Orgasmic disorder – anorgasmia (Coughlan’s Syndrome)

Orgasmic disorder presents as an inability to orgasm (anorgasmia), an orgasm that is far less intense than it should be, or an orgasm that is delayed despite high subjective arousal (which means you are turned on and everything should be working).

While this condition is often blamed on women being ‘unable to let go’ and typically classified as a psychiatric disorder, there are a lot of reasons why you can become anorgasmic or have problems orgasming that have nothing to do with psychology.

Orgasmic disorder, outside of drug-related anorgasmia, is a descriptive term, not a disease.

Anorgasmia is set up into four classifications

  1. Primary anorgasmia – a person has never experienced an orgasm, more common in women
  2. Secondary anorgasmia – the loss of the ability to have orgasms, can be caused by alcoholism, depression, grief, pelvic surgery, injury, medicine, illness, a loss of oestrogen, or sexual assault. Trans women who have had their prostate removed may experience issues, which is why this practice is not common.
  3. Situational anorgasmia – orgasm may occur during some occasions with some people, and not others, for no discernible reason/many reasons. This is not considered problematic and anyone sexually active has likely encountered this. Sometimes it just isn’t going to happen.
  4. Random anorgasmia – sometimes orgasmic, but not to a satisfactory level (to you), either via sexual satisfaction or expectations.

The most obvious cause of anorgasmia

If you are not turned on enough (physiologically speaking), you don’t like your partner, your partner isn’t very skilled or attentive to your needs, there is not enough foreplay to physiologically turn you on, or you aren’t getting what you want, you may not orgasm very easily or at all.

The less obvious causes of anorgasmia

  • Nerve damage from surgery or illness can contribute, for example from multiple sclerosis, diabetes, or genital diseases
  • Vulvar dermatoses – lichen sclerosus, lichenoid conditions, skin conditions
  • Antidepressants – SSRIs are a very common cause of inability to orgasm in women
  • Heroin or opiate use
  • Genital mutilation
  • Genital surgery
  • Pelvic trauma (straddle injuries)
  • Hormonal imbalances
  • Total hysterectomy
  • Spinal cord injury
  • Uterine embolism
  • Childbirth trauma, episiotomy
  • Vulvodynia
  • Cardiovascular disease

Testing for anorgasmia

To rule out physical causes, a physical examination and some tests may be required. Full blood count, liver function, hormone levels, etc. to check for ovulation, normal testosterone levels, diabetes, and hormone imbalances.

Treatments for anorgasmia

Treatment depends on the cause, so you will be carefully assessed to determine why anorgasmia is happening, then with your physician, choose a pathway forward that suits you.

The causes are incredibly many and varied, so seeing a doctor to rule out certain issues, especially if you were orgasming just fine, and then it’s changed or stopped. If your orgasms stopped and this is a surprise and shock for you, because everything else is going well, this is a reason to see your doctor. Do not ignore this symptom.

How drugs affect orgasm

Drug-induced anorgasmia needs addressing with your prescriptions, and is likely to include a change of medication (or an addition). Some medication may work well for the problem you had originally, and a lack of orgasm might be an unwanted but tolerable outcome.

Talk to your doctor about your options.

It’s unclear what mechanisms negatively impact orgasm via most medications.

When it’s nerve damage

Nerve-damage orgasm problems are harder to solve, and may need the professional eye of your doctor or neurologist, who can provide clearer insights into your particular nervous system.

Further surgeries may be indicated if that was the original cause of the problem.

Utilising a sex therapist

Outside of drugs, learning how to orgasm by going through sex therapy with a trained sex therapist can work wonders on one’s sense of sexual self. This can be done as a couple or alone.

Masturbation as a tool

Depending on the cause of anorgasmia, masturbation can be a great start for many people, since it starts the process that builds on itself. The more sexual stimulation you get, the more you will want, and so on, or so the theory goes.

Sex aids

Vibrators or other sex aids may be of great assistance, but fantasy – written, visual, auditory or mental – is a use tool to get your body on the same page as your desire to orgasm.

The importance of fantasy

Fantasy is underrated, and it doesn’t have to result in orgasm or masturbating. Lie back and imagine ideal scenarios, and let your mind – which, by the way, doesn’t understand the difference between reality and fantasy – do its thing. It will stimulate your body in the process.

The importance of foreplay

Foreplay cannot be underestimated. It is thought that at least 20 minutes good quality foreplay is mandatory, and gives a woman an 80 per cent chance of orgasming, and anything less than that leaves her with just a 20 per cent chance of orgasming.

Fact is, lots of people do not understand sex and the female body, and it is your job and theirs to learn. Not orgasming isn’t a life choice. Learning how to orgasm is something many women need to actively work on.

Women do not tend to respond very well to sex drugs like viagra, since the amount of tissue that responds to this type of drug varies considerably from woman to woman.

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Jessica Lloyd - Vulvovaginal Specialist Naturopathic Practitioner, BHSc(N)

Jessica is a degree-qualified naturopath (BHSc) specialising in vulvovaginal health and disease, based in Melbourne, Australia.

Jessica is the owner and lead naturopath of My Vagina, and is a member of the:

  • International Society for the Study of Vulvovaginal Disease (ISSVD)
  • International Society for the Study of Women's Sexual Health (ISSWSH)
  • National Vulvodynia Association (NVA) Australia
  • New Zealand Vulvovaginal Society (ANZVS)
  • Australian Traditional Medicine Society (ATMS)