Anorgasmia is the scientific term for an inability to achieve orgasm or a significant reduction in the frequency or intensity of orgasms. Anorgasmia is diagnosed in women as Female Orgasmic Disorder (FOD). 10-15% of women have never experienced an orgasmic release.1 Other women may have experienced a frustrating shift in the frequency or quality of their orgasms.
Anorgasmia is less common in men and falls under the diagnosis of Delayed Ejaculation (DE).
What Is Anorgasmia?
Anorgasmia, or female orgasmic disorder (FOD) happens when there is a markedly reduced intensity or frequency of orgasms for at least six months that causes significant distress. In some cases, anorgasmia may mean that a someone is no longer able to reach orgasm or has never experienced an orgasm. When there is consistent difficulty in eliciting an orgasm, female orgasmic disorder may be diagnosed.
Types of Anorgasmia
The different types of anorgasmia include:2
- Lifelong: Never have experienced orgasm
- Acquired: Previous experience of orgasm and now having difficulty reaching climax
- Generalized: Experiencing difficulties with orgasm regardless of the type of stimulation, situation, or partner
- Situational: Experiencing difficulties with orgasm only with certain types of stimulation, situations, or partners
Symptoms of Female Orgasmic Disorder
The primary symptom of FOD is a distressing inability to reach orgasm or a significant decrease in the intensity or frequency of orgasms. The majority of females do not orgasm from penetrative sex alone, and they show wide variability in the type of stimulation which induces orgasm.3 Situational anorgasmia is only an appropriate diagnosis when an individual has previously experienced an orgasm with a certain type of stimulation and is no longer able to reach orgasm in that manner.
When to See a Doctor
You should see a doctor any time you are feeling worried about inability or difficulty with orgasm. It can impact females despite their relationship status and can impact the health of a relationship. It’s important to discuss this concern with your doctor and if you are in a relationship, consider attending couples counseling or sex therapy together to determine ways to support the sexual health of the relationship while going through treatment.
What Can Cause Anorgasmia?
Orgasm is a complex psychological and physiological process. While there is rarely a single root cause for anorgasmia, there are many potential factors that can keep a someone from reaching orgasm consistently or with satisfying intensity. Stress of any kind is often a major contributing factor to a reduction in the frequency or intensity of orgasms, and a lack of desire for sex.
Here are several potential causes for female orgasmic disorder:
Medical Problems
Illnesses and medical conditions of any kind can impact psychological and physical health in a way that impedes orgasm. Issues of particular concern include diabetes, multiple sclerosis, Parkinson’s disease, and gynecological surgeries or conditions.
Psychological Concerns
Stress and anxiety are major impediments to experiencing the relaxation necessary for sexual release. Mental health diagnoses, such as mood disorders, can impact the ability to orgasm. Shame, guilt, or anxiety around sexual activity, body image issues, or a history of trauma or abuse may also be factors in FOD.
Relationship Conflict
Unresolved conflict, such as broken trust or infidelity, may make it difficult to achieve sexual connection and satisfaction. A lack of communication around sexual preferences may also contribute to FOD.
Substance Use
Consuming alcohol, cigarettes, or other controlled substances can interrupt the process of orgasm by impacting neurological function or blood flow to the genitals.
Medication Side Effects
Many medications have the side effect of reduced libido or reduced ability to orgasm, including Selective Serotonin Reuptake Inhibitors (SSRIs) prescribed to treat depression, antipsychotics, antihistamines, and blood pressure medications.
Aging
Physiological changes over the lifespan can alter a female’s ability to orgasm reliably. Anatomical and hormonal shifts through pregnancy, childbirth, and lactation may impact the ability to orgasm. Reduction in estrogen levels during perimenopause and menopause decreases blood flow to the genitals and may contribute to FOD.
How Is Female Orgasmic Disorder Diagnosed?
FOD is primarily diagnosed based on self-report. Orgasm is a subjective experience and therefore only someone impacted by FOD can establish the frequency and intensity of orgasm and what level of distress is being experienced due to difficulty reaching climax. However, consulting with your doctor and/or a certified sex therapist can be helpful in figuring out the cause and treatment approach for FOD.
Anorgasmia Treatment
Treatment for anorgasmia will vary depending on the underlying causes and how long it has been a problem. The first step will be consulting with your primary care physician or OBGYN. Although you may have some embarrassment discussing sexual issues, don’t let that keep you from seeking treatment. The longer that sexual dysfunction becomes entrenched, the more difficult it is to treat.
