The reasons that women may not be enjoying sex are numerous and often complex.

Sexual experiences reflect the mingling of the mind and the body. What goes on in the mind is affected not only by what is going on sexually and nonsexually between the partners, but by everything that has gone on in the woman's life. Sometimes even experiences from childhood can be relevant.

This means that what she feels when her body is being stimulated by her partner depends not only on the partner's skill, gentleness, care, and ability to be guided by her needs, but also by what is going on in her mind while this is going on.

Despite the complexity of these issues, many women and their partners can be helped by learning more about the many ways women can receive sexual pleasure.

A slow approach to sexual play works best.

A woman can be pleasured in many ways, include sexual talking, caressing, holding, and the physical contact of her partner's body. Focusing early on genital stimulation is often neither pleasant nor arousing, and may even create negative feelings, both physically and emotionally. Similarly, the potential for pleasure from breast touch is usually high but, again, the timing, type, and duration of touch that a woman will enjoy can be extremely variable, not only from woman to woman but from one occasion to the next.

Lack of stimulation from intercourse is a common concern. Sensing little physical response from the vagina itself is actually quite appropriate - the vagina is cleverly designed to deliver a baby and large numbers of highly sensitive nerve endings would be inappropriate. Women have plenty of sexually sensitive structures, but most of them are hidden.

The clitoris - discovering this sexually sensitive, but hidden organ.

The clitoris is much more extensive than the tiny part that may show under the clitoral hood (see Figure 1).

Clitoris region and erectile tissue

Figure 1

Clitoris region and erectile tissue.

The head of the clitoris is highly sensitive, and many women prefer that it not be stimulated directly. The body of the clitoris extends right up to the pubic bone and then divides and runs along the 2 sides of the pubic arch. Indirect stimulation of the clitoris through the mons or from the sides, coming through the lips or labia, can be very rewarding, as can direct stimulation of the shaft but not the head, although oral stimulation here may be very enjoyable.

The clitoris is made of spongy tissue that fills with blood as the woman becomes sexually aroused. This tissue is similar to penile tissue, and is also called erectile tissue. A little more erectile tissue of the clitoris is found around the urethra. This can be stimulated by a finger placed about one inch into the vagina, stimulating the front wall.

Some women may initially find that this sensation reminds them of an urge to pass urine but on repeated occasions, pleasure, high arousal, and orgasms can be experienced (some have referred to this as the "G" spot). There is yet more erectile tissue on either side of the vaginal opening but it's underneath the labia and also underneath a thin layer of muscle. It can be stimulated by fingers massaging through the labia on each side of the vagina, but this stimulation needs to be firm and consistent. Because the erectile structures are so well protected here, the feeling of hypersensitivity that many women get from touching the head of the clitoris does not occur.

The sad thing is that because these structures are so hidden, they cannot be effectively stimulated during intercourse unless both partners' bodies are particularly close. Sometimes after the man has ejaculated and his penis is slightly smaller, both pelvises can be much closer and she can move her pelvis on his, and therefore stimulate the mons area and indirectly stimulate the clitoris.

But some women get very aroused by intercourse and have orgasms that way. Why don't I?

Probably far less than 50% of women reliably have orgasms during intercourse itself, so it's certainly not abnormal to find that high arousal and orgasm does not occur solely through intercourse.

It is usually one of the following situations that allows for high arousal, pleasure, and orgasm to be possible with intercourse:

  • Sometimes it may simply be a matter of anatomical fit - if the penis is fully inserted and the 2 pelvises are pressing on each other, the woman has much more "outside" stimulation.
  • Many women will say that if they're very aroused (and therefore the vaginal walls are very full of blood), there is the pleasant deep pressure sensed with entry and thrusting of the penis - for some women the pleasure is enough to lead to orgasm.
  • There is a very complicated network of nerves in front of the deeper part of the vagina, and this may be stimulated sufficiently in some women by the penis itself from inside.
  • Remember, the mind is also important in determining the response - the mental excitement from intercourse itself may also be the reason the physical sensations seem much stronger.
  • If the partner delays his ejaculation, then the woman can have internal stimulation for longer. If she finds intercourse itself mentally very exciting and perhaps they combine other physical stimulation to the breast or the genitalia and perhaps also kissing, all of these stimulations together may lead to higher arousal and orgasm.

The path to greater pleasure

Women who feel little pleasure from sexual activity need to consider the different possibilities that might be at the root of it: Whether they feel sufficient trust and emotional closeness with their partner, or whether issues from their past are interfering. If this is the case, psychologists, physicians, or counsellors might be appropriate people to ask for help. If, however, she feels it is more a matter of understanding her body's response and having more information, she and her partner can consult books or therapists.

Rosemary Basson, MD