The Big “O”rgasm

The Big “O”rgasm

One of the difficulties in sexual functioning and sexual expression is the cultural emphasis and priority on orgasm. The belief that every sex act must result in an orgasm can be a barrier to sexual health. This belief can create performance anxiety inhibiting functioning. You may have the thoughts, “It isn’t good sex unless I had an orgasm.” or, “My partner didn’t enjoy the encounter since she didn’t orgasm.” Undoing the mis-perceptions of orgasm are important. (for example, in men, orgasm and ejaculation are different processes. You may not have both occur at the same time.” 

There are alternatives to emphasizing orgasm. The “Tantric” approach to sexuality is an example of an approach to sexuality that often emphasizes the entire sexual experience and not orgasm. Many of the exercises in the workbook are designed to create pleasurable experiences without an emphasis on orgasm. Yes, you can move any experience toward orgasm, but you don’t have to. The development of sexual skills exercise highlights how orgasm is only one part of the process. All the other skills can be very pleasurable. The exercises on sensual touch and erotic touch are examples of the process. It is possible to have an amazing sexual experience without orgasm.

As you move forward in your sexual health, pay attention to the messages you’ve heard about orgasms. Consider how these messages relate to your chemical use and sexual satisfaction.  One quick way to identify your feelings is to reflect on what you feel when a sexual partner doesn’t orgasm in your presence.  

Aging and Sexuality

One of the inevitable realities of the human body is the fact we age.  Every one of us will need to address the impact of aging on our sexuality.  The cultural messages about aging and sexuality was briefly highlighted in the cultural and identity section. Two classic examples are the belief that “Old people are alone.” “Sex is only for the young.” As you build your recovery, it is important to address the cultural messages you have heard about aging.  This can be done by examining each section in the workbook with the questions, “What is the impact of aging on _____(fill in the blank).  “What is the relationship between __________(fill in the blank), aging, and my chemical use.”   One example of this relationship is that we might use chemicals as a way to cope with the loneliness we feel as we age.

It is also important to address the physical consequences of aging on the physical body and the impact on sexuality.  The range in changes that occur in the body as we age are significant.  A few of these changes are listed simply to get you started in your journey.

The intensity of the sexual response cycle changes as we age.  It may take longer to get aroused. For both men and women, the intensity of arousal can slowly decrease as we get older.  The intensity of the orgasm may lesson. The refractory period between orgasms increases. 

 Men and women struggle with changes to our genitals.  Women might not create enough lubrication for penetration. Men often loose intensity in erections.

Hormonal changes for both men and women occur.  Menopause was briefly highlighted in the section on Women’s Sexuality.  Men’s level of testosterone slowly decreases over time.

 Our body changes, as compared to the unrealistic ideal images of a man or woman.

Assignment

Review your responses to the messages you have about aging from the section on Cultural Identity (page).

Describe 2-3 examples where your sexual expression has changed as a result of aging.

Describe 2-3 sexual health concerns you have as you grow older.

Sexual Functioning and Development of Sexual Skills

When asked to define healthy sexual expression, many individuals first respond with the idea of sexual intercourse. They envision a typical explicit movie and assume that he/she needs to have sex “like them.” For many individuals, this is unrealistic.

A number of sexual functioning problems exist (See the topic on Sexual Functioning). In addition, many individuals struggle with sexual shame that they simply shut down any sexual energy. Individuals who struggle with sexual anorexia/sexual avoidance may believe they lack a level of competence in the skills to engage in sexual behavior. For individuals who struggle with sexual anxiety, the necessary skills evoke such anxiety that his/her performance results in unpleasurable experiences creating a cycle that leads to additional anxiety. Individuals who are sexually compulsive will sometimes focus on one type of sexual experience at the expense of all other types of sexual intimacy. In these examples, one goal of sexual health is the development of the knowledge, comfort, and skills to engage in a variety of forms of sexual expression.

Sexual Health requires self-knowledge, and the awareness to assertively communicate what you want. I’ve heard stories from individuals about how they were looking for one type of sexual intimacy, but didn’t know how to ask for it, or how to maintain the boundary if they knew what they were looking for. Many times, the individual and the partner don’t feel comfortable talking about the different types of sexual intimacy.

Below is a list of different types of sexual intimacy. They are listed, in my opinion, on increasing levels of intensity. Other clinicians may have a different order. While we may have different orders, it is generally believed that clients need to develop the skills at each level, moving toward increasingly complex skills. I use the metaphor of math skills. You start with addition and subtraction, moving to multiplication and division before learning about algebra and calculus. Only then would you teach statistics. My goal with this post is to highlight some basic skills and help you eventually move toward increasingly complex forms of sexual expression.