When consulting with your doctor about potential FOD, they will typically perform a medical examination, which includes a pelvic exam, in order to rule out any anatomical reasons for lack of orgasm. Your doctor will also take a detailed medical history to explore possible causes.
Be prepared to answer questions about your sexual history, including any sexual trauma, when and how you have experienced orgasm (if ever) and when your experience of orgasm began to change. Bring a list of any past or current medical conditions and medications, including dosage and duration.
Medical Treatments for Anorgasmia
There are several methods of treatment that may help when dealing with FOD. These include:
Lifestyle Changes
Diet, exercise, and stress levels can all impact sexual function. Your doctor may ask you to engage in practices that improve these areas of health.
Physical Therapy
If pelvic tension or muscular laxity is a contributor to orgasmic issues, physical therapists that specialize in pelvic dysfunction may be an appropriate referral.
Estrogen Therapy
Typically for postmenopausal females, estrogen in the form of a pill, patch, or gel may reduce menopausal symptoms and improve sexual response. Local estrogen (such as a vaginal cream or ring) can also increase blood flow to the area and improve the frequency and quality of orgasm.
Testosterone Therapy
Although the exact mechanism is not known, testosterone plays a role in healthy female sexual function. Testosterone replacement therapy can improve the frequency and quality of orgasm. However, side effects such as acne, excess body hair, and other side effects can occur.
Medication Adjustment
Many over-the-counter and prescribed medications can impact sexual function. Your doctor may adjust your medication levels or replace your current medication with a chemically similar compound that could result in a reduction of sexual side effects.
Sildenafil (Viagra)
Some doctors believe this may benefit those with FOD stemming from the use of SSRIs for depression.4 The Food and Drug Administration (FDA) has not approved the use of sildenafil therapy in females for the purpose of treating sexual dysfunction, so this would be considered an off-label use.
Addressing Other Medical Conditions
Issues such as diabetes, multiple sclerosis, Parkinson’s disease, or gynecological conditions can impact the frequency and quality of orgasm. Your doctor may address these issues in order to reduce sexual symptoms.
Once a doctor has explored whether there are medical factors contributing to your FOD, it can be helpful to seek treatment with a certified sex therapist. You may seek sex therapy as a couple or individual.
How a Sex Therapist Can Help
Once any potential physical causes for anorgasmia have been addressed, a sex therapist can help you deal with anorgasmia through:
- Education around sexual techniques and types of stimulation.
- Coaching for you and/or your partner on exercises to enhance pleasure or improve orgasm.
- Helping you explore relational issues that may contribute to FOD.
- Fostering improved communication skills around sex.
- Techniques for reducing stress that may be impeding your enjoyment of sex.
- Helping you to explore and diffuse trauma history, sexual shame, or negative self-talk.
- Addressing any underlying psychological factors contributing to anorgasmia, such as depression or anxiety.
How to Get Help for Female Orgasmic Disorder
First consult with your Primary Care Physician or OBGYN. They can rule out underlying medical issues and help guide you through the next steps for seeking help. They may make referrals to other medical practitioners or a sex therapist. If your doctor lacks experience in treating sexual dysfunction such as FOD, consider finding a sex therapist. A sex therapist will help you to formulate a treatment plan and find other appropriate treatment providers.
Finding the Right Sex Therapist
When consulting a sex therapist, make sure that your mental health practitioner is AASECT (American Association of Sexuality Educators Counselors and Therapists) certified. “Sex therapist” and “sex therapy” are not protected terms, meaning that anyone can call themselves a sex therapist in their marketing.
Additionally, most mental health licensure requirements contain little or no instruction in human sexuality. AASECT certified providers receive an additional 18-24 months of training and a minimum of 300 additional hours of supervision in sex-specific psychological issues.
Using an online therapist directory is a great way to find a sex therapist in your area.
How Much Does Sex Therapy Cost?
Typical rates for an AASECT certified sex therapist are on the upper end of private pay therapy rates in your area. Most sex therapists see individual clients for 45-60 minute sessions at rates between $120-$180 and couples for 75-90 minute sessions at rates between $190-$310. These rates may vary widely based on the availability of certified sex therapists in your area and on general mental health costs in your state.
