Orgasm Anxiety: Causes, Treatments & How to Cope

Causes of Orgasm Anxiety

Orgasm anxiety can be caused by a wide range of stressors, underlying mental health issues, or other sexual dysfunctions. While there is no single cause, orgasm anxiety is typically part of a broader issue with anxiety in the relationship or within the individual.

Common causes of orgasm anxiety include:

Reduction in Ability to Achieve Orgasm

Orgasms may occur less frequently or intensely due to stress, age, or a side effect of medication. This can lead to a self-perpetuating cycle of stress about whether you will be able to have an orgasm.

Self-Consciousness

Weight gain, changes in appearance, or other body image issues or loss of self-esteem can create self-consciousness with a partner. Fears about being uninhibited during sex, by making noise or an unattractive expression, can also lead to self-consciousness. These anxieties may make orgasm more difficult to achieve and trigger orgasm anxiety.

Fear of Disappointing a Partner

Men are often concerned about climaxing too soon, not soon enough, or not climaxing at all and being perceived as less masculine or decreasing their partner’s enjoyment. All genders, particularly women, may worry that not having an orgasm will be perceived as not enjoying sex or not being attracted to their partner. While sexual partners may be understanding of orgasm difficulties, some may be shaming or judgmental and create a lasting impact on an individual’s confidence during future sexual encounters.

Relationship Issues

Increased relationship conflict, lack of communication, and other relational problems can cause a reduction in both frequency and satisfaction in sexual activity. When sex does occur, there may be increasing pressure for experiencing an orgasm as a litmus test for the survival of the relationship.

Other Anxieties

Racing thoughts associated with anxiety can inhibit sexual pleasure. Anxious thoughts are often intrusive, creating a frustrating barrier to enjoying sex and causing orgasm to become another focus of more generalized anxiety. Also, a history of sexual trauma or relationship PTSD might heighten someone’s sexual anxiety.

Common Co-Occurring Issues

Orgasm anxiety often occurs alongside other mental health and/or sexual issues, including the following¹:

• Female Orgasmic Disorder (FOD)/Anorgasmia: An inability to achieve orgasm, or a significant reduction in the frequency or intensity of orgasms.
• Erectile Dysfunction (ED): An inability to achieve and maintain an erection sufficient for satisfying penetrative sex.
• Delayed Ejaculation (DE): An inability to achieve orgasm and/or ejaculation despite adequate sexual stimulation.
• Performance Anxiety: Fears about sexual inadequacy or the inability to please a partner, which in men tends to be centered on sexual impotence or the inability to maintain a strong erection.
• Generalized Anxiety Disorder (GAD): Excessive anxiety and worry causing restlessness, irritability and/or fatigue.

When to Seek Help for Orgasm Anxiety

Occasional difficulty achieving orgasms or experiencing orgasm anxiety is normal, particularly with a newer partner or when there is a high amount of stress in your relationship or daily routine. However, if orgasm anxiety has been occurring for longer than three months, with more than one partner, or is causing stress outside of the bedroom, it may be time to seek help with a medical professional and/or sex therapist.

The sooner that underlying issues are addressed, the easier it will be to eliminate orgasm anxiety. Anxiety can easily become habitual and entrenched if not mitigated quickly. A doctor can help you rule out orgasm anxiety that is caused by a side effect of medication or a hormone imbalance. A sex therapist can help you, with or without a partner, to explore the anxiety cycle and offer interventions for reducing orgasm anxiety during sexual encounters.

Treatment for Orgasm Anxiety

Sex therapy is often the first line of treatment for orgasm anxiety. There are a few medical options for mitigating orgasm anxiety, depending on the underlying cause, but medical interventions will be most effective in conjunction with individual or couples counseling with a qualified sex therapist.

Sex Therapy

A certified sex therapist is trained to address sex-specific issues related to sexual function or well-being, such as orgasm anxiety. While a traditional psychotherapist can help treat anxiety, they may not have had sex-specific training.

Medication

Medical interventions for orgasm anxiety include:

Anti-Anxiety Medications

There are two primary classes of medications for anxiety. Either may be effective in helping to reduce orgasm anxiety. However, both classes of drugs may also increase sexual dysfunction and worsen orgasm anxiety. Talk carefully with your doctor about these drugs if you are already taking them or would like to consider being on them for treatment.

