Generally, orgasms vary in intensity and frequency, as well as the amount of stimulation required to trigger an orgasm. Forget what you see in the movies: achieving orgasm is not a simple, certain thing. This is because this pleasurable peak is in fact a complex reaction to numerous physical, psychological and emotional factors. Problems experienced due to any of these factors may affect the ability to orgasm.
Medical conditions and neurological diseases may affect this part of the human sexual response cycle. In general, medical conditions that affect the blood and nerve supply to the pelvis such as hypertension, multiple sclerosis, Parkinson disease and diabetic neuropathy lead to anorgasmia. Spinal cord injury, cauda equine syndrome, and cardiovascular disease may also cause difficulties in reaching orgasm. Chronic diseases responsible for anorgasmia include cancer, heart disease, diabetes, kidney disease and liver disease. Hormonal disorders such as hypothyroidism, Addison disease, Cushing syndrome, hyperprolactinemia, hypopituitarism, decreased estrogen and androgen levels, as well as chronic illnesses affect general health and sexual interest.
Anorgasmia may result from aging, physical changes, medical issues or medications the woman is on.
Climax may be impacted by pregnancy, gynecologic surgeries such as cancer surgery and hysterectomy. Moreover, failure to have an orgasm can also be as a result of other sexual issues such as painful or uncomfortable intercourse. Genital mutilation, pelvic trauma, hormonal imbalances, vulvodynia, uterine embolisation and childbirth trauma may also result in anorgasmia. The following pelvic disorders may also give rise to anorgasmia:
- Vaginal dryness – This occurs in menopause due to a decrease in estrogen levels. Poor lubrication may also be as a result of a hormonal imbalance, other diseases or taking certain medications. This has the effect of inhibiting arousal and making intercourse for the woman uncomfortable.
- Vaginismus – This condition is characterized by a painful spasm of the muscles surrounding the vaginal opening thereby causing the vaginal opening to tighten. This may prevent penetration or make penetration an extremely painful experience. Vaginismus may also occur as a result of surgical scars or injuries, abuse, infection, childbirth, condoms, spermicides or irritation from douches. This condition may also be simply as a result of fear in the woman.
- Sexually transmitted diseases – STDs – These are infectious diseases that are spread by sexual contact including gonorrhea, genital warts, herpes, syphilis and Chlamydia. These may result in changes in the genital area that cause sex to be uncomfortable or even painful.
- Vaginitis – This condition is characterized by irritation or inflammation of the vaginal tissues due to infection or other causes that can make sexual intercourse uncomfortable or painful.
- Endometriosis, ovarian cyst, pelvic mass, surgical scars – These may result in an obstruction in the vaginal area which makes intercourse difficult, painful or prevents it altogether.
- Pelvic inflammatory disease – This is a vaginal infection that progresses up into the cervix, uterus and ovaries. This disease may be painful on its own, or even result in extremely painful intercourse.
- Nerve damage following surgery – During pelvic surgery such as a hysterectomy, small nerves will need to be cut, which may later decrease sexual response and sensation in the woman.
Numerous over-the-counter and prescription medications may hinder orgasm. These include blood pressure medications, antihistamines, anxiolitics, anticonvulsants, barbiturates, venlafaxine and antidepressants – particularly selective serotonin reuptake inhibitors (SSRIs) including Prozac and Zoloft. Post-SSRI sexual dysfunction (PSSD) is the name given to sexual dysfunction that results from previous use of SSRI antidepressants. Research has shown that 17-41% of women using SSRIs suffer from a form of sexual dysfunction. Decreased libido progressing to anorgasmia is a common adverse side effect of taking D2-blocking antipsychotics that increase prolactin levels through dopamine antagonism.
Chemotherapy drugs or drugs for high blood pressure and antipsychotics also contribute to sexual dysfunction in women. Medical treatments such as radiation therapy for certain cancers may also contribute to a reduction in vaginal lubrication. Such treatments may also result in tender and sensitive skin and membranes lining the genital area.
