Orgasmic disorder is lack of or delay in sexual climax (orgasm) or orgasm that is infrequent or much less intense even though sexual stimulation is sufficient and a woman is sexually aroused mentally and emotionally.
Some women have trouble having an orgasm or are unable to have one at all.
Women may not have an orgasm if there is consistently insufficient foreplay, early ejaculation by the partner, or poor communication about sexual activity preferences.
Women with orgasmic disorder may 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 a woman's description of the problem and specific criteria.
Women are encouraged to try self-stimulation (masturbation), and for some women, psychological therapies are helpful.
The amount and type of stimulation required for orgasm varies greatly from woman to woman. Most women can reach orgasm when the clitoris is stimulated, but fewer than half of women regularly reach orgasm during vaginal intercourse. About 1 of 10 women never reaches orgasm, but some 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 a woman.
Causes of Orgasmic Disorder in Women
Female orgasm disorder often has more than one cause. It is influenced by a combination of physical, psychological, relationship, and social or cultural factors.
Physical (biological) factors may include certain medical conditions, such as diabetes, multiple sclerosis, chronic pain, spinal cord injuries, or conditions affecting the vulva. Hormonal changes, especially during menopause. may also affect orgasm, possibly due to lower levels of hormones like estrogen, progesterone, and testosterone. Some medications, including blood pressure medicines and certain antidepressants (especially SSRIs), can also make it harder to reach orgasm.
Psychological factors can also affect the ability to orgasm. For example, depression, anxiety, or feeling distracted during sexual activity may make it more difficult. Some women may feel as though they are “watching themselves” during sex rather than being fully engaged. Negative body image or discomfort with one’s genitals can also play a role.
Relationship factors may also contribute. These include a lack of emotional closeness, ongoing relationship conflict, unresolved anger or resentment, or poor communication about sexual needs. Sexual difficulties experienced by a partner can also have an impact. In addition, discomfort with masturbation may make it harder for some women to learn what kinds of stimulation help them reach orgasm.
Social and cultural influences can affect sexual experience as well. Feelings of shame or guilt about sex, often related to cultural or religious beliefs, may reduce comfort with sexual expression. Limited or inaccurate sexual education—especially about female anatomy and how orgasm occurs—can also contribute. For example, a common misconception is that most women should be able to reach orgasm through penetration alone, when in fact many women need direct clitoral stimulation.
Symptoms of Orgasmic Disorder in Women
Some women with orgasmic disorder have never been able to have an orgasm. Others have had orgasms but no longer do or have difficulty having an orgasm.
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.
Women with orgasmic disorder may 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.
Anxiety disorders and depression are common in women with orgasmic disorder.
Diagnosis of Orgasmic Disorder in Women
A doctor's evaluation, based on standard psychiatric criteria
Doctors interview a woman and, sometimes, her partner. They ask a woman to describe the problem in her own words.
Doctors diagnose orgasmic disorder based the following criteria:
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 of Orgasmic Disorder in Women
Self-stimulation (masturbation)
Psychological therapies or sex therapy
Treatment for female orgasm disorder should take a whole-person approach, meaning it addresses physical, psychological, relationship, and social and cultural factors. This may include education, therapy, and sometimes referral to specialists such as a sex therapist or a pelvic floor physical therapist.
One important part of treatment is education about sexual health. Learning about how the body responds to sexual stimulation, including the role of both physical and emotional factors, can be helpful. It is also important to understand that female orgasm disorder is common, which may help reduce worry or frustration. Addressing common myths is key. For example, many people believe women should be able to reach orgasm through penetration alone; however, most women need direct clitoral stimulation to have an orgasm.
Health care professionals may also recommend resources to improve communication with a partner and to explore different ways of increasing pleasure. Some women find that using a vibrator is helpful. If problems with orgasm continue, a referral to a sex therapist may be helpful.
Sex therapists are trained mental health professionals who focus on sexual concerns. They often use approaches such as cognitive behavioral therapy (CBT) or mindfulness techniques to address thoughts and behaviors that affect sexual function. One common method used is guided or directed masturbation, which involves structured exercises at home to help women become more aware of their body and what feels pleasurable. Another technique, called sensate focus, involves a series of touching exercises that help reduce anxiety and distraction and improve focus on physical sensations.
Referral to a pelvic physical therapist may also be helpful. This type of therapy focuses on improving how the pelvic muscles function, which can play an important role in sexual arousal and the ability to achieve orgasm.
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