Dr. Andrea and the Mystery of the Possibly Missing Clit*

Ahoy.

Welcome, troubled friends, to the third installment of Ask Doctor Andrea. Dr. Andrea is our groovy IBWMW Doctor-at-Large with specialties in women's/sexual health, nutrition, and Ayurveda. If you have an entertainingly embarrassing problem, or hell, just a regular old boring one, man up and email it on in. (Note: This is not a substitute for individual medical advice or care. So if Dr. Andrea tells you to stick a rusty tin can up your butt or something, check with your doctor first.)

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I have been married for 35 years and I have seen my wife have four orgasms in that time. The first one was on our 25th anniversary vacation. She says she has very little desire for sex. But we make love once or twice a week and she says she enjoys it to a degree (the touching, skin-on-skin, closeness, cuddling, etc.). 

We have had ups and downs in the relationship but overall do pretty well together.  We have seen counselors to keep the relationship healthy and we have talked about her lack of desire and lack of orgasms.  The conclusion is that she just has a low libido and is “wired” with a low sex drive.  That’s just how she is, physically and personality-wise, so I am trying to accept that (as one might accept a physical disability in a partner). 

Still, there are some paths we have not explored thoroughly.  To get to the point, what is a "normal" clitoris? I know where it is supposed to be, but will an aroused woman have a little button or bump or something external that a man can feel there (with finger or tongue or whatever)? Because I have never felt anything more than a slight swelling at the top of my wife's genitals. I suspect that may a contributor to her lack of responsiveness.

I have only been intimate with my wife, so I have nothing to use as a comparison.  But when I read erotica: “He rolled my swollen clit between his fingers” or self help books (Satisfaction, K. Cattrall & M. Levinson): “The clitoris responds quickly when his tongue draws circles on its surface.”

Surface?  Circles?  Swollen?  Sounds like their should be a little button or nub or something.  In all my years of going down there, there is nothing “sticking out” or swollen or anything but concave cleft between her labia minor. My wife says she can feel her clit, but I certainly cannot. I have heard there are medical conditions where the clit never "descends" or stays under the clitoral hood. She could have a general sensation there but nothing I can detect externally.  How common is that?

She is also very sensitive in that area.  When I rub it to try to stimulate her, after a minute or so, she pushes me away, complaining I am “rubbing her raw,” even if we are using a lot of lubricant.  I have talked to her about this over the years, and although I try to be very gentle about it, it's a difficult subject to discuss, as she takes it as me criticizing her, or saying something is wrong with her. Well, four orgasms in 35 years, it sounds like something is not right. But she says she has asked her OBGYN and she says she's "normal" physically.

I just wonder if this could be related to her difficulty in enjoying sex.

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Dr. Andrea: First of all, thank you for asking! It shows you are willing to find new information to be more aware of what's going on and try to change a situation that isn't as fulfilling as it could be. Kudos.

I have to say I have several questions before I answer as best I can with limited information- it's odd to do it over the internet and not in person so I can see the expressions/body language/energy of both people.

That said, here is my response:

It's probably not her anatomy. Everyone's clitoris is different- and the thing is, it's a tiny area with a fantastically dense amount of nerve endings, and since she's 'super sensitive in that area,' you have noticed 'swelling,' and there's no history of female circumcision (RIGHT?!?), she's likely perfect. Most don't actually 'pop out.' It's not a penis, and there's a reason it was so 'mysterious' for much of western medical history (cultural patriarchal issues aside for the moment). When did you start trying to find her clitoris? Atrophy does occur in women as they age, and the entire area can flatten and thin out, especially if sex is infrequent (or unsatisfying- the positive hormonal and anatomical response is important in keeping the tissue functioning), so the anatomy may have changed slightly since you married. Is she peri- during- or post-menopausal? Changing hormonal balance could also affect her perception, lubrication, enjoyment, and communication, depending on how it's going for her.

