Orgasmic Difficulties (Women)

What it is

Female orgasmic disorder is a persistent or recurrent difficulty in reaching orgasm, or a markedly reduced intensity of orgasm, despite adequate sexual arousal and stimulation, that causes the woman distress. It is diagnosed only when the difficulty is persistent and genuinely distressing to the woman herself, not when it simply differs from expectations set by others or by unrealistic portrayals of sex.

An important and reassuring point frames this whole condition: many women do not reach orgasm from penetration alone and require other forms of stimulation, and this is entirely normal, not a dysfunction. A great deal of distress about orgasm comes from misinformation and unrealistic expectations rather than from any actual problem. Genuine orgasmic difficulty, persistent and distressing despite adequate arousal and the right stimulation, is a real condition, but distinguishing it from normal variation and the effects of misinformation is the essential first step.

What it can involve

Some women have never experienced orgasm; others have lost the ability to, or find it has become much harder or less intense. The difficulty may be present in all situations or only some. Because reaching orgasm depends heavily on adequate and suitable stimulation, on relaxation and on feeling safe and unpressured, many cases are closely tied to circumstances, knowledge and state of mind rather than to a fixed physical fault. Anxiety, including anxiety about whether orgasm will happen, is a particularly common obstacle, since the very pressure to reach orgasm tends to prevent it.

How common is it

Orgasmic difficulty is one of the most commonly reported sexual concerns among women. A meaningful proportion experience it at some point, though not all find it distressing. It is strongly influenced by factors that can change, which is part of why the outlook for help is good. Like the other conditions in this chapter, it is widely under-discussed.

What causes it

Contributors are usually a mix. Lack of knowledge, about one's own body and what stimulation is needed, is extremely common and very addressable. Psychological factors include anxiety, pressure to perform, stress, depression, body image concerns, guilt or shame about sex (sometimes rooted in upbringing or cultural messages), and past negative or traumatic experiences. Relationship factors, communication, comfort and the partner's understanding, matter greatly. Physical factors include some medical conditions, hormonal changes, and the side effects of some medicines, notably certain antidepressants. As elsewhere, these factors interact.

How it is diagnosed

A clinician explores the nature and context of the difficulty, its persistence, the woman's distress, her knowledge and experiences, her physical health and medicines, and the relationship context, in a respectful, non-judgemental way. Reviewing medicines is important, since some, especially certain antidepressants, commonly affect orgasm. The assessment distinguishes genuine difficulty from the effects of misinformation and unrealistic expectations, and centres the woman's own experience.

How it is treated

The outlook is good, and treatment is largely psychological and educational rather than medical. Accurate information, about the body and the stimulation many women need, relieves a great deal of unnecessary distress on its own. Reducing the pressure and anxiety that block orgasm is central, sometimes through specific therapeutic approaches that shift the focus away from orgasm as a goal. Sex therapy and, where a relationship is involved, couple work help by improving communication and comfort and addressing any underlying issues. Where past trauma or shame contributes, trauma-informed or psychological therapy helps. Reviewing medicines that affect orgasm, and treating depression or anxiety, can make a real difference. No specific medicine treats the condition itself.

Orgasmic difficulty in the African context

Difficulty reaching orgasm is common in women, yet the silence around women's sexual health here means many women never learn what is normal, never feel able to discuss it, and may believe the difficulty is simply their lot. Myths and a lack of accurate information are widespread. It is worth knowing that many factors are involved and addressable: anxiety, lack of information, relationship and communication difficulties, pain, depression, and the effects of some medicines, especially certain antidepressants. Trauma can also play a part. Understanding that this is common, that accurate information and open communication help greatly, and that effective support exists, removes shame and opens the way to help.

Getting help and support

Information, communication, and a calm approach help most.

• Know that this is common and that accurate information about the body removes a great deal of unnecessary worry.
• Address anxiety, stress, and any depression, which commonly interfere.
• Review medicines with a doctor, since some, especially certain antidepressants, can affect orgasm. Do not stop them on your own.
• Work on communication and closeness with a partner, gently and without pressure.
• Where it persists or distresses, see a clinician or therapist experienced in sexual health. Our find a therapist page can help.