“I demand that I climax. I think women should demand that. I have a friend who’s never had an orgasm in her life. In her life! That hurts my heart. It’s cuckoo to me.” —Nicki Minaj

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According to Rowland, Cempel, and Tempel, as reviewed in their recent study “Women’s Attributions Regarding Why They Have Difficulty Reaching Orgasm,” reports of difficulty or inability to orgasm in women range from 10 to 40 percent. Many factors can impede orgasmic capacity: age, hormonal status, sexual experience, physical stimulation, general health, type of stimulation, the kind of sexual activity (e.g., masturbation or not), and whether the relationship is a brief encounter or longer term. Further studies show that while the majority of women can masturbate to orgasm, up to 50 percent of women do not orgasm during sexual intercourse, even with additional stimulation.

Why do women have difficulty with orgasm? There are many possible factors, ranging from reduced sexual desire, pain during intercourse, difficulty becoming sexually aroused, and psychological and relationship factors, including anxiety and post-traumatic symptoms. Researching sexuality is difficult because of complex and inter-related factors, including statistical challenges as well as social stigma and taboos around discussing sexuality. Yet, given the scope of the problem, research is required to guide clinical interventions for women and couples for whom decreased sexual satisfaction is a source of individual distress and relationship problems.

In order to better understand what women themselves attribute orgasmic difficulties to, Rowland and colleagues surveyed 913 women over the age of 18, including 452 women who reported more severe problems achieving orgasm on initial screening. For women with more severe difficulty, 45 percent reported problems with orgasm during half of sexual experiences, 25 percent in three-quarters of sexual experiences, and 30 percent during almost all sexual experiences. Researchers first formed several focus groups to develop a set of commonly reported factors and then developed an online survey gauging demographic information, lifestyle, relationship status, how often they had sex, relationship quality, use of medication, sexual responses, physiologic factors (e.g., arousal and lubrication), and orgasm.

Finally, they looked at the level of distress from difficulty with orgasm, which is not necessarily perfectly correlated with actual difficulty, as some women are not bothered by it or prefer to abstain from sexual activity for various reasons. Three groups were identified for comparison: women who had orgasm difficulty, but were not distressed by it, women who were distressed, and women who did not have orgasm difficulty. They were all asked about why they thought they had difficulty with orgasm, using 11 categories identified during the original focus group and study development, including a 12th “Other” category:

1. I am not interested in sex with my partner.

2. My partner does not seem interested in sex with me.

3. I do not enjoy sex with my partner.

4. My partner does not seem to enjoy sex with me.

5. I am not sufficiently aroused/stimulated during sex.

6. I am not adequately lubricated during sex.

7. I experience pain and/or irritation during sex.

8. We do not have enough time during sex.

9. I am uncomfortable or self-conscious about my body/appearance.

10. I feel that medication or a medical condition interferes with having an orgasm.

11. I feel that my stress and/or anxiety make it difficult to have an orgasm.

12. Other

The most common overall reasons given by women were stress and anxiety, reported by 58 percent; lack of enough arousal or stimulation by nearly 48 percent; and not enough time by 40 percent. Moderately common issues were negative body image, reported by 28 percent; pain or irritation during sex from 25 percent; insufficient lubrication by 24 percent; and medication-related problems by almost 17 percent. The other factors were less commonly reported, by less than 10 percent of respondents.

When distressed women were compared to non-distressed women, researchers learned that more distressed women experienced anxiety and stress around sex and believed their partners did not like having sex with them. More distressed women, when asked to identify the single most important contribution to decreased orgasm, reported anxiety and stress, while non-distressed women reported less interest in sex and not having enough time to reach orgasm during actual sexual encounters.

Many of these factors are seemingly straightforward to remedy and are likely reflective of relationship quality and partner inattentiveness, among other reasons. There are simple ways to improve the frequency and quality of orgasm via changes in technique and specific communication strategies, which improve overall sexual and relationship satisfaction. While many of these approaches to improving orgasmic and sexual satisfaction sound like common sense, barriers such as poor relationship quality, inadequate or dysfunctional communication styles, unaddressed individual issues, such as depression, anxiety, trauma, and sexual and medical disorders, are often difficult to actually address.

Sexuality remains infused with pressure and shame for many people, in spite of greater positive and open attitudes. On personal and couple levels, people often rely on avoidant coping to deal with the anxiety and shame surrounding sex and sexual problems, solidifying pessimistic views, confirming negative self-image and amplifying low self-esteem, and reducing belief in their ability to make positive changes. Fortunately, by providing “esteem support,” partners can help one another with self-esteem and self-efficacy, making it easy to tackle challenges.

