Female Orgasmic Disorder is a surprisingly common condition clinically defined as a persistent reduction or complete inability to experience orgasm.
Difficulty with orgasming is the second most common concern women bring to health providers. We don’t really know how many women suffer from this, as statistics vary widely and indeed, one source compiling data said that the range varies from eight to 72%. According to a 2020 paper published in the International Society for Sexual Medicine, up to 28% of women in the United States and up to 46% in countries across Asia are affected by this disorder.
Symptoms and Signs of Orgasmic Disorder
The International Classification of Diseases, Tenth Revision defines female orgasmic disorder as “a persistent or recurrent delay in or absence of orgasm despite normal sexual excitement and adequate stimulation.”
It also says that for a diagnosis, psychological factors should be a prominent cause of the problem.
However, many women come to clinicians with orgasm problems that don’t meet these criteria but who still need help. For example, a woman may come to a sex therapist for lack of orgasm and the cause may be inadequate stimulation. Likewise, someone may have a lack of orgasm due to a medical condition.
Likewise, some women come to clinicians having never had an orgasm and others come because they used to orgasm and no longer do.
What is a Female Orgasm? (And How It Works)
Before we dive into why orgasms may not be happening, let’s quickly explain what an orgasm is. It is the peak of sexual arousal. An orgasm involves an automatic body response. It includes many physical changes (e.g., changes in pupil size and increased blood pressure) and the release of feel-good messengers in the brain (neurotransmitters) like dopamine and oxytocin.
It also involves the erectile tissue in our genitals (which are mainly on the inner clitoris) engorging with blood. This buildup feels great. Orgasm includes the trapped blood being released by contractions of the pelvic floor muscles.
Importantly, these contractions feel fantastic. Sometimes, women also ejaculate and squirt during orgasm. Female orgasms can last from about 13 to 51 seconds, compared to male orgasms, which average from 10 to 30 seconds.
Why It Happens: Physical, Psychological, and Social Factors
Physical reasons for Female Orgasmic Disorder
- Chronic health conditions: Such as diabetes, or multiple sclerosis may contribute to an inability to orgasm
- Gynecological issues: Gynecologic surgeries such as cancer surgery or hysterectomies may damage tissue and impact the ability to orgasm. Likewise, vulvar skin issues can impact orgasm.
- Medications: Medications unrelated to sexual function, such as antipsychotic medicines, and some birth control pills may inhibit orgasm. Additionally, antidepressants such as SSRIs (Selective Serotonin Reuptake Inhibitors) in particular are a common culprit, with studies showing up to 80% of patients taking SSRIs reporting difficulties with sexual function.
- Lifestyle factors: Alcohol and smoking can inhibit nervous system activity and blood flow, dulling orgasmic potential
- Hormonal changes: Peri-menopause, menopause, and aging may all contribute to sexual problems including weakened orgasms.
Psychological Reasons for Female Orgasmic Disorder
- Anxiety surrounding body image, your partner, or losing control
- Past sexual or emotional abuse
- Intense stress or pressure, which can hamper the body’s ability to be in the moment
- Mental health conditions such as depression or anxiety
Social Reasons for Female Orgasmic Disorder (The Orgasm Gap)
- Embarrassment or guilt about sex due to upbringing and cultural or religious beliefs
- A lack of knowledge about sexual stimulation due to poor sexual education
- An inability to speak about what is pleasurable due to societal constraints
There’s a long history of female sexuality being repressed throughout many cultures, ranging from cultural and religious taboos against expressing desire to outright excision in the case of Female Genital Mutilation (FGM). Unfortunately, such taboos continue to contribute to an unequal orgasmic playing field for those with vulvas and those with penises.
A rigorous 2017 study by the International Academy of Sexual Research found that 95% of heterosexual men said they always or almost always orgasmed during sex, compared to 65% of straight women, 66% of bisexual women, and 86% of lesbian women. Known as “ the orgasm gap,” this disparity is mainly due to the prioritization of male pleasure (penetrative sex) and the cultural silence around women’s most orgasmic organ, the clitoris.
Female Orgasmic Disorder Treatment Options
Self-Help
Research shows that when it comes to learning to orgasm, self-help works. Two books with evidence for their effectiveness are the older “Becoming Orgasmic” and the more recent “Becoming Cliterate.” Other great books are “Sex for One” and “For Yourself.” Likewise, mymojo.com offers guided courses based in sexual science and sex therapy for women who’ve never orgasmed and those who used to but lost their orgasm. Additionally, for those for whom anxiety is getting in the way, the book Better Sex Through Mindfulness (and its similar handbook) is quite useful.
Sex Therapy
If self-help doesn’t work, it’s best to see a therapist, who can offer more individualized treatment. You can find a provider at the websites of the American Association of Sex Therapists Counselors and Educators and The Society for Sex Therapy and Research.
Medical Interventions
There are many things that sexual medicine physicians can do to assess if a lack of orgasm is due to a medical issue, and many “off label” treatments that can be provided. The International Society for the Study of Women’s Sexual Health can help you find a provider.
For those who used to orgasm and no longer do, potentially due to SSRIs, stress, or menopause, one medical option is a topical cream made with sildenafil and other vasodilators applied to the clitoris. You can get a medical consultation here.
FAQs
Can you fix female orgasmic disorder?
Female Orgasmic Disorder is indeed treatable by tackling physical, psychological, and emotional components.
Is it common to never have an orgasm?
Yes! Studies show that up to 20% of women have never experienced an orgasm. However, again, this is something that can be changed with interventions such as those discussed above.
What is the difference between anorgasmia and low libido?
Anorgasmia refers to the inability to achieve orgasm, while low libido is a reduction or absence of sexual desire.
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