An orgasm is a peak feeling of intense pleasure in response to stimulating sexual activity.

Vaginal penetration during sex indirectly stimulates the clitoris. But this may not be enough stimulation for orgasm. Many women may also need direct manual or oral stimulation of the clitoris to reach orgasm.

Anorgasmia, or female orgasmic disorder, is defined as experiencing any of these in a significant way:

• Delayed orgasm.
• Absence of orgasm.
• Fewer orgasms.
• Less-intense orgasms.

Anorgasmia can also be:

• Lifelong, if you've never had an orgasm.
• Acquired, if you have new problems with having orgasms.
• Situational, if you have problems with orgasm only in certain situations, with certain kinds of stimulation or with certain partners.
• Generalized, if you have problems with orgasm in any situation.

Women who don't always reach orgasm during sexual encounters may not find it distressing. In that case, the lack of an orgasm is not considered a disorder.

When to see a doctor

Talk to your healthcare professional if you have concerns about your sex life, especially if you're concerned about your ability to have an orgasm.

Sexual arousal and orgasms are complex reactions to various physical, emotional, sensory and psychological factors. Difficulties in any of these areas can affect your ability to have an orgasm.

Personal and psychological factors

Past experiences, behaviors, background or mental well-being may contribute to problems with orgasms. These include:

• Past sexual or emotional abuse.
• Lack of knowledge about sexual stimulation or interactions.
• Poor body image.
• Guilt or embarrassment about sex.
• Cultural or religious beliefs about sex.
• Stressors, such as financial problems or loss of a loved one.
• Mental health conditions, such as anxiety or depression.

Relationship factors

Problems with your sex partner may be contributing factors to problems with orgasms. These may include:

• Lack of emotional intimacy.
• Unresolved conflicts.
• Poor communication of sexual needs and preferences.
• Infidelity or breach of trust.
• Intimate partner violence.
• Partner's sexual dysfunction, such a male partner with erectile dysfunction.

Physical causes

A wide range of illnesses, physical changes and medications can interfere with orgasms:

• Health conditions. Long-term conditions — such as diabetes, overactive bladder or multiple sclerosis — may be contributing or complicating factors in orgasm disorders.
• Gynecological treatments. Tissue damage from gynecologic surgeries, such as hysterectomy or cancer surgery, may affect the ability to have an orgasm.
• Medicines. Many prescription and nonprescription medications can inhibit orgasm, including blood pressure medicines, antipsychotic medicines, antihistamines and antidepressants — particularly selective serotonin reuptake inhibitors (SSRIs).
• Alcohol and smoking. Alcohol suppresses the nervous system and may hamper the ability to have an orgasm. Smoking can limit blood flow to your sexual organs, affecting your ability to have an orgasm.
• Age-related changes to the body. Changes to the body after menopause or later in life may contribute to various types of sexual dysfunction.

Related sexual disorders

Women experiencing anorgasmia may have one or more related sexual problems. These may contribute to or complicate the problem with having orgasms. These conditions include:

• Problems with sexual arousal.
• Little or no desire for sex.
• Pain from sexual intercourse or other sexual stimulation.
• Dryness of the vagina or vulva.
• Involuntary tightening of the vagina, called vaginismus.

Risk factors linked to having trouble with orgasm include:

• Low education level.
• Low income.
• Poor health.
• Depression and other mental health conditions.
• History of trauma, such as sexual abuse.

Your primary care professional or gynecologist will review your medical history and conduct a general medical exam and pelvic exam. These exams may identify physical conditions that contribute to problems having orgasms.

Your care professional may ask you questions about your experiences with orgasms and other related issues. You may also receive a questionnaire to fill out that answers these questions. You may be asked about:

• Your recent and past sexual experiences.
• Your partner or partners.
• How you feel about your sexual experiences.
• The types of stimulation or sexual activity you engage in.

Your healthcare professional may want to talk with both you and your partner or meet with your partner separately.

Treatment for anorgasmia depends on what's contributing to the problem. Possible treatments include lifestyle changes, therapy and medicines. If an underlying medical condition is contributing to anorgasmia, your healthcare professional will recommend appropriate treatment.