Point two about anatomy- the female body has about a billion potential erogenous zones. Let that sink in. Think about a billion. Yes, the clitoris is a magical thing. But imagine this: take all the nerve endings in your penis, all of them, and shrink the physical size of skin area down to smaller than your pinky finger tip, then poke/prod/itch/tap/lick only that tiny area for more than a second or two = overwhelm and irritation = forget it. Especially if it's never been successful before. Not fun so much. 

So, what other areas are lovely and sensitive but perhaps with slightly less tendency for sensory overwhelm? There can be a 'g spot' of increased nerve ending density inside the vagina, about an inch up, midline, on the anterior (front) side, and some women can have orgasms solely from stimulating that area. Breasts, nipples, earlobes, lips and tongue, fingertips, hip bones, backs of knees and fronts of elbows, feet, neck... there are myriad. And each woman is different, so the most fun part is finding YOUR woman's favorite spots, and NOT overdoing it.

No matter what area you decide to try, remember clearly these two points: 

a. only stay in the same area as long as her body tells you it's a good idea. Read her breath, amount of her own lubrication, her back arching, overall body tension/relaxation, any little vocal noises that might escape... Her body has a language that if you can read you don't need to talk at all. Don't grade or analyze or ask for input if you don't have to- if she's resigned and overthinking, it's likely better to get her 'out of her mind' and back into her body by exploring instead with BOTH of you reading her body's response. 

b. GENTLE. Especially in the area you think her clitoris might be. Touch with only as much pressure as you'd put on a baby's eyeball to get an eyelash out (clearly, never actually do that.)Then increase or decrease pressure, direction, speed (go with achingly SLOW for a while) based on her response, which you should note at every single moment. Like meditation.(See Nicole Daedone's TED talk on Orgasmic Meditation, "Orgasm: The Cure For Hunger in the WesternWorld" below)

Since it's not likely her anatomy, what else could it be? Some (most) women take a longer time than you would think to become aroused (certainly longer than most men, and certainly more likely after 35 years of NOT being aroused much) so need more time and attention and usually emotional or intellectual stimulation as well. That said... focusing on the orgasm may be a big part of the issue in this case. I'd like to suggest a few things. Start with a goal of not having an orgasm yourself. Imagine just taking time to get to know her body better, and to learn the language of her body, however quiet and hidden it might seem to you. If she senses your disappointment (and she does), she has likely learned this behavior pattern to avoid disappointing you and also having to confront/be reminded of her "inadequacy" in your eyes as she and you seem to perceive it. Both of you could make use of learning the language of her body, and perhaps starting with you appreciating small things the lessons may go well! Do sweet physical things more often than usual, for however long she enjoys, and try not to talk about it, except perhaps to say you'd like to give her a massage and don't want anything in return. Try a few of the other erogenous zones and see if they seem pleasurable to her. When you come home, or randomly, when you hug her, hold her longer than usual and maybe look into her eyes and say "I love you" (and mean you love all of her including her body) while holding onto her, kiss her neck while you're doing dishes, whatever, be creative. Don't think you'll have sex because of this, you're just learning the language. Think '?donde esta el biblioteca?' during first year Spanish. This might take 4 years like that did, but heck, what have you got to lose?

Also, she might say 'orgasms are overrated,' (which I suppose is true from a wider/esoteric perspective) but they're enjoyable for most, and I suspect if she had more she might feel less cynical about it... But if there are other issues with enjoying other aspects of life, this might be even deeper than just a translation issue... Let me know if this helps at all, I'd love to see you both having a totally fulfilling relationship!

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Remember, if  you have a question for the good doctor, email it to jillhamilton001@gmail.com. For more info on Dr. Andrea, check out her web site.

(Note: Submitted questions may be edited for clarity. Also, I have no idea what's up with these mutant font sizes. I hope they didn't offend your aesthetic sensibilities.)

*My friend Heather knows I am a word prude and hate "clitoris" and, by association "clit," so I swear to god, she makes sure she works "clitoris" into every damn conversation we have. Which, as it turns out, is surprisingly easy.