Anorgasmia is a complex condition. Here’s how you can try to work through it.
Despite what you may see on TV, plenty of people have exciting, pleasurable sex without orgasming. But for some people, consistent difficulty having an orgasm can become a real issue that affects how they feel both physically and mentally when it comes to sex. If you never reach climax but would like to, then you may have a condition called anorgasmia. That might sound simple enough, but anorgasmia treatment isn't straightforward. The condition is a complex topic in the sexual-health world – its diagnosis and even definition are still somewhat up for debate. Just to be clear, climaxing can certainly be one positive aspect of sex, but it’s not the be-all and end-all of good sex. That extremely prevalent cultural notion is annoying for many reasons, including that it can make you feel like something’s deeply wrong with you for not having an orgasm (or not caring much about orgasms, if that’s your situation!). there might be a reason you’re not Words by griffin Wynne orgasming With that said, it’s also understandable if you want to orgasm and find it frustrating if it’s just not happening for you.
If this is the case, there are ways to work toward potentially having regular and fulfilling orgasms, according to Dr Janelle Howell, pelvic physical therapist at Northwestern Medicine. “Everybody is capable of pleasure and everybody is capable of change,” Dr Howell tells Glamour.
What even counts as an orgasm, anyway?
At this point, you might be wondering how you can tell if any pleasure you experience during sexual encounters (either alone or with a partner) is actually an orgasm. First, know that there’s no ‘right’ way to orgasm, and the sensation varies from person to person. Generally, orgasms bring an intense feeling of physical pleasure.
Because orgasms are individualised, there’s no one way to tell if you’ve had one. But in general, signs that you might be orgasming include: feeling your muscles contract, experiencing a release of physical tension, breathing heavily, or feeling physically warm, according to the Cleveland Clinic in the US. For some people, orgasms are that clear-cut and intense. But they can also be more low-key with fewer sensations, Dr Jessica Shepherd, ob-gyn and women's health expert at the University of Illinois in Chicago, tells Glamour. (Meaning not everyone will be the dramatic toe-curling scene portrayed in movies.) Additionally, some people may not enjoy the feeling of orgasming. Totally fair!
What is anorgasmia?
The term describes a situation wherein people are unable to reach orgasm even after significant sexual stimulation and, crucially, feel distressed when they don’t get there, according to the Mayo Clinic. If you don’t climax during every sexual encounter, or at all, and you’re completely fine with that, then you don’t have to worry about anorgasmia. If you need certain types of sexual activity (like clitoral stimulation, which the vast majority of people with vaginas do need to orgasm) or contexts to orgasm and that’s cool with you, then that’s great. Not having an orgasm, not having them consistently, or having them under really specific circumstances is truly only an issue if it bothers you. Under guidance from the American College of Obstetricians and Gynaecologists, some physicians may refer to anorgasmia as an orgasmic disorder, says Dr Tara Scott, clinical associate professor of ob-gyn at Northeast Ohio Medical University in the US. The condition is outlined as not climaxing in at least 75% of your sexual encounters (even with signifi cant stimulation) for roughly six months and feeling upset about the situation, according to a July 2020 paper published in Obstetrics and Gynaecology. There are a lot of nuances in sexual health. So not every doctor follows these diagnostic guidelines strictly when it comes to anorgasmia, and an empathetic physician will work with you to fi gure out why you may not be orgasming if it’s bothering you and you don’t meet these criteria.
Types of anorgasmia
Just like there are diff erent kinds of orgasms, there are also diff erent kinds of anorgasmia. First, anorgasmia is classified by time: whether you’ve never orgasmed, or you have but now you’ve stopped orgasming. The condition is then further categorised by the situations where you may not climax. Lifelong, also called primary, anorgasmia describes cases when someone has never experienced an orgasm. Heads up that this doesn't mean you can't have one – just that it hasn't happened for you yet. Acquired, also called secondary, anorgasmia describes cases when someone previously orgasmed but now has trouble climaxing. Generalised anorgasmia happens when someone struggles to orgasm during sex either solo or with a partner. You may have experienced an orgasm before and know what it feels like, but on the regular, it's hard to climax. Situational anorgasmia occurs when someone can only finish in specific situations to the point that it bothers them. For example, maybe you regularly climax when your partner performs oral sex, but no matter how hard you try, you can’t orgasm when you’re masturbating using a sex toy that mimics those sensations or when having penetrative sex that includes plenty of clitoral stimulation. You may feel exasperated and frustrated because you want to climax during various types of sex and not just with oral. It’s important to note that there’s overlap between the classifications, so you may have acquired situational anorgasmia, for instance.
What causes anorgasmia?
Anorgasmia is complex and may be caused by several factors, including medical conditions, medications, traumatic experiences, or relationship confl icts, says Dr Howell. Sometimes more than one of these factors can contribute. For example, you may develop anorgasmia after having a hysterectomy, which is technically a physical factor, but you could also have an emotional response tied to that procedure that’s playing a role too.
