Anorgasmia is the medical
term for regular difficulty reaching orgasm after ample sexual
stimulation, causing you personal distress. Anorgasmia is actually a
very common occurrence, affecting at least 1 in 5 women worldwide.
Orgasms vary in intensity, and women vary in the frequency of their
orgasms and the amount of stimulation necessary to trigger an orgasm. In
fact, fewer than a third of women consistently have orgasms with sexual
activity. Plus, orgasms often change with age, medical issues or
medications you're taking.
If you're happy with the climax of your sexual activities, there's no
need for concern. However, if you're bothered by lack of orgasm or the
intensity of your orgasms, talk to your doctor about anorgasmia.
Lifestyle changes and sex therapy may help.
An orgasm is a feeling of intense physical pleasure and release of
tension, accompanied by involuntary, rhythmic contractions of your
pelvic floor muscles. But it doesn't always look — or sound — like that
famous scene from "When Harry Met Sally." Some women actually feel
pelvic contractions or a quivering of the uterus during orgasm, but some
don't. Some women describe fireworks all over the body, while others
describe the feeling as a tingle.
By definition, the major symptoms of anorgasmia are inability to
experience orgasm or long delays in reaching orgasm. But there are
different types of anorgasmia:
* Primary anorgasmia. This means you've never experienced an orgasm.
* Secondary anorgasmia. This means you used to have orgasms, but now experience difficulty reaching climax.
* Situational anorgasmia. This means you are able to orgasm only
during certain circumstances, such as during oral sex or masturbation.
This is very common in women. In fact, about 80 percent of women
experience orgasm only from stimulation of the clitoris.
* General anorgasmia. This means you aren't able to orgasm in any situation or with any partner.
When to see a doctor
Talk to your doctor if you have questions about orgasm or concerns about
your ability to achieve orgasm. You may find that your sexual
experiences are normal. Or your doctor may recommend strategies to
reduce your anxiety and increase your satisfaction.
Despite what you see in the movies, orgasm is no simple, surefire thing.
This pleasurable peak is actually a complex reaction to many physical,
emotional and psychological factors. If you're experiencing trouble in
any of these areas, it can affect your ability to orgasm.
A wide range of illnesses, physical changes and medications can interfere with orgasm:
* Medical diseases. Any illness can affect this part of your
sexuality, including diabetes and neurological diseases, such as
multiple sclerosis. Orgasm may also be affected by gynecologic
surgeries, such as hysterectomy or cancer surgeries. In addition, lack
of orgasm often goes hand in hand with other sexual problems, such as
* Medications. Many prescription and over-the-counter medications
can interfere with orgasm. This includes blood pressure medications,
antihistamines and antidepressants — particularly selective serotonin
reuptake inhibitors (SSRIs). In men, SSRIs can actually result in both
anorgasmia and inability to obtain an adequate erection for satisfactory
sexual activity (erectile dysfunction).
* Alcohol and drugs. A glass of wine may make you feel amorous, but
too much alcohol can cramp your ability to climax; the same is true of
* The aging process. As you age, normal changes in your anatomy,
hormones, neurological system and circulatory system can affect your
sexuality. The drop in estrogen that occurs during the transition to
menopause can be a particularly notable foe of orgasm. Lower levels of
this female hormone can decrease sensations in the clitoris, nipples and
skin and impede blood flow to the vagina and clitoris, which can delay
or stop orgasm entirely. Still, anorgasmia isn't limited to older women.
And many women say sex becomes more satisfying with age.
Many psychological factors play a role in your ability to orgasm, including:
* Mental health problems, such as anxiety or depression
* Performance anxiety
* Stress and financial pressures
* Cultural and religious beliefs
* Fear of pregnancy or sexually transmitted diseases
* Guilt about enjoying sexual experiences
Many couples who are experiencing problems outside of the bedroom will
also experience problems in the bedroom. These overarching issues may
* Lack of connection with your partner
* Unresolved conflicts or fights
* Poor communication of sexual needs and preferences
* Infidelity or breach of trust
Preparing for your appointment
If you rarely or never experience orgasm from sexual activity and it's
causing you distress, make an appointment with your doctor. You may feel
embarrassed to talk about sex with your doctor, but this topic is
perfectly appropriate. Your doctor knows that a satisfying sex life is
very important to a woman's well-being at every age and stage of life.