Lifestyle changes and therapy

Treatment for anorgasmia usually begins with one or more approaches to understand your body better, learn what works for you and change behaviors. These treatments may include:

• Education. Your healthcare professional likely will begin with a discussion of female sexual anatomy and how different parts of the anatomy respond to stimulation. This conversation can help you address any questions, clear up any misunderstandings and help you understand the purpose of other recommended treatments. Your care professional also may recommend educational materials.
• Directed masturbation. This program of instruction and at-home exercises helps you become familiar with your own body and explore self-directed sexual stimulation. After you have learned to bring yourself to orgasm, the knowledge about what you have learned is practiced with your partner.
• Sensate focus. This approach for couples provides instruction and at-home exercises. It begins with non-erotic touch and gradually introduces more intimate touch and sexual stimulation. A goal is for each partner to understand the other person's needs and to learn how to communicate and direct each other in order to reach orgasms.
• Changes in sexual positions. Your healthcare professional may recommend changes in sexual positions that increase stimulation of the clitoris during vaginal sex.
• Sexual enhancement devices. Devices that enhance sexual stimulation may assist you in having an orgasm. These include vibrators and air-pulsating devices that stimulate the clitoris. Another device held over the clitoris creates mild suction to increase blood flow. Your healthcare professional may recommend using them alone to understand what works for you and then trying them with your partner.
• Cognitive behavioral therapy. Individual or couples therapy may help you address your thinking about sex in general or with your partner. Therapy can help with behaviors that may promote good sexual relations, such as learning ways to talk with your partner about sex or communicate your needs during sex.

Medical treatments

Although some medicines have been tested for treating anorgasmia, there's not enough evidence to support their use. Hormone replacement therapies may have some benefit, but they have risks that require careful monitoring. These include:

• Estrogen therapy. If you are receiving treatment for menopausal symptoms, the treatment may also have some effect on improved sexual experience. Also, a low-dose estrogen therapy for the vagina, such as a cream or suppository, can improve blood flow to the genitals and improve lubrication of the vagina. Long-term use of estrogen pills is associated with a risk of breast cancer and cardiovascular disease.
• Testosterone therapy. For some women in menopause who have testosterone levels lower than what is considered typical for women, testosterone replacement may improve arousal and orgasms. Side effects may include acne, excess body hair, a decline in HDL or "good" cholesterol, and risks similar to estrogen replacement therapy.

Natural products, such as those made with L-arginine or Russian olive tree extract, are marketed for improving women's sex lives. They have been studied in very small trials using multiple herbal products or combined with other drugs or lifestyle management programs. There isn't enough data to know if they have any treatment effect.

Talk with your healthcare professional before trying natural therapies, which can cause side effects and interact with other medicines.

If your lack of orgasm from sexual activity distresses you, make an appointment with your primary care professional or your gynecologist. Here's some information to help you prepare for your appointment.

What you can do

Make a list of the following items that are important to share with your healthcare professional:

• Your symptoms, when you first began having problems with orgasms and under what circumstances the problems occurred.
• Your sexual history, including relationships and experiences since you became sexually active and any history of sexual trauma or abuse.
• Medical conditions you have, including mental health conditions.
• Medicines, vitamins and other supplements you take, including doses.
• Questions you have about sexual activities or healthy sexual relationships.

What to expect from your doctor

In addition to the information you prepare, your healthcare professional will likely ask questions to understand your sexual experiences, your ability to reach orgasm and your thoughts about your sexual relationship. You might think about answers to the following questions:

• Are you sexually active now?
• How many partners do you have now?
• Does your partner identify as a man, woman or nonbinary?
• What kind of sexual activities do you engage in?
• Do you become sexually aroused during sexual interactions with your partner?
• How satisfied are you with your sexual relationship with your partner? Has your satisfaction changed over time?
• How satisfied were you with a previous partner?
• Have you been able to have orgasms in the past?
• Is difficulty having an orgasm only with certain activities?
• Are you able to have an orgasm with masturbation?
• Do you have pain with vaginal penetration or other sexual activity?
• Do you use protection during sex?
• Have you had a sexual transmitted disease?
• Are you currently trying to come pregnant or have concerns about becoming pregnant?
• Do you use birth control?
• Do you use alcohol or recreational drugs? How much?
• What messages about sex did you receive growing up?
• How satisfied are you overall with your current relationship?