What Is Anorgasmia?

Overview

Anorgasmia is a type of sexual dysfunction in which a person cannot achieve orgasm despite adequate stimulation. It can cause sexual frustration and affect one’s sexual relationships. Anorgasmia can be classified as primary (never having an orgasm) or secondary (losing the ability to have orgasms). It can also be situational (only occurring in certain circumstances) or generalized (occurring in any situation). Anorgasmia can have various causes, such as psychological factors, medical conditions, medications or drug use. Treatments can include education, therapy, devices or medications.

Anorgasmia in men

Anorgasmia in people assigned male at birth (PAMAB) is when a person has difficulty or is unable to achieve an orgasm despite adequate stimulation. It can also be called delayed ejaculation or inhibited ejaculation. Anorgasmia in PAMAB can be: 

• Primary - never having an orgasm 
• Secondary - only having an orgasm in certain conditions  

It can cause problems with sexual performance and pleasure, often leading to anxiety and avoiding sex.  

This can be caused by: 

• Hormonal imbalances
• Nerve damage
• Medical conditions
• Medications
• Psychological issues

Anorgasmia in women

Anorgasmia in people assigned female at birth (PAFAB) is a condition when a person has difficulty or cannot achieve orgasm despite being aroused and stimulated. It can also refer to orgasms that are less intense or less frequent than desired, which can cause distress and affect sexual relationships. 

Anorgasmia in PAFAB  can be classified into four types: 

• Primary - never having an orgasm 
• Secondary - losing the ability to have orgasms
• Situational - only having orgasms in certain situations 
• General - not having orgasms in any situation 

Anorgasmia in PAFAB  can have various causes, such as medical conditions, medications, psychological issues, or lack of knowledge about sexual stimulation.¹

Causes of anorgasmia

The causes of anorgasmia can be different for different people and genders. 

Some common causes of anorgasmia are:

• Psychological factors -  anxiety, depression, stress, guilt, trauma or relationship issues
• Physical factors -  nerve damage, loss of penile or clitoral sensitivity, hormonal imbalances, pelvic pain or genital mutilation 
• Medical conditions -  diabetes, multiple sclerosis, Parkinson's disease, spinal cord injury or cardiovascular disease 
• Medications -  antidepressants (especially SSRIs), cocaine, opiates or blood pressure drugs

Anorgasmia can also be influenced by the type and amount of stimulation needed to have an orgasm, which can vary from person to person and from time to time. 

Signs and symptoms of anorgasmia

The signs and symptoms of anorgasmia depend on the type and severity of the condition. Some common signs and symptoms of anorgasmia are:

• Not reaching sexual climax (orgasm) despite being aroused and stimulated
• Delayed climaxing (it takes a long time to orgasm)
• Fewer orgasms than desired or expected
• Less intense orgasms than desired or expected
• Not feeling fulfilment from sexual climax
• Reduced desire for sex (decreased libido)
• Distress, frustration, anxiety, guilt, or embarrassment about the inability to orgasm
• Avoidance of sexual activity or intimacy due to the inability to orgasm

Management and treatment for anorgasmia

The treatment of anorgasmia depends on the underlying cause and the type of anorgasmia. Some common treatments of anorgasmia are listed below.

Changing medications 

if your anorgasmia is caused by certain medications (antidepressants or blood pressure drugs) you may need to switch to a different medication or reduce the dosage.  If it is caused by drug use, such as cocaine, you might want to stop using drugs. 

Treating medical conditions 

If your anorgasmia is caused by a medical condition such as diabetes, hormonal imbalances or nerve damage, you may need to treat the condition or manage the symptoms.

Psychotherapy 

If your anorgasmia is caused by a psychological issue, such as anxiety, depression, trauma or relationship problems, you may benefit from undergoing psychotherapy. Psychotherapy can help you address the emotional and mental factors that affect your sexual function and satisfaction.

Sex therapy 

Certain forms of sex therapy may help you to enjoy sex and reach orgasm more easily. Sex therapy can involve education about sexual anatomy and stimulation, directed masturbation (learning how to stimulate yourself), sensate focus (focusing on sensations rather than performance), sexual enhancement devices (such as vibrators) or couple therapy (improving communication and intimacy with your partner).

Diagnosis

The diagnosis of anorgasmia involves a medical history, a physical exam, and sometimes some tests. 

