Anorgasmia

What is anorgasmia?

Anorgasmia is when a person has difficulty or can’t orgasm even if they’re enjoying sex and it feels good to them. It also describes orgasms that aren’t as strong or don’t happen as frequently as you’d like. It’s a form of sexual dysfunction that affects all genders. It can take a toll on your mental health, causing distress and anxiety, and can even interfere your relationships. Anorgasmia is also called orgasmic dysfunction.

Orgasms (also called sexual climaxing) are feelings of pleasure or sexual excitement that occur after being aroused. It may feel like a release and involve bodily movements beyond your control. They can vary in duration and intensity. Some people need more sexual stimulation to have an orgasm, while others need less.

With anorgasmia, you can still have a desire for sex and feel pleasure. However, you may feel anguish or emotional distress because you can’t have an orgasm. Your healthcare provider can help determine the cause of anorgasmia and recommend treatment.

Anorgasmia in women or people assigned female at birth (AFAB)

Anorgasmia in women or people assigned female at birth (also called female orgasmic disorder) is classified into four types:

• Primary (or lifelong): You’ve never had an orgasm.
• Secondary (or acquired): You were once able to have an orgasm but can’t now. This is common with menopause.
• Situational: You can only reach orgasm in specific situations like with masturbation (self-stimulation).
• General: You don’t reach orgasm in any situation, even when you feel aroused or excited.

Problems with orgasm increase as you age, but it can affect people of any age. Up to 15% of women or people AFAB report never having an orgasm.

Anorgasmia in men or people assigned male at birth

Healthcare providers often classify anorgasmia in men or people assigned male at birth (AMAB) as a type of sexual dysfunction called delayed ejaculation or inhibited ejaculation. This causes problems with sexual performance and pleasure, often leading to anxiety and avoiding sex. Anorgasmia in men has two types:

• Primary: You’ve never had an orgasm or ejaculated for as long as you can remember.
• Secondary: You only orgasm or ejaculate under certain conditions.

Ejaculation is a complex process that involves hormones, nerves and organs, as well as your mental state. A disruption in any part of this process can interfere with your ability to orgasm. Certain medical conditions can also impact orgasm.

Who does it affect?

Anorgasmia can affect anyone. It’s most common after menopause in women or people AFAB.

What are the symptoms of anorgasmia?

The main symptom of anorgasmia is not reaching sexual climax (orgasm). Other symptoms are delayed climaxing (it takes a long time to orgasm) or not feeling fulfillment from sexual climax.

What causes anorgasmia?

Many factors can make reaching orgasm difficult. These factors can be physical, mental, emotional or medical (related to a disease or condition). In many cases, a combination of factors make orgasm difficult, and sometimes it’s hard to determine the root cause(s).

Medical and physical causes

• Age (especially women or people AFAB in menopause).
• Medical conditions like multiple sclerosis (MS).
• Medications, especially selective serotonin reuptake inhibitors (SSRIs).
• Surgeries on your genitals and organs near or connected to your reproductive system.
• Complications from cancer or radiation therapy.
• Pelvic floor dysfunction or pelvic trauma.
• Reliance on masturbation (you find that more satisfying).
• Hormonal conditions.
• Congenital disorders (conditions you’re born with) of the vagina or penis.

Psychological causes

• Depression, stress or anxiety.
• Previous sexual abuse or assault.
• Cultural or religious factors.
• Being shy or unable to express yourself through sex.
• Lack of confidence.
• Relationship, trust or intimacy issues with your partner.

Can low testosterone cause anorgasmia?

Low testosterone may affect the ability to orgasm in men or people assigned male at birth (AMAB). It often has connections with erectile dysfunction, delayed ejaculation or similar problems. Other hormones, such as prolactin, can also affect sexual function in people who have a penis.

Do SSRIs cause anorgasmia?

