How To Know If You Have Anorgasmia + 9 Steps To Treating It
Kelly Gonsalves is a sex educator, relationship coach, and journalist. She received her journalism degree from Northwestern University, and her writings on sex, relationships, identity, and wellness have appeared at The Cut, Vice, Teen Vogue, Cosmopolitan, and elsewhere.
If you consistently can't reach orgasm during sex, especially as a woman, you may wonder if you have a physical problem. People who don't climax or struggle with it regularly may be dealing with anorgasmia, though getting the "diagnosis" of anorgasmia itself is less important than getting to the root cause of your orgasm difficulties.
What is anorgasmia?
Anorgasmia is a medical term for having difficulty reaching orgasm despite having plenty of stimulation, such that it causes significant distress for the individual. It can be caused by countless physical and psychological issues, including hormonal changes, menopause, drug and alcohol use, medication side effects (particularly SSRIs), surgery side effects, chronic illnesses, anxiety, depression, stress, negative body image, trauma, relationship issues, sexual shame, performance anxiety, and more.
Basically, almost anything can be messing with your ability to reach orgasm. "Anorgasmia is just another way of saying problems having orgasms," psychologist and AASECT-certified sex therapist Lauren Fogel Mersy, Psy.D., tells mbg.
"It is not a specific physical condition," adds AASECT-certified sex therapist Diana Urman, LCSW, Ph.D. "And since the term orgasm is vaguely defined, the term anorgasmia isn't well defined either.”
In the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5), anorgasmia is called "female orgasmic disorder" for people with vulvas and "delayed ejaculation" for people with penises.
"I choose not to use these diagnoses because they are gendered and pathologize normal variations in human sexuality. I prefer to use language like 'problems having orgasms,' as this feels more reflective of the situation," Fogel Mersy notes.
Is it normal for a girl to never come?
No, it is not "normal" for girls to never come or reach orgasm during sex. But anorgasmia is much more common in women than it is in men: A 2016 review of over 400 studies on female sexual dysfunction concluded some 26% of premenopausal women experience female orgasmic disorder. Other studies have put the number as high as 41%. On the other hand, a 2018 study estimates between 1 and 5% of sexually active men experience delayed ejaculation.
While it's common for women to struggle with orgasm, it's not because it's "naturally" harder for women to climax than it is for men. The vast majority of women can reach orgasm from masturbation; it's heterosexual partnered sex that's not particularly stimulating, largely because penis-in-vagina intercourse usually doesn't stimulate the clitoris, the main source of women's pleasure. (Here's more on the science of orgasms.)
How to know if you have anorgasmia.
In the DSM-5, the criteria for being diagnosed with female orgasmic disorder or delayed ejaculation (the two official terms for anorgasmia for vulva owners and penis owners, respectively) are experiencing a "marked delay in, marked infrequency of, or absence of orgasm" during at least 75% of your sexual activity for at least six months. Additionally, this must be causing you "significant distress."
"Anorgasmia can be diagnosed via physical examination or medical history, or both, but it doesn't have to, as generally speaking, any difficulties with achieving orgasm over a short or extended period of time can be called anorgasmia without having a medical professional to diagnose it," Urman explains.
Here are a few helpful ways to know if you might have anorgasmia:
1. Consider whether you've ever had an orgasm, ever.
If you have no trouble having orgasms in certain situations—such as during masturbation by yourself, or when you get a ton of oral sex, or during sex with certain partners—then your orgasm difficulties are likely more related to the current circumstances of your sex life than to any health issues.
But if you're consistently having trouble reaching orgasm in all circumstances, it's worth checking in with your doctor. Likewise, if you've noticed a significant change in your experience of orgasm or your ability to reach orgasm, that's something to talk to a professional about just in case there's a physical cause that should be addressed.
2. Consider the breadth of your sexual experiences.
Some people need very specific types of stimulation to reach orgasm: For example, they might definitely need oral sex, or clitoral stimulation, or for sex to last a certain length of time, or for a vibrator to be in play. Some people are more able to reach orgasm in certain sex positions, some people are best able to get off from rough sex, and others prefer the slow sensuality of something like tantric sex. If you haven't experimented a lot with sex, it's possible you just haven't found the right kind of sexual stimulation that gets you there.
3. Consult with your doctor.
Whether or not the above apply to you, if you're concerned about your ability to reach orgasm, talk to your doctor about it. It's possible you have a health-related or medication-related issue that's inhibiting your ability to climax during sex, which your doctor can help you figure out. Even if you don't, it can be helpful to rule out those possibilities so you can then focus on the possible psychological causes of your anorgasmia.
