Primary Anorgasmia

  • Anorgasmia is defined as the inability to achieve orgasm, despite sufficient sexual stimulation and can lead to personal distress.

  • Primary anorgasmia is used to describe the experience never having an orgasm, even after “sufficient” stimulation.

  • It is estimated that around 10-15 percent of women have never had an orgasm.

  • Difficulty reaching orgasm is the second most common sexual complaint reported by women.

  • Primary anorgasmia is most common in people who:

    • Younger

    • Less sexually experienced

    • Grew up in sexually repressive environments

  • Issues with orgasm are not uncommon

    • In one study, 24% of women reported they had experienced a lack of orgasm for at least several months or more in the previous year. 

    • Lifelong or primary anorgasmia was reported by 4% of all women in one survey and was highest among young, single women, in whom the prevalence was reported to be 8%; earlier estimates ranged from 6–10% or 11%.

    • Only 25% of women always reach orgasm during intercourse, and 30% climax only sometimes or less frequently during sex with their primary partner.

    • 7% of women have never had an orgasm during sex.

    • 10% of women have reported difficulty reaching orgasm all or most of the time.

    • 29% of women reported orgasmic difficulties.

    • An analysis of 33 studies over 80 years found that during vaginal intercourse just 25 percent of women consistently experience an orgasm, about half of women sometimes have an orgasm, 20 percent seldom or ever have orgasms, and about 5 percent never have orgasms.

What is an orgasm?

  • The orgasm is widely regarded as the peak of sexual excitement. It is a powerful feeling of physical pleasure and sensation, which includes a discharge of accumulated erotic tension.

  • The genital muscles, including the uterus and introitus, experience rhythmic contractions around 0.8 seconds apart. The female orgasm typically lasts longer than the male at an average of around 13-51 seconds.

  • Unlike men, most women do not have a refractory (recovery) period and so can have further orgasms if they are stimulated again.

  • It is commonly held that orgasms are a sexual experience, typically experienced as part of a sexual response cycle. They often occur following the continual stimulation of erogenous zones, such as the genitals, anus, nipples, and perineum.

  • Physiologically, orgasms occur following two basic responses to continual stimulation:

    • Vasocongestion: the process whereby body tissues fill up with blood, swelling in size as a result.

    • Myotonia: the process whereby muscles tense, including both voluntary flexing and involuntary contracting.

  • It is thought that the central nervous system rather than the genitals that is key to experiencing orgasms.

  • The female orgasm is variable: Some women are promptly and reliably orgasmic with a minimum of stimulation, whereas other women require concentrated stimulation in a particular fashion for extended periods of time for orgasmic release to be triggered.

  • Problems reaching an orgasm are generally categorized into two subtypes corresponding to the nature of onset: lifelong versus acquired.

    • Acquired, secondary, or situational anorgasmia refers to women who are able to reach orgasm in some circumstances but not in others.

    • Not only may there be a lack of orgasm for some women, some women may have markedly diminished intensity of orgasmic sensation.

    • Women who have never had an orgasm can be treated with success, and the sexual satisfaction of women whose orgasmic difficulties are situational can generally be improved.

  •  Women can benefit from the guidance of their physician in defining their orgasmic problem, and providing information about treatment.

Origins of Anorgasmia

  • The major origins to anorgasmia can be grouped broadly under three headings: physical, psychological, and interpersonal.

  • For most women, however, the major physical contributor to orgasmic difficulty is anatomy: penile thrusting is not the most effective way of providing the sensory stimulation that triggers orgasmic release in women. Kinsey and associates5 noted more than 40 years ago that women reach orgasm more easily during masturbation than during intercourse. The vagina is not particularly sensitive to deep penile thrusting because it is the outermost third of the vagina that is most suffused with nerve endings. Furthermore, the male “on top” position does not provide the right kind of stimulation to the clitoris.

  •  Secondary anorgasmia is most common in women:

    • Who have recently gave birth or went through menopause

    • Who have had genital surgery

    • Were assaulted later in life

    • Recently started a new medication

    • Have experienced a change in weight

    • Have recently been injured

  • Situational anorgasmia

    • Situational anorgasmia occurs when you aren’t able to orgasm during certain sexual activities.

    • Environmental, emotional, mental, spiritual, and physiological factors all work together to mediate a vulva owners sexual response.

  • Pelvic floor over or under activity

    • Poor pelvic floor muscle awareness, and pelvic floor muscle overactivity and underactivity, can all cause anorgasmia.

  • Dyspareunia (pain during sex)

    • There are several causes of painful sex, including:

      • Endometriosis

      • Vaginal scarring

      • Vaginitis

      • Vaginismus

      • Pelvic inflammatory disease

      • Uterine fibroids

  • Certain chronic health conditions

    • Some orgasmic problems can be attributed to a medical condition alone, particularly those that affect the nerve supply to the pelvis (such as multiple sclerosis, spinal cord tumors or trauma, and diabetic neuropathy) and circulatory disorders affecting the pelvic region.

    • Women can retain a normal capacity for orgasm even after the loss of genital tissue or pelvic organs.

    • There are many many medical conditions that can cause anorgasmia. Aging, apart from health problems, does not produce a decline in orgasmic capacity.

      • Diabetes

      • Hytertension

      • Crohn’s disease

      • Vascular disease

      • Chronic pain

      • Autoimmune disease

      • IBS and chronic constipation

  • Medications

    • Prescription medications for hypertension and psychiatric disorders have been found to contribute to orgasmic difficulties, particularly methyldopa at higher doses, fluoxetine, phenelzine, sertraline, trazodone, and clomipramine.

    • Antidepressant and anti-anxiety medications are well-known as being damaging to orgasmic response

    • Antipsychotics, blood control medications, and hormonal supplements may also contribute

  • Psychological Contributions

    • Although psychological factors seem to be implicated in most orgasmic complaints, no particular psychiatric diagnosis has been found to correlate with these difficulties. Neither depression nor a history of sexual trauma appears to directly affect orgasmic ease, although both can cause desire and arousal difficulties.

    • Sexual abuse histories contribute indirectly to orgasmic dysfunction through the impairment of both desire and arousal by post-traumatic symptoms such as flashbacks and dissociation, particularly when the sexual activity replicates the abusive situation.

    • Cultural beliefs about female sexuality can greatly influence a woman's comfort and dissatisfaction with her orgasmic experience.

Treatment