Female Orgasmic Disorder: Solutions for No-Show O's

Few things are more frustrating than being in the heat of the moment, getting closer and closer and closer to an orgasm, and then…nothing. You get in your head, feeling defeated, wondering, “Why can’t I orgasm!?” as the elusive climax slips further and further away from you. 

Enter: female orgasmic disorder, aka anorgasmia or inorgasmia — all fancy words for having difficulty with orgasm. Sure, sex (or masturbation) can feel great even if there is no big O — but let’s be real, it’s a whole lot more satisfying when there is one. It’s like when you feel a sneeze coming on, you gear up for it, and then the urge disappears. It just feels better when you have that big release.

If you’ve never had an orgasm before, or if it feels harder to get there than it used to, it’s important to understand female orgasmic disorder, its causes, and how to treat it. Read on to learn more.

What is Female Orgasmic Disorder?

According to pelvic floor physical therapist Dr. Ashley Rawlins, PT, DPT, female orgasmic disorder or anorgasmia is characterized by not being able to orgasm at all, having trouble orgasming, taking a very long time to orgasm, or having orgasms that feel muted in sensation. Womp, womp. 

Under the umbrella of anorgasmia, there are a few different types.

Primary Anorgasmia 

Primary anorgasmia is when you’ve never been able to have an orgasm, Dr. Rawlins says. You can likely still feel pleasure and have a good time during sex, but there’s no big climax or release. It’s estimated that around 10% to 15% of women, or those assigned female at birth (AFAB), have not experienced an orgasm…and if you’re wondering if you’ve ever had an orgasm before, you probably haven’t. The feeling is hard to miss! 

Secondary Anorgasmia 

Secondary anorgasmia is when you used to be able to orgasm, and now your experience is different. “Your sexual function felt normal, and you had orgasms that felt satisfying. Then, for one reason or another, your ability to orgasm, or the way the orgasms felt, has changed,” says Dr. Rawlins. 

This could include not being able to orgasm at all anymore, taking way longer than it used to, or having dull orgasms. According to the The 2024 Origin Pelvic Health Study, secondary anorgasmia in women is quite common. Within the last year, 33% of participants reported experiencing an inability to orgasm, 25% had unsatisfying orgasms, and 18% had delayed orgasms.

Situational Anorgasmia

As the name suggests, situational anorgasmia refers to being able to orgasm in some situations but not others. A common presentation of this is that you can climax through masturbation but can't orgasm with a partner. Or, Dr. Rawlins says you might find that you can only orgasm from certain forms of stimulation or with certain partners. Different strokes for different folks, right? 

Not to mention, it’s very common to be unable to reach orgasm from penetrative (penis in vagina or PIV) sex alone, with only 50% of women climaxing from PIV sex, compared to 90% of men orgasming from penetration…ugh!

What Are the Causes of Female Orgasm Disorder?

It might take some digging deep, with the help of a trusted healthcare provider, to figure out the cause of your anorgasmia. Everyone’s different and deals with different health struggles. 

Anorgasmia can affect you at any point in your life, even if you’ve always struggled. On the flip side, you might have had no trouble with orgasms when you were younger, but you’re having a hard time now that you’re older. Age alone is not a cause.

Plus, arousal, orgasms, and sex, in general, are not straightforward. “Sexual function is biopsychosocial in nature. There are so many factors,” Dr. Rawlins says. “Physical causes, medical causes, and psychological causes can all impact your ability to orgasm.” 

Here are some common causes within each of these three categories. 

Physical Causes

Physical causes of female orgasmic disorder or anorgasmia are typically linked to muscles, nerves, or injuries.

One potential physical cause of anorgasmia in women is pelvic floor muscle dysfunction. “If the muscles are tight and overactive, then there can be pain, which is not a sexy feeling, and it can disrupt the arousal process,” Dr. Rawlins says. “Or, when your muscles are weak and underactive, maybe they're not strong enough to have as much of an intense sensation during penetration, or maybe the blood flow is not so great because of the muscle weakness.”

Aside from muscle dysfunction, other physical causes include spinal cord injury, or injuries to the genitals or surrounding nerves can also play a role, such as if you’ve had surgery on or around any reproductive organs. 