Instructions for the process:
Start with each step. Make sure you absolutely comfortable before you move to the next step. This process can be time consuming (think months). Some steps may be easier than others. It is important to develop and maintain open communication with your partner and his/her willingness to participate; this may require couples therapy. Obviously if you are struggling with this process, quickies or one-time encounters will interfere with this process. The key is to move slowly. When you feel anxiety or uncomfortable, say so, slow down and stop, if necessary. Comfort at each level is necessary before moving to the next step. After each experience, reflecting and talking about the experience is necessary. The debriefing can give you insight about what was easy, difficult, liked, disliked and whether or not you think you are ready to move toward the next step. If something is too uncomfortable or too anxiety producing, you may have to stay at that step for a while, or even move to an earlier step.

1) Looking
Often the first place to start is an awareness to whom you are attracted. What kind of person do you find attractive? What characteristics do you like? And the characteristics you don’t like. Focus beyond just the physical. If you can, think about why you answered the questions the way you did. Share your responses with your support system. Provide them with examples. Recognizing your attractions leads to the next step.

2) Flirting
Once you start to recognize your attractions, the next step is disclosure with the person to whom you are attracted. Often this is where people get stopped. This step requires addressing fears of rejection. In some cases, rather than dealing with rejection, people either shut down their attractions or settle for someone else.

3) Spending time together
Learning how to spend time together is the next step. Sometimes this may be simply going out to coffee or dinner, or a more formal type of date. Review the (future) topic on dating. Many of these activities can be integrated into this section.

4) Touching
Learning healthy, safe and respectful touch is a next step. This can involve simply holding hands, perhaps dancing or even light kissing. Being able to express what you like and don’t like is a part of this process. At this part of the development, the assumption is that you are “clothes on.” Future steps will introduce the experience of clothes off. At this point, the goal is to simply be comfortable with touch.

5) Kissing and Touching
At this step, you move toward increased physical touch. It is assumed that the clothes are still on, and that the touch focuses on areas other then genitalia and breasts. You might focus on touching parts of the face, hands, head, etc. Once you feel comfortable with types of touch in this area, moving toward touching breasts and genitalia over the clothes is the next step. As with all other steps, it is important to be aware of what you like/dislike and what feels comfortable/uncomfortable. Ongoing communication with your partner and support system is also assumed.

6) Nurturing and Full Body Touch.
In this stage, you still have your clothes on, but the level of touch has increased to the point where multiple parts of the body are touching. You may also be sitting next to each other on a couch, etc, or lying next to each other. This level of touch is sometimes described as “spooning” or laying front to back. As with the previous two steps, starting with touching non-genital parts of the body, moving toward eventual touching the genitals/breasts over the clothes.

7) Nudity
Moving up scale, the next level is being next to each other naked. This may have to start slowly, for example, simply being in undergarments before being naked. Again, starting off touching parts of the body other then breasts and genitalia is important. Once the touch is comfortable, move toward touching your partner’s genitalia as well as being comfortable with your partner’s touch is the next step.

8) Masturbation and Mutual Masturbation
Continuing up the scale of intensity, masturbating yourself in front of your partner and watching your partner masturbate is the next step. Many individuals struggle with shame, guilt, and embarrassment around masturbation. Reviewing the topic on masturbation may be helpful to help you increase self-awareness on this issue. Mutual masturbation (you masturbating your partner and your partner masturbating you) is the next step. At this point, orgasm isn’t the goal, simply being comfortable with the level of touch and sexual intimacy is the key. Perhaps when you are comfortable with the touch, orgasm through masturbation can be introduced at this level. Orgasm may be also be introduced at the later stages as well.

9) Fantasy
I believe fantasies are extremely powerful. I place them this far up the scale because I think they give others a views to the inner most part of the person. It takes a lot of trust to share your fantasy with your partner. This is where reviewing the topic on fantasy as well as your fantasies with your therapist may be helpful before sharing your fantasy with your partner.

10) Penetration
The next step is developing comfort with sexual intercourse. The first step at this point is feeling comfortable with penetration. Understanding what you like/dislike, and what feels comfortable/uncomfortable is the key. Learning strategies and positions for penetration are required as well. Some people struggle with penetration due to pain, shame, or fear. As with all stages, ongoing reflection and conversation in this step is important with your support system and your partner.

11) Orgasm
Clinicians disagree whether orgasm is required in the final stage. I place it at the end because many individuals do see it as the goal and they struggle with experiencing an orgasm. And, obviously, orgasm feels great. Orgasm isn’t always required or needed. It is included, however, because my goal is to help you develop the skills, comfort, and self-awareness to experience orgasm. At this step, all of what you learned in the previous steps is used to facilitate success at this step. It is difficult to provide universal instructions, so working with your support system and your partner is very important.


ASSIGNMENT
1) Review your sex timeline. What parts of the above process do you need to address?
2) What do you need to discuss with your partner?
3) Develop a plan to build your sexual experience and skills.

Getting you and your partner off.

o increase your sexual satisfaction, it is important to address the six most common types of sexual performance problems.

Impotence problems reflect struggles with achieving and maintaining an erection.

