Behind the doors of a sex therapist, clients seek understanding, acceptance, and answers.  But how can mental health professionals help their clients achieve these goals?  Dr. Stephanie Buehler, a licensed psychologist, sex therapist and a recognized author, invites you to “Step Into My Office” with monthly sidebars taken from her own experience.

In terms of the couple, a woman’s lack of knowledge and inability to communicate to her partner what will arouse her and bring her to orgasm definitely contributes to problems. But partners are also sometimes ignorant and simply assume that all is well unless a woman complains. However, women can be too embarrassed to say anything or fearful that a complaint may make their partner feel inadequate.


Referred to me by a couple’s therapist, Felice complained that she had never had orgasm—not by herself, and not with her husband of 28 years. When I asked if her husband had ever checked in with her to see if she enjoyed their encounters, she looked at me with surprise and said, “No, and I never thought it was unusual that he didn’t ask, but now that you mention it, it’s kind of weird!” After several meetings geared toward developing rapport and educating Felice about the mechanism of orgasm, William came to the office with her. William explained that all these years he just thought Felice was enjoying herself. The couple admitted that they were both brought up in conservative households where no one talked about sex and that they were virgins when they married. Thus, neither one really had an idea of what was supposed to happen when a woman had orgasm, or how to get Felice to that point.

The first step toward helping Felice experience climax was getting the couple to overcome their shame and embarrassment so that they could simply talk to one another about sex. Fortunately, this couple was resilient in that they were able to compliment themselves on all the ways in which they had grown together and functioned well as a couple; other couples in the same circumstances do not always fare so well when a woman finally tells her partner that she has never had an orgasm.

Women are faced with overt and covert messages about female pleasure. If or when they attended a sex education class, women (and men) might be presented with an outline of the uterus, fallopian tubes, and ovaries— no mention of the vulva, clitoris, or vagina. They are sold products to freshen natural odors, sending the message that female genitals are “dirty.” More recently, women are faced with physicians who are willing to provide “vaginal rejuvenation” and surgical reduction of the labia, with the implication that normal labia are unattractive. Finally, most women learn about orgasm from friends or the Internet, which can be a fount of misinformation, including Freud’s misinformed idea that mature women have orgasm through intercourse. Even lesbian women sometimes need counseling to understand the importance of clitoral stimulation.

PrintMaintaining control of one’s sexual urges is a common cognition contributing to anorgasmia. Orgasm requires letting go of muscle tension as well as permitting the emotional experience of fun and pleasure. Many women raised with the message that “nice girls don’t” or who have suppressed sexual fantasies and feelings in the service of religious beliefs often express that once they are in an appropriate relationship, it is difficult to “flip the switch.” They have a hard time believing that they deserve pleasure and generally put much more energy into all other endeavors of a relationship than into sex.

For a full list of activities to help overcome a situation like this, check out Stephanie Buehler’s book What Every Mental Health Professional Needs to Know About Sex.