Medical Causes

Various medical conditions can play a role in developing a female orgasmic disorder, even if they aren’t directly linked to the genitalia. For example, diabetes and multiple sclerosis (MS) can disrupt the neurological aspect of orgasm, Dr. Rawlins explains.

Other potential medical causes include:

• Menopause
• Hormonal disorders
• Complications from cancer or cancer treatment 
• Vaginismus
• Endometriosis
• Chronic pelvic pain
• Side effects of medications (SSRIs and anorgasmia are commonly linked, for example)

This isn’t an exhaustive list. Many chronic health conditions can impact your sex life in one way or another, whether that’s causing orgasm problems or lack of sexual desire altogether.

Psychological Causes

The mind-body connection is strong, especially when it comes to sex. In fact, many experts consider the brain to be our biggest and most important sex organ. 

There are so many factors that can play into this –– including societal pressures and even stress about having an orgasm. TV shows, movies, porn, and the like make it seem like everybody’s orgasming no problem, even with minimal stimulation.

“Sex can still feel really fabulous when you don’t have an orgasm, but then you feel broken because you can’t have an orgasm because everyone should have an orgasm, right?” Dr. Rawlins says. “Then sex becomes this weird ‘What's wrong with me?’ kind of thing.” This perpetuates the cycle of anorgasmia. Not to mention, this added stress can happen on top of physical or medical causes of anorgasmia, resulting in even more difficulty having an orgasm. 

On top of internalized pressure, other psychological causes of anorgasmia include:

• Anxiety
• Depression
• Sexual trauma from past sexual assault or rape
• Internalized shame from your culture or religion
• Self-consciousness surrounding sex
• Having trust issues with your partner

What Is the Treatment for Female Orgasmic Disorder?

Since the causes of female orgasmic disorder or anorgasmia vary so much, treatment will depend on the cause or causes. There is no universal solution for how to cure anorgasmia. Many times, there are multiple contributing factors to anorgasmia, which means you might need to take multiple approaches to treatment and work with a variety of providers.

Anorgasmia diagnosis and treatment require knowledgeable, sex-positive providers to first determine the cause (or causes) of your anorgasmia and then devise a treatment plan to resolve or lessen the problem. Sex-positive providers will understand the importance of orgasms and will not shame you for wanting to improve your sex life.

There are various clinicians who can help determine what’s causing your lack of orgasms and recommend treatment from there. Dr. Rawlins says you can work with a:

• Primary care physician
• Pelvic floor physical therapist
• Gynecologist
• Urogynecologist
• Urologist
• Mental health professional
• Sex therapist

For example, if pelvic floor dysfunction is contributing, a pelvic floor physical therapist can assess whether you are dealing with tight or weak muscles, and then teach you different exercises you can do together and at home to improve your pelvic health. If you’re a sexual trauma survivor and the block is psychological, you may opt to see a trauma-informed therapist who can help you work through this trauma and reclaim your sexuality. Or, if your antidepressant medications are to blame, your psychiatrist might have to tweak your dose or switch you to a different antidepressant, nixing SSRIs. If you’re not sure exactly where to begin, you can start with a visit to your primary care doctor. 

Unfortunately, there aren’t really any quick fixes for anorgasmia, but in the meantime (and maybe forever after), adding a clitoral vibrator into the mix certainly doesn’t hurt. Dr. Rawlins says external vibrators can be a huge help in providing additional stimulation that can help get you over the edge, whether you’re playing solo or with a partner. 

You can also benefit from some sex-ed surrounding the stuff they didn’t teach you in school, like the female sexual response cycle. Understanding desire, arousal, orgasm, and the science behind the way your body works can be a game changer. You can learn about that on the Origin blog here. 

Have Better Sex with Pelvic Floor Physical Therapy

If you struggle with female orgasmic disorder, you deserve a more satisfying sex life, complete with all the orgasms your heart desires. 

Whether you deal with primary anorgasmia, secondary anorgasmia, or situational anorgasmia, there is hope for you to experience amazing orgasms again or even to have your very first one! 

If you think that pelvic floor dysfunction could play a role in your anorgasmia, Origin can help provide treatment for some of the physical causes of anorgasmia. Origin’s sex-positive pelvic floor physical therapists can evaluate you for a tight or weak pelvic floor and then devise a treatment plan to help you get on track to your best sex yet.