At birth humans respond to stimuli based on instinct and are very sensitive to sexual stimuli. This is why, for example, breastfeeding and exposing genitals to air results in sexual arousal in infants. At this age, orgasm is a simple physical reflex because the mind did not learn yet the "suitable" sexual responses. It is good to note that babies of both genders are equally orgasmic.

From puberty age onwards, humans are gradually taught the "suitable" sexual responses and select the "good" and "bad" ones based on their education, society, and family environment.

From that stage, sexual orgasm and arousal will involve body, mind, and soul. The brain will receive different types of stimuli: sexual fantasy, visual stimuli, audible stimuli, olfactory stimuli, taste, and mechanical stimuli (caresses, touches). At that level a woman may feel sexual arousal but may not feel orgasm. To do so, she needs the mind and the body to work together.

Sexologists broke the female sexual response into four phases: excitement, plateau, orgasm, and resolution. Recently, Gesthalt method divided this cycle into eight stages. All these stages are arbitrary and a person is not likely to be aware of their body experiencing each individual phase. The amount of time a person spends in each phase, and even the order in which they experience them may vary. A woman on a date may become sexually aroused several times without her ever reaching the plateau phase. She may experience arousal and the plateau phase during an intense session of dancing, but return to her un-aroused state during the ride home.

All the studies carried out on this subject showed that most women are aware of what it feels like to be sexually aroused but it seems their brain filters these messages away since the context look inappropriate. So the issue of arousal is not a straightforward mechanism (like in men) and thus involves many factors: psychological, attractiveness, body language, safeness, sense of belonging, etc.

It is important for you to know that two body changes take place when a healthy woman is going through an orgasm: vasocongestion and myotonia.

• Vasocongestion is the huge flow of blood in the genitalia and breast causing them to change color and become larger, along with a feeling of body warmness and vaginal lubrification.
• Myotonia is the sexual tension you feel in your muscles that make up the point of no return towards full orgasm.

According to Masters and Johnson, the sexual response cycle in women is broken into four phases: excitement, plateau, orgasm, and resolution. The following physical responses to mental and/or physical stimuli may be observed during the sexual response cycle:

• Vaginal lubrication (transudation) begins first, within 10-30 seconds.
• The inner two thirds of the vagina expand.
• The uterus and cervix are pulled upwards.
• The labia majora flatten and spread apart.
• The labia minora increase in size.
• The clitoris increases in size.
• The nipples may become erect as the result of muscle contractions.
• When highly aroused the breasts may increase in size (20-25% for women who have not breast-fed a child, for women who have, there is less or no increase in size).
• The heart rate increases.
• The "sex flush" (increased blood flow on chest and other body parts) becomes gradually pronounced.

According to Masters and Johnson, an orgasm "begins with a momentary sense of suspension, quickly followed by an intensely pleasurable feeling that usually begins at the clitoris and rapidly spreads throughout the pelvis. The physical sensations of the genitals are often described as warm, electric, or tingly, and these usually spread through the body. Finally, most women feel muscle contractions in their vagina or lower pelvis, often described as "pelvic throbbing.""

Perceiving orgasms differ from one woman to another and for the same woman in different situations: orgasms are organically the same but differ in length and strength. For instance, many women do feel "greater" orgasms during masturbation than during intercourse because they are the center of attention, are not worried about or distracted by a partner, and can guarantee an orgasm. Some women are more aware of their vaginal contractions when their vagina has something to clamp down on, or when it is empty and contracts on itself. Approximately, all women experience total body orgasms, clitoral orgasms, vaginal orgasms, and uterine orgasms.

During an orgasm, rhythmic muscle contractions occur in the outer third of the vagina, the uterus, and anus. The first muscle contractions are the most intense, and occur at a rate of 1 contraction every 0.8 second. As the orgasm continues, the contractions become less intense and occur at a more random rate. A mild orgasm may have 3-5 contractions, intense one 10-15 contractions. If a woman experiences one orgasm, she can usually have many more in one session, as long as adequate stimulation continues. Some women will have one orgasm right after another, for as long as the stimulation is continued. Most multiple orgasms occur during masturbation as there is nothing or no one to distract a woman from her pleasure, and a vibrator is more likely to be utilized. An electric vibrator does not get tired, unlike a woman's own hand, or that of her partner. A male partner who has himself experienced an orgasm may find himself incapable of continuing his stimulation of his partner. If a partner wants to bring their female partner to multiple orgasms, they will probably have to forego their own pleasure, at least temporally.

Lack of orgasm means you do not feel it in a sexual intercourse but you do feel it when you masturbate. I think this issue really matters for you and it would be crucial to talk to a sexologist and sextherapist that will help you sort out this issue before it influences on your relationship. The main reason behind your lack of arousal is psychological: depression, anxiety, history of sexual trauma (sexual abuse or rape), sexual education background, or inadequate stimulation from your partner (lack of foreplays).

