Orgasms After Cancer: Part II

Orgasms After Cancer (Part II): Exploring the “O” in “OMG!

Disclaimer: This information is not a substitute for medical care. Always inform your healthcare team of any concerning symptoms you are experiencing, and consult with your provider before starting new treatments, therapies, or health routines.

Welcome to Part II of “Orgasms After Cancer!” In case you missed Part I, head back to the March 2022 issue of Elephants and Tea for a quick peek; it will be helpful as we move on to Part II. After all, the more you know about how things work, the more likely you are to discover what works for you. Sit tight, because things are about to get stimulating!

Creating A Climactic Context

Changes that occur due to cancer treatments often alter the landscape of our bodies, requiring us to re-learn what works within this new context of survivorship. Essential ingredients to taking charge of your sexual pleasure include intention, curiosity, and a willingness to explore. Let’s take a look at some strategies that can help you find the right mental space as well as the right physical technique to get on track.

FINDING THE RIGHT MENTAL SPACE

According to the Dual Control Model, (6,9) there are two competing pathways that impact our sexual response. The inhibitor pathway is triggered by different kinds of distractions, reducing our interest in and ability to enjoy being sexual. The excitor pathway is triggered by things that we perceive as sexually stimulating, and sparks our sexual attention. Learning how to reduce distractions (dampen down those inhibiting triggers) and how to prime the pump (turn up the volume on those excitatory triggers) can help you target your mental energy toward present moment pleasures.

• Reducing Distractions. In contrast to the orgasmic “threshold of inevitability” that our counterparts with penises experience (meaning, once their orgasm reflex is initiated—it’s happening!), (11) clitoris-owners often have to work hard at not only finding “The Zone,” but then staying in it the whole time to achieve orgasm. This helps explain why our orgasms can be notoriously fickle. All it takes is one ill-timed distraction to interrupt our concentration, and it can be game over!
• Addressing Distracting Thoughts. The problem is that most of us have a hard time shutting down our random, rapid-fire thoughts. These could be associated with our sexual experience (Does my stomach look weird in this position? Will my partner feel bad if I don’t orgasm? Why is it taking so long?), or totally unrelated to sex (Did I forget to add milk to the grocery list?). We all get in our own head sometimes, but there are ways to reduce these mental roadblocks. Mindfulness is a skill that strengthens present awareness, which can help your brain stay in-the-moment long enough during sex to nurture an orgasm to fruition. Learn more in Dr. Lori Brotto’s book Better Sex Through Mindfulness.
• Addressing Distracting Environments. Adjusting your physical space can really help prevent environmental distractions (11). Make sure you have adequate privacy and time so that you don’t feel rushed and aren’t worried about being interrupted. Is the temperature of the room warm enough? Is the lighting relaxing and visually pleasing? Are there any cats meowing, dogs barking, or piles of unfolded laundry in the corner of the room ready to catch your eye? You get the idea.

Priming the (Erotic) Pump

Just as important as reducing distractions is the idea of sexy stimulation for your brain. Finding ways to pique mental interest and get those gears turning can encourage your body to respond more readily to sexual touch. Essentially, it can help you reach that orgasm threshold.

• Use Your Imagination. Examples include remembering a previous experience you have had that was especially exciting or erotic, visualizing a steamy movie scene, or creating a sexual fantasy. Watching or reading erotica (look up author Emily Foster) can also get the creative juices flowing. Get your partner in on the fun by taking turns reading erotic fiction bedtime stories aloud to each other.
• Use All Five Senses. Our senses are closely linked with our emotional responses. Think of how quickly a specific song or a scent can evoke a vivid memory or a strong, visceral feeling. Spend some time considering the circumstances around some great sexual encounters you have had. What bits and pieces of these scenarios can you bring into your current sensory experience?
• Tune into Touch. What does it feel like to explore the palms of your hands, inner thighs, collar bone, lips, scalp? Experiment with how different types of touch create sensations in other areas of your body. This can be done alone or with a partner, as long as genitals are off limits! Touching for touch’s sake can be fun and relaxing, and it’s a way to reconnect to the sensations that often get lost when the focus is purely on “doing sex.”
• Bolster Blood Flow. Exciting things that get our adrenaline pumping create a lot of the same physiological changes that occur when we are sexually charged: faster heart rate and breathing, increased oxygenation and blood flow, perspiration, feelings of tense anticipation, and a heightened sense of alertness and focus. This means that even if the cause wasn’t really related to sex, we can still capitalize on our physiologic response by reading it as arousal (7). For example:

• • Seek Some Thrills. Of course, avoid putting yourself in a situation that is truly terrifying or unsafe, but thrill-seeking can occur at whatever level is comfortable for you. If you love a good horror film or roller coaster ride, great. If your idea of adventure is more like trying a new flavor of ice cream, go for it! The exhilaration that accompanies novel experiences, especially when you share them with your honey, can translate to feeling feisty between the sheets, too.
  • Get Moving. Have you ever felt especially in the mood after a workout? The flood of feel-good endorphins and rush of oxygenated blood throughout the body (genitals included!), combined with the body confidence we get from feeling fit and strong, can all work together to set the stage for a playful frolic in the bedroom. Forget the snooze-fest inspired by bubble baths—go out for a sweat-inducing run or head to a dance party to get your body moving.

FINDING THE RIGHT PHYSICAL TECHNIQUE

In addition to finding the right frame of mind, the second piece of the puzzle is to find a stimulation technique that actually works. Although we have learned that the clitoris often plays an important role in achieving orgasm (see Part I); we also know that triggering the orgasm reflex can take practice, (2) meaning that it’s normal to require experimentation to learn the method or approach that fits your unique needs.

• Get Comfortable. Promoting comfort is critical. If you experience genital pain with sexual touch, the cause should be investigated and managed. This may include something as simple as beginning a vaginal moisturizer regimen and using (a generous amount of) personal lubricant with sexual activity. Ways to ease other physical discomforts could include taking an analgesic or a good soak in a warm bath before getting your groove on to help with neuropathies or to soothe achy muscles and joints.
• Experiment with Positioning. Certain sexual positions may be better for clitoral stimulation, either by making simultaneous manual stimulation by you or your partner easier, or by promoting stimulation of the internal clitoral structures during penetration. Also, something as simple as changing the positioning of your legs (keeping them close together or spreading them apart) or rhythmically contracting and relaxing your pelvic floor muscles may heighten sensation (1). Supporting body parts with pillows during sex can help, too. You might put pillows under your knees if lying on your back, or between your knees if lying on your side, or strategically placed between you and your partner to prevent pressure on your chest or on an ostomy device, for example.
• Experiment with Different Types of Stimulation. Self-touch for sexual pleasure is very common. It’s a great way to figure out what’s changed since cancer, and to explore and learn what works for you. In fact, masturbation is often one of the first professional recommendations for addressing orgasm problems because it is such an effective strategy (5). There are lots of different ways to self-pleasure (3). Consider “priming the pump” (see above) or incorporating a sexual aid (see below). Just make sure that you are not in a rush; the length of time you need to dedicate to appropriately direct stimulation is probably longer than you think (2) (A full Bridgerton episode, perhaps? Thanks, Netflix!). After your own self-guided tour, you might choose to provide a hands-on tutorial for your partner to show them what you have learned.
• Adopt Sexual Aids. Augmenting sexual encounters with products that provide reliable stimulation can help with sexual response. Both the American Cancer Society (1) and the National Comprehensive Cancer Network (10) suggest considering a device such as a vibrator to help with orgasm problems after cancer. These devices are not just for solo love; they can also be incorporated into partner play. An advantage to the use of a vibrator is that it can prevent fatigue because it makes it easier to sustain the amount and duration of stimulation that you might need to reach orgasm. Your local sexual health boutique is a great place to talk with a knowledgeable expert and to see different device options, but sometimes people feel more comfortable ordering online. Great retailers include A Woman’s Touch, The Tool Shed, and Smitten Kitten, among others. If you are looking for a way to spend your Target, Amazon, or Walmart gift card, look no further! Options abound at these retailers, too. To learn more about vibrators, check out the guide (4) from A Woman’s Touch.
• Try Some Bibliotherapy. This is just a fancy term for educating yourself by reading! Some books on the topic include Becoming Orgasmic by Julia Heiman and colleagues, Come as You Are: The Surprising New Science that Will Transform Your Sex Life by Emily Nagoski, Woman Cancer Sex by Anne Katz, and Sex Matters for Women, Second Edition: A Complete Guide to Taking Care of Your Sexual Self by Sallie Foley and colleagues. A Woman’s Touch also has a great online resource (3) to get you started. If you have a partner, consider enlisting them as a study buddy.