Yes, many SSRIs (selective serotonin reuptake inhibitors), often used to treat depression or anxiety, can affect sexual function. If you’re taking this kind of medication, talk to your healthcare provider about your symptoms and discuss alternative medications. Some SSRIs are less likely to cause anorgasmia, and there are other types of antidepressants that may help also.

Medications that may impact orgasm

In addition to SSRIs, other medications may affect your ability to orgasm. Some examples of these are:

• Tricyclic antidepressants (TCAs).
• Monoamine oxidase inhibitors (MAOIs).
• Antipsychotic medications.
• Anti-mania medications.

Medications used to treat high blood pressure can also cause erectile dysfunction. Some antihistamines and decongestants can also cause erectile dysfunction or problems with ejaculation.

How is anorgasmia diagnosed?

Your healthcare provider can diagnose anorgasmia based on your symptoms and a discussion about your sexual history. This discussion could shed light on reasons or underlying causes for sexual dysfunction. They may also perform an exam or tests like ultrasound or blood tests to check for underlying hormonal or medical conditions that could be part of the problem. Your provider may suggest a penile sensitivity test if that’s a suspected factor.

Once an underlying cause is determined, many options are available to treat anorgasmia. Your provider may also refer you to a specialist (such as a gynecologist or urologist) who can help develop a treatment plan that addresses orgasmic disorders.

How is anorgasmia treated?

It depends on the underlying cause. There’s no one method that fits all cases, and treatment may involve a combination of approaches. Some treatments for anorgasmia include:

• Changing medications.
• Treating any underlying health issues.
• Learning self-stimulation (masturbation) techniques.
• Counseling or psychotherapy to address relationship issues, mental health conditions or past sexual trauma.
• Sex therapy to address sexual needs or underlying factors preventing climax.
• Using hormone therapy to enhance blood flow and increase sensitivity.
• Introducing new stimuli to the relationship such as new techniques, sex toys and devices or erotic media.

How long does it take to cure anorgasmia?

It depends on the cause. In the case of sex therapy or couples counseling, it may take several months to reach a point where orgasm feels possible. If medications are the likely cause, you have to allow time for the medication to leave your system (which could take weeks). The good news is that most people can orgasm again with proper treatment.

Is anorgasmia preventable?

Anorgasmia can’t be prevented, but dealing with the cause of the orgasmic dysfunction can help you cope with the problem. Some of these general recommendations may help:

• Follow your healthcare provider’s treatment plan for any medical conditions.
• Communicate openly and honestly with your partner about your sex.
• Get treatment for emotional or psychological issues.
• Get regular exercise and eat a healthy diet.

It’s common for people with this to feel embarrassed, shy or ashamed. If you feel this way, tell your healthcare provider. They can help you understand that this isn’t a rare problem or a cause for shame. They can also help you find resources or specialist experts with specific training and experience in treating sexual dysfunction and related issues.

What's the outlook if I have anorgasmia?

Anorgasmia can be upsetting and frustrating. It can impact intimacy with your partner and affect your self-esteem. It’s also extremely unlikely that you can solve this problem without proper medical care or guidance. Your healthcare provider can help you with anorgasmia so you can enjoy a fulfilling sex life.

When should I see my healthcare provider?

Talk to your healthcare provider if you have any concerns about your ability to orgasm. They can help you figure out why having an orgasm is difficult and find a solution to your problem. Be open with your provider about your sexual and medical history, including your relationship with your partner. Don’t be afraid or embarrassed to seek treatment. It’s the best way to get to the root of the problem and enjoy pleasurable sex.

A note from Cleveland Clinic

Being unable to orgasm can be frustrating and upsetting. You’re not alone — many people seek treatment for orgasmic dysfunction. It’s nothing to be ashamed about. Your healthcare provider can help determine why you’re struggling and discuss potential solutions. This may mean talking to a counselor or sex therapist, or changing medications. With the right treatment, you can enjoy sex — and all the physical and emotional benefits — without worrying about reaching orgasm.