Notably, not all doctors are trained to treat sexual issues, especially the ones pertaining to pleasure. It can thus also be really helpful to work with a sex therapist, as sex therapists are specifically trained to treat you for any sexual dysfunction and help you figure out what's keeping you from having pleasurable, orgasmic sex.
How to treat anorgasmia.
If you feel like you can't reach orgasm during sex these days (or ever), here are a few next steps:
1. Explore physical and medical causes with your doctor.
If there's a physical issue behind your anorgasmia, your doctor can help you figure out solutions—for example, adjusting medications, receiving estrogen therapy (through a pill, patch, or gel), or treating underlying conditions like depression or anxiety.
2. Reflect on your relationship with sex.
Do you have a fraught relationship with sex? For example, maybe you grew up in a culture where sex was discouraged, and you have some guilt or stress around being sexual. Or perhaps you've had some pretty negative sexual encounters or trauma in your past, and you feel like they've affected how you approach sex today. Or maybe sex just generally makes you nervous, anxious, or stressed out for some reason. Having these negative feelings around the act of sex can definitely get in the way of how much pleasure you experience during it.
If you think your relationship with sex could be better, it can be helpful to listen to some sex-positive podcasts or read some modern books about sex. Come As You Are by Emily Nagoski, The Sexually Liberated Woman by Ev'Yan Whitney, Becoming Cliterate by Laurie Mintz, and Pleasure Activism by adrienne maree brown are a few great places to start.
3. Reflect on your relationship with your body.
Your relationship with your body affects your sex life. Research has found a link between body image and sexual pleasure, and it's not just women who deal with self-consciousness about their bodies. Men's insecurities about penis size and body size can also mess with their ability to focus on pleasure. If you have a lot of anxiety about your body—or just don't feel particularly connected to your body—that might be an area to work on.
4. Reflect on your relationship with your partner.
It can sometimes be hard to reach orgasm and enjoy sex with your partner if you're not totally comfortable with them or if you have ongoing issues in your relationship. Even relationship problems that aren't related to sex at all (e.g., fighting about household chores, or being too busy to spend time with each other, or feeling disrespected by your partner) can affect your ability to concentrate and climax during sex. Take some time to consider if there are any lingering tensions in your relationship that haven't been addressed, and see if coming to a better place with your partner might help with your ability to reach orgasm. (Or getting a new partner!)
5. Experiment with toys and erotica.
Spend some time getting to know your body and your erotic self, especially if you haven't done it before or in a while. "It's not uncommon for orgasms to change over time and with age," Fogel Mersy says. "At times, the type of stimulation that used to work best may not feel adequate anymore. It helps to take time out to practice different methods of self-stimulating to learn about what works best for your body at any given time. Also, sex toys can be useful to intensify pleasure and sensation during sexual activity."
Experiment with different types of masturbation techniques, pick up some new kinds of sex toys, and watch different types of porn to see if something gets you particularly turned on or can uniquely push you to orgasm.
6. Explore with your partner.
Likewise, involve your partner in your exploration! Anorgasmia is frustrating, but finding solutions can be something that's a lot of fun. Sometimes just that extra communication and attentiveness from your partner can create the intimacy you need to connect in bed again and climax together. (Here's our guide to how to make a woman have an orgasm, plus other tips for how to please a woman.)
7. Try mindfulness.
A mindfulness practice can actually help improve orgasms, according to Fogel Mersy. She explains, "Mindfulness means paying attention to the present moment on purpose and without judgment. Many people struggle with distracting thoughts during sexual activity or engage in something called 'spectatoring,' which is when you feel disconnected from your body, like you're observing the situation instead of participating in it. Mindfulness can help to refocus on pleasure and what's happening in the moment."
A 2019 study found people who practice mindfulness have more sexual satisfaction, and another study found people who meditate have better sexual functioning. Urman also recommends working to improve body awareness and minimize stress, both of which mindfulness can help with immensely.
8. Work with sexuality professionals.
You definitely don't need to work through these challenges by yourself. A good sex therapist or sex educator can help you explore many of these psychological and psychosomatic causes for anorgasmia, and they can guide you in techniques, reflections, and practices that can help you discover your orgasm again.
9. Stay patient and positive.
"Anorgasmia is a multilayered issue that needs to be addressed from a variety of angles," Urman reminds. She stresses the importance of "being able to have an open mind and willingness to experiment with different modalities and be creative."
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