Synonyms
Subdivisions
Lifelong Anorgasmia/ Primary Anorgasmia
Acquired Anorgasmia / SecondaryAnorgasmia
Situational Anorgasmia
Generalized Anorgasmia
General Discussion
Anorgasmia is a general term used to describe the absence of orgasm during sexual activity. Anorgasmia falls under the broader categories of Female Orgasmic Disorder. It is typically defined as the absence of orgasm in all or almost sexual encounters over a minimum duration of 6 months. In order for it to be considered under the category of Female Orgasmic Disorder rather than just orgasmic dysfunction, symptoms must cause clinically significant distress.This can be further broken down to identify whether the anorgasmia has been present for one’s entire life and someone has never experienced an orgasm, versus whether it was acquired despite having previously been able to orgasm (the most common type). Anorgasmia can also be specific to certain situations, or be generalized. Individuals may also experience other issues with orgasming under Female Orgasmic Disorder such as marked delay and infrequency of orgasm.
It is difficult to assess how many women truly experience anorgasmia as the data available only represent the number of women who were surveyed. The estimated number of women with primary anorgasmia is approximately 4-10%. Several studies spanning from different continents estimate secondary anorgasmia to occur in approximately 20-30% of women.
It is important to note that orgasms can vary in intensity and sensation from individual to individual, and from each different sexual event. Not everyone will ejaculate with orgasms.
Signs & Symptoms
Signs of primary anorgasmia is never having had an orgasm. Secondary anorgasmia, on the other hand, presents as a loss of the ability to orgasm after previously being able to do so. Anorgasmia can also be experienced in certain specific situations or settings. This is called situational anorgasmia. For example, some patients will report that they are able to orgasm on their own, but not with a partner. There may be an inciting event that led to the loss of the ability to orgasm as well. Sometimes, individuals may first notice a decrease in the frequency of orgasms or an increase in the amount of time and stimulation required to orgasm.
For many women, anorgasmia is often also encountered with decreased desire or arousal.
Causes
Although the causes of anorgasmia were originally thought to all be psychological, more recent data has acknowledged that there are many different causes. Furthermore, it is usually a result of many different things. The following are some examples of things that may contribute to anorgasmia.
Medication– Antidepressants, anti-seizure medications, antihistamines, antipsychotic medications, birth control, chemotherapy, other cancer treatments
Anatomical causes like clitoral adhesions (a condition where the hood of the clitoris may become stuck to the end of the clitoris, leading to other issues)
Female Genital Mutilation
MedicalConditions- Diabetes, vascular disease, heart disease, cancer, multiple sclerosis, and other neurological problems
Alcohol-Despite people commonly recommending a glass of wine
Smoking-Affects blood flow to the genitals
Aging-changes in hormonal levels, the neurological system, the vascular system can all affect one’s ability to orgasm
Psychological-Trauma/stress/depression/anxiety/poor body image
Social-cultural/religious beliefs surrounding sexual health and pleasure
RelationshipIssues- Ranging from lack of connection and communication, to trauma from infidelity.
Pelvic Surgery -Patients who have undergone various surgeries in the pelvis may experience changes in their ability to orgasm based on which parts of the anatomy or innervation have been altered.
Pelvic radiation can alter the architecture of the anatomy to this region affecting an individual’s sexual function.
Affected Populations
Previous studies do not necessarily demonstrate frequency of anorgasmia is linked with age. There are some studies to suggest that patients with psychiatric conditions such as depression or anxiety are more likely to also have anorgasmia.
Diagnosis
A healthcare provider can help with diagnosing anorgasmia. They may refer you to a provider who is specifically specialized in treating female sexual dysfunction. Although anorgasmia is a type of orgasmic dysfunction, the clinical diagnosis falls under the umbrella of female orgasmic disorder (FOD) in the DSM V. To be categorized as such it must fit specific criteria:
• Presence of symptoms for greater than 6 months
• Absent orgasm after a normal sexual arousal phase on all or almost all occasions of sexual activity(75-100% of the time)
• The orgasmic dysfunction leads to distress or interpersonal problems
• There is no other medication, substance or disorder that is identifiable as the cause of the orgasmic dysfunction
Standard Therapies
Standard therapies need to be specifically targeted to address the cause of anorgasmia. Below are different treatment options depending on each individual’s situation.
Ensuring adequate stimulation:
This can involve using sexual aides such as vibrators or clitoral suction devices (also known as clitoral vacuums), manual stimulation, oral stimulation, vaginal/anal stimulation
Lysis of clitoral adhesions
Learning anatomy and the use of a mirror to explore pleasurable regions
Sensate Focus therapy
Sex therapy
Directed masturbation
Systemic desensitization
Sexual education
Communication skills
Cognitive Behavioral Therapy
Diet/exercise/stress reduction
Fantasizing and using fantasy aides
Identifications of goals and expectations amongst couples
Warm baths before genital activity
Location/time of day/position
Mindfulness
Investigational Therapies
There are no FDA approved devices specifically for anorgasmia; However, vibrators and clitoral suction devices are commonly used to aide in clitoral stimulation. More research that focuses on combined interventions for treatment and their efficacy.
Support Available
There are providers across the country who specialize in female health and sexual dysfunction.www.ISSWSH.org can help you find a provider in your area who specializes in treating this condition.
OMGyes.com is an evidence-based website dedicated to exploring the science of improving women’s pleasure, and providing individuals with practical techniques.
References
1. A., Bradford. "Female orgasmic disorder:Epidemiology, pathogenesis, clinical manifestation, course, assessment, and diagnosid." n.d. Uptodate. 20 04 2022.
2. Alexander M, et al. "Randomized trial of clitoral vacuum suction versus vibratory stimulation in neurogenic female orgasmic dysfunction." Archives of Physical Medicine and Rehabilitation. (2022):299-305.
3. Hayes R, Dennerstein L. "The impact of aging on sexual function and sexual dysfunction in women: a review of population-based studies." J Sex Med (2005): 317-330.
4. IsHak WW,Bokarius A, Jeffrey J K, Davis MC "Disorders of Orgasm in Women: A Literature Review of Etiology and Current Treatments" J Sex Med(2010):3254-3268
5. Laan E, Rellini AH, Barnes T. S. "tandardoperating procedures for female orgasmic disorder: consensus of theInternational Society for Sexual Medicine. ." J Sex Med (2013):74-82.
6. Laumann EO, Glasser DB, NevesRC, et al. " A population-based survey of sexual activity, sexual problems and associated help-seeking behavior patterns in mature adults in the UnitedStates of America." Intern
