Female Orgasmic Disorder is a surprisingly common condition clinically defined as a persistent reduction or complete inability to experience orgasm.
While worldwide statistics vary, around 16-18% of women report some form of Female Orgasmic Disorder, though in reality these statistics may be higher, as female sexual conditions are chronically underreported due to social stigma. According to a 2020 paper published in the International Society for Sexual Medicine, up to 28% of women in the United States and up to 46% in countries across Asia are affected by this disorder.
Symptoms and Signs of Orgasmic Disorder
The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) diagnostic criteria for Female Orgasmic Disorder includes:
- Reduced intensity of orgasmic sensations
- Marked infrequency or complete absence of orgasm
- Experiencing significant distress due to these symptoms
- Symptoms not directly related to a physiological cause such as medication or other medical conditions
- Symptoms persisting for over 6 months
Female Orgasmic Disorder can be further classified as Primary and Secondary. Primary Orgasmic Disorder is a lifelong condition where the individual has never once experienced orgasm, and is sometimes referred to as “preorgasmic.” Secondary Orgasmic Disorder, or “acquired” FOD, is when a woman who has previously achieved orgasms suddenly loses her ability to do so, or experiences a marked reduction in her ability to do so.
What is a Female Orgasm? (And How It Works)
Before we dive into why orgasms may not be happening, let’s quickly explain what happens when they do. Research published by the Boston University Center for Sexual Medicine breaks the female sexual response cycle into four parts: “desire, arousal, orgasm and resolution (both physiologic and psychologic).”
Leading up to the climax stage – what we call orgasm – is excitement and sexual arousal. Blood flow increases to the genitals during the arousal phase, heightening sensitivity and causing the clitoris and vulva to swell. Glands secrete lubrication, which is why you get “wet” when aroused.
The visible part of the clitoris becomes more prominent, and tension continues to mount in the body; your heart rate rises, respiration heightens, and muscles contract, building up to climax. Climax is the most intense phase of the female orgasm. The pelvic and uterine muscles contract rhythmically, potentially as a way to encourage sperm into the uterus, and the body floods with feel-good hormones like dopamine and oxytocin, which creates a sense of intense pleasure, warmth, and release.
Sometimes women can also ejaculate, thanks to tiny glands called Skene’s glands which secrete fluid through ducts near the urethra in a homologous way to the male prostate. Female orgasms can last from 13 to 51 seconds, compared to male orgasms, which average from 10 to 30 seconds.
Why It Happens: Physical, Psychological, and Social Factors
As the female orgasm involves an intricate symphony of physiological, mental, and emotional factors, the causes behind female orgasmic disorder are equally complex.
Physical reasons for Female Orgasmic Disorder
- Chronic health conditions: Such as overactive bladder, diabetes, or multiple sclerosis may contribute to an inability to orgasm
- Gynecological issues: Gynecologic surgeries such as cancer surgery or hysterectomies may damage tissue and impact the ability to orgasm
- Medications: Medications unrelated to sexual function, such as antipsychotic medicines and antidepressants may inhibit orgasm
- Lifestyle factors: Alcohol and smoking can inhibit nervous system activity and blood flow, dulling orgasmic potential
- Hormonal changes: Peri-menopause, menopause, and aging may all contribute to sexual dysfunction
Psychological Reasons for Female Orgasmic Disorder
- Anxiety surrounding body image, your partner, or losing control
- Past sexual or emotional abuse triggering a body to shut down pleasure centures as a reponse to trauma
- Intense stress or pressure, which can hamper the body’s ability to be in the moment
- Mental health conditions such as depression or anxiety
Social Reasons for Female Orgasmic Disorder (The Orgasmic Gap)
- Embarrassment or guilt about sex due to upbringing and cultural or religious beliefs
- A lack of knowledge about sexual stimulation due to poor sexual education
- An inability to speak about what is pleasurable due to societal constraints
There’s a long history of female sexuality being repressed throughout many cultures, ranging from cultural and religious taboos against expressing desire to outright excision in the case of Female Genital Mutilation (FGM). Unfortunately, such taboos continue to contribute to an unequal orgasmic playing field for those with vulvas and those with penises.
A rigorous 2017 study by the International Academy of Sexual Research found that 95% of heterosexual men said they always or almost always orgasmed during sex, compared to 65% of straight women, 66% of bissexual women, and 86% of lesbian women. Known as “ the orgasmic gap,” this disparity may be due to the prioritization of male pleasure (penetrative sex) in patriarchal societies and lowered expectations for female pleasure.
Female Orgasmic Disorder Treatment Options
Directed Masturbation
Directed Masturbation is a method of cognitive behavioral therapy used to assist women struggling with Female Orgasmic Disorder learn how to achieve orgasm. The process centers around creating a mind-body connection and increased awareness of sexual sensations, typically starting with touching non-genital zones and edging towards guided self-stimulation. Devices such as vibrators may be recommended to enhance vulval or clitoral stimulation.
These methods are particularly effective for those with primary (lifelong) FOD, with studies showing a significant majority of women with primary FOD achieving orgasm when treated. Directed masturbation can be facilitated either individually or as part of couples therapy, where psycho-social factors such as fear, guilt, and difficulties can be discussed.
Sensate Focus
Sensate focus is a six-week process developed by seminal sex researchers Masters & Johnson to help those with FOD achieve orgasm with their partners. Operating on the basis that the inability to orgasm with a partner may be (ironically) due to the pressure to achieve immediate orgasm, sensate focus allows couples to explore each others’ bodies without the overt goal of orgasm.
This method involves a period of non-genital touching building up to self-stimulation and mutual stimulation before introducing slow, caressing intercourse focused on sensation and mind-body connection.
Medical Interventions
For those with Secondary Orgasmic Disorder, certain medications may interfere with the ability to orgasm. Antidepressants such as SSRIs (Selective Serotonin Reuptake Inhibitors) in particular are a common culprit, with studies showing up to 80% of patients taking SSRIs reporting difficulties with sexual function.
If you are concerned about medication-induced FOD, you should consult with your doctor about potentially switching medications as a treatment step.
When to See a Professional
Female Orgasmic Disorder can be highly distressing and negatively impact the sufferer’s mental and emotional well-being. If you’ve already tried individual treatment methods such as Directed Masturbation and consulted with your primary care physician regarding medications and hormonal testing to no avail, it may be time to seek professional help. Working with a professional sex therapist or psychologist can help provide guidance through sexual difficulties.
FAQs
Can you fix female orgasmic disorder?
Female Orgasmic Disorder is often treatable by tackling physical, psychological, and emotional components.
Is it common to never have an orgasm?
Yes! Studies show that up to 20% of women have never experienced an orgasm
What is the difference between anorgasmia and low libido?
Anorgasmia refers to having sexual desire but the inability to achieve orgasm, while low libido is a reduction or absence of sexual desire.
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