Expert Answers Factual Answers to Your Sexual Health Questions

Anonymous on September 8, 2011

I’m a quad woman and I’ve only been able to have an orgasm from manual stimulation. Am I missing something?

I’m a woman and – due to muscular dystrophy – I’m a quadriplegic who uses a ventilator. I’ve also had a hysterectomy. Both of these changes came before I started sexual activity…so I can’t compare “before” and “after.” I’ve only ever had an orgasm from manual stimulation instead of intercourse. That’s great, but am I missing something?

answered by
Mitchell Tepper, PhD, MPH on September 8, 2011

Thank you for sharing your concern about your inability to orgasm with intercourse, in relation to your disability and hysterectomy.

First, you're not alone. Many people living with a disability weren’t sexually active before becoming disabled...and many wonder if they might be missing out. And the fact that you can’t reach orgasm through intercourse is a common experience among women…with or without a disability or hysterectomy.

Only 28% of women reported always achieving orgasm during intercourse with a partner in one of the largest national studies on sex behavior conducted to date ⎼ the National Health and Social Life Survey. Many more women (61%) reported almost always or always being able to orgasm from masturbation...so it’s possible you’re simply in the large percentage of women who don’t orgasm from intercourse.

Why, then, do vaginal orgasms seem so important and common…if they aren’t? Historically, we can look to psychoanalyst Sigmund Freud’s theory that – as women mature – their center of erotic pleasure shifts from the clitoris to the vagina. Although Freud’s work remains influential to this day, that particular theory didn’t pan out to be true.

You also mentioned that you’ve had a hysterectomy and, yes: a hysterectomy can affect a woman’s ability to orgasm.That said, researchers at theUniversity of Marylandfound that most women who had a hysterectomy actually reported higher sexual function after the surgery. Why? Because the health issue(s) for which the hysterectomy was needed were resolved (e.g., uterine pain), resulting in many women enjoying sex a lot more than pre-surgery.

Of course, hysterectomies that include removal of the ovaries (anoophorectomy) can have a different result. In these cases, women often experience sudden menopause (because the ovaries manufacture the body’s estrogen), which can decrease sexual function. If you’ve had a total hysterectomy, the good news is that your doctor can likely prescribehormone therapy, if needed and not contraindicated because of your paralysis.

Something else to keep in mind…

There is no such thing as a “standard” orgasm.Beverly Whipple, a well-respected sex researcher, says that an orgasm is what a woman says an orgasm is. In other words, you – along with every other disabled or able-bodied woman – can define your own orgasms, including where and how they originate.

So, if you’re happy with the orgasms you’ve experienced so far, that’s a great start. And if you’d like to experiment with other ways to orgasm, you could try stimulating your genitals using hands, a vibrator, your partner’s tongue or fingers, or different positions during intercourse. You may even find that, like manywomen with spinal cord injuries, other areas of your body are particularly pleasurable to touch.  

Bottom line? I can't say whether your ability to orgasm only through manual stimulation is the result of physical impairment. But what I can offer you is the knowledge that the ability to orgasm is resilient, and avenues to orgasm are plenty.

Thanks again for writing, and I wish you sexual well-being.

Related info:

Mitchell Tepper, PhD, MPH

Dr. Tepper directs sexual health education at SexualHealth.com. An AASECT-certified sexuality educator and counselor, his areas of expertise include sexual dysfunctions, sexuality following disability or illness, pleasure and orgasm, relationships, and military and veteran couples' counseling. Dr. Tepper was educated at the University of Pennsylvania and Yale University.

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