O, Ladies: Closing the Gap to Sexual Pleasure

by: Sarah G. Bickle, B.A. (Hons.)

For many women, orgasm and sex don’t necessarily go hand in hand. Only one-quarter of women “reliably” orgasm during sex and, on average, say that orgasms are their 15th motivator for sex – following motivators such as an expression of attraction or love, a desire to feel good or have fun, and a desire to please and feel closer to their partner. 

No more is orgasm an essential part of a woman’s typical sexual interaction than it is limited to it; in fact, women report having orgasms during all kinds of experiences – such as sleep, meditation, breastfeeding, assault, and medication-induced states. What’s more, not all women experience orgasms the same way. For example, 70% report feeling an orgasm throughout their entire body, 47% are multi-orgasmic, and 77.5% find that sometimes they have orgasms that are better than others. 

So, what features are important to a good orgasm? More than half of women agree that spending time to build arousal (77.2%), having a partner who knows what they like (58.6%), and emotional intimacy (55.5%), significantly contribute to a good orgasm. The possibilities of what leads to intense orgasmic experiences, however, are vast and highly detailed. For example, 39% of women find that clitoral stimulation is essential for the quality of their orgasm. The specified preferences for this source of pleasure alone can be highly variable among women with respect to: 

  • location (e.g., mons pubis, hood, left side of the clitoris, direct, etc.), 
  • pressure (e.g., light, firm, consistent, variable, etc.), shape/style (e.g., side to side, circular, tapping, flicking, squeezing, etc.), and 
  • pattern (e.g., rhythm & repetition, alternating between motions, teasing & delaying, consistency, etc.).

The obstacles many women face regarding reaching their full orgasmic potential are undoubtedly affected by the lack of education and shame that has been produced by our cultural history. When research shows that most men and women agree that it is the responsibility of the male to stimulate the female to orgasm, and 43.9% of men cannot locate the clitoris on a diagram, many women inevitably reach an impasse. Fortunately, however, the study of female sexuality and education is growing, and research and clinical work with sexuality are helping many women become more empowered to take on an active role in closing this orgasm gap! 

The Relationship and Sex Therapy Service at CFIR offers clients comprehensive assessment, psychotherapy, and counselling to address a wide range of relationship and/or sexual issues for both individuals and couples. Through treatment, we will help you to develop stronger relationships, heal relationship injuries, improve or add new relationship skills, and address sexual issues that interfere with sexual satisfaction and fulfillment, regardless of sexual orientation. 

Read more about our Relationship & Sex Therapy Treatment Service

Sarah Bickle, B.A., is a counsellor at the Centre for Interpersonal Relationships, working under the supervision of Dr. Dino Zuccarini, C.Psych, and is currently completing a Masters of Clinical Psychology at the Adler Graduate Professional School in Toronto. Sarah works with adults in psychotherapy to support them to increase emotional wellness and resolve depression, trauma-related symptoms, and interpersonal difficulties.

A Look at Hypersexuality: Treatment and Assessment

by: Dr. Ainslie Heasman, C.Psych.

The classified advertising site, Backpages.com, was recently shut down by the United States government, thereby making it inaccessible in Canada as well.  The website, which hosted everything from child care to real estate ads, was recently suspended by U.S. law enforcement due to activity stemming from the “adult” sections on the site.

Many essential political and societal discussions have transpired following the decision to close the site, including debates about whether the intention to prevent sex trafficking will benefit from this action.  

Amid these discussions, some of my clients who use the internet to access sex services, and who identify as having problems regulating their sexual behaviour feel a sense of relief.  Some are experiencing an unexpected external control over their response, albeit temporary, now that Backpages.com is no longer accessible.

What is hypersexuality?

Problematic sexual behavior is referred to using a variety of labels – from sex addiction to compulsive or impulsive sexual behaviour to hypersexuality.  Societally, this is commonly labeled as sex addiction, but there remains little scientific evidence to support sex as an addiction.  There is also some suggestion that perceived addiction to pornography can contribute more to psychological distress than pornography use itself (Grubbs, Volk, Exline, & Pargament, 2013).  

Many of my clients seek out therapy for problems managing their sexual behaviours, sexual interests or both. Regardless of the label, many men (and it is mostly men that seek treatment for this in my practice) are struggling with a variety of sexual behaviours, from anonymous sexual encounters to frequent masturbation and pornography use.  Some men also experience distress related to the content of their sexual thoughts, or pornography use (versus the frequency of their sexual behavior).  In other words, they experience a sexual interest that is atypical or less common; the inclination could turn illegal if acted upon and/or it contributes to significant moral distress.  


