Women may not have an orgasm if lovemaking ends too soon, there is not enough foreplay, they do not communicate what feels good to them, or the partner does not respond to that communication.
Many women with orgasmic disorder have other types of sexual problems, such as pain during sex and involuntary contraction of the muscles around the opening of the vagina when entry into the vagina is attempted.
Doctors diagnose orgasmic disorder based on the woman's description of the problem and specific criteria.
Women are encouraged to try self-stimulation (masturbation), and for some women, psychologic therapies are helpful.
(See also Overview of Sexual Dysfunction in Women Overview of Sexual Dysfunction in Women Sexual dysfunction includes pain during intercourse, involuntary painful contraction (spasm) of the muscles around the vagina, and lack of interest in (desire for) sex and problems with arousal... read more .)
The amount and type of stimulation required for orgasm varies greatly from woman to woman. Most women can reach orgasm when the clitoris (which corresponds to the penis in men) is stimulated, but fewer than half of women regularly reach orgasm during sexual intercourse. About 1 of 10 women never reaches orgasm, but many of them nonetheless consider sexual activity to be satisfactory.
Many women with orgasmic disorder cannot have an orgasm under any circumstances, even when they masturbate and when they are highly aroused. However, if a women does not have an orgasm because she is not sufficiently aroused, the problem is considered an arousal disorder, not an orgasmic disorder. Inability to have an orgasm is considered a disorder only when the lack of orgasm distresses the woman.
Lovemaking without orgasm can cause frustration and may result in resentment and occasionally a dislike for anything sexual.
Causes
Situational and psychologic factors can contribute to orgasmic disorder. They include the following:
Lovemaking that consistently ends before the woman is aroused enough (as when the man ejaculates too soon)
Insufficient foreplay
In one or both partners, lack of understanding about how their genital organs function
Poor communication about sex (for example, about what sort of stimulation a person enjoys)
Problems in the relationship, such as unresolved conflicts and lack of trust
Anxiety about sexual performance
A physically or emotionally traumatic experience, such as sexual abuse
Psychologic disorders (such as depression)
Physical disorders can also contribute to orgasmic disorder. They include nervous system damage (as results from diabetes Types of Diabetes Complications People with diabetes mellitus have many serious long-term complications that affect many areas of the body, particularly the blood vessels, nerves, eyes, and kidneys. (See also Diabetes Mellitus... read more 
, spinal cord injuries Injuries of the Spinal Cord and Vertebrae Most spinal cord injuries result from motor vehicle crashes, falls, assaults, and sports injuries. Symptoms, such as loss of sensation, loss of muscle strength, and loss of bowel, bladder, and... read more 
, lichen sclerosus Lichen Sclerosus Lichen sclerosus is a disorder that tends to cause itching and can cause scarring in the area around the anus and genitals. The cause of lichen sclerosis is unknown, but it may involve the immune... read more 
, or multiple sclerosis Multiple Sclerosis (MS) In multiple sclerosis, patches of myelin (the substance that covers most nerve fibers) and underlying nerve fibers in the brain, optic nerves, and spinal cord are damaged or destroyed. The cause... read more ), and abnormalities in genital organs.
Certain drugs, particularly selective serotonin reuptake inhibitors Selective serotonin reuptake inhibitors (SSRIs) Agomelatine, a new type of antidepressant, is a possible treatment for major depressive episodes. Several types of drugs can be used to treat depression: Selective serotonin reuptake inhibitors... read more (SSRIs, a type of antidepressant), may specifically inhibit orgasm.
Symptoms
Some women with orgasmic disorder have never been able to have an orgasm. Others have had orgasms but no longer do.
Other women with this disorder have orgasms, but the orgasms are infrequent or much less intense even though sexual stimulation is sufficient and the women are sexually aroused mentally and emotionally.
Many women with orgasmic disorder have other types of sexual problems, such as pain during sexual intercourse (dyspareunia) and involuntary contraction of the muscles around the opening of the vagina when entry into the vagina is attempted (levator ani syndrome, previously called vaginismus).
Anxiety disorders and depression are common in women with orgasmic disorder.
Diagnosis
A doctor's evaluation based on specific criteria
Doctors interview both partners separately and together if possible. They also ask the woman to describe the problem in her own words.
Doctors diagnose orgasmic disorder based on criteria from Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published by the American Psychiatric Association. These criteria require the following:
Orgasm that is delayed, infrequent, absent, or much less intense after normal sexual arousal during all or almost all sexual encounters
Distress or interpersonal problems due to problems with orgasm
No other disorder or substance that accounts for the problems with orgasm dysfunction
Symptoms must have been present for at least 6 months.
Treatment
Self-stimulation
Psychologic therapies
Doctors may encourage women to learn what type of touch is pleasurable and arousing by trying self-stimulation (masturbation).
Doctors may also suggest increasing the type and intensity of other stimuli, including fantasy, role playing, videos, pictures, written materials, and sounds.
Other techniques that may help include relaxation techniques and sensate focus exercises. In sensate focus exercises, partners take turns touching each other in pleasurable ways. Couples may try using more or different stimuli, such as a vibrator, fantasy, or erotic videos. A vibrator may be especially useful when there is nerve damage.
Learning more about the woman's anatomy and ways to arouse her may help. For some women, incorporating stimulation of the clitoris may be all that is needed.
Psychologic therapies may help women identify and manage anxiety about sexual performance and issues of trusting a partner. These therapies include psychotherapy, cognitive-behavior therapy, mindfulness-based cognitive therapy (MBCT), and sex therapy.
Psychotherapy and cognitive-behavior therapy may be useful for women who have been sexually abused or have psychologic disorders. These therapies may help women identify and manage fear of vulnerability and issues of trust with a partner.
Practicing mindfulness (focusing on what is happening in the moment) can help women pay attention to sexual sensations, without making judgments about or monitoring what is happening.
Sex therapy often helps women and their partner deal with issues that affect their sexual life, such as specific sexual problems and their relationship with their partner.
If an SSRI is the cause, adding bupropion (a different type of antidepressant) may help. Or a doctor can recommend another antidepressant.
There is no recommended drug therapy for female orgasmic disorder.
Drugs Mentioned In This Article
| Generic Name | Select Brand Names |
|---|---|
bupropion |
WELLBUTRIN, ZYBAN |
