Why can’t I orgasm? Causes and treatment for anorgasmia 

It’s the subject most of us shy away from: sexual dysfunction.

You're not alone if you’re cringing at the thought of it. According to one study, 55% of men and 60.5% of women in Australia admitted to having at least one sexual problem in the previous year [1].

Anorgasmia is just one type of dysfunction, and one that doesn’t get enough press. It’s when an orgasm is infrequent, delayed, lacking intensity, or just plain not there at all. Nobody needs to tell you that not getting the orgasm you want and expect is the fastest way to turn a steamy night into a crushing disappointment.

So, what is this condition, why does it happen, and is there anything you can do about it?

What is anorgasmia? 

Anorgasmia, also known as Coughlan’s syndrome, is when you’re unable to get an orgasm even though you’ve received sufficient sexual stimulation [2]. It’s a problem for both genders, but tends to be a bit more common in women.

According to Oxford Academic, a recent study showed that 18% of men didn’t achieve human male ejaculation in their last sexual encounter, whereas 68% of women reported not orgasming [3]. Of course, that could be due to any number of issues, but there’s no doubt that anorgasmia is well-represented.

Before moving on, let’s examine the physiology of male and female orgasms.

Male and female sexual dysfunction: The physiology of the orgasm

Orgasms are a combination of physiological and psychological processes during sexual activity. Don’t assume it’s just about the physical sensations. It’s also the nerves, hormones, and the brain that go into providing adequate sexual stimulation and achieving sexual satisfaction.

Males and females both follow the same sexual cycle, and the orgasm is the third of four phases [4]:

1. Sexual desire (Your libido)
2. Sexual arousal (Excitement)
3. Orgasm (Sexual climax)
4. Resolution (Post-sexual intercourse feelings)

No matter who you’re having sex with, women achieve orgasm by stimulating the clitoris directly or indirectly and blokes achieve orgasm via penis stimulation. None of this should be a surprise to anyone.

Types of anorgasmia

Anorgasmia can be a lifelong condition, but it could also appear over time, or even something that comes on suddenly in certain situations. Typically, there are four types of Anorgasmia. See which one makes the most sense for your situation [5]:

• Primary anorgasmia – You’ve never been able to achieve an orgasm. This is most often due to a problem you were born with because of your genetics.
• Secondary anorgasmia – You’ve had orgasms before, but now you can’t. Psychological and medical reasons fit into this category.
• Situational anorgasmia – You’re only able to achieve orgasm under certain conditions, such as masturbation. For example, The Journal of Sex and Marital Therapy found that 37% of American women could only orgasm if they had direct clitoral stimulation [6].
• Drug-Induced anorgasmia – You’re taking something, and it’s stopping you from achieving orgasm. These might be medications leading to conditions like antidepressant associated sexual dysfunction, but they could also be illicit substances.

What causes anorgasmia?

No sole cause of orgasm dysfunction exists. Of all the reasons why, this type of sexual function can be split into physical or mental issues. It’s also not uncommon for people to have a confusing combination of causes that can make the problem worse.

Many causes are common to all genders, whereas others are unique to each sex. Let’s go through them.

Physiological causes of anorgasmia in men and women

• Medical conditions, like spinal cord injuries and multiple sclerosis, that affect the nerves running to the genitals.
• Thyroid disease
• High prolactin levels (known as hyperprolactinemia)
• Alcoholism
• Drug abuse
• Certain medications (like antidepressants, which can restrict blood flow)
• Pelvic radiation treatment

Male orgasmic dysfunction physiological causes

Specific causes of male anorgasmia include:

• Low testosterone
• Prostatectomy complications
• Erectile dysfunction

Psychological causes of anorgasmia in men and women

• Anxiety
• Stress
• Depression
• Mental disorders
• Relationship problems
• Performance anxiety
• Past sexual trauma (including childhood sexual abuse)
• Phobias
• Grief

Who does anorgasmia affect?

Anorgasmia can affect anyone of any age if they’ve reached sexual maturity. It’s something that could have always been there or something that’s come on suddenly.

Sometimes, it’ll disappear on its own, such as if a certain medication causes it, or it might never go away, and you’ll have to think about options like sex therapy.

What are the symptoms of anorgasmia? 