Benzodiazapines

Drugs such as Valium or Xanax, can be taken daily or as needed to treat acute or situational anxiety. A doctor may offer you a prescription to take prior to having sex to help alleviate orgasm anxiety. A benefit to this type of medication is that you can identify quickly whether it is effective and stop taking it immediately if there are no positive results. However, high doses of high potency benzodiazepines are associated with a higher occurrence of sexual dysfunction, including difficulty with erections.²

Selective Serotonin Reuptake Inhibitors (SSRIs)

Drugs like Prozac or Celexa are prescribed to treat both depression and anxiety. These medications are taken daily and may require a few weeks before working optimally. Depending on the dosage, you may also need to taper off of these prescriptions if they are not effective. A benefit to this type of medication is that you don’t have to anticipate when you will experience anxiety in order to effectively treat your symptoms. However, SSRIs can cause a decrease in libido, arousal, and ability to have a satisfying orgasm, along with other side effects like weight gain.³ You may want to consider these potential side effects before using them to treat a sexual issue.

Hormone Therapy

If underlying hormone imbalances are causing difficulty with arousal or orgasm, hormone replacement therapies can effectively help to reduce orgasm anxiety.

• For Women: An estrogen patch, cream, or pill may be prescribed if sexual dysfunction is associated with a menopausal drop in hormone levels.
• For Men: A testosterone injection, gel, or patch may be prescribed if sexual dysfunction is associated with low testosterone levels.
• For Transgendered/Non-Binary individuals: A reassessment of hormonal therapies currently being prescribed by your PCP or endocrinologist may benefit your sexual experience.

Phosphodiesterase (PDE) Inhibitors

Medications such as Viagra or Cialis may be prescribed for erectile difficulties. These medications can sometimes provide the confidence necessary for someone experiencing orgasm anxiety to be less preoccupied with performance and more present with their partner in the sexual experience.

Lifestyle Changes

Improved diet and exercise can decrease orgasm anxiety in all genders. Exercise and a healthy diet keep the body functioning optimally, increasing confidence and sexual stamina. Exercise can also be helpful in the reduction of generalized anxiety. There is strong evidence that exercise and regular activity can mitigate anxiety symptoms. Numerous studies and meta-analyses show that exercise is also associated with reduced anxiety in clinical settings.⁴

How to Get Help for Orgasm Anxiety

If you or your partner is experiencing frequent or chronic orgasm anxiety, you should first seek treatment through your primary care provider. They will be able to assess whether further medical treatment is needed or if referrals to other medical providers should be made. It’s important to make sure that there are no underlying medical conditions, hormone imbalances, or side effects to current medications before treating the psychological components of orgasm anxiety.

Once medical factors have been addressed, seeking further treatment with a mental health practitioner is the next step. Even if the initial cause of orgasm anxiety is physiological, anxiety can become cyclical and may not dissipate once underlying causes have been addressed. When a sexual dynamic has been disrupted, regardless of the underlying cause, avoidance of sexual interactions or anxiety about sexual intimacy often occurs. In order to adequately treat avoidance or anxiety cycles around sex, an AASECT certified sex therapist should be consulted.

Finding the Right Therapist

To ensure that you receive adequate and knowledgeable care, make sure that your mental health practitioner is AASECT 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.

If you’re ready to find a certified sex therapist, try searching an online therapist directory, where you can find someone in your area and filter for specific qualifications

Cost of Sex Therapy

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.

Orgasm Anxiety Statistics

While there are no statistics for orgasm anxiety a unique diagnosis, we can gain a sense of how prevalent orgasm anxiety is by looking at statistics for related issues:

• Female Orgasmic Disorder (FOD) is present in approximately 26% of premenopausal women.⁵
• 10-15% of women report never having had an orgasm.⁶
• According to a 2018 meta-analysis, only 18% of women report having an orgasm from intercourse alone and 36% of those women require additional clitoral stimulation to reach climax.⁷
• Erectile Dysfunction (ED) occurs in 18% of men over 20 in the U.S.⁸
• Lifelong Delayed Ejaculation (DE) affects approximately 1% of sexually active men and acquired DE affects approximately 4% of sexually active men.⁹

Three Ways to Deal With Orgasm Anxiety

There are a few steps you can take on your own to improve partnered sexual experiences and reduce anxiety related to orgasm. While a sex therapist may be able to guide you through interventions more specific to your situation, these tips will be generally applicable to anyone experiencing orgasm anxiety.