How to Cope With Anorgasmia
If you believe that you may have FOD, seeking help is an important first step. However, there are treatment options you can explore on your own or as an adjunct to professional treatment, including:
Up Your Exercise & Diet
A consistent program of physical fitness which emphasizes overall cardiovascular health can improve blood flow to the genitals and increase frequency and intensity of orgasm.
Pelvic Floor Exercises
Many factors can weaken your pelvic floor muscles, including pregnancy, childbirth, surgery, aging, excessive straining from constipation or chronic coughing, and being overweight. Weak pelvic floor muscles can impact the ability to experience orgasm.
Pelvic floor strengthening, commonly called a “Kegel exercise,” is easy to learn. To identify where your pelvic floor muscles are, experiment with stopping urination in midstream. Once you identify the action of tightening your pelvic floor, you can practice this in any position and in just about any situation.
You might choose to combine this exercise with another daily activity such as brushing your teeth or driving so that you remember to practice. For best results, perform this exercise at least three times a day in sets of ten. Try to breathe freely and avoid tensing the muscles around your pelvic floor, such as your glutes or psoas.
Sex Education
A better understanding of anatomy and sexual technique can help you discover your own sexual response patterns and improve the frequency and intensity of orgasm.
There are many resources available, such as:
- The book Come as You Are by Emily Nagoski, an essential exploration of why and how female sexuality works, based on groundbreaking research and brain science.
- The book Living an Orgasmic Life by Xanet Pailet, for those who find sex challenging and feel disconnected from their sexual selves.
- The website OMGYes, a non-pornographic forum helping females to explore different pleasure techniques in order to find the style(s) most effective for their body.
Self-Exploration
Taking the time to masturbate frequently, even if you have difficulty achieving orgasm when masturbating, can improve your self-awareness and increase orgasmic intensity and frequency. Self-stimulation may be supplemented with a standard vibrator or with one of the many newer devices currently available for improving genital stimulation:
- Pulsators are made of high-quality silicone and offer pulsation action instead of only standard various intensities of vibration. The clitoris can be overstimulated by the sensation of direct vibration and many females respond more pleasurably to a sex toy that thrusts back and forth on its own.
- Clitoral Stimulators create clitoral suction, providing another alternative to the traditional vibrator sensation. This toy can be used directly on the external head of the clitoris, or along the internal anatomy of the clitoris for a less intense effect.
- The Lioness is a unique, tech-savvy vibrator which utilizes biofeedback to map your sensual experience. Tracking temperature, muscle contractions and orgasm as you use a high quality, rabbit-style vibrator, the lioness creates a visual representation of what stimulates you. You can explore the intimate details of your erotic blueprint by seeing exactly how you respond physiologically to different stimulation.
If Your Partner Has Anorgasmia
If your partner is dealing with anorgasmia, it can certainly be a challenge for the both of you and the relationship. It’s important to understand that no one is at fault, and like any other issue in a relationship, you should approach this as a team while being compassionate with your partner. Have open and honest conversations about your needs and figure out ways to ensure the health of the relationship is considered throughout treatment.
It is not selfish to discuss your concerns or needs, and it’s important to consider attending couples therapy and figuring out ways to communicate about each others’ sexual needs if that is also an issue. It can be difficult and uncomfortable to talk about, but it’s important to have emotional discussions to ensure both parties are being heard and understood. Couples therapy and/or sex therapy can help to address performance anxiety, sexual trauma, and/or relationship issues which may be contributing to these issues as well as identifying physical sexual conditions.
Orgasmic Disorder Statistics
Female issues with orgasm, ranging from unsatisfying climax to never having experienced orgasm, are a common sexual complaint.
Relevant statistics regarding sexual issues include:
- About 12% of women in the United States report distressing sexual health concerns and as many as 40% report sexual concerns overall5
10-15% of women report never having had an orgasm6 - Approximately half of women who do not consistently reach orgasm during sexual activity do not report distress and are therefore not classified as having FOD7
- Directed masturbation has been shown to have an 80-90% success rate when used to treat lifelong FOD8,9
- Treatment for acquired FOD (including sex education, communication training, anxiety reduction, and relational therapy) varies widely in success from 10-75%10,11
- Although sex therapy for couples does not always result in an increase in orgasmic frequency or intensity, it has been shown to be generally helpful in improving the relationship and communication about sex11,12
