The amount and type of stimulation required for orgasm varies greatly from woman to woman. Most women can reach orgasm when the clitoris (which corresponds to the penis in men) is stimulated, but fewer than half of women regularly reach orgasm during sexual intercourse. About 1 of 10 women never reaches orgasm, but many of them nonetheless consider sexual activity to be satisfactory.
Women with orgasmic disorder cannot have an orgasm under any circumstances, even when they masturbate and when they are highly aroused. However, not having an orgasm usually occurs because the woman is not sufficiently aroused and is thus considered an arousal disorder, not an orgasmic disorder. Inability to have an orgasm is considered a disorder only when the lack of orgasm distresses the woman. Lovemaking without orgasm can cause frustration and may result in resentment and occasionally a dislike for anything sexual.
Situational and psychologic factors can contribute to orgasmic disorder. They include the following:
Lovemaking that consistently ends before the woman is aroused enough (as when the man ejaculates too soon)
In one or both partners, lack of understanding about how their genital organs function
Poor communication about sex (for example, about what sort of stimulation a person enjoys)
Problems in the relationship, such as unresolved conflicts and lack of trust
Anxiety about sexual performance
Fear of letting go, being vulnerable, and not being in control (possibly as part of a fear of not being in control of all aspects of their life or as part of a general tendency to keep emotions in check)
A physically or emotionally traumatic experience, such as sexual abuse
Psychologic disorders (such as depression)
Physical disorders can also contribute to orgasmic disorder. They include nerve damage (as results from diabetes, spinal cord injuries, or multiple sclerosis) and abnormalities in genital organs.
Certain drugs, particularly selective serotonin reuptake inhibitors (SSRIs, a type of antidepressant—see Table: Drugs Used to Treat Depression), may specifically inhibit orgasm.
Doctors may encourage women to learn what type of touch is pleasurable and arousing by trying self-stimulation (masturbation). Other techniques that may help include relaxation techniques and sensate focus exercises. In sensate focus exercises, partners take turns touching each other in pleasurable ways (see Sexual Arousal Disorders : Treatment). Couples may try using more or different stimuli, such as a vibrator, fantasy, or erotic videos. A vibrator may be especially useful when there is nerve damage.
Education about sexual function may help. For some women, incorporating stimulation of the clitoris may be all that is needed.
Psychologic therapies, such as cognitive-behavior therapy and mindfulness-based cognitive therapy (MBCT—see Treatment), may help women identify and manage fear of relinquishing control, fear of vulnerability, or issues of trusting a partner. Psychotherapy may be useful for women who have been sexually abused or have psychologic disorders, as may MBCT. Practicing mindfulness (focusing on what is happening in the moment) can help women pay attention to sexual sensations, without making judgments about or monitoring what is happening.
If an SSRI is the cause, adding bupropion (a different type of antidepressant) may help. Or another antidepressant may be substituted. Some evidence suggests that if women stopped having orgasms when they started taking SSRIs, sildenafil may help them have orgasms again.