Many Aussies with the problem think that they’ve got trouble orgasming and that’s that. Those with limited sexual experience might even think it’s normal. But anorgasmia has a range of symptoms that can point you in the right direction.

According to the International Society for Sexual Medicine, it’s defined by five main symptoms [8]:

1. Delayed orgasm: It takes much longer than usual to reach orgasm. If you masturbate, compare how long it takes, and you might be surprised.
2. Orgasm absence: You don’t orgasm at all, despite getting all the physical and mental material you could ever want. If you’re someone who has to masturbate at the end of sex to finish, this could be anorgasmia.
3. Lack of sensitivity: Both genders get this as penile sensation loss or vaginal sensitivity loss. This doesn’t mean that you’re not aroused. It just means you can’t progress any further.
4. Emotional distress/frustration: Sufferers of anorgasmia tend to be distressed and frustrated when they can’t reach orgasm. It’s a massive source of stress that can weave its way into your whole ecosystem.
5. Relationship impact: Are you finding that there’s strain on your relationship? A lack of intimacy? A decrease in intimacy? Significant sexual dissatisfaction? Miscommunication with your partner? These are all signs that one or both could be suffering from anorgasmia.

Of course, the difficulty with anorgasmia is that these symptoms can also be symptoms of other forms of sexual dysfunction. Without a formal diagnosis and treatment plan, it’s impossible to tell for sure that it’s anorgasmia that’s causing your problems in the bedroom.

How is anorgasmia diagnosed? 

Anorgasmia can’t be diagnosed by a simple test. You’ll need to work with your healthcare provider to discuss your symptoms and your sexual history. It might be an awkward conversation, but it’s one that’s needed to properly understand why you’re having issues and what the cause could be.

If your doctor thinks a medical issue could be causing it, you might get a blood test, penile sensitivity test, or an ultrasound to check that an underlying medical condition isn’t part of the issue.

Depending on the underlying cause, you’ll receive a selection of treatment options to help treat it. In some cases, you might be referred to a specialist who can provide you with the help needed.

How is anorgasmia treated?

Anorgasmia is a complex condition, and that means there’s no single pill you can take and be on your way. You’ll have to work with your doctor to decide what’s best for you. All travels start with your usual doctor, and perhaps even a urologist. From there, it depends on what the underlying cause is.

Here are some of the treatment options that your doctor might recommend:

Sexual health specialist 

You might be referred to a sexual health therapist, such as a sex counsellor or therapist, if psychological factors are at play. During these sessions, you’ll learn about coping strategies and different therapies that could help.

For example, if you’ve got issues with mental health conditions, like anxiety, you might learn coping techniques to calm you down. Likewise, if it’s sexual relationship problems, such as stemming from a partner's sexual dysfunction, couples counselling might be on the cards.

Therapeutic techniques

Therapy isn’t just about talking about yourself. You’ll also learn behavioural and therapeutic techniques to reduce anxiety and enhance your sensations during sex. These might take the form of mental or physical exercises, including:

• Cognitive Behavioural Therapy (CBT)
• Mindfulness
• Guided imagery
• Pelvic floor therapy
• Kegels 

Can you prevent anorgasmia?

Treatment can be tricky, but can you do anything to stop it from happening in the first place? Based on our current science, there’s no reliable way of preventing the condition or reducing the chances of it appearing.

Prevention boils down to treating any medical conditions you have, including psychological and emotional ones, and living a healthy lifestyle. Unfortunately, if anyone’s trying to sell you any miracle preventative treatments for this, they’re a shonky operator playing on your anxieties and fears to get into your wallet.

Of course, some treatments could stop other conditions from blooming that could cause you problems in the bedroom. Everyone knows about penile erectile dysfunction, such as premature and delayed ejaculation, and how it can impact your life.

Options like Pilot’s erectile dysfunction treatment, delivered by Australian practitioners, could be the help you need to get back on your game in the bedroom. Simply take an online consultation and our Aussie practitioners will create a treatment plan for you, which is then delivered discreetly to your door so there's no need for a trip to the doctor's surgery or chemist.

Remember, sexual problems are more common than you think, and we understand them more than ever before. Whether it’s a little problem or not, chat to your healthcare provider and get it sorted. 

Photo credit: Pexels