Ayden Ferstenberg, Psy.D.
When orgasm isn't on the menu
The Big “O.” Even if sex feels great, many people walk away from sex feeling dissatisfied and unfulfilled if they didn't achieve an orgasm. People sometimes talk about orgasm as the "goal" for sex, that there is an expectation that sex should culminate with the intense pleasure of an orgasm. The problem is, orgasm isn’t necessarily guaranteed and the pressure to have an orgasm often detracts from the experience of pleasure, especially when orgasm doesn’t or can’t occur. Further, there are some women who don't experience orgasm regardless of the type of stimulation is used.
Female orgasmic disorder is the absence, delay, or a reduction in the intensity of orgasm. In order for the diagnosis to be given, the problem must be present for a minimum of six months and cause the person distress. Importantly, the orgasmic difficulty can’t be primarily caused by other psychological issues, a medical problem, or relationship distress. Orgasmic disorder can be lifelong or acquired after a period of time of typical orgasmic functioning. It can also occur in specific contexts (for example, with partnered sex but not with solo sex; with a specific partner but not a different partner) or generalized across settings.
Research shows that about 30% of women can achieve orgasm through vaginal stimulation or intercourse. This means about 70% of women can’t achieve orgasm through intercourse alone! Importantly, about 80% of women can achieve orgasm through clitoral stimulation and 94% of women can experience an orgasm with the use of a vibrator. If you’re doing the math here with us (calculators are fine!), that means about 6% of women don’t achieve orgasm (though other studies have seen rates as high as 20%). Now, it’s definitely possible to have a satisfying sex life without orgasm, and we’ll get into that later. For now, let’s talk about factors that influence one’s ability to achieve orgasm.
Factors that influence anorgasmia
Knowledge about sex
The vagina is often equated to the penis in that the penis is considered the fundamental pleasure organ in the male body and the vagina is the fundamental pleasure organ in the female body. This, however, is a common misconception that can often contribute to difficulty with orgasm because it leads to a focus on the wrong part of the body. In uterine development, the clitoris and the penis both develop from the same genital tubercle, and are thus comparable in developmental and sensory makeup. In other words, the clitoris, not the vagina, is the fundamental pleasure organ in the female body. Stimulation of the penis allows for direct contact with the primary pleasure organ in the male’s body. Telling someone to engage in vaginal stimulation for orgasm is the equivalent of telling men that stimulation of the scrotum is more effective for orgasm than stimulation of the penis. Sure, it’s certainly possible to achieve orgasm through non-penile stimulation, just as it’s possible to achieve orgasm through non-clitoral stimulation, but it’s not the most direct and reliable way of doing so.
Another point that is often misunderstood has to do with clitoral stimulation for orgasm. The clitoris is more than just the little external nub of skin at the top of the vulva. This is actually only a small part of the clitoris, which extends internally and extends around the vaginal canal, similar in shape to a wishbone. The type of motion people use when engaging in vaginal intercourse often involves an in-and-out thrusting motion. This type of motion creates inconsistent engagement of the clitoris–-the female pleasure organ-–and therefore doesn’t allow for the consistent stimulation that is most helpful for orgasm. In other words, the type of motion most people use when having sex interferes with the clitoral stimulation necessary for orgasm. Instead, a more helpful way of consistently connecting with this pleasure organ during vaginal intercourse is moving the pelvis in an upwards-downwards type of motion. This is also referred to as the coital alignment technique. This creates a more consistent contact with the clitoris that increases the possibility of orgasm. Taken together, what this may tell us is that people may not be engaging in partnered sex in a way that maximizes clitoral stimulation.
Lack of knowledge can also mean a general lack of knowledge of your own body. If you’ve never looked at yourself in the mirror, never gotten a personal look at your own genitals, it’ll be hard for you to know what we’re even talking about here when we mention the clitoris. Sure, you might know generally where it is and what it looks like in theory, but it’s important you know where it is and what it looks like on your own body. The same principle applies to touch-–if you don’t know what type of touch you enjoy, it’ll be hard to know what type of touch is necessary for you to achieve orgasm. A valuable component to exploring sexuality and sexual experiences is to become knowledgeable about your own body.
2. Individual factors
Some medical conditions can contribute to difficulty achieving orgasm. These include hypertension, asthma, thyroid problems, heart disease, and multiple sclerosis. Various medications might also play a role here, including SSRIs (a common type of medication used to treat depression and anxiety), and some contraceptive pills and implants. It’s not only medical factors that can influence an individual’s ability to achieve orgasm. Various psychological factors can play an important role here as well. Anxiety and depression itself can also inhibit orgasm, as can fatigue, shame, guilt, poor self-esteem or body image, eating disorders, or trauma.