You may have a treatable, underlying condition, or your may benefit from
lifestyle changes, therapy or a combination of treatments. Your regular
doctor may diagnose and treat the problem or refer you to a specialist
Here's some information to help you prepare for your appointment, and what to expect from your doctor.
Information to write down in advance
* Your symptoms. It will help your doctor to know whether you've ever had an orgasm, and if so, under what circumstances.
* Your sexual history. Your doctor likely will ask about your
relationships and experiences since you first became sexually active. He
or she also may ask about any history of sexual trauma or abuse.
* Your medical history. Write down any medical conditions with which
you've been diagnosed, including mental health conditions. Also note
the names and strengths of all medications you're currently taking or
have recently taken, including prescription and over-the-counter drugs.
* Questions to ask your doctor. Creating your list of questions in
advance can help you make the most of your time with your doctor.
Basic questions to ask your doctor
The list below suggests questions to raise with your doctor about
anorgasmia. Don't hesitate to ask more questions during your appointment
at any time that you don't understand something.
* What may be causing my inability to orgasm?
* Do I need any medical tests?
* What treatment approach do you recommend?
* If you're prescribing medication, are there any possible side effects?
* How much improvement can I reasonably expect with treatment?
* Are there any lifestyle changes or self-care steps that may help me?
* Do you recommend therapy?
* Should my partner be involved in treatment?
* Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?
What to expect from your doctor
Your doctor may ask a number of very personal questions and may want to
include your partner in the interview. To help your doctor determine the
cause of your problem and the best course of treatment, be ready to
answer questions such as:
* When did you first become sexually active?
* For how long have you had difficulty reaching orgasm?
* If you've had orgasms in the past, what were the circumstances?
* Do you become aroused during sexual interactions with your partner?
* Do you experience any pain with intercourse?
* How much are you bothered by your inability to reach an orgasm?
* How satisfied are you with your current relationship?
* Are you using any form of birth control? If yes, what form?
* What medications are you taking, including prescription and over-the-counter drugs as well as vitamins and supplements?
* Do you use alcohol or recreational drugs? How much?
* Have you ever had surgery that involved your reproductive system?
* Have you been diagnosed with any other medical conditions, including mental health conditions?
* What were your family's beliefs about sexuality?
* Have you ever been the victim of sexual violence?
What you can do in the meantime
While you wait for your appointment, talk with your partner about taking
a break from sexual intercourse and instead focusing on other ways of
being intimate. Focusing on the connection you can share — both
emotional and physical — without the goal of an orgasm is often an
essential first step in treating anorgasmia.
Tests and diagnosis
A medical evaluation for anorgasmia usually consists of:
* A thorough medical history. Your doctor may also inquire about
your sexual history, surgical history and current relationship. Don't
let embarrassment stop you from giving candid answers. These questions
provide clues to the cause of your problem.
* Physical examination. Your doctor will probably conduct a general
physical exam to look for physical causes of anorgasmia, such as an
underlying medical condition. Your doctor may also examine your genital
area to see if there is some obvious physical or anatomical reason for
lack of orgasm.
Treatments and drugs
It can be difficult to treat anorgasmia. Your treatment plan will depend
on the underlying cause of your symptoms, but your doctor may recommend
a combination of these tactics:
Lifestyle and home remedies
For most women, treatment means more than medications. It's important to
address relationship issues and everyday stressors. Understanding your
body and trying different types of sexual stimulation also can help.