Research has been conducted to identify the characteristics of individuals who seek out help for hypersexuality, along with related treatment targets (Cantor et al., 2013; Sutton, Stratton, Pytyck, Kolla, & Cantor, 2014). The paths leading people to engage in hypersexual behaviour are varied and beyond the scope of this current blog, but there are more common ones I see in my clients.  Clients often use sexual behaviour as a way of procrastinating, avoiding, and escaping stressors.  Many of my clients struggle with identifying, labeling, and expressing their emotional experiences (preferring instead to ignore and suppress). This is even more common with emotions experienced as being more challenging to manage (i.e., frustration, anxiety, anger, disappointment), and they seek out a distraction, and a way of temporary escape, through sexual behaviour.  

Other clients have varied sexual interests that are explored through pornography or sexual activity with another, that they may not feel comfortable talking about or exploring in their partnered relationship.  At times there is a mismatch in sexual drive or interests in a relationship, but what is often apparent is a lack of healthy communication between partners about their needs and experiences in their sexual relationship. 

What is essential when seeking support is finding a mental health clinician who will engage in a detailed assessment to understand the nature of the problem and the contributing factors.  It is also essential to determine if there are other mental health concerns (i.e., depression, anxiety, bipolar disorder to name a few) that are influencing the behaviour and also require intervention.  There is no ‘one size fits all’ approach to treating individuals who struggle with sexual behaviour. As a result, an assessment helps to determine the most relevant treatment targets to assist those seeking help to achieve their goals. 


A therapist assists clients in understanding the origins and development of their behaviour.  Clients are offered support through their journey to develop and refine skills to live a life that is more in line with their values.  This path is often challenging and filled with a range of emotions, and mistakes and a return to old patterns may occur.  With the guidance of a therapist, these challenges can be navigated and explored in a safe and supportive environment. The client can take steps they feel are necessary to define and live a more fulfilling and value driven life.

Often when a man is in a partnered relationship, couples therapy is recommended, mainly when the sexual behaviour of concern involved infidelity.  In these situations, the sexual behaviour that occurred happened in the context, and with all the relevant dynamics, of a relationship.  If the couple desires to remain together, at the very least, the rebuilding of trust occurs again in the context of the couple.  With that in mind, many men still seek out therapy on their own, either at the insistence of their partner or without their partners’ knowledge that there is a problem.  

If you can identify with these struggles, there is help and support.  Individual and couples therapy is available at the Centre for Interpersonal Relationships (CFIR).


Cantor, J., Klein, C., Lykins, A., Rullo, J., Thaler, L., & Walling, B. (2013). A treatment-oriented typology of self-identified hypersexuality referrals. Archives of Sexual Behavior. 42. 10.1007/s10508-013-0085-1.

Grubbs, J., Volk, F., & Exline, J., & Pargament, K. (2013). Internet pornography use: Perceived addiction, psychological distress, and the validation of a brief measure. Journal of Sex & Marital Therapy. 41. 10.1080/0092623X.2013.842192.

Sutton, K., Stratton, N., Pytyck, J., Kolla, N., & Cantor, J. (2014). Patient characteristics by type of hypersexuality referral: A quantitative chart review of 115 consecutive male cases. Journal of Sex & Marital Therapy. 41. 10.1080/0092623X.2014.935539.

Improving Your Sex Life: How We Help You

by: Dr. Lila Z. Hakim, C.Psych. & Dr. Dino Zuccarini, C.Psych.

Sexuality is an essential part of who we are. At CFIR, we promote healthy sexuality. A crucial first step is to ensure that individuals and couples have access to accurate information about sex and how our bodies work, and an understanding of the physical (e.g., contraception, sexually-transmitted infections) and emotional risks involved in expressing ourselves sexually. Healthy sexuality also suggests being comfortable with ourselves (i.e., liking our bodies, finding ourselves attractive, being aware of and accepting our desires and fantasies, feeling capable sexually, knowing our sexual boundaries and asserting our limits), being able to experience sexually arousing feelings, communicating our sexual desires, and engaging in satisfying intimate-sexual relations with others. 

Sexuality, however, can also be a source of great distress. Distress can occur when we do not have accurate knowledge or information or are experiencing sexual functioning problems or sexual and pornography addictions. Some of our sexual issues flow from a lack of, or inaccurate, learning about how our bodies actually function, or distress over fears of pregnancy or sexually transmitted infections. A lack of knowledge can create anxiety about decisions and choices and sexual expressions. 

Sexual functioning problems related to desire, arousal, and orgasm are also a source of emotional distress for individuals and couples. The causes of such issues are vast. Sexual functioning is affected by a wide range of organic, biological, and medical issues, as well as social, cultural, and psychological factors. Some of us become overly consumed by negative thoughts and emotional reactions about oneself (e.g., our bodies, genitalia, sexual performance), or our sexual partner. We may also engage in relationship or sexual patterns that diminish arousal and the desire or interest in sex. Some individuals experience sexual pain or other difficulties during sexual intercourse due to a complex blend of physical or psychological factors. 

