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People sometimes talk about orgasm as the "goal" for sex, that there is an expectation that sex should culminate with the intense pleasure of an orgasm. The problem is, orgasm isn't necessarily guaranteed and the pressure to have an orgasm often detracts from the experience of pleasure, especially when orgasm doesn't or can't occur. Further, there are some women who don't experience orgasm regardless of the type of stimulation is used.
Female orgasmic disorder is the absence, delay, or a reduction in the intensity of orgasm. In order for the diagnosis to be given, the problem must be present for a minimum of six months and cause the person distress. Importantly, the orgasmic difficulty can't be primarily caused by other psychological issues, a medical problem, or relationship distress. Orgasmic disorder can be lifelong or acquired after a period of time of typical orgasmic functioning. It can also occur in specific contexts or generalized across settings.
Research shows that about 30% of women can achieve orgasm through vaginal stimulation or intercourse. This means about 70% of women can't achieve orgasm through intercourse alone. About 80% of women can achieve orgasm through clitoral stimulation and 94% of women can experience an orgasm with the use of a vibrator.
The vagina is often equated to the penis in that the penis is considered the fundamental pleasure organ in the male body and the vagina is the fundamental pleasure organ in the female body. This, however, is a common misconception. In uterine development, the clitoris and the penis both develop from the same genital tubercle, and are thus comparable in developmental and sensory makeup. In other words, the clitoris, not the vagina, is the fundamental pleasure organ in the female body.
The clitoris is more than just the little external nub of skin at the top of the vulva. This is actually only a small part of the clitoris, which extends internally and extends around the vaginal canal, similar in shape to a wishbone. The type of motion people use when engaging in vaginal intercourse often involves an in-and-out thrusting motion. This type of motion creates inconsistent engagement of the clitoris and therefore doesn't allow for the consistent stimulation that is most helpful for orgasm. Instead, a more helpful way of consistently connecting with this pleasure organ during vaginal intercourse is moving the pelvis in an upwards-downwards type of motion, also referred to as the coital alignment technique.
Lack of knowledge can also mean a general lack of knowledge of your own body. If you don't know what type of touch you enjoy, it'll be hard to know what type of touch is necessary for you to achieve orgasm.
Some medical conditions can contribute to difficulty achieving orgasm. These include hypertension, asthma, thyroid problems, heart disease, and multiple sclerosis. Various medications might also play a role here, including SSRIs and some contraceptive pills and implants. Various psychological factors can play an important role here as well. Anxiety and depression itself can also inhibit orgasm, as can fatigue, shame, guilt, poor self-esteem or body image, eating disorders, or trauma.
One specific way psychological factors might show up is through "spectatoring"—where someone having sex starts thinking, "I wonder if I'm doing a good job. Is my partner enjoying this?" These types of thoughts distract from a focus on the present moment and the sensations in the body, creating enormous pressure to "perform" that detracts from the sexual experience.
Effective communication about sex is often infinitely harder than other topics. Being able to ask for the type of stimulation you need, the intensity, the focus, the pressure, the speed—all of this enhances becoming immersed in your sexual experience and increases the likelihood of experiencing an orgasm.
Relationship distress also plays a key role. If there is general dissatisfaction with the relationship or feelings of resentment or anger toward your partner, it will be hard to foster an environment where sexual intimacy can be embraced fully. If there is a lack of trust or difficulty feeling emotionally safe in the relationship, it will be hard to let go enough to allow for orgasmic release.
The way sex was talked about in your childhood will influence how you feel about it in your adulthood. If sex was always associated with shame, it's no wonder you have a hard time embracing sexuality enough to allow for orgasmic release. Religious and cultural influences might have shaped your views about sex as well, contributing to misinformation or feelings of shame or guilt around sexual pleasure.
A number of different strategies can be used to treat female orgasmic disorder. Behavioral strategies that increase your focus on your body and what gives you pleasure can facilitate a more immersive experience. Relationship strategies that work on improved communication and navigating areas of relationship conflict or mistrust help create openness and safety. Cognitive strategies can help you address unhelpful thought patterns that might interfere with sex. Research shows mindfulness can be especially helpful for improving sexual function.
Importantly, while there are many helpful ways of treating anorgasmia, difficulty with orgasm does not mean you can't have a satisfying sex life. When you shift the focus of sex to one of connection, closeness, intimacy, enjoyment, and pleasure, rather than "orgasm", the journey of sex can continue to be meaningful and fulfilling.
Taking the first step can feel difficult, but you don't have to do it alone. We are here to walk alongside you, offering support, guidance, and a safe space to help you create meaningful change and move toward the life you want.
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