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How To Achieve The Perfect Orgasm...

Female Orgasmic Difficulties and Concerns
by Dr. Michael Goodman

dr goodman photo

“Sex is the most fun you can have without laughing.”
-Woody Allen (in the movie Manhattan)

Many women report having difficulty achieving “orgasmic release” with male partner lovemaking. If you ask them about it they’ll say, “…Yes, I have difficulty achieving orgasm,” but when asked more questions they end up revealing that that’s not the complete story. They’re fine and experience success from self-pleasuring — rubbing their clitoral area or even going inside, perhaps fantasizing. The difficulty comes with “getting off” with their partner inside them but not with “releasing” via clitoral stimulation (self; vibrator; fingers; tongue…). These women report feeling “cheated” because when their lover releases with his penis, they’re not achieving the “vaginal” or “vaginally activated” orgasm (“VAO”) via the stroke of the penis that they’d internally hoped for.

Some doctors and therapists differentiate orgasms into the 2 categories of “clitoral” orgasm and “vaginally activated” orgasm. One is not “better” than the other, but their activation and the internal body feelings each evokes may differ.

Clitoral orgasm stems from stroking of the external clitoris (tip or shaft; perhaps also a bit inside…), and has been described as “electric”, “spreading outward from the clit”, “shuddering”, “spreading superficially”. A VAO is more internal. It is activated by stroking and pressure against the upper vaginal wall (the area called the “G-Spot”) and intra-vaginal dilation by a large object (penis, toy) activating intra-vaginal receptors and likely stretching receptors of the interior clitoral “roots” in the upper vaginal walls as well. The uterus may even contract with a VAO.

Whichever type of orgasm one is discussing, there are so many connections involved in making it happen. These include nerves, organs, emotions, hormones, relationship issues and psychologic considerations. Anxieties, worries, health issues that interconnect with the actual stimulation … all of this mean that there is no one way of “fixing” an individual’s inability or difficulty in “coming” when and in the way they either desire or think they should.

Having difficulty orgasming is disturbing, whether the concern is with coming at all or with coming in the way that you think you should or would like to. No article will give you the “key” to swinging from the chandeliers. Your best and most rewarding bet is to invest some time consulting — either alone or along with your partner — with a “Sexual Medicine Practitioner.” That being said, what follows in no particular order is a list of things/issues/pearls for you (and your partner) to ponder when wondering whether you are under-achieving in the orgasm department.

Knowledge: “The earth can move” in different ways, and none of them are better, best, right or wrong. It’s All Good. It is truly okay if — during penetrative sex — your orgasm is produced by touching, fingering, stroking, licking or fantasizing. Orgasms do not HAVE to be caused by the stroke of a penis or toy to be shudderingly enjoyable. Clitoral orgasm is just as good as VAO and vice versa.

Communication: Talk with your lover about how you like to be stroked, licked, fingered, touched, or penetrated. Also tell them if you would like them NOT to do any of those things. Discuss what (s)he and you like and do not like to do. Negotiate, be open minded, and try new stuff as you wish. Through all of this, remember: it’s about fun and emotional closeness. Orgasm may or may not come (pun intended!)

Self-stimulation: There’s nothing wrong with it, and that includes mutual stimulation and watching. Stimulation doesn’t always have to be about coming with “…the ol’ in ‘n out…” An orgasm is an orgasm, and may be shared in multiple ways, including “interlocked.”

VAO: Would you like to increase the possibility of VAO? Learn the location of your G-Spot and how you like to be stimulated there. Learn about the angles and positions that turn you on the most. If you have given birth and are experiencing a “loose & lax” vagina and increasing orgasmic difficulty, learn about vaginoplasty surgery and pelvic floor exercises. You may also want to look into the new radiofrequency or laser therapies.

Hormones: Make sure you are hormonally complete. If vaginal dryness, burning or pain is an issue you may want to consider making an appointment with a Certified Menopause Practitioner to learn about the MANY ways of regaining the level of comfort, lubrication, and pliability that you had during your younger years. Your choices include micro-dose intra-vaginal estradiol or estriol, intra-vaginal DHEA suppositories, an oral capsule, and “resurfacing” the vaginal interior with laser or radiofrequency(“RF”) energy.

Therapy: Hey! If none of the above work to your satisfaction and you feel that you should be having ‘way more’ satisfying orgasms in your life, then I suggest that you seek out a qualified, experienced sexual medicine practitioner with proper qualifications such as “AASECT”, “IF” (ISSWSH Fellow), etc. Again, remember this: It’s All Good. But also remember that therapists can help. What better way to spend money than by investing in having a better sex life?

Have a question you want answered? Let us


By Micheal Goodman, M.D., May 12, 2017


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