Orgasm disorder (English: orgasm disorder, anorgasmia) is the general term for a persistent and recurrent difficulty or inability to reach orgasm despite adequate sexual arousal and stimulation. It occurs in both sexes, but presents differently.

Female orgasm disorder (anorgasmia)

DSM-5 sets out an independent diagnosis, Female Orgasmic Disorder, defined by a marked delay, reduced intensity, or absence of orgasm despite adequate sexual stimulation, persisting for at least six months and causing distress.

The primary (lifelong) form is one in which orgasm has never been experienced; estimates run at 5–10 per cent of women. The secondary (acquired) form is one in which orgasm was formerly experienced but is no longer obtained, often triggered by a change in medication, hormonal shift, relationship problems, or psychological change. The situational form reaches orgasm in masturbation but not in partnered intercourse (or the reverse); this applies to a great many women, but is not regarded as a disorder absent distress.

About 10–15 per cent of adult women report never having experienced orgasm (surveys from Kinsey et al., 1953 onward), making it one of the most common sexual dysfunctions. Yet surveys also find that not reaching orgasm in partnered intercourse applies to about 70 per cent of women, so the boundary between a “disorder” and a matter of education or technique is blurred.

Male orgasm disorder

In men, orgasm disorder appears as delayed ejaculation or anejaculation. Delayed ejaculation is a state in which ejaculation is not reached even with prolonged intercourse, or is difficult to reach intravaginally. The prevalence of male orgasm disorder is low at 1–4 per cent, though it is said to be underreported. A frequent cause is drug-related, from SSRIs and antipsychotics; among the sexual side effects of SSRIs, delayed and absent ejaculation are the most frequently reported. Other contributors include neurological factors (spinal cord injury, diabetic neuropathy, post-prostatectomy) and strong psychological inhibition.

Principal causes

Drug-related: SSRIs (selective serotonin reuptake inhibitors) are the most common drug cause of orgasm disorder, with serotonin antagonising dopamine and raising the orgasm threshold. SNRIs, tricyclic antidepressants, antipsychotics, and antihypertensives (beta-blockers) may also contribute.

Psychological: performance anxiety, religious or cultural taboo (“one must not feel”), past sexual trauma, relationship dysfunction, and “spectatoring” (mentally scoring and monitoring one’s own response) all impede orgasm.

Hormonal and neurological: low testosterone or estrogen, neuropathy from multiple sclerosis, diabetes, or spinal cord injury, and nerve damage after pelvic surgery.

Treatment and management

When drug-related, changing the prescription (switching to an agent with less effect on orgasm, such as bupropion) is the priority. When psychological factors dominate, cognitive behavioural therapy, mindfulness, and directed masturbation are effective. Directed masturbation, in which the person explores and learns their own sexual response independently under a therapist’s guidance and then applies it to partnered sex, has confirmed efficacy for primary anorgasmia in many studies.

Related terms

• Orgasm
• Anorgasmia / frigidity
• Vaginismus