The Big O (And We Don’t Mean Oprah!)

Orgasm. Such a complicated topic; so many questions, so few answers. But let’s focus on the most important point, which is, that for women, the biggest obstacle to experiencing orgasm is anxiety. How can anyone relax while having sex if she’s thinking, “Will it happen this time or won’t it?”

As you can imagine, research on this topic is somewhat limited. But the renowned sex researchers William Masters and Virginia Johnson, who were the first to describe the four-step process of experiencing orgasm (during intercourse) many decades ago, said there are four steps involved:

1) Excitement. During foreplay, blood begins to engorge the clitoris, vagina, and nipples, and creates a full body sexual blush. Heart rate and blood pressure increase.

2) Plateau. Sexual tension builds as a precursor to orgasm. The outer one-third of the vagina becomes particularly engorged with blood, creating what’s called "the orgasmic platform."  Heart rate, blood pressure, and respiration continue to increase.

3) Orgasm. A series of rhythmic contractions occur in the uterus, vagina, and the pelvic floor muscles. Sexual tension releases, and muscles throughout the body may contract. A feeling of warmth usually emanates from the pelvis and spreads throughout the entire body.

4) Resolution. The body relaxes, with blood flowing away from the engorged sexual organs. Heart rate, blood pressure, and respiration return to normal.

(For another model of sexual arousal, remember Rosemary Basson's, which takes into account women's more complicated reality.)

Another good thing to know is that experiencing orgasm during intercourse takes time. In one study of 1,000 women, the “mean duration” was about 13 minutes. So trying to hurry it along or time it to coincide with your partner’s is probably not going to help.

It all gets back to the whole idea of relaxing—of letting go and focusing on the moment, enjoying the closeness and intimacy itself without worrying about what the outcome will be every time you have sex.

And, too, most women—two thirds of us—never experience orgasm at all during intercourse; some say the only way they ever get there it is through hand stimulation (their own or their partner’s) or with a vibrator, which often is the quickest route.

If you’re having trouble experiencing orgasm, try some things on your own to see what works and what doesn’t, not just physically, but mentally. Some women, for example, find that fantasizing puts them in a “zone” where they can escape the distractions of life. (Imagine yourself on a desert island with the one you love!)

This is one of those things that can only get better with honest, open communication. Talk with your partner about your feelings, your reactions—everything—so that you both have a good understanding of what’s going on and why.

Let us know your questions about experiencing orgasm; we’ll do our best to answer them (if you’d rather not post them here, use the “Ask Dr. Barb” button on our site). And in the meantime, relax and enjoy the journey.


Sleepless Isn’t Sexy

Last month we talked about some of the disincentives to sex, and fatigue was one of the top three. As you may know from your own experience, getting a good night’s sleep during or after menopause is often a challenge. Hormonal fluctuations are often the culprits; lack of progesterone and estrogen can bring on night sweats and hot flashes, and who can sleep with all that going on! (Chances are your partner can’t either–a double whammy.)

Insomnia, snoring, sleep apnea, and restless leg syndrome are also very common among menopausal women. In fact, in one study, more than 40 percent of post-menopausal women polled reported waking up frequently during the night.

Lack of sleep can really take its toll on you, physically, mentally, and emotionally. You walk around like a zombie the next day and don’t feel like doing much of anything, least of all having sex. And if it becomes chronic, happening night after night, it can create a vicious cycle of constant fatigue that can have some serious repercussions, including:

  • Inability to concentrate
  • Reduced memory function
  • Increased irritability
  • Problems in relationships
  • Becoming accident-prone
  • Tendency to overeat

Chronic sleep disorders can also lead to depression and anxiety, creating a whole new set of problems that can be difficult to treat—and that can further handicap your sex life. That’s why it’s so important to do something about it right away.

First, try some of these steps, which many sleep experts recommend:

  • Go to bed at the same time every night and get up the same time each morning.
  • Use the bedroom only for sleep—and sex (and having sex just before sleep might help, too!).
  • Get 30 minutes of exercise during the day (but not after 8 p.m.).
  • Limit fluid intake in the evening.
  • Avoid alcohol and caffeine (many sodas have caffeine).
  • Practice relaxation techniques, such as meditating or visualizing yourself in a calm, restful setting.

If none of these techniques work, talk with your doctor about the possibility of taking medication. Sometimes it’s just a matter of breaking the non-sleep cycle. There are some good over-the-counter drugs and herbal remedies available, too. If the problem persists, you might consider going to a sleep clinic.

Just don’t allow a sleep disorder to rob you of the things you love to do. Keep trying until you find a solution that works for you.

Good Sex Is Relaxing

(But you probably knew that, right?)

I wanted to elaborate a bit more on the Wall Street Journal article I mentioned in a recent post. “The Joy of Researching the Health Benefits of Sex,” (a play on the famous book, The Joy of Sex) talks about what researchers are finding about the physiology of sex and the health benefits that may come along with it—a topic I’m always interested in exploring.

Dr. Irwin Goldstein, a urologist and director of sexual medicine at Alvarado Hospital in San Diego, says some benefits are obvious even without scientific evidence. “When you have good sex, there’s a relaxation response and a satiation response… you lie there and life is great.”

That’s the result of hormones and neurotransmitters that rise and fall during sexual activity, especially dopamine and oxytocin, which we’ve discussed before. That nice relaxed feeling is what sometimes causes people to fall asleep right afterwards. In fact, in a 2006 survey of 10,000 British men, 48 percent admitted to having fallen asleep during sex!

Not that we want to encourage that, but it’s comforting to know there’s a physiological reason for it.

Another researcher, Stuart Brody, a psychologist at the University of the West of Scotland, says all this relaxation can be very helpful in reducing stress in both men and women. In one study, he had people keep diaries of their sexual activities for two weeks, then took their blood pressure while performing a stress-inducing activity such as adding numbers rapidly in their heads. Those who had had intercourse during the fortnight had smaller blood pressure spikes more quickly than those who had no sex at all.

While you’ve probably experienced a peaceful feeling immediately following sex, you may not have been aware that its benefits were so long lasting.

Researchers have also studied sex and its relationship to cancer: Can frequent sex lower the risks of some types of cancer? Although there is evidence that does point to that, most researchers say there are too many other variables in the studies to draw any certain scientific conclusions about it.

The real lesson, says Dr. Erick Janssen, a senior scientist at the Kinsey Institute at Indiana University, is how sex can contribute to our overall well-being. “If you’re having sex in a frequency and in a way that is compatible with who you are, then that’s healthy.”

I couldn’t agree more. How about you?