at the beginning, he agreed to abstain from direct stimulation to his genitals for a week. During that time, his job was to figure out what other types of stimulation aroused him and whether any other sensations could bring him to climax. Since Frank worked in a hospital and was all too familiar with patients who were unable to give themselves direct stimulation, I suggested he imagine what it would be like if he was in their position: how would he go about deriving sexual pleasure if he could not quickly, effectively masturbate with his hand?
By refreshing his palette and directing him away from instant gratification, Frank discovered a world of new sensation he had not previously considered. It took only a few weeks before he was eager to explore these new understandings of his body with his lover, Don, who was stunned when Frank offered to turn the tables, and see which spots made him extra happy as well. Of course, there were still times when Frank liked to get off in a hurry but the better he became in bed, the more patient he grew and the more willing he was to let orgasm take a backseat to sensuality. When Don told him he had turned into a wonderfully versatile and skilled lover, Frank felt like a completely new, and much happier, man.
Another patient, John R., a newlywed in his mid 20s, was having difficulty adjusting to married sex because he kept expecting to feel all the same things he felt during masturbation when he made love to his wife, Kendra. Since boyhood, John had masturbated in one specific way and had inadvertently conditioned himself to climax from that one method — which involved a lot of tugging and rough sensation to his penis. After only six months of marriage, he was already locking himself in the bathroom to relieve his sexual tension. Although he was very attracted to Kendra, he was too embarrassed to admit what he liked and couldn’t bring himself to tell his beloved that their sex life didn’t satisfy him. Happily for him, Kendra was willing and eager to make changes and, at my recommendation, came with him to his next session. I recommended that they start out by simply exploring mutual masturbation — with him coaching her on the sensations he liked the most. Kendra wasn’t just a loving woman, she was a smart one with a strong dominant streak. She took to rough play like a duck to water, and quickly figured out the kinds of sensations that sent him through the roof. They were both shocked to realize how intense their chemistry could be once they gave themselves permission to reveal ALL their secrets. The more he told his wife about his hot buttons and fantasies, the more she confessed her own. In just two months, they began a truly adult, mature, loving model of sex, based on what made them happiest.
A meaningful consideration in figuring out what you, personally, need from sex is that innumerable physical variables make one person’s sexual response different from another’s. Human genitals are as different in their minutiae as hands or feet. Size and color are the most apparent differences but subtle variations, internal and external, are the rule. Not all genitals are positioned exactly the same: your parts may be slightly higher or lower, further up front or further back, than the next person’s. The distance between genitals and anus vary. Some of your genital aspects may be more prominent or less prominent. You may have hair where someone else is (naturally) bare. You may have a curve where someone else is straight, or wrinkles where the next person is smooth. Your veins may be closer to the surface, and your nerves may cluster in slightly higher concentrations. Your overall skin sensitivity may be low, medium or high. Such normal physical variations contribute to differences in sensitivity and response; the same caress or stroke that feels fantastic to one person could feel painful to another and won’t feel like anything at all to a third.
Lena R. was a vibrant, optimistic woman in her late 20s. She had freely explored her body and her sensuality since childhood. Her favorite activity was pulling the bed-sheets tight between her legs and riding them until “the oooh feeling,” as she described it. Sometimes she added other things — a shampoo bottle, a bar of soap — to increase the intensity of the pressure against her vulva. In her college years, she’d sown all her wild oats and then some, but one thing still eluded her: being able to climax during intercourse. Now in a happy marriage, she still couldn’t orgasm unless something was pressed tight against her labia over the clitoral hood. As we talked, it struck me that Lena wasn’t “stuck” on any one type of masturbatory habit. She had experimented with dozens of different ways of reaching climax. But in every case, the method that put her over the top invariably involved pressure on the outside of the vulva. She volunteered that once, by accident, her husband pressed down hard on her pelvis during sex and she “almost” came. She was frustrated by her lifelong inability to climax from penetration and wondered if she’d “masturbated too much” as a girl and ruined her chances of being able to enjoy “normal” sex.
Contrary to the popular image of women masturbating in ways that mimic the pleasures of intercourse — an image belabored in pornography for men — in my clinical experience, female orgasm commonly derives from pressure, friction, and other sensation either to the outside or visible aspects of female genitals (such as the clitoris, labia, and pubic mound). Vaginal penetration is wildly exciting to some women, but for many others, it is primarily an adjunct to their pleasures (or fantasies), not the mechanism for their orgasm. This is, indeed, one of the reasons why foreplay is so important. Stroking, caressing and other manipulations to female genitalia prepare a woman for orgasm.
Getting to understand your individual anatomy is a vital piece of the puzzle in successful masturbation and climax. Endocrinologists use a term I love: genital congestion. It may sound as if you have a cold in your groin but it’s the opposite: it’s a measure of blood-flow (and subsequent warmth), based on the amount of swelling that occurs. Depending on your sexual health, genetic traits, and vascular fitness, swelling in the genitals (penis, clitoris, vagina, and testicles) can range from truly impressive to barely noticeable. Some men find that their penis in repose is small but that they grow surprisingly large when fully erect; others may seem well-endowed, but do not see significant lengthening during erection; and most men fall between the two ends of the spectrum. Similar variations are common in women in as well. Some are endowed with a clitoris that swells significantly and protrudes from the labia; others show little or limited clitoral growth during arousal.
Some people experience genital congestion as a light, tingling pleasure; some as a swooningly sharp pang; some as a desperate clawing need for relief. All of these little (or not so little) variations impinge on what kind of pressure you need on your genitals as well.
Many of the women I’ve worked with admit that they still masturbate as they did as little girls, only in place of blankets or objects, they now use vibrators. Indeed, one of the most popular vibrators ever sold — the “Magic Wand,” manufactured by Hitachi — is a non-penetrative toy. As sex toys for women become more sophisticated, the emphasis has trended away from penetrative toys. The most upscale new tinglers focus on stimulating the clitoris and external genital region. Abundant anecdotal material proves again and again that, in private, for many different reasons, women opt for non-penetrative masturbation. Wishing you were built slightly differently, or could climax from things that biologically don’t work for you, is, in my opinion, a recipe for dysfunction. Far better for every woman to accept that her body is unique, to map its sweetest spots, and then to exploit her natural sensuality.
I suggested to Lena that instead of reaching for a goal that may never be possible, we assume it was natural for her to need pressure to climax. It was entirely possible that the location of her clit, or the sensitive nerves concentrated behind the clit, meant that her body simply responded best when stimulation was applied from the outside, not the inside. If this was how she was anatomically geared, she could fight and ultimately lose, or work with her body to find new pathways to coupled orgasm. We reviewed different sex positions and movements that could increase pressure on her pelvic region — from having him manually apply pressure during sex (placing his hand over her mound and pushing down), to doggie-style sex with something under her pelvis that she could grind against. Knowing they were very creative and open-minded, I requested that she allow him to watch her masturbate so he could better understand what she did to climax. It might give him ideas about what he could add to the mix. They agreed to try a range of new techniques and were thrilled with the results. They found one sure-fire method that worked for them — he entered her from behind and
