September 22, 2010

Please Sir, I Want More

From Oliver, the 1968 movie version.

Psychologists often explore the role of sexual satisfaction in a patient's emotional health.  Sex plays a unique role in marriage and monogamous relationships. Sex is one of those activities that depends on partner willingness. If a partner or spouse doesn't like to read and discuss books, for example, the avid reader can join a book club. If a partner doesn't like to go bowling, it's socially acceptable to join a bowling league.
But if a person does not meet the sexual needs of his or her partner, couples generally are not free to go out and have sex with others; or, at least this is not viewed as a socially acceptable option. The promise of monogamy means sex with my partner or spouse only.

The result of the demands of monogamy are thus: When a sexual stalemate occures, couples need to keep trying, keep improving the relationship, and work at communicating.

Disclaimer: This post does not talk about relationship problems and resentments that can interfere with sexual satisfaction, and there are many. Nor does it talk about medical problems that can interfere with healthy sex. Please talk to your physician, preferably a discussion with Ob-Gyn, urologist, or other medical specialist to rule out some of the physical causes of sexual dysfunction. An annual exam, complete with blood work, is essential to rule out physical problems and for maintaining good sexual health.

When I assess an individual's or a couple's sexual intimacy, one the most common problems I see in heterosexual women is believing that their sexual preferences are neglected, ignored, or in some way not prioritized. While similar problems occur in same sex relationships, I will confine this discussion to straight couples for the ease and flow of wording.

In many cases, women report sexual passivity: A typical pattern is for the man to initiate the sexual flow, from start to finish, with the woman giving little input. Not surprisingly, she is often deprived of an orgasm.

Or if she does experience one, it is not fully satisfying. After all, some studies indicate that the average female orgasm can last up to 20 seconds. Compared to a man's 8 seconds. But many women estimate their orgasms last in the 4-5 second range. It's an orgasm, yes, but not as satisfying as can be. Researchers tell us women are capable of so much more. More frequent, longer and even multiple orgasms.

In short, many women are left humming the familiar Peggy Lee tune:

For too many women, too much untapped potential remains. Which may help explain why so many long-term couples report the bed-dead syndrome. No sex at all. For years. Or near dead. Sex that occurs along the order of once or twice a year. A sex life in need of resuscitation.

With this in mind, I frequently encourage women to let their partners know what they want. Simple enough, right?

Not at all, as it turns out. Many women report finding it difficult to approach their mates with sexual requests or to give honest feedback when their needs are not met. When, in short, they don't reach orgasm. Many women report feeling shy, awkward, and inhibited.

Sexual Assertiveness 101 - I wish it were a required course in the school of relationships.
Let's look at cases where women DO tell their husbands what they want, usually some form of wanting more direct clitoral stimulation, either orally or manually. Problem solved? Not so fast. The complaint I frequently hear is that the man doesn't follow through. He doesn't change his usual repetoire. Or the change is so short lived that she still doesn't get where she wants to go. So he may give her more, but its only about a minute or so more, when what she really needs is, say, 20 minutes more. Or longer.

In fact, research has shown us that women require, on average, 20 minutes of direct clitoral stimulation to reach orgasm during partner sex (from a partner; during masturbation, the average time required shortens considerably).

On average means that some women take only a few minutes and some women take much longer, say 30 or 40 minutes. Which is not to say women can't work to reduce this time frame. Women can. With practice and experimenting with various modes of stimulation. And with regular communication, men can learn what women like and lessen her time-to-orgasm and help her achieve more satisfying orgasms.

But back to women communicating with little success. I often hear that after a woman works up the nerve to express her preferences, her partner follows through for the next few encounters, but then the changes trail off. Back to the ordinary fare. No orgasm for the unlucky lady. She often feels neglected and assumes her pleasure is unimportant to him.

This scenario can be a disappointing, frustrating, confusing, lonely, and even an angry, time in a relationship. Must he be handed a honey-do-list before each and every sexperience? Why doesn't he get that these preferences are something needed as part of the main course and not an optional dessert? Is he that dense? Or uncaring? These are some of the questions I hear.

Some women are left wondering if he cares more about (1) pleasing himself; (2) giving the woman what he wants her to enjoy (refer to #1) rather than what she actually enjoys; (3) giving the woman what he hopes she will enjoy, without checking to see whether she actually does enjoy it -- unless we count the cursory and often dreaded question, "Was that good for you, too?" Too often, however, neither the question nor the answer is honest.

Speaking of dishonesty, many women report they fake orgasms in order to "get it over with" because they know their partner won't stop until he thinks she's had one. The thinking goes, if he's going to persist in all that misguided thrusting, often to the point of soreness, she may as well end it sooner rather than later. It's easy to see how a vicious cycle of faking can develop.

An equal opportunity factoid: Men fake orgasms too. But it's certainly more common in women.