Here are my 10 tips for you to arouse easily:

• Find your best sexual position i.e. gives the maximum pleasure.
• Breathe well: Many women stop their breath while orgasming. You have to know that during orgasm all your body muscles contract and will definitely need oxygen for that. Consequently feel free to breathe the way you like.
• Move yourself: Do not freeze while you are making love. On the contrary, move your hips, your entire body to enter the real circle of sexual pleasure.
• Ask your partner to talk 'sexy' to you: sex is not only motion but it is also emotion.
• Ask your partner for rhythmic movements : A variety of movements such as slow and regular, then a little bit faster, then harder and harder are your partner's movements that will help achieve a better orgasm.
• Stimulate your clitoris with your fingers or a sex toy.
• You and/or your partner caress your breasts: especially the mamelons and the area around. This allows your body to produce ocytocine, the hormone that interferes in your orgasm.
• Perform regular exercises for your perinea muscles: You can refer to the exercises of Masters and Johnson.
• Fantasize: Think erotically and on regular basis during sexual intercourse and during your daily life. This small brain training will make you more receptive to arousals. You can enhance your fantasies through reading erotic books or watching erotic films.
• Masturbate: Even though the idea seems odd, but I do advise it for women who have a lack of orgasm as you. This will allow understanding your sexual rhythm and figure out your erogenous zones. You can also share this masturbation activity with your partner.

Faking orgasm is definitely not a solution. It started with you as a means of saving face in front of your husband, and as a means of giving him a morale boost, and it turned to end up being a permanent way of life with you. You are blaming yourself for everything that goes wrong in a relationship, so hiding your inability to orgasm will make you pay the price. You were afraid to tell your partner you have been faking orgasm because it will upset him: Now it seems he is upset without saying it. Your husband is feeling you are hiding something from him, fooling him and lying to him.

When you experience an orgasm, real or faked, you are indicating to your partner that he has done a good job; that he does not need to do anything differently next time which is totally opposite of what you should be telling him. This is true if you are sexually healthy i.e. you do not have sexual problems yourself. Now you are frustrated by your inability to orgasm, and this is the beginning of avoiding sex altogether, this is why he is not performing as well as before.

To me, your case needs a clinical assessment in order to know where the "missing node" is. Your husband might be performing very well while you are not receptive; the opposite also might be true. At my clinic the challenge will be to help you achieving a balance between your desire for orgasm and your sexual happiness with your husband.

The majority of preorgasmic women show psychological problems. If a woman can bring herself to orgasm through masturbation but not during intercourse then the problem is not biological, it is rather relational.

The main factors of anorgasmia are:

• Stress (whether in life or in the relationship) is a sex killer and can prevent a woman from enjoying sex to its fullest.
• Performance anxiety and sexual boredom: Woman sexual confidence needs to eb restored.
• Past traumatic experiences, whether in adulthood or childhood, such as rape and child abuse.
• A strict religious upbringing in which children were taught that sex is wrong can also be a problem, as the adult still carries an instilled fear of intimacy.
• Alcohol abuse and illegal drugs and some prescription medications.
• Chronic sickness such as hormonal problems, hypertension, heart conditions and diabetes.

The treatment of anorgasmia does not involve heavy medicine or surgery. An overall physical examination is required followed by a sex therapy. Because this condition is a sexual problem and not a medical condition, a sex therapist is the most qualified and experienced professional to handle the case. A sex therapist works with a patient to provide education and treatment so that the sexual aversion or fear can be overcome.

• Empty your bladder first.
• Use a dildo if you are alone as you massage your clitoris or your fingers or your partner's fingers.
• Stimulate your urethra by massaging the top of your vagina with only light pressure at first, using your fingers or a dildo
• Massage the full length of your urethra , from the opening of your vagina up to 3cm back into your vagina.
• Keep up the clitoral massage . Try different pressures and strokes. Stimulating your urethra may cause you to feel the need to release liquid from your bladder and this is desired. Do not fight the urge; just go with the flow.

• Relax and breathe deeply.
• Continue massaging your clitoris to the point of orgasm . A slow build up with lots of teasing may help produce the greatest urge and strongest orgasm.

Since so few women masturbate by stimulating their vagina alone, it would seem it is not as sensitive to sexual stimulation as is the clitoris that possess a lot of nerve endings condensed in a small area surface. Analysis of the anatomy of the vagina reveals that it is not as densely populated with nerve endings as is the clitoris, and the nerves endings that are present are usually located only near the vaginal opening. The reason the vagina is not highly populated with nerve endings is likely because it also serves as the birth canal. It would seem counter productive to have an extremely sensitive vagina when it came time for a woman to give birth.