Addiction: Understanding ORGASMIC DYSFUNCTION for Love Sex and Porn Recovery
ORGASMIC DYSFUNCTION Some women and some men do not achieve the third phase of sexual response: orgasm. How easily different women can achieve orgasm lies on a continuum. At one extreme are the rare women who can have an orgasm merely by having an intense erotic fantasy, without any physical stimulation at all. Then there are women who climax merely from intense foreplay, women who have orgasm during intercourse, and women who need long and intense clitoral stimulation in order to climax. At the other extreme are approximately 10 percent of adult women who have never had an orgasm in spite of having been exposed to a reasonable amount of stimulation.
Non-orgasmic women frequently have a strong sexual drive. They may enjoy foreplay, lubricate copiously, and love the sensation of phallic penetration. But as they approach climax, they lose psychologically what they are prepared for physiologically. The woman may become self-conscious; she may stand apart and judge herself. She may ask herself, "I wonder if I'll climax." "This is taking too long; he's getting sick of it." Frustration, resentment, and the persistent erosion of a couple's erotic and affectionate relationship bring nonorgasmic women into therapy (Kaplan, 1974; McCary, 1978).
Failure to have an orgasm may be primary, with orgasm never having occurred, or secondary, with loss of orgasm. It may be situation specific, with orgasm occurring, for example, in masturbation when alone but not in intercourse, or it may be global. In men, there are two kinds of orgasmic difficulties and they are opposite problems: premature ejaculation and retarded ejaculation.
Premature Ejaculation Most men have ejaculated occasionally more quickly than their partner would like, but this is not equivalent to premature ejaculation. Premature ejaculation is the recurrent inability to exert any control over ejaculation, such that once sexually aroused, the man reaches orgasm very quickly. This is probably the most common of male sexual problems. Premature ejaculation can wreak havoc with a couple's sex life. A man who is worried that if he becomes aroused he will ejaculate right away cannot be a sensitive and responsive lover. His partner expects him to be better. Not being so, he becomes more self-conscious, and she commonly feels rejected, sometimes perceiving him as cold and insensitive. Not uncommonly, secondary erectile dysfunction follows untreated premature ejaculation.
Retarded Ejaculation Retarded ejaculation, which is less common than premature ejaculation, is defined by great difficulty reaching orgasm during sexual intercourse. Frequently, the man may be able to ejaculate easily during masturbation or foreplay, but intercourse may last for an hour or more with no ejaculation. Contrary to myth, the staying power of the retarded ejaculator does not place him in an enviable sexual position. His partner may feel rejected and unskilled, he may feign orgasm, and he may have high anxiety accompanied by self-conscious thoughts like, "She must think something is wrong with me." Secondary erectile dysfunction sometimes follows.
It is dangerous to attach time numbers to both retarded ejaculation and premature ejaculation, saying, for example, that premature ejaculation occurs whenever ejaculation persistently takes less than thirty seconds and retarded ejaculation occurs whenever ejaculation persistently takes more than halfan hour. This misses the important point that the definition of the sexual problem, both orgasmic and arousal, is always relative to one's partner's expectations. Many couples are able to work out quite satisfactory erotic relationships even when one partner climaxes very quickly or very slowly, and it would be inappropriate to label these individuals as having a sexual dysfunction.
THE CAUSES OF SEXUAL DYSFUNCTION
Physical Causes The physical causes of sexual dysfunction probably account for a very minor fraction of the problems. Injuries, physical anomalies ofthe genitals, hormonal imbalances, neurological disorders, inflammations, drugs and alcohol, and the aging process itselfcan all interfere with a woman's capacity for sexual arousal (Kaplan, 1974; McCary, 1978).
As for male sexual dysfunctions, perhaps 15 percent are physical, caused by excessive alcohol or drugs, circulatory problems, aging, exhaustion, or anatomical defect. There is a useful way of distinguishing between which men are physically and which men are psychologically unable to get erections. All of us dream approximately 100 minutes a night, and in the male dreaming is almost invariably accompanied by an erection (in the female by vaginal lubrication). We are not certain why this occurs, but it does tell us if a man is physically capable of erection. If a man who is otherwise "impotent" gets erections during dreaming or has an erection upon waking in the morning, the problem is ofpsychological, not physical, origin.
Psychological Causes Psychological problems probably cause the great majority ofthe sexual dysfunctions. There is general clinical agreement that negative emotional states impair sexual responsiveness. Earlier, we spoke of the sensitive interplay of physiological and psychological factors. The physiological part ofthe sexual response is autonomic and visceral; essentially it is produced by increased blood flow to the genitals under the control of the autonomic nervous system. Certain autonomic responses, sexual arousal among them, are inhibited by negative emotions. If a woman is frightened or angry during sex, visceral responding will be impaired. Similarly if a man is frightened or feeling pressured during sex, there may not be sufficient blood flow to cause erection.
What are the sources of the anxiety and anger that women feel which might cause sexual unresponsiveness? From a psychoanalytic point ofview, one cause may be unresolved unconscious conflict: a woman unconsciously hostile toward her husband might express her hostility by withholding her sexual response, just as a consciously hostile woman would. Psychoanalysts also express a view about male sexual dysfunctions. They claim that erectile dysfunction is a defense against castration anxiety. According to Freud, a boy between the ages ofthree and five wishes to possess his mother and, in his own mind, becomes a hated rival to his father. He fears that his father will castrate him in retaliation. When this Oedipal conflict is unresolved, erectile dysfunction may later ensue. By failing to have an erection, he wards off the anxiety of castration. That is, he will not commit the act with his "mother" and thereby not be castrated by his "father."
These psychoanalytic formulations have not been tested in the laboratory and indeed are quite difficult to test. But in cases of erectile dysfunction, clinical experience suggests substantial unresolved conflicts over the man's mother and father (Masters and Johnson, 1970; Kaplan, 1974). Alternatively, erectile dysfunction can be understood dynamically not as a defense to ward off anxiety but as a physiological response to anxiety that may be coming from any source. When an individual's defenses fail to prevent anxiety, erection will not occur.