Let’s talk about one specific way psychological factors might show up during sex in a way that contributes to difficulty with orgasm. Consider someone who is having sex and and starts thinking, “I wonder if I’m doing a good job. Is my partner enjoying this? Do they wish I was better at this?” How do you think these types of thoughts will influence their enjoyment and ability to deeply immerse in the sexual experience? Most likely these types of thoughts distract you from a focus on the present moment and a focus on the sensations in your body. Instead, they keep your attention invested in an evaluative and judgmental place, this is also called "spectatoring", where it’s all too likely you’ll tell yourself you’re coming up short. If you’re like most people, these types of thoughts create an enormous pressure on you to “perform” or “deliver” on some sort of expectation. This type of pressure often detracts from an individual's or couple's sexual experience. Another example is if your partner touches your body in a spot that you feel insecure about, you might notice thoughts such as “I’m ugly. My partner won’t like me. There’s something wrong with me. Who would want to be with someone like this?” Similarly to the previous example, these thoughts serve as a distraction and introduce an anxiety or a tension that keeps your focus away from the experience in the moment, potentially making it more difficult to experience an orgasm.
3. Relationship factors
Effective communication is not easy. Effective communication about sex is often infinitely harder. Effective communication about your specific needs and fantasies and pleasure can be exponentially harder than that. Just ask any couple who is experiencing sexual difficulties, just about any other topic of conversation feels preferable that talking about sex. But this is going to serve as a significant impediment to your ability to orgasm. Being able to ask for the type of stimulation you need, the intensity of that stimulation, the focus of the stimulation, the pressure, the speed, etc., are all going to enhance becoming immersed in your sexual experience and increase the likelihood of experiencing an orgasm. If you can’t direct your partner to touch you in a more stimulating way, the chances of you being appropriately stimulated begin to drop.
Relationship distress also plays a key role here. If there is general dissatisfaction with the relationship or feelings of resentment or anger toward your partner, it will be hard to foster an environment where sexual intimacy can be embraced fully. If there is a lack of trust or a difficulty feeling emotionally safe in the relationship, it will be hard to let go enough to allow for orgasmic release. If you find that there is a lack of emotional safety in the relationship–-for instance if the four horsemen of apocalypse run rampant–-you might need to focus on changing these problem areas before being able to focus on improving orgasm.
4. External factors
Aside from lack of knowledge and personal and relationship factors that can interfere with your ability to achieve orgasm, there are larger systemic factors that are important to understand as well. The way sex was talked about in your childhood will influence how you feel about it in your adulthood. If sex was always associated with shame, it’s no wonder you have a hard time embracing sexuality enough to allow for orgasmic release. If you consistently got the message that the purpose of sex is for procreation, or that sex is a necessary evil, or that it’s inappropriate/sinful/indulgent to experience pleasure, you can bet it’ll be hard for you to allow yourself to enjoy sex to the point of orgasm.
Religious and cultural influences might have shaped your views about sex as well. These influences might have contributed to misinformation or lack of knowledge about orgasm (for example, movies, TV shows, and books continue to perpetuate myths about vaginal orgasms, including portraying them as hierarchically superior to clitoral orgasms, or a symbol of sexual success). These influences might also have contributed to feelings of shame or guilt or self-consciousness around sexual pleasure, which also interferes with your ability to engage meaningfully in the pleasure or joy of sex or sexual fantasy.
What can you do with this information to enhance your sexual experiences?
A number of different strategies can be used to treat female orgasmic disorder. Behavioral strategies that increase your focus on your body and what gives you pleasure can facilitate a more immersive experience in tuning into your experience of pleasure. Relationship strategies that work on improved communication and navigating areas of relationship conflict or mistrust help create openness and safety. Cognitive strategies can help you address unhelpful thought patters that might interfere with sex, processing the stories and narratives you have about sex, and updating those stories with more helpful ones that reflect of your present-day values. Research shows mindfulness can be especially helpful for improving sexual function.
Importantly, while there are many helpful ways of treating anorgasmia, difficulty with orgasm does not mean you can’t have a satisfying sex life. Sex doesn’t have an agenda-–there is no "finish line" or outcome that has to occur for the journey of sex to be pleasurable. When you shift the focus of sex to one of connection, closeness, intimacy, enjoyment, and pleasure, rather than “orgasm”, the journey of sex can continue to be meaningful and fulfilling. Even if this is the case, if you are experiencing difficulty with experiencing an orgasm during partnered or solo sex, and would like to see that part of your experiences can improve, don't hesitate to reach out.