Ejaculation problems
Sometimes a guy gets off too quickly or not able to get off at all. Ejaculation is when come is present and is not the same as an orgasm. They are often linked, so confusion is possible.

Orgasm problems
Some people aren't able to orgasm. An orgasm is the body response that is “involuntary” to sexual arousal. It is equivalent to the “sneezing” response of the body --it is going to happen no matter what.

Anal pain
Some people have too much pain when getting penetrated.

Low Sexual Desire
Sexual desire changes over time, both in terms of frequency and targets of sexual pleasure.

Sexual Aversion
An avoidance of sexuality or sexual behavior.

Obstacles To Blast Off

Medical care
You've heard it before but it still holds true. The first place of intervention is to get a complete medical check-up and address any medical issues. The causes of sexual dysfunction are varied and require tailored treatment plans. Medical issues could be age, high blood pressure, side effects of medications, etc. If there is a medical condition, no amount of talk therapy will help.

Knowledge
Many partners don't know how to stimulate their partners. Your job is to ask your partner what he likes just as it is your job to share with your partner what you like. Each of us has body parts more arousing for us. On the topic of masturbation and lasting longer, I highlighted the importance of getting to know your body and sharing this with your partner. Great sex requires talking with each other about what you like as well as what you don't like

Life
Sometimes life events such as stress, lack of sleep, job changes impair your ability to function. In these cases, healthy coping with the events will help you on the sexual functioning level.

Mental Health
Anxiety, depression, self-esteem, performance anxiety, and fear of disapproval are examples of mental health concerns that may impair getting off.

Reality
Keeping a realistic expectation is important. Older guys typically have a longer time between the ability to have an erection and the intensity of ejaculation changes (usually for the worse) than younger guys. If we compare ourselves to the young porn stars all the time, we're bound to have difficulties.

It's just the wrong time?
This is a catch all category. Take a look at what might be getting in the way. If you're going for a quickie, the rush and pace of the setting can curb your libido. And 'newsflash' guys; if you've been drinking expect things to take longer to happen, if they happen at all.

What You Can Do

1. Get a medical check-up. As the commercials go, make sure you're healthy enough for sex.
2. Learn about your body. What do you like or don't like. Share this with your partner and ask him about what he likes and doesn't like.
3. Address external circumstances in your life such as stress, exhaustion etc.
4. Address mental health issues related to functioning. A conversation with a professional may help.
5. Be realistic in light of age, circumstances, or setting.
6. Take your time. Improved sexual functioning is a process of practice, taking your time and learning what works and doesn't work. With a partner, using various touch techniques can decrease anxiety and address internal messages. Shame due to poor body image can be addressed through mutual affirmation with a partner which can take time. Addressing anal pain requires time to loosen the muscles allowing a guy to be penetrated.
7. Focus on other forms of sexual pleasure other than exclusive attention to the erection or orgasm.

Sexual Functioning

One of the components of the sexual health model is freedom from problems with sexual functioning. The treatment of dysfunction issues falls generally into two categories, physical issues and mental health issues. The first place of intervention for sexual dysfunction is to obtain a complete medical check-up. If there is a medical condition, no amount of therapy will help address the issue. If the medical issues are identified and resolved and do not appear to be cause of the functioning issues, it is important to seek help to address the additional issues. The causes of sexual dysfunction are varied require an equally number of treatment plans that are beyond the focus here. The goal is to help you possibly identify the issue and respond with plans.

The majority of physical functioning issues include:

Female Dysfunction issues.

Dyspareunia and Vaginismus are issues addressing female genitalia. The causes are varied. A medical review is required to address the cause and treatment. Once medically treated medically, you and your doctor can identify strategies to adjust for the medical issue. While the majority of causes are medical, there may be some psychological issues (such as unresolved abuse issues) that can contribute to the condition.

Male Dysfunction issues.

Male dysfunction issues are typically categorized as impotence problems and (premature and retarded) ejaculation problems. The key is to first get a medical check-up to eliminate physical causes.

Both Male and Female Dysfunction issues. :

Orgasm problems: Problems with achieving orgasms occurs for both men and women, yet are often experienced more often by women. Treatment may or may not be physical and require a medical review. Sometimes, the partners of females need education to assist women in achieving an orgasm.

Low Sexual Desire: Sexual desire changes over time; sometimes a decrease in sexual desire is normal, other times it may be a problem due to medical issues (such as hormone changes) or mental health issues.

Sexual Aversion is when there is an avoidance of sexuality or sexual behavior. More often this is a mental health issues.

Finally, it is important to review how your sexual behavior has changed to cope with sexual functioning concerns. Review your sexual behavior timeline/history, are there any correlation with functioning issues? Have there been changes in your sexual behavior because of functioning concerns (increased masturbation/pornography use b/c of problems with erections). Medication changes/chemical use, depression can all adversely impact your sexual functioning. Are any of these relevant? If sexual functioning concerns are present, what are your plans to address the issues?