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 or Female Orgasmic Disorder (FOD)?
An orgasm is a climax of sexual excitement typically centered in the genitals and culminating in involuntary muscular contractions and a release of tension. An orgasmic release is often accompanied by ejaculation in men (and some women). The quality of an orgasm may vary in intensity at different times and between individuals. The stimulation required to induce an orgasm may vary and is likely to change over the lifespan.
Women show wide variability in the type and intensity of stimulation that induces orgasm. A woman’s pelvic nerve is uniquely wired; while many women require direct stimulation of the external clitoris, other women’s nerve endings branch primarily into the vagina, perineum, or mouth of the cervix. Age, medical conditions, and medications can all impact how sexual stimulation to the pelvic nerve is experienced.
Anorgasmia is diagnosed 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 woman 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 (FOD) may be diagnosed.
Symptoms of Female Orgasmic Disorder (FOD)
The primary symptom of FOD is a distressing inability to reach orgasm or a significant decrease in the intensity or frequency of orgasms.
The different qualifiers for FOD 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
- Mild, Moderate, or Severe: Level of subjective distress resulting from loss of orgasm
The majority of women do not orgasm from penetrative sex alone3 and women show wide variability in the type of stimulation which induces orgasm. 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.
Causes & Triggers of Female Orgasmic Disorder (FOD)
Orgasm is a complex psychological and physiological process. While there is rarely a single root cause for FOD, there are many potential factors that can keep a woman 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.
The following considerations may contribute to FOD:
Medical
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
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 or guilt around sexual activity, body image issues, or a history of trauma or abuse may also be factors in FOD.
Relational
Unresolved conflict, such as broken trust or infidelity, may make it difficult to achieve sexual connection and satisfaction. A lack of clear 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
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 woman’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 (FOD) Diagnosed?
FOD is primarily diagnosed based on self-report. Orgasm is a subjective experience and therefore only a woman 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 ascertaining the cause and subsequent treatment approach for FOD.
Treatment of Female Orgasmic Disorder (FOD)
Treatment for FOD will vary depending on the underlying causes and how long FOD 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 causation.
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.
Interventions Your Doctor May Offer
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 women, 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 male-pattern baldness can occur.
The Food and Drug Administration (FDA) has not approved the use of testosterone replacement therapy in women for the purpose of treating sexual dysfunction. This would be considered an off-label use.
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 women 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 women for the purpose of treating sexual dysfunction. 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.
Interventions a Sex Therapist May Offer
- 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/FOD, such as depression or anxiety.
How to Get Help for Female Orgasmic Disorder (FOD)
First seek consultation for FOD 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.
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.
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.
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
Living With Anorgasmia: Coping & Managing
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 medical/psychological care:
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 women’s sexuality works, based on groundbreaking research and brain science.
- The book Living an Orgasmic Life by Xanet Pailet, for women who find sex challenging and feel disconnected from their sexual selves.
- The website OMGYes, a non-pornographic forum helping women 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 women 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.