Putting Orgasms in their Place

OK, so after all this talk about orgasms, I just want to be clear that experiencing an orgasm is not essential for satisfying sex. I repeat, orgasm is not the only route to sexual satisfaction. In fact, you might even be thinking to yourself, What’s all the fuss about? I don’t need an orgasm to truly enjoy a good romp with my partner! To this I say: Truth! Enjoying sex without having an orgasm is totally legit. Not to mention, it’s common.

If you don’t orgasm with sex, you are normal. (Please visit the section “Am I Normal?” for some additional reassurance). In fact, a lack of orgasms with sexual activity in itself isn’t considered dysfunctional at all. While about 20 percent to 40 percent of women around the world report difficulties achieving orgasm with sex, only a minority (in one American study, less than 5%) report also being concerned or distressed about this (6). For a lot of vulva-owners, whether or not they orgasm with sexual activity isn’t necessarily a top priority or a motivation for sex.

The research of Cindy Meston and David Buss showcases this point—they identified 237 unique reasons women reported for engaging in sex, and having an orgasm was just one of them (7). What can I say? We are complex! Other reasons included: (7) for pleasure or excitement, emotional connection and intimacy, relationship building, curiosity and adventure, relaxation, relieving pesky period cramps, to burn some calories, boredom, and because their partner just smelled freakin’ irresistible.

The Bottom Line

If you are curious about exploring your orgasm potential, there are lots of different things to try that can support your orgasm efforts. However, orgasms are just one component of human sexual response. While they can be a fabulous by-product of a sexual excursion, orgasms are not a requirement for fun, enjoyable, and satisfying sex.

Whether or not an absence of orgasms warrants further investigation or examination really depends on whether or not it’s bothersome or distressing to you. Remember, orgasms do not exist as a performance for anybody—they are for you to enjoy if you wish. Pleasure is the measure; the barometer for a successful tryst should be how it makes you feel, rather than any orgasm tally. Check in with yourself to determine whether your needs and desires are being met, and go from there. Happy exploring!

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AM I NORMAL?

First of all, the short answer is yes. Yes, you are normal.9 Secondly, if you think you are not, it’s probably because every movie you have ever watched has lied to you.

I guess that’s probably a little dramatic, but the bubble that I am trying to bust here is that orgasms do not magically just happen with penis-in-vagina sex, as so many film scripts would have us believe. In fact, whenever a sexy scene comes on-screen, I usually can’t enjoy it because I am too busy rolling my eyes and whispering to whoever is within earshot that “it SO doesn’t work like that!” I mean, come on. Where’s the mental and emotional (i.e., non-genital) lead-up? The lube application? The condom? All the handsy stuff? Where are the weird body noises and facial expressions, the occasional head bumps, the nervous giggles?

My point is that sexual authenticity is sorely lacking representation in our popular culture, and it’s important that we don’t buy into everything we see. (One exception I have found is the endearing sex scene featured in the film Nick and Norah’s Infinite Playlist, which gave me all the feels!) At the risk of being labeled as the wet blanket of erotica, I prefer realism and honesty over staged ecstasy. If sexual encounters in Hollywood looked more like they actually happen in real life, maybe we all wouldn’t feel so woefully inadequate all the time about our bodies and the human variability in our sexual responses. Sex can be silly or steamy. Sometimes it’s mind-blowing; other times, meh. It’s normal to experience fluctuating levels of desire, intensity, and satisfaction on occasion.

So, if what you experience, enjoy, and prefer to do sexually does not mirror that of paid actors, never fear! If it’s safe, happy, and consensual, then it’s right and good. Authentically satisfying sexual encounters are often perfectly imperfect. That’s life, and that’s normal.

