Anorgasmia

Anorgasmia is the medical term for regular difficulty reaching orgasm after ample sexual stimulation, causing you personal distress. Anorgasmia is a common occurrence, affecting a significant number of women.

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, most women don’t consistently have orgasms with vaginal penetration alone. 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 it does in the movies. The way an orgasm feels varies from woman to woman, and in an individual woman, it may even differ from orgasm to orgasm.

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:

• Lifelong anorgasmia. This means you’ve never experienced an orgasm.
• Acquired 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 with a certain partner. Most women can’t reach orgasm through vaginal penetration alone.
• Generalized 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 reach 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 media, orgasm is no simple, sure 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.

Physical causes

A wide range of illnesses, physical changes and medications can interfere with orgasm:

• Medical diseases. Any illness can affect this part of the human sexual response cycle, including diabetes and neurological diseases, such as multiple sclerosis.
• Gynecologic issues. Orgasm may be affected by gynecologic surgeries, such as hysterectomy or cancer surgeries. In addition, lack of orgasm often goes hand in hand with other sexual concerns, such as uncomfortable or painful intercourse.
• Medications. Many prescription and over-the-counter medications can interfere with orgasm, including blood pressure medications, antihistamines and antidepressants — particularly selective serotonin reuptake inhibitors (SSRIs).
• Alcohol and smoking. Too much alcohol can cramp your ability to climax; the same is true of smoking, which can limit blood flow.
• The aging process. As you age, normal changes in your anatomy, hormones, neurological system and circulatory system can affect your sexuality. A tapering of estrogen levels during the transition to menopause can decrease blood flow to the vagina and clitoris, which can delay or stop orgasm entirely.

Psychological causes

Many psychological factors play a role in your ability to orgasm, including:

• Mental health problems, such as anxiety or depression
• Poor body image
• Stress and financial pressures
• Cultural and religious beliefs
• Fear of pregnancy or sexually transmitted infections
• Embarrassment
• Guilt about enjoying sexual experiences
• Past sexual or emotional abuse

Relationship issues

Many couples who have problems outside of the bedroom also experience problems in the bedroom.Overarching issues may include:

• Lack of connection with your partner
• Unresolved conflicts or fights
• Poor communication of sexual needs and preferences
• Infidelity or breach of trust
• Intimate partner violence

If you rarely or never experience orgasm from sexual activity and it distresses you, make an appointment with your doctor. Your regular doctor may diagnose and treat the problem or refer you to a specialist who can.

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 you may benefit from lifestyle changes, therapy or a combination of treatments.

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 may also 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, vitamins and supplements.
• 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 if you don’t understand something.

• What may be causing my difficulty 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 websites 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 sexually aroused during sexual interactions with your partner?
• Do you experience any pain with vaginal penetration?
• How much are you bothered by your lack of 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, be open with your partner about the situation. Continue sexual activity, and also explore other ways of being intimate. Shifting the focus from orgasm to pleasure may be a helpful strategy in treating anorgasmia.

A medical evaluation for anorgasmia usually consists of:

• A thorough medical history. Your doctor may ask 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.
• A physical exam. 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’s some obvious physical or anatomical reason for lack of orgasm.

Anorgasmia can be difficult to treat. Your treatment plan will depend on the underlying cause of your symptoms, but your doctor may recommend a combination of lifestyle changes, therapy and medication.

Lifestyle changes and therapy

For most women, a key part of treatment includes addressing 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. Self-stimulation or using a vibrator can help you discover what type of touch 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. Women who’ve never had an orgasm may not be 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 vaginal penetration; some positions also allow for you or your partner to gently touch your clitoris during sex. Using a vibrator during sex also can help trigger an orgasm. Mental imagery or fantasizing during sex also may help.

  For some women, a device called a clitoral vacuum may improve blood flow and increase stimulation. This device is battery operated and hand-held, with a cup that fits over the clitoris.

• Seek couples counseling. Conflicts and disagreements in your relationship can affect your ability to orgasm. A counselor can help you work through disagreements and tensions and get your sex life back on track.
• Cognitive behavioral therapy. This type of therapy attempts to change the negative thoughts you may have about sex. You may be given directed masturbation exercises to do at home to learn how to achieve orgasm on your own.
• Try sex therapy. Sex therapists are therapists who specialize in treating sexual concerns. 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 focusing on orgasm. Or you and your partner may learn how to combine a situation in which you reach orgasm — such as clitoral stimulation — with a situation in which you desire to reach orgasm, such as vaginal penetration. 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.

Medical treatments

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 for postmenopausal women. 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 sexual arousal. In some cases, your doctor may prescribe a combination of estrogen and progesterone.
• Testosterone therapy. Testosterone plays an important role in female sexual function, though in much lower amounts. As a result, testosterone may help increase sexual arousal. However, replacing testosterone in women is controversial and it’s not approved by the Food and Drug Administration for sexual dysfunction in women.

  Additionally, it can cause negative side effects, including acne, excess body hair (hirsutism) and male-pattern baldness. 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, such as those made with L-arginine, are marketed as helpful for improving a woman’s sex life. But these supplements haven’t been well-studied for this use, and they’re not regulated by the Food and Drug Administration.

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.

If you’re experiencing difficulty reaching orgasm, it can be frustrating for you and your partner. Plus, concentrating on climax can make the problem worse.

Most couples aren’t experiencing the headboard-banging, earth-shaking sex 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 orgasm.

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