Anorgasmia is the persistent and consistent failure to attain orgasm (i.e. climax during sexual intercourse) even after adequate stimulation. It is more documented in females when compared to males and leads to personal distress. Nearly 10% of the men and around 30% of the women reported this problem. In females, it is called female orgasmic disorder.

Based on the symptoms, anorgasmia is classified into three types as below:

  • primary anorgasmia – if an orgasm is never achieved at any point in life
  • secondary anorgasmia - if orgasm could be attained in the past but not any longer in the present
  • situational anorgasmia - if an orgasm cannot be achieved only in certain situations

There are several causes of anorgasmia which are similar for both men and women.

Psychological problems: Performance anxiety is the most important psychological problem for anorgasmia. However, the other problems such as stress can be corrected in relatively short duration. Some persons may develop negative attitudes towards sex, either due to sexual abuse or rape which can be another cause for anorgasmia. Certain other perceptions such as monotonous sex life, boredom with the relationship and marital strife also contribute for anorgasmia. In others, it can be due to the fear of painful intercourse, fear of pregnancy, the undesirability of the partner, etc.

It is estimated that psychological problems are the cause for about 90% of the anorgasmia related cases.

Medical problems: Several medical conditions are also found to be associated with anorgasmia. They include diabetic neuropathy, radical prostatectomy, multiple sclerosis, spinal cord injury, genital surgery, pelvic trauma, hormonal issues (low levels of testosterone and thyroid), hypertension and chronic pain.

In males, the biggest risk factor is the use of antidepressants, especially selective serotonin reuptake inhibitors (SSRIs).

SSRIs can affect nearly 25% of the users in terms of attaining orgasm.

Alcohol or drug abuse (opioids and heroin) can cramp your ability to the climax of sex.

During the aging process, several changes occur in your hormones, anatomy, the neurological and circulatory system which can affect your sexuality. While reaching menopause, estrogen levels get tapered which reduces circulation to the genitals, either delaying or stopping orgasm.

Initially, your doctor will ask about your sexual history, current relationship, and surgical history. Do not hesitate to answer these questions, as they provide a clue to your doctor about your problem.

Following this, a physical examination is performed to check if the underlying cause is any medical condition or if there is any physical or anatomical reason for anorgasmia.

Confirmatory diagnosis of anorgasmia is done by performing several blood tests. A detailed neurological examination, evaluation of the hormonal levels, sugar levels in the blood and genital blood flow is performed.

A sexual therapist can best manage orgasm problems. The success rate for the anorgasmia treatment is about 80-90% while for secondary anorgasmia it is 10-75%. You must consult your doctor if you have the problem of reaching orgasm.

  • If the condition is due to any medical condition, then that needs to be addressed at first.
  • If your problem is due to psychological issues, then you will receive communication training which involves reducing pressure, developing relaxed and playful interactions.
  • Counseling primarily involves teaching the mechanism of sexual arousal to the couple, focusing on the differences in their sexual response cycle. It also focuses on the emotional and situational factors of both the partners, which contribute to the problem.
  • Changes in lifestyle and sexual practices. Certain sensate focus exercises, Kegel exercises, directed masturbation, systematic desensitization techniques are suggested by your physician which can be followed at home.
  • Trying different techniques of sexual arousal, using devices such as vibrators and vacuum pumps.
  • Hormonal imbalances can be treated with hormonal therapy, which is mostly used for women. Estrogen therapy increases blood flow to the genitals, increasing the sensitization. These are available either as pills or as patches.
  • Medications such as phosphodiesterase inhibitors (mainly sildenafil, popularly known as Viagra) are found to be effective for both males and females. Vardenafil is approved for use in men. The drug needs to be taken an hour before having intercourse. The other beneficial drugs include bupropion, amphetamine, amantadine, cabergoline and yohimbine.
  • If anorgasmia is due to drugs, then decreasing the dose of such drugs can reverse the condition. It is safe to coordinate with your psychiatrist before making any changes, especially with SSRIs.

Anorgasmia cannot be treated completely if the nerves supplying genitals are damaged.

It can be frustrating for both the partners if either of them is having the problem to reach orgasm. Most of you might be having an opinion that sex is more or less van-rocking or earth-shaking as telecasted in movies. But this is not true. So come out of such expectations. Instead of thinking about orgasm, focus on mutual pleasure. You will experience a sustained pleasure plateau which is as satisfying as the orgasm.