Orgasm difficulties can stem from many sources. Here’s what you need to know about orgasmic disorders.
Sexual dysfunctions are super common among people of all genders. So if you’re wondering if you’re the only one, trust that you’re not.
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There are many reasons why you might have challenges in the bedroom, but one possibility is a sexual health condition called orgasmic disorder.
Orgasmic disorder is a type of sexual dysfunction that ultimately affects a person’s ability to orgasm during solo or partnered sex.
The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) reserves “female orgasmic disorder” for folks assigned female at birth and “erectile disorder” for those assigned male at birth.
Sex and gender exist on a spectrum. Research in this article uses “women” and “men” to reflect the terms assigned at birth. But your gender identity may not align with the symptoms and condition types below.
A healthcare professional may be able to help you better understand your presentation of orgasmic disorder and how your specific circumstances will translate into diagnosis, symptoms, and treatment.
According to the DSM-5, there are seven specifiers of sexual dysfunction including female orgasmic disorder and erectile disorder:
- lifelong: present since the first sexual experience
- acquired: developed after a period of “normal” sexual function
- generalized: not limited to specific situations, partners, or stimulation
- situational: limited to specific types of situations, partners, or stimulation
To receive a diagnosis, orgasmic disorder symptoms must be present for at least 6 months and cause significant distress.
For people with vaginas, female orgasmic disorder symptoms include:
- delayed orgasm
- infrequent orgasms
- lack of orgasm
- reduced intensity of orgasm
- problems reaching climax
For people with penises, erectile disorder symptoms include:
- difficulty getting an erection during sexual activity
- difficulty maintaining an erection
- an inability to achieve orgasm or ejaculate
- a decrease in the rigidity of erections
The symptoms must be a standalone issue — meaning it’s not affected by any of the following contributing factors:
- substance use
- mental health conditions
- a lack of stimulation needed to achieve orgasm
- significant life stressors
“People with vulvas and penises can experience difficulty with arousal, which is generally a problem with orgasm issues since arousal is usually the driver of orgasm,” says Good Vibrations staff sexologist Dr. Carol Queen. “They can get highly aroused but not get ‘over the top.’”
Orgasmic disorder presents similarly in transgender people and gender nonconforming folks as well.
“Because orgasmic disorder has more to do with the brain than the genitals, it’s an equal opportunity condition,” says Dr. Betsy Greenleaf, a New Jersey pelvic health expert with the retailer pH-D Feminine Health.
There are many reasons why you might not be able to orgasm. According to Greenleaf, some potential causes of orgasmic disorder may include:
- relationship or partner difficulties
- psychological factors
- mental health conditions
- muscle weakness
- nerve issues
- heart disease
- back or spinal cord injuries
- herniated discs
Especially for transgender folks and nonbinary individuals, Queen says hormones can play a major role in your ability to orgasm. She notes other contributing factors for these identities can include:
- gender dysphoria
- what types of sex they’re having
- other mental and physical health issues
Greenleaf says it’s important to note that orgasmic disorder is not a purely genital issue. “The brain plays a large role in orgasmic disorder and many of the sexual dysfunctions. Anything that affects mental health can affect pelvic and sexual health,” she says.
She notes that mental health meds can interfere with orgasming or have negative side effects on sexual function.
“Though it’s true that you don’t have to have an erection to orgasm, many men find the emotional stress of erectile dysfunction distracting enough to prevent orgasm,” Greenleaf adds.
Queen says to consider whether you’re aroused enough during sex — and if not, why not? She says you might not feel turned on enough to fully enjoy sex due to:
- feeling conflicted, stressed, or coerced
- having a history of trauma
- hormonal issues
- insufficient activities to increase arousal
- not enough clitoral stimulation
- feeling pressured to orgasm within a certain timeframe
- fear of sex
“If the brain isn’t mentally stimulated, then you can do all you want to the genitals and nothing is going to work,” adds Greenleaf. “At the same time, if the brain is stimulated, touching the skin anywhere on the body can produce an orgasm.”
Queen also recommends thinking about whether you can reach orgasm under any circumstance. For example, can you orgasm during masturbation but not partnered sex? If so, you may need to engage in different sexual acts or better communicate your needs with your partner.
Managing or overcoming orgasmic disorder is possible. And finding help starts with talking about it.
Greenleaf says speaking with a healthcare professional can help to make sure you don’t have any underlying medical conditions that could be contributing to your inability to maintain or achieve orgasm.
Consider seeing any of the following experts:
You can also talk with a friend, partner, or counselor.
“Sometimes people are shy, embarrassed, or shameful about sexual health concerns,” says Greenleaf. “There’s no judgment. This is a natural part of life and we’re here to help.”
You could also try these strategies to increase your chances of achieving orgasm:
- better manage your stress
- strengthen your pelvic floor muscles with kegels or reverse kegels
- increase your sex education
- engage in masturbation to better understand your wants and needs
- expand your view of pleasure, broadening from orgasm as your sexual goal
- try regenerative medicine therapies like red light therapy,
shockwave therapy, platelet rich plasma
Greenleaf reminds that you’re enough, whether or not you reach orgasm.
“This is just your body telling you that there’s something you need to look into,” she says. “This is not a race, and it’s not a measurement of success or failure.”
“Our bodies are different, and sometimes orgasm issues are a signal to get care or diagnosis. But also, it’s a sign to get more information about sex,” adds Queen.
Orgasmic disorder is a common sexual dysfunction among all people. Symptoms typically include difficulty reaching or maintaining orgasm during sexual activity.
There are many contributing factors and causes of female orgasmic disorder and erectile disorder. If you face challenges while orgasming during solo or partnered sex for any reason, consider seeing a sexual health professional or therapist who specializes in sexual dysfunctions.
You can heal from any challenges you face living with orgasmic disorder. In the meantime, you can try shifting your focus from achieving orgasm to pleasure in general. Reframing your thinking can lead to more fulfilling sexual experiences, whether or not you reach climax during sex.