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So you've never had an orgasm.

Or you're not sure if you've been orgasmic. Or you haven't been able to have an orgasm in some way that you wish you could. Or you used to be orgasmic but now you aren't. What can you do? What can your husband do?

An orgasm is a reflex response that gets triggered when there is enough build-up of sexual tension from effective stimulation and freedom to go after it without inhibition or fear of being out of control. We cannot "will" an orgasm, but we can encourage it or resist it.

Sexual arousal and release (orgasm) are controlled by our involuntary, or autonomic, nervous system. Arousal, getting "turned-on" or sexually excited, is controlled by the passive branch of our involuntary nervous system. Arousal happens early in sexual play, in our sleep and even throughout the day. Nipple erection and vaginal lubrication are indications of arousal. To get aroused, we have to be relaxed and soaking in pleasure, because the passive or relaxed branch of our involuntary nervous system has to dominate.

Orgasm, however, is controlled by the active branch of our involuntary nervous system. As arousal builds to the point where we are just about to go "over the edge," our body shifts from the parasympathetic nervous system (the relaxed side of our involuntary nervous system) being dominant to the sympathetic nervous system (the active branch of our involuntary nervous system) being dominant. So to have an orgasm, we have to get active and go after it. Many women who struggle to be orgasmic tend to remain passive during their sexual experiences, so they don't help their bodies make the shift to the active nervous system's control.

Sexual arousal and release are conditioned responses. If, as a child or young adolescent, you learned to block intense sexual feelings that would have moved you toward orgasm because of guilt or shame, you may, as an adult, continue unknowingly to stop your arousal before it leads to orgasm. Perhaps you learned to be orgasmic by rocking on your pillow to help you fall asleep as a child and now you have no clue how to transfer that form of stimulation into sex with your husband. Or perhaps you were exposed to pornography or had your first orgasm in response to a negative stimulus, and now you may have to picture that same stimulus to have an orgasm. You are left in a lose-lose dilemma: to have an orgasm and feel guilty about the images in your mind or not have an orgasm and feel sexually unsatisfied. Fortunately, if we have learned to respond or not respond in a certain way, we can retrain our bodies to respond differently.

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