Here’s what you should know about the potential causes of anorgasmia:
Physical causes of anorgasmia
Whether you’ve never orgasmed or you suddenly have trouble climaxing, Dr Shepherd suggests first scheduling an appointment with your physician to assess whether any medical conditions such as diabetes or medications could be at play. For example, certain antidepressants can make it harder for you to orgasm. Your physician may be able to recommend an alternative medication that doesn’t affect your sex life. If you’ve hit menopause, which happens when your body makes less estrogen and you stop menstruating, then that may explain why you’re not orgasming the way you’d like. Sometimes, your vaginal lining becomes thinner and drier or less sensitive when your estrogen levels drop, which understandably makes it difficult to enjoy sex, according to the Cleveland Clinic. If your medical history and medications aren’t preventing you from climaxing – and you don't think your anorgasmia is due to an emotional or relationship cause, which we'll get to below – Dr Howell suggests asking your ob-gyn to assess your pelvicfloor muscles. “Your pelvic-floor muscles contract and relax during arousal and increase blood flow to the clitoris and vagina to increase the likelihood of orgasm,” Dr Howell says. “If your pelvic floor is extremely weak, tight, or even painful, it can cause difficulty achieving orgasms,” she explains.
Psychological and emotional causes of anorgasmia
Of course, sex isn’t only physical, and there are a number of psychological and emotional factors that can affect your sex life. Understandably, people who were taught as children that sex is shameful or that having sex will most likely lead to sexually transmitted infections may have lingering fears about it as an adult. Those stressful thoughts can make it difficult to relax during your experience and orgasm, Dr Shepherd says. There may be times when you struggle to find pleasure in anything – including sex. If you’re experiencing chronic stress or depression, then it can be really hard to orgasm, according to the US National Library of Medicine. Or if you are anxious about how your body looks every time you’re naked, then your thoughts could distract you from experiencing pleasure, according to Dr Lexx Brown-James, sex therapist and adjunct professor at Widener University in the US. More seriously, having sex after experiencing any kind of sexual abuse or trauma can be emotionally painful. Know that it’s normal to feel confused or terrified about sex and sexuality after going through this. relational causes of anorgasmia Unless you’re solely having sex with yourself (which, by the way, is normal), your sex life probably includes other people. If you and your partner are always arguing or you’re working through other relationship hurdles, then you may not be feeling all that sexy. Even if you don’t have any conflicts, you might be uncomfortable speaking up when you’re not orgasming and communicating your sexual preferences.
People experience pleasure in different ways, so orgasming could be about finding what works best for you and THINK Sex.indd 104 4/6/22 10:27 AM illustrations: robyn-lee pretorius your body. If you’re not sure whether you’ve been having orgasms and you’re in search of a more definitive answer, Dr Shepherd says pinpointing what you like and dislike can help you better understand if and when you might be orgasming. Let’s say, for example, you realise that you really love a specific kind of clitoral stimulation and that the shivery, relaxed feeling you get during that stimulation is actually an orgasm (even if it’s not as intense as you’ve been led to believe). If you’ve determined you don’t climax and would like to, you may need to use several approaches to try and make it happen, says Dr Shepherd. “I don’t want people to think of it as, you need to do one thing or the other, you most likely need multiple things.”
Physical anorgasmia solutions
Dr Shepherd recommends first talking to a health care professional to determine whether current medications, medical conditions, hormone levels, or injuries are behind what’s going on. “Your doctor can manage your chemical levels, have you try a new medication, or have you see a neurologist to see what the neuropathy is.” Once your doctor has ruled out any underlying medical conditions, they may ask if you’re experiencing pain during penetration, having trouble going to the bathroom, or feeling tight in your pelvis to look for signs of pelvic-floor dysfunction. “If you're experiencing these symptoms, a pelvic physical therapist can work with you to improve the quality of your pelvic-floor muscle function and sexual wellness,” Dr Howell says. Some people could benefit from doing Kegel exercises, says Dr Howell. When performed very consistently and also correctly, Kegels may strengthen your pelvicfloor muscles, which can potentially help with orgasms, according to the Cleveland Clinic. Or maybe you just haven’t found what really arouses you. Try masturbating with a specific focus on taking an inventory of the kinds of sensations that feel good to you (i.e., stroking with your fingers, feeling the pulse of a showerhead) and then doing more of those, rather than pressuring yourself to orgasm.
Emotional anorgasmia solutions
You may not know whether your feelings (either conscious or subconscious) about sex are the reason behind your anorgasmia. If you’ve talked to your doctor and explored your body – and still don’t climax – then working with a therapist or a dedicated sex therapist can help you uncover and work through possible emotional factors, including depression, negative body image and trauma. Being mindful of how your thoughts after masturbation or sex may help you pinpoint any feelings of guilt or shame. With support, trust, and patience you may be able to get in the moment more easily and orgasm. If you’re working with a counsellor, your practitioner may suggest homework assignments that help you explore your sexuality, such as sensory exercises or journaling. If you’ve experienced any past sexual abuse or trauma, then it’s really important to work with a therapist who has experience navigating this area. Of course, everyone is different, and there is no right way to manage your mental health or past sexual trauma. You’re on your own timeline, and you get to decide what feels right moving forward.
Relational anorgasmia solutions
Broaching your conflicts or difficulty orgasming with someone can feel intimidating, but communicating is the only way your partner will know what you’re thinking (and vice versa). Easier said than done, right? When working through relational sex issues, Dr Brown-James suggests putting orgasms on the back burner. “I know it sounds weird and most lovers hate it when I say it, but take sex off the table,” Dr Brown-James says. In some cases, you and your partner might prefer working with a therapist who can offer guidance and help you talk through difficult conversations, Dr James-Brown says. Ultimately, it may take some time to figure out why you aren’t orgasming. Working with a variety of medical experts can help you figure out if you have anorgasmia as well as possible solutions. And remember that you deserve to feel good in your body, and while that may mean orgasms – it certainly doesn't have to.
This article originally appeared in Glamour’s May 2022 Wellness Issue.