Men, when confronted with their partner's request for change, have reportedly replied, "But what we've been doing has always worked for you before." This sets up what can become an opportunity for the woman to admit she's been faking. But should she? A dicey situation. The answer is highly individual, depending on the couple (true of virtually every sexual scenario). Women often report feeling more worried about their partner's ego than they do about their own pleasure. They often will not admit to faking. They feel stuck.

Yet another motive in the man's lack of persistence in following his partner's request: He avoids the awkwardness and uncertainty of trying unfamiliar techniques. It's psychologically uncomfortable. It feels risky. What if this doesn't work, either? Does that make me a lousy lover? He may not want to ruin his heretofore all too infrequent chance at sex. And who wants to end sex with nobody having an orgasm? With disappointment and despair? So he sticks to his comfort zone, the safety of what he knows, and hopes for the best.

So is this another one of those men-are-selfish-cads rant? No. Most men report that they want very much to please their partners. They find a woman's pleasure a big turn on. In this regard, traditional pornography may be teaching us something relevant (reluctant as I am to admit that pornography offers anything close to a healthy education). Ever notice how the camera is frequently aimed at the woman's face? Way more often than the man's? Men, apparently, are turned on by seeing a woman's facial signs of pleasure (never mind that the porn star is faking, too). Porn fantasy is all about placing oneself in the starring role, and for men, that role is being a successful, knowing sex partner, reliably giving his partner an orgasm. Giving her scads of them, in fact, and if pornography is to be believed, orgasms with just his magnificent penis!

But the plain truth of couple's sexuality is that only 20% (or thereabouts) of women regularly orgasm through penetration alone. I haven't checked out much pornography lately, but the "penis only" formula was pretty much the standard fare the last time I looked. Little or no oral sex for the woman. Little or not manual stimulation. Little or no direct clitoral stimulation. At least not for the length of time most women require.

By the way, you've probably noticed by now that 20 seems to be the magic number* when it comes to female sexuality:
- 20-second orgasms
- 20-minutes to get there
- 20% can orgasm through penetration alone.

*These numbers are approximates, of course. Different studies show varying results.

There are many avenues this post can take, but my main point is to inform women and men of something I don't think we hear often enough: You are not alone. Forget what so many magazines say. Sexual surveys are some of the most inaccurate -- this has been studied, too -- with people consistently over reporting their sexual frequency and satisfaction.

Don't go by what you read, or what you see in the movies or pornography (never) and certainly not what he hears in the locker room. Go by what you feel. Take an honest accounting of your sexual experience. If you're feeling dissastified, if you realize that your partner is not responding to your needs, don't give up on yourself.

Work on it. Read about it. Talk to your partner about it. Explain that you want to have good orgasms too, and yes, maybe even multiple orgasms. And that you want to bat closer to 1000 like he does (maybe). It's an entirely doable goal to reach orgasm close to 100% of the time.

Or, okay, maybe you don't want to shoot for the moon. Shoot for stopping the charade and letting him know you want both of you to enjoy more satisfying sex at least most of the time. If you have trouble talking about it (most couples do), write him a letter, leave him a love note on his pillow, send him an email, send him a link to this post, suggest a book, or better yet, read a book together.

Here are a few books that I like to recommend:

1. The Elusive Orgasm by Vivienne Cass, Ph.D. A comprehensive, up-to-date exploration of physiological and emotional contributions to the female orgasm.

2.. How to Give Her Absolute Pleasure by Lou Paget. This book covers the full gamut in a plain speech format. I especially like how she covers the politics between men and women in the bedroom. She is helping men understand us a little better, like, why, for instance, we are worrying about the piles of laundry while he's trying to pleasure us and what he can do about it (fold laundry), such as, help us unwind before sex instead of "diving right in."

3. Satisfaction by Kim Cattrall ("Sam" from Sex in the City fame). This book gives special attention to oral sex technique, with simple illustrations that men can see for themselves "how to do it." When my husband saw these, he said, "Finally! A picture that lets me see what to do!" Read an excerpt os Satisfaction, here.

4. She Comes First by Ian Kerner. Excerpt here. This book presents this rarely promoted but highly useful concept: couples should prioritize the woman's orgasm first. Afterward, he can have his, because, in general, his is easier, and because her prime is pumped and she can have another while he's having his. Because many women are capable of orgasm via penetration alone AFTER they've had their first (or better, multiple) orgasm. And mostly because, as we experienced women know, he falls asleep after his.

If after much time and communication attempts you feel you are getting nowhere, talk to a licensed professional about it. People routinely consult a professional to improve their golf game or change their hair color. Think of how fulfilling marriage and relationships could be if people reached out as readily for something as vital and as sex.

-Sandy Andrews, Ph.D.
CBT Cognitive Behavioral Psychologist 

Austin, Texas

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