In therapy and through self-help, individuals and couples can address psychological and emotional issues, improve communication and relationship difficulties, and thereby directly work on intimate behaviors to achieve better sex for both partners. Restoring self-esteem and self-efficacy, practicing more adaptive, active coping, cultivating realistic optimism, and modifying relationship behaviors provides relief of underlying issues and improves overall relationship quality and sexual enjoyment. Rather than setting unrealistic short-term goals, which leads to chronic failure and hopelessness, approaching challenges with investment in compassion for oneself and others, gratitude, curiosity, and patience paves the way for long-term gains.

Please send questions, topics or themes you’d like me to try and address in future blogs, via my PT bio page.

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You’re cleaning up the house, thinking about the bills you have to pay, the friend you haven’t called in weeks, and that oh-so-awkward conversation you had with your new coworker yesterday, when your partner appears, touching your waist and giving you a sexually suggestive wink.

Now what?

Maybe sex seems like a fun and welcome distraction. In that case, great! Enjoy it.

But maybe you’re thinking something more along the lines of “Are you kidding me? You want sex right now? That’s certainly not happening!”

As I’ve written about previously, sexual rejection can be a difficult pill to swallow, particularly if one person is largely (or even entirely) responsible for initiating sex in a relationship.

But being the person who is rejecting sex doesn’t feel that great, either. Maybe we are annoyed that our partner initiated sex and clearly couldn’t read our mood or the situation. And so we roll our eyes, criticize our partner’s timing and initiation strategy, or even push them away entirely. Or we might feel bad because we hate saying no and disappointing them, so we agree to have sex to make them happy.

The latest sex research suggests that — compared to going along with sex to avoid negative outcomes — turning down sex doesn’t necessarily hurt relationship satisfaction, as long as we do it in positive ways.¹ Here are three approaches to keep in mind.

1. Clearly explain why you’re saying no.

If you’re not in the mood for sex when you’re partner initiates it, one of the best things you can do is explain to them why you’re not in the mood.

That’s because many people naturally take sexual rejection personally. We can drive ourselves into a tizzy trying to come up with a reason why we’re being turned down, often landing on it having something to do with us (e.g., they don’t find me attractive anymore, they are angry with me, they don’t love me as much as they used to).

So if you’re feeling too tired for sex, say that. If you had a long day, and you’re distracted by the stress at work, share that. It helps your partner understand your inner world a bit better and shows that your lack of interest in sex isn’t a reflection of your lack of interest in your partner.

Or, if your lack of interest in sex has everything to do with your partner (e.g., you’re fighting or not getting along these days, and sex feels temporarily off the table), say that. It’s much more helpful to start that conversation (even if it’s difficult) than to let more tension build up with silences and misunderstandings.

2. Suggest another time — soon(ish).

Think about rejecting sex similarly to making social plans with friends. If we invite a friend out for a bite to eat, and they just say “no,” it can feel pretty jarring. We might wonder: “Are they saying they don’t want dinner tonight? Or are they trying to hint that they want to hang out less frequently? Maybe they don’t like me as much as they used to?” It feels unsettling, because we don’t have all the information, and so we are left to fill in the gaps.

On the other hand, if you invite your friend to dinner, and they say: “Sorry I really need to recharge and have a night at home tonight, but maybe could we try next week?” It clarifies that the “no” is just a “not right now.” You know where you stand, and there is a plan to spend time together again soon.

Likewise, when it comes to sex, a flat out “no” can feel pretty harsh. We similarly tend to wonder, how long is that “no” for? And should we ask again in an hour? A day? A week? Never? Are they trying to tell me something else by turning down sex?

But sexual rejection usually feels a lot more manageable when we’re given a safety net. Something like: “I’m not feeling it right now, but maybe we could try on the weekend, once my work deadline has passed? Or later tonight after I go for a run? Or in the morning before work, after I’ve had a good sleep?”

3. Find another way to connect.

Just because you’re not in the mood for sex doesn’t necessarily mean you have to turn down other bids for connection and closeness.

We know from the research that women and men get so much more from sex than just physical gratification (like feeling loved and feeling safe). So perhaps sexual activity is off the table, but a nice cuddle, hand holding, a meaningful conversation, or even a game or activity you both enjoy might feel pretty good.

It might not be sex, but if your partner is reaching out as a way of feeling close, there are several different ways that this can be accomplished, even when sex doesn’t feel like an option. If there is some relationship-affirming activity you’re in the mood for that would make you feel good and closer to your partner, try suggesting that instead.

Take Away

Rejecting your partner’s sexual advances with these three tactics doesn’t ensure there won’t be any conflict or that your partner won’t be disappointed you said “no” to sex. But that’s not necessarily the end goal. Differing preferences for desired frequency of sex is one of the most common challenges in relationships and a key area of sexual concern for many, many couples. However, it’s important to keep in mind that it’s not conflict itself that hurts or strengthens relationships, but rather the way that couples manage conflict.

Most people don’t like feeling rejected (or being the one to do the rejecting), but offering a “no” that 1) provides an explanation, 2) suggests another time in the near-ish future, and 3) provides an alternative way to connect can help you let your partner down a bit easier.