* Understand your body better. Understanding your own anatomy and
how you like to be touched can lead to better sexual satisfaction. If
you need a refresher course on your genital anatomy, ask your doctor for
a diagram or get out a mirror and look. Then take some time to explore
your own body. Masturbating or using a vibrator can help you discover
what type of touching feels best to you, and then you can share that
information with your partner. If you're uncomfortable with
self-exploration, try exploring your body with your partner.
* Increase sexual stimulation. Many women who've never had an orgasm
aren't getting enough effective sexual stimulation. Most women need
direct or indirect stimulation of the clitoris in order to orgasm, but
not all women realize this. Switching sexual positions can produce more
clitoral stimulation during intercourse; some positions also allow for
you or your partner to gently touch your clitoris during sex. Using a
vibrator during sex can also help trigger an orgasm.
* Seek couples counseling. Conflicts and disagreements in your
relationship can zap your ability to orgasm. A counselor can help you
work through disagreements and tensions and get your sex life back on
Try sex therapy. Sex therapists are therapists who specialize in
treating sexual problems. You may be embarrassed or nervous about seeing
a sex therapist, but sex therapists can be very helpful in treating
anorgasmia. Therapy often includes sex education, help with
communication skills and behavioral exercises that you and your partner
try at home.
For example, you and your partner may be asked to practice
"sensate focus" exercises, a specific set of body-touching exercises
that teach you how to touch and pleasure your partner without worrying
about orgasm. Or you and your partner may learn how to combine a
situation that allows you to achieve orgasm — such as clitoral
stimulation — with a situation in which you want to achieve orgasm, such
as intercourse. By using these techniques and others, you may learn to
view orgasm as one pleasurable part of sexual intimacy, not the whole
goal of every sexual encounter.
Hormone therapies aren't a guaranteed fix for anorgasmia. But they can help. So can treating underlying medical conditions.
* Treating underlying conditions. If a medical condition is
hindering your ability to orgasm, treating the underlying cause may
resolve your problem. Changing or modifying medications known to inhibit
orgasm also may eliminate your symptoms.
* Estrogen therapy. Systemic estrogen therapy — by pill, patch or
gel — can have a positive effect on brain function and mood factors that
affect sexual response. Local estrogen therapy — in the form of a
vaginal cream or a slow-releasing suppository or ring that you place in
your vagina — can increase blood flow to the vagina and help improve
desire. In some cases, your doctor may prescribe a combination of
estrogen and progesterone.
* Testosterone therapy. Male hormones, such as testosterone, play an
important role in female sexual function, even though testosterone
occurs in much lower amounts in a woman. As a result, testosterone may
help increase orgasm, especially if estrogen and progesterone aren't
helping. However, replacing testosterone in women is controversial and
it's not approved by the Food and Drug Administration for sexual
dysfunction in women. Plus, it can cause negative side effects,
including acne, excess body hair (hirsutism), and mood or personality
changes. Testosterone seems most effective for women with low
testosterone levels as a result of surgical removal of the ovaries
(oophorectomy). If you choose to use this therapy, your doctor will
closely monitor your symptoms to make sure you're not experiencing
negative side effects.
Natural products are available that may help some women who have
difficulty reaching orgasm. These oils and supplements work by
increasing sensation in the clitoris and surrounding tissue.
The following products may benefit some women with anorgasmia:
* Zestra. This botanical massage oil helps warm the clitoris and may increase sexual arousal and orgasm.
* ArginMax. This oral nutritional supplement contains L-arginine, a
substance that relaxes blood vessels and increases blood flow to the
genital area, and the clitoris in particular.
Talk with your doctor before trying any natural therapies. These
products can cause side effects and may interact with other medications.
Your doctor can help determine if they are safe for you.
Coping and support
If you're experiencing difficulty reaching orgasm, it can be frustrating
for you and your partner. Plus, concentrating on climax can make the
Most couples aren't experiencing the headboard-banging, van-rocking
intercourse that appears on TV and in the movies. So try to reframe your
expectations. Focus on mutual pleasure, instead of orgasm. You may find
that a sustained pleasure plateau is just as satisfying as real climax.