Some women can bring themselves, or have their partners bring them, very close to an orgasm. They have all the physical signs of being about to reach an orgasm, but all of a sudden they reach a flat moment. When this happens, these women think that theyre not going to have an orgasm. And as soon as they think that, it becomes a self-fulfilling prophecy, and they dont.     The key to overcoming the flat moment is to keep at it. Not every woman goes through this flat moment, but enough do to indicate that the problem is a fairly common occurrence. But the flat moment is only a momentary thing. If the stim- ulation keeps up, then a woman will go back upward on the arousal curve and have her orgasm. So as far as the flat moment goes, persistence is everything.     Filing a missing orgasm report   If youve ever misplaced something - such as your glasses or the keys to the car - you know how frustrating an experience that can be. Imagine the frus- trations of not being able to find your orgasm!   Right about now, those of you not suffering from this condition are probably saying to yourselves, "Dr. Ruth, youre pulling my leg. How can you miss an orgasm?" I know that the partners of women who have missed orgasms dont understand the problem because they report their concerns to me in their letters or in my office. When a woman tells her spouse or lover that she doesnt know whether shes had an orgasm - something that men have absolute cer- tainty about - he just cant believe it.   And the women themselves cant really believe it either. They say to me: "Is it possible? Can I not recognize an orgasm? Isnt it supposed to be a very strong, very intense feeling? How can I not recognize it? How can I miss it?"   Unlike a woman who cant have an orgasm, a woman who has missed orgasms does have an orgasm, at least physiologically, but the sensations dont regis- ter in her brain. What I mean is, her heart rate goes up, her vagina lubricates, she has all the outward physical signs of an orgasm, but none of the pleasure.   Treating women who have this problem can be a bit tricky. They have to be taught to feel the orgasms that their bodies undergo. Knowing that they indeed have orgasms, at least physically, is usually helpful to these women. A sex therapist may use any of several different modalities of treatment.   If you have missed orgasms, I definitely recommend seeing a sex therapist because you probably wont be able to handle this problem on your own. Appendix A discusses visiting a sex therapist.     Playing show-and-tell with your partner