider the following:

• 39% of women vs. 91% of men say they usually or always experience orgasm in partnered sex
• 55% of men vs. 4% of women say they always orgasm during first-time hookup sex
• 85% of men vs. 68% of women say they orgasmed during last instance of relationship sex

Often I share these stats with women normalizing the wide disparity of orgasm experiences among women and men. In heterosexual sexual encounters, penis-in-vagina penetration is the cultural standard with the sexual script going something like this:

One of the partners bid for sex (usually him), foreplay is a means to get her vagina ready to receive his penis, followed by intercourse until the man orgasms then maybe a few moments of cuddling.

It’s all about context

In human sexual functioning, in order for a woman’s body to be primed for orgasm, a combination of psychological, interpersonal, relational and biological conditions are necessary. We need to rule out side effects of medication or other health treatments, pelvic floor or vulvar pain, impacts of trauma, as well as neurological damage. We also need to look at how much she knows about her own sexual functioning, how well he’s aware of her conditions for her body to be primed for orgasm and their communication and erotic patterns as a couple.

Current studies on heterosexual sexual encounters indicate that on average, foreplay last between 11 to 13 minutes. While these studies indicate a range of time prior to intercourse, what’s often not reported is the quality of her physical and psychological arousal and whether her arousal response coincided with foreplay length. With intercourse lasting on average 5.3 minutes (or less), and with 13 minutes of foreplay, this makes a full sexual encounter to under 20 minutes.

So is foreplay’s ultimate purpose is to prime his body for his orgasm?

If foreplay is to prime her vagina to receive his penis, the lingering question remains, What about priming her body in order for her to experience sexual excitement, arousal and orgasm – if she wants to. And what if the traditional definition of sex, i.e. sex means intercourse, is a reframed as sex means eroticism that can include an array of non-hierarchical or goal centered sexual activities such as intercourse and/or orgasm?

Emily Nagoski, author of Come As You Are, shares the several reasons why a woman don’t always experience an orgasm including:

• She’s still learning how to orgasm
• She believes she can’t so she doesn’t put in enough effort to prime her own body
• She doesn’t want to given her multiple work-life responsibilities
• There’s not enough attention to the clitoris (within the right context)
• She’s distracted by self-monitoring when their partner is, or isn’t in the room
• She’s distracted by self-monitoring her own body during sex
• She’s healing from trauma
• She’s occupied with worrying about not having an orgasm

That being said, I had the privilege of sharing a meal with Dr. Laurie Mintz author of Becoming Cliterate: Why Orgasm Equality Matters – And How to Get It who suggested a cultural linguistic change when it comes to sex and women’s orgasms. Given that clitoral stimulation (her pleasure) during foreplay can require more time and effort than intercourse or the sexual encounter in its entirety, then the definition of sex shifts away from intercourse. Rather, “Clitorial stimulation is sex and postplay is intercourse.”

Culturally this proposed linguistic shift is easier said than done but within the context of an erotic connection, this practical sexual shift along with the principle of what I call “pleasure not pressure” can serve as one of many foundational hallmarks towards her pleasure that may include orgasm. This shift can also maintain or rekindle the passionate, erotic, sexual experience for her and her partner.