Some individuals will struggle with sexual or pornography addictions, including the use of internet porn, massage parlours, or risky sexual encounters. In these situations, individuals and their relationship partners may experience significant distress. Sexual functioning issues, regardless of their origins, can block an individual and couples from experiencing positive feelings, such as joy and pleasure, within the sexual aspect of the relationship. Sexual issues can also spill over into other aspects of the relationship, including emotional and physical intimacy. 

Psychologists and clinicians at CFIR have published research and theoretical articles in peer-reviewed journals, and written book chapters in the area of couple and sex therapy. We help you by providing a comprehensive psychological assessment to help you understand the causes of your sexual difficulties and then develop the most appropriate treatment plan to address underlying causes. We are well-informed about contraception, sexually transmitted infections, and the physical aspects of sexual functioning, and the psycho-social issues associated with these topics. We also support clients to develop sexual authenticity by helping them to clarify desires and remove blocks to the expression and assertion of their sexual needs in relationships. We also help to resolve sexual functioning issues to restore one’s sexuality as a source of joy, sensuous pleasure, and connection. 

The Sex Therapy Treatment Service at CFIR offers clients comprehensive assessment, psychotherapy, and counselling to address a wide range of relationship and/or sexual issues for both individuals and couples. Regarding treatment, we offer individual, couple, and group therapy to help you to develop stronger relationships, heal relationship injuries, improve or add new relationship skills (e.g., communication, problem-solving and negotiation skills), and address sexual issues that interfere with sexual satisfaction and fulfillment, regardless of sexual orientation. 

Read more about our Sex Therapy Treatment Service

Sex and Attachment

by: Dr. Dino Zuccarini, C.Psych and Dr. Marie-Pierre Fontaine-Paquet, Psy.D., C.Psych.

Are you struggling with sex in your relationships

How you relate to your partners sexually is affected by how you relate to each other outside of sex.

In the CFIR blog post ‘Anxiety and Your Relationships’, we describe how attachment theory may help you to understand your experience of your self and others in your relationships. We also talk about the concept of attachment style, which includes ways of seeing your self (“Am I worthy of love and care?”) and others (“Are you there for me, will you respond when I need you?”) in your close relationships. Sex can be viewed as an attachment behavior, and thus your attachment style affects how you engage in sex. Attachment anxiety and avoidance can interfere with enjoying sex and creating an enriching and fulfilling erotic life.

If you are anxiously attached, you might have doubts about your self-worth and attractiveness, and about your partner’s availability to meet your feelings and needs. Sex can be a way to obtain reassurance about these things – about whether your partner finds you beautiful or sexy, and about whether your partner loves you, cares about you and wants to be close to you. When sex is a way for you to obtain reassurance and to soothe your deep fears about your self or your relationship, you may become demanding and critical of partners when they do not respond to you sexually in the ways that you hoped.

If you are avoidantly attached, you might find it difficult to be close to your partner during sex because you fear rejection by your partner. You might tend to keep more distance during sex and be more focused on tasks and duties, and on performing in such a way that is pleasing to your partner. It might be difficult for you to access your true desires, feelings, and needs and to share these with your partner. You might also struggle with understanding and being attuned to your partner’s feelings and needs when you are so focused on performance and tasks during sex.

When sex becomes a place filled with fear, it may be difficult for both partners to be in touch with, explore and share their erotic potentials and all that sex has to offer.

Here are some tips on how to deal with attachment anxiety and avoidance during sex:

For the anxiously attached:

  • If you have doubts about your self-worth and attractiveness, start working on nurturing a more positive relationship with yourself and your body – as opposed to overly relying on your partner’s responses to reassure you. Try to explore what makes you feel sexy and nurture these parts of yourself.
  • Try not to over-interpret your partner’s cues as being related to you, how much they care about you and your relationship. Learn to calm yourself and to take a step back to notice all of the other factors that may be influencing your partner’s responses to you.

For the avoidantly attached:

  • Develop more awareness of your true desires, feelings, and needs. Try to take a risk to share these with your partner and talk about what interests and excites you in sex – instead of avoiding taking risks by distancing yourself during sex or even avoiding sex altogether.
  • Learn to be more present to your own and your partner’s desires, feelings, and needs during sex. Recognize when you are distancing from yourself and your partner, and remember that the more you distance, the more you can create distress in your relationship.

A psychologist can:

  • help you find and create a more fulfilling sex life by working with you individually and/or as a couple.
  • assess your attachment style and its impact on your sex life, help you understand your sexual desires, emotional reactions, and needs, and help you communicate these to your partner more effectively.
  • help you learn how to respond to your partner’s desires, feelings and needs to help you build a more secure and satisfying sexual relationship.

Especially when couples feel stuck in constant negative interactions as a result of fears that block sexual fulfillment and erotic exploration, a psychologist can help you better understand these moments and help you create more security in your relationship. Over time, sex can feel less dangerous and become a space to explore and connect in movement, touch and shared emotions of excitement and joy.

Read more about our Relationship & Sex Therapy Treatment Service.