Seeking Orgasms and Female Sexual Satisfaction

If a woman has never experienced an orgasm, does this mean she would be diagnosed with Anorgasmia or, as it is now called in the DSM 5, Female Orgasmic Disorder (FOD)? In the recent film  Good Luck to You, Leo Grande, 55 year old British widow Nancy Stokes, played by Emma Thompson, has never had an orgasm. At the start of the film, Nancy (a retired religious school teacher) has only ever had penetrative sex with one man (her recently deceased husband) in one position. She describes her body as a carcass she’s been dragging around with her for decades.

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The inability to orgasm is a common presenting issue brought to a sex therapy practice. It is estimated that up to 41 percent of women worldwide do not experience orgasm and 50 percent of those who do, are dissatisfied with how often they orgasm. A number of factors that contribute to a women’s inability to orgasm including internalized shame about sex, religious conflict, body image issues, previous sexual trauma, fatigue, stress, depression, and shyness about asking for adequate touch. After conducting a sexual history, a therapist would diagnose FOD if the client has not been able to orgasm after a normal sexual excitement phase in all (or almost all) sexual encounters.

A sexual history of Nancy would have revealed that she has never attempted to self-pleasure and that her husband never offered to stimulate her manually, orally, or with a sex toy. Given this history, a sex therapist would not have diagnosed Nancy with FOD, but rather honed in on the behavioral issues contributing to her unexplored orgasmic potential. A sex therapist might begin by debunking the societal myth that women should be able to orgasm solely through vaginal penetration with a partner. In a study exploring middle aged women and touch researchers discovered that women who rarely or never engaged in sexual touching, were almost 3 times less likely to climax than those who always engage in sexual touching.

In the film, Good Luck to You, Leo Grande, Nancy does not employ the help of a sex therapist, but rather a young sex worker who goes by the name Leo Grande. After the death of her husband, Nancy’s embarrassment about her limited sexual knowledge and experience is outweighed by her desperation to find out what she has missed out on–including the elusive orgasm. 

Nancy and Leo’s banter throughout the film ranges from witty and playful to thoughtful and moving–exploring the themes of aging and sex, women’s critical self-image, and feelings of guilt related to pleasure. Nancy, like many women, begins the film believing that the desire for sexual pleasure is irrational, gluttonous, and shameful. She is unable to prioritize her erotic feelings and sexual desires after years of catering to a husband’s needs and shunning her own.

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In their first meeting, Nancy reads Leo a list of sexual activities she wants to experience. When Leo begins to initiate touch and tries to remove Nancy’s clothing, she withdraws and repeats negative descriptions of her older body, assuming that it disgusts him. Like Nancy, so many women experience body shame or dysphoria. Body image issues have been shown to cause low sexual desire, difficulty with lubrication and orgasm, and painful or unpleasurable sex. While women of all ages carry body shame due societal beauty standards and what the media centers as “beautiful”, post menopausal women carry unique issues resulting from the natural weight gain that ensures after one stops having a period.

Part of the work of sex therapy is encouraging clients to become embodied, and to view their physical bodies with compassion and curiosity so they are open to experimenting with erotic and sensual touch. An important element of this is an invitation to put aside a goal of having an orgasm–which Leo communicates to Nancy. For a woman like Nancy, learning to be present and in the moment is the most important first step. 

The theme of being cut off from one’s body is also explored as it is related to the societal role of women, and mothers in particular, who spend more time in their heads making lists, planning ahead, and chastising themselves than they don’t meet all their goals including being sexually responsive. When Leo tells Nancy that in order to enjoy their time together she’ll have to let go of the part of her that watches and judges her from the outside–a phenomenon that sex therapists refer to as “spectatoring”–, she tells him that that voice is the only thing that keeps her life on track.

For many women, another intrusive voice is the one that pressures women to constantly put the needs of their families above their own. When Nancy’s daughter calls her numerous times, Nancy tells Leo that she always–no matter what–answers her phone. Many mothers who seek out sex therapy report feeling guilty if they are not fully available for their loved ones, but then resent their loved ones when they are unable to be in the moment.

No matter how long a woman reports she hasn’t been able to climax, there is hope. Between 80 and 92 percent of women who have never had an orgasm are able to orgasm after sex therapy  treatment. Included in this statistic are women like Nancy, who desire sexual fulfillment and are no longer willing to participate in the charade that they are enjoying themselves. Sixty-seven percent of women who have faked an orgasm are no longer willing to do so as they age.

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Good Luck to You, Leo Grande is a movie about the mental prerequisites for experiencing sexual fulfillment–feeling entitled to happiness and pleasure, contentment with oneself, and peace with one’s body. In the film, two people learn about themselves and one another through intimacy, being fully present, and honoring and communicating boundaries. The movie ends (spoiler alert!) with Nancy experiencing her first orgasm through self-pleasure. When Nancy stands gazing at her naked body in the mirror at the end of the film, it is clear she has learned to treat herself with compassion rather than judgment, experience mindful embodiment, and how empowering sexual arousal can be–all lessons that are important at any age.