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 for some time 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. Being a control freak is definitely a cause of orgasmic disorder, but here we go through a few more options and explain the medical view of anorgasmia.

Orgasmic disorder, outside of drug-related inorgasmia, is a term that actually doesn’t mean that much. It is merely the description of a symptom of something else, and nothing more, so generally, you won’t go to the doctor and be told you have ‘orgasmic disorder’. It’s always linked to something else, and that should be treated. There is no ‘cure’ for orgasmic disorder, as such, and it involves a lot of talking, experimenting, and getting over stuff.

Anorgasmia is set up into four classifications

  1. Primary anorgasmia – where you have 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 – this is where you might orgasm during some occasions with some people, and not others, for no discernable reason, though there are many reasons. This is not considered problematic.
  4. Random anorgasmia – sometimes you may be orgasmic, but not to a satisfactory level (to you), either via sexual satisfaction or expectations.

The most obvious cause of no orgasms

If you are not that turned on, you don’t like your partner, your partner isn’t very good at sex or foreplay, you don’t get enough foreplay, or you aren’t getting what turns you on in the sack, you aren’t going to orgasm very easily. If you don’t understand how sex works, or how your body works, orgasm can be elusive.

Check out the sexuality section for Sex 101, cunnilingus, fingering, and other sex information and tips. You need to learn how to do it, and that probably means communicating effectively with your partner, as frightening as that may seem. You will also need to try touching your own body.

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 obviously depends on the cause, so carefully assess why this is happening, then with your physician, choose a pathway forward that suits you.

Drug-induced inorgasmia needs addressing with your prescriptions, and is likely to include a change of medication (or an addition).

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.

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

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.

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. This is science, ladies, and you need to get what you need.

Men’s bodies behave differently – let’s say their goal is to get their sperm in as many women as possible as often as possible, they need to be able to just squirt it out at a moment’s notice. Women, on the other hand, are designed to ward off this sperm until The Chosen One arrives (to impregnate her), and we take longer to arouse, and the set of criteria are often muddy to the observing eye. (Read: many men find women mysterious.)

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.

Jessica Lloyd - Naturopathic Practitioner, BHSc(N)

Jessica Lloyd - 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)
Read more about Jessica and My Vagina's origin story.