PLEASURE IS THE MEASURE

Societal norms like to tell us that sex without an orgasm is like coffee without the caffeine (what’s the point?). But I say that sex without orgasm is more like ice cream without the cake (still delicious!).

Hear me out. We know that reaching orgasm through penis-in-vagina sex alone is not a realistic expectation for many (correction: most) women (5). We also know that lots of women don’t consider orgasming to be an essential component of a great sexual experience. So why is there still so much insistence that reaching orgasm is the ultimate measure of sexual success or failure?

Thinking about sex as a step-by-step event (first comes desire, then comes arousal, then comes orgasm) is problematic. That’s because it can lead to spectatoring, where we basically become preoccupied with analyzing and comparing what is happening to what we think should be happening, instead of enjoying ourselves in the moment. But who invited this black cloud of performance pressure to come rain on our pleasure parade, y’all? If we are worried about our performance (how we look, how we sound, whether we are taking too long, etc.), we are not paying attention to the good stuff! After all, sex isn’t really about performing for anyone—it’s about how we feel while engaging in it.

Honesty is typically the best policy. Rather than pretending (turns out that faking orgasm is super common [8]), communicate about what you like and what’s important to you. Assert yourself and your needs. If that means helping your partner learn what feels good to you, great! If that means taking things into your own hands (literally), fabulous! If that means helping your partner understand that you really don’t need an orgasm to enjoy being with them, say so! Give yourself permission to step down from the performance podium. Instead, get curious about what it feels like to be immersed in the pleasure experience, and encourage your partner to do the same.

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BIBLIOGRAPHY AND REFERENCES

1. “Managing Female Sexual Problems Related to Cancer,” American Cancer Society, (2022). https://www.cancer. org/treatment/treatments-and-side-effects/physical-side- effects/fertility-and-sexual-side-effects/sexuality-for-women-with-cancer/problems.html. Accessed April 17, 2022.
2. “Orgasms for People with Vulvas and Vaginas,” A Woman’s Touch Sexuality Resource Center, (2020). https://sexualityresources.com/wp-content/uploads/Orgasm20-1.pdf. Accessed April 17, 2022.
3. “Self-Pleasuring for People with Vulvas and Vaginas,” A Woman’s Touch Sexuality Resource Center, (2021). https://sexualityresources.com/wp-content/uploads/SelfPleasureVulva21-1.pdf. Accessed April 17, 2022.
4. “Tips for First-Time Vibrator Users,” A Woman’s Touch Sexuality Resource Center (2020). https://sexualityresources.com/wp-content/uploads/TipsFirsttimeVibes20-1.pdf. Accessed April 17, 2022.
5. Andrea Bradford, PhD, “Treatment of Female Orgasmic Disorder,” UpToDate, (2020). https://www.uptodate.com/contents/treatment-of-female-orgasmic-disorder. Accessed April 17, 2022.
6. Andrea Bradford, PhD, “Female Orgasmic Disorder: Epidemiology, Pathogenesis, Clinical Manifestations, Course, Assessment, and Diagnosis, UpToDate, (2021). https://www.uptodate.com/contents/female-orgasmic-disorder-epidemiology-pathogenesis-clinical-manifestations-course- assessment-and-diagnosis. Accessed April 17, 2022.
7. Cindy M. Meston and David M. Buss, Why Women Have Sex: Understanding Sexual Motivations from Adventure to Revenge (and Everything in Between). (Times Books; First edition, August 28, 2009).
8. Charlene L. Muehlenhard and Sheena K. Shippee, “Men’s and Women’s Reports of Pretending Orgasm,” Journal of Sex Research, 47(6), 552–567 (2010). https://doi.org/10.1080/00224490903171794. Accessed April 17, 2022.
9. Emily Nagoski, Come as You Are, (Simon & Schuster; First edition, March 1, 2015).
10. National Comprehensive Cancer Network. “NCCN Guidelines: Survivorship,” [Version 1.2022], March 30, 2022. https://www.nccn.org/professionals/physician_gls/pdf/survivorship.pdf. Accessed April 17, 2022.
11. John P. Wincze and Risa B. Weisberg, Sexual Dysfunction, Third Edition: A Guide for Assessment and Treatment Third Edition, (The Guilford Press; Third edition, May 11, 2015.)