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Orgasms After Cancer: Part II

by Marloe Esch RN, BSN, OCNSurvivorNovember 22, 2022View more posts from Marloe Esch RN, BSN, OCN

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.


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.

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.


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.

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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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.


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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  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). Accessed April 17, 2022.
  3. Self-Pleasuring for People with Vulvas and Vaginas,” A Woman’s Touch Sexuality Resource Center, (2021). Accessed April 17, 2022.
  4. Tips for First-Time Vibrator Users,” A Woman’s Touch Sexuality Resource Center (2020). Accessed April 17, 2022.
  5. Andrea Bradford, PhD, “Treatment of Female Orgasmic Disorder,” UpToDate, (2020). Accessed April 17, 2022.
  6. Andrea Bradford, PhD, “Female Orgasmic Disorder: Epidemiology, Pathogenesis, Clinical Manifestations, Course, Assessment, and Diagnosis, UpToDate, (2021). 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). 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. 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.)

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