Medical history 

Your healthcare provider will ask you questions about your sexual experiences, such as when you started having problems with orgasms, how often you have sex, and what kind of stimulation you need or prefer. Whether you use any medications or substances that may affect your sexual function, and whether you have any psychological or emotional issues that may interfere with your sexual satisfaction.

Physical exam 

Your healthcare provider will conduct a general medical exam and a pelvic exam (for PAFAB) or a genital exam (for PAMAB), to check for any physical conditions that may contribute to problems with orgasms. These may include nerve damage, loss of sensitivity, pelvic pain, genital mutilation, or hormonal imbalances.

Tests 

Your healthcare provider may order some tests to measure the levels of hormones or other substances that may affect your sexual function. These may include blood tests to measure testosterone, thyroid stimulating hormone (TSH), prolactin, or other hormones. You may also undergo a biothesiometry test to measure whether there is a loss of sensation in the penis (for PAMAB).¹

FAQs

Can anorgasmia be prevented?

Anorgasmia may not be completely preventable, but there are some steps you can take to reduce your risk of developing it or to improve your sexual function and satisfaction. Some possible prevention strategies are:

• Avoid or limit alcohol and smoking - Alcohol and smoking can suppress the nervous system and may hamper your ability to have an orgasm
• Review your medications - Some medications, such as antidepressants, blood pressure drugs, antihistamines or antipsychotics can inhibit orgasm. Talk to your healthcare provider about the possible side effects of your medications and whether you can switch to a different medication or adjust the dosage
• Treat any underlying health issues - Some medical conditions, such as diabetes, hormonal imbalances, nerve damage or pelvic pain can affect sexual function. Seek medical attention if you have any symptoms or concerns about your health
• Learn about sexual stimulation and anatomy -  A lack of knowledge about sexual stimulation or interactions can lead to problems with orgasms. Educate yourself about the different parts of your sexual anatomy and how they respond to stimulation. Experiment with different types of stimulation, such as manual, oral, or using sexual enhancement devices, to find out what works for you
• Communicate with your partner - Relationship issues, such as lack of intimacy, trust or communication can affect sexual satisfaction. Talk to your partner about your sexual needs and preferences, and encourage them to do the same. Express your feelings and listen to theirs andtry to create a comfortable and relaxed atmosphere for sex
• Seek professional help - If you have psychological issues that interfere with your sexual function, such as anxiety, depression, stress, guilt, trauma, or low self-esteem, consider seeking counseling or psychotherapy. A mental health professional can help you address the emotional and mental factors that affect your sexual satisfaction. You may also benefit from sex therapy, which can help you learn how to enjoy sex and reach orgasm more easily

How common is anorgasmia?

The exact prevalence of anorgasmia is unknown; however, some studies have estimated that:

• Anorgasmia affects 4.6% of  PAFAB and 0.8% of  PAMAB¹
• Anorgasmia affects 15% of  PAFAB who have never had an orgasm.
• Anorgasmia affects 37% of  PAMAB who have undergone radical prostatectomy (surgical removal of the prostate gland)²
• Anorgasmia affects 26.3% of reproductive-aged  PAFAB in Iran³

Anorgasmia can vary in severity and frequency, and it can be influenced by various factors, such as age, health status, medication use, psychological issues, and sexual experience. 

Who is at risk of anorgasmia?

Some risk factors for anorgasmia are:

• Age- Anorgasmia may become more common as you get older, especially for PAFAB who have gone through menopause
• Medical conditions - Anorgasmia may be associated with certain medical conditions that affect your sexual function, such as diabetes, multiple sclerosis, Parkinson's disease, spinal cord injury, cardiovascular disease or hormonal imbalances
• Medications -  Anorgasmia may be caused by certain medications that affect your sexual function, such as antidepressants (especially SSRIs), blood pressure drugs, cocaine or opiates^1,2
• Psychological factors - Anorgasmia may be influenced by psychological issues that affect your sexual satisfaction, such as anxiety, depression, stress, guilt, trauma, relationship problems, poor body image, cultural or religious beliefs about sex or lack of knowledge about sexual stimulation
• Surgical procedures - Anorgasmia may occur after certain surgical procedures that affect your sexual function, such as radical prostatectomy (surgical removal of the prostate gland in  PAMAB) or genital mutilation^2,3

Summary

Anorgasmia is a sexual dysfunction,  where a person cannot achieve orgasm despite adequate stimulation. Causes of anorgasmia can be different such as psychological factors, medical conditions, medications, or drug use but it can be treated by education, therapy, devices, or medications.