Research has unveiled a sexual dysfunction and orgasm dysfunction rate of 16 -27% for quietiapine, aripiprazole, ziprasidone and perphenazine. A higher rate of 40 – 60% has been reported for haloperidol, clozapine, olanzapine, thioridazine and risperidone. In certain cases, decreased libido and anorgasmia have been reported for carbamazepine, benzodiazepines, phenytoin gabapentin, pregabalin and topiramate. Other common causes of unsatisfying orgasm, delayed orgasm or lack of orgasm are antihypertensive agents – in particular beta-blockers.
Alcohol and Drugs
An excessive intake of alcohol or the use of street drugs could interfere with your ability to have an orgasm. Excessive tobacco may also induce vascular and possibly neurological damage which could affect your sexual function. Opiate addiction, in particular heroin, is another known cause of anorgasmia. Other drugs that could lead to this condition include cocaine, marijuana and amphetamines as they result in sedation or direct impairment of orgasmic responsiveness.
The aging process is accompanied by normal changes in your anatomy, neurological system, hormones and circulatory system which could impact your sexuality. During the transition to menopause, a tapering of estrogen levels may reduce sensations in the nipples, clitoris and skin. Blood flow to the clitoris and vagina may also be affected, thereby delaying or stopping orgasm altogether.
Many psychological factors impact the ability to have an orgasm, which causes anorgasmia to sometimes be classified as a psychiatric disorder. In some instances, there is no clear reason why the woman cannot achieve orgasm, even with a caring skilled partner, enough privacy and time, and in the absence of medical issues known to hinder sexual satisfaction. Without a good level of internal, implicit comfort in the woman, the skill and attention of a partner will not lead to orgasm. As such, anorgasmia is fairly common in women with adequately skilled and attentive partners.
Research has been unable to conclude that psychosocial factors such as age, education, religion, personality, social class or relationship issues alone lead to anorgasmia. If psychological disorders are diagnosed, they will need to be treated before anorgasmia is diagnosed and targeted for specific treatment. These may be due to negative attitudes towards sex due to childhood sexual experiences or unresolved feelings about early experiences of sexual abuse or rape. Psychological causes of anorgasmia generally include:
- Performance anxiety
- Cultural beliefs
- Strong religious upbringing – This may hinder the woman’s ability to view sex as a normal and enjoyable part of a relationship. They may instead associate sexual feelings or intercourse with shame.
- Stress and financial pressures
- Guilt about enjoying sexual experiences – This is due to a perception that female sexual desire is somehow “wrong” in women who have been raised in repressed environments. Such women are thereby impeded from being able to enjoy natural and healthy sexual feeling.
- Fear of pregnancy or contracting sexually transmitted disease
- Mental health problems, including depression and high levels of anxiety associated with sex
- Lack of sexual education
- Weak pubococcygeus muscles in women
- Past sexual abuse – This may prevent the woman from trusting her partner enough to relax and become aroused.
- Depression and high neuroticism
- Unrealistic expectations – Women with unrealistic expectations about their sexual encounters are likely to become disappointed when these are not fulfilled. Such women may have been misled by the easy and fantastic portrayals of sex on TV and the movies, and end up believing that this is how it is supposed to be in real life. And when the sex is not as earth-moving as they expected, they may even become distressed.
- Sexual problems of their partner – Impotence or lack of desire in a woman’s partner may serve to inhibit the woman’s own sexual satisfaction.
Emotional (Relationship) Causes
Discord in other aspects of a relationship may result in sexual issues. These include problems relating to the distribution of labor, money or childrearing. Control or abuse issues are known to be particularly damaging to sexual harmony. These problems are known factors in preventing women from communicating their sexual needs and desires to their partners, which could lead to resentment that further compounds the sexual dysfunction in the woman.
Most couples experiencing problems outside their bedroom will also experience troubles inside the bedroom. These may include:
- Infidelity or breach of trust
- Unresolved fights or conflicts
- Lack of connection or emotional closeness with your partner
- Poor communication of sexual preferences and needs
- Impotence or early ejaculation in the male partner
- Boredom or monotony in sexual activity
While most of the aforementioned factors have demonstrated a correlation with anorgasmic women, no one factor has been found to significantly contribute to the condition than any other. Anorgasmia is therefore often treated as a complex combination of many or all of the factors above.