The following are useful tips for dealing with orgasm anxiety:

1. Increase Self-Knowledge & Exploration

Take the time for sexual self-exploration. Even if you already masturbate, you may be engaging in a practice that has a specific sexual script and little time for novelty. Bodies change over time and what was stimulating for years may have shifted or could be augmented. Make sure you set aside a couple of times a week, at a minimum, for private time to get curious about yourself.

The goal with self-exploration is not to take the fastest path to orgasm, but to notice what creates pleasurable sensation and what relaxes you mentally. If you have no problem climaxing when you are alone, this is the perfect space to notice what’s different between your partnered and self-exploration experiences. Is it the type of stimulation or mental imagery being utilized? Is it self-consciousness when with another person? Is it performance anxiety or more generalized stress when in a partnered context?

When you are alone you may choose to use visual pornography, written erotica, and/or sex toys to enhance your play. If you have a vulva and are not sure where to start with erotic self-stimulation, you might try the site www.OMGYes.com, which is a non-pornographic approach rooted in scientific research that guides exploration in female self-pleasure techniques.

When you explore self-pleasure in private, you remove any pressure to please or perform for a partner. The knowledge you gain through self-exploration will help shift partnered sexual experiences as well, allowing for increased self-awareness and confidence. Knowing what is pleasurable for your own body and mind can help you to participate more fully in partnered sexual encounters.

2. Communicate With Sexual Partners

Tell your partner(s) about the orgasm anxiety you have been experiencing. Communicate before, during, and/or after sexual experiences about the anxiety to help diffuse its power over your pleasure. Discuss with your partner(s) that orgasm is not a measure of how attracted you are to them or how enjoyable a sexual encounter is. Sometimes simply naming orgasm anxiety out loud as an issue can be enough for it to dissipate.

Try tracking orgasm anxiety during sexual experiences as it occurs. Communicate with your partner(s) at the first sign of anxiety so that they can help you feel less pressure to climax. This communication can be verbal feedback, such as “I’m worried I won’t be able to come” or “I’m feeling like you need me to climax soon.” Or you may feel more comfortable communicating through non-verbal signals which you have discussed ahead of time with your partner(s).

Tell your partner(s) what kind of touch or other stimulation that you enjoy. This information can be either broad or specific, but gives your partner(s) a pleasure map to follow. Some orgasm anxiety can originate from lack of communication and from feeling pressure to orgasm from intercourse alone or from stimulation that is not suitable for your body.
Do not fake an orgasm to avoid anxiety. This can create a feedback loop which makes it increasingly difficult to be present with your experience instead of performative, reducing your ability to feel genuine pleasure.

3. Reduce Distractions & Enjoy the Moment

General stress can be a major contributor to orgasm anxiety. Make sure to reduce distractions during your sexual encounters and have plenty of time to relax and enjoy each other before focusing on climax. Kids, work and other responsibilities can all detract from the sexual experience, if not adequately set aside mentally during sexual play.

Although women typically need longer with “foreplay” than men in order to climax, all genders may experience enhanced pleasure when more time is given for sexual play prior to orgasm. Adequate blood flow is necessary for both the penis and the clitoris to be primed for orgasmic release.

Notice what happens when you focus on sensations all over your body, not just your genitalia. Heightened awareness of all five senses and of subtle sensations can help to quiet a spinning mind and enhance full-bodied pleasure. You might also try focusing on your breathing by slowing down and extending your exhales, which can reduce anxiety and bring you back into your body.

Let go of the goal of an orgasm and be present in the unique connection with your partner(s) instead. Sex can be immensely enjoyable without orgasmic release, particularly if your orgasms are frequently precipitated by anxiety and cloud the rest of your experience. Enjoy the moment and, if an orgasm arrives, allow it to be icing on an already delicious cake instead of a required ingredient.