Definition: Orgasmic dysphoria is a medical term used to express repeated difficulty in achieving orgasm after sufficient sexual arousal, which causes a person to be subjectively distressed. It is common and affects a large number of women.
Women differ in terms of the frequency of orgasm and the amount of arousal needed to reach it. Women’s orgasms also differ in intensity. It has been proven that less than a third of women consistently reach orgasm during intercourse. Moreover, orgasms often change depending on age, medical reasons or medications the woman is taking.
If the woman is satisfied with the climax she reaches during sexual intercourse, there is no cause for concern. If she is bothered by the lack of orgasm or by the degree of its intensity, it is advised that she consult her doctor, as lifestyle changes and sex therapy may be beneficial for her.
An orgasm is a sense of intensive physical delight, accompanied by regular involuntary contractions of the pelvic floor muscles. Some women actually feel pelvic contractions or womb shaking during an orgasm, and some don’t. And it varies from one woman to another so that it can be very severe or slight.
By definition, the main symptom of dysuria is the inability to feel a peak or a long delay in reaching it. There are different types of orgasmic disorders:
- Lack of initial orgasm: This means that the woman has never felt an orgasm.
- Secondary failure to reach orgasm: It means that the woman used to have orgasm before, but she is finding it difficult to reach orgasm.
- Lack of postural orgasm: It means that the woman is able to reach orgasm only in certain circumstances, such as oral sex or when practicing masturbation. This type is very common in women. In fact, most women feel orgasm only when the clitoris is stimulated.
- General lack of orgasm: It means that the woman is unable to reach orgasm under any circumstances.
When should you consult a doctor?
It is recommended that women speak with their doctor if they have any questions regarding orgasm or concerns about their ability to achieve it. The woman may discover that her sexual abilities are normal. Or your doctor may recommend strategies to reduce anxiety and increase feelings of satisfaction.
Regardless of what is seen in some movies, reaching orgasm is not something simple and certain. This pleasurable climax is a complex response to many physical, emotional, and functional factors. If a woman is having problems with any of these factors, it may affect her ability to experience orgasm.
1- Physical causes
There are a wide range of illnesses, physical changes, and medications that may interfere with orgasm.
- Medical diseases: Any disease can affect this part of the sexual response cycle in humans, and these diseases include diabetes and neurological diseases, such as multiple sclerosis.
- Gynecological problems: Orgasm may be affected by gynecological surgeries, such as hysterectomies or cancer surgeries. Furthermore, the loss of orgasm often accompanies other sexual concerns, such as uncomfortable or painful penetration.
- Medications: Many medications, either prescription or over-the-counter, can interfere with orgasm. These include high blood pressure medications, antihistamines, and antidepressants, especially selective serotonin reuptake inhibitors (SSRIs).
- Alcohol and drugs: Consuming a large amount of alcohol can impair the ability to have an orgasm, and this also applies to drugs.
- Aging: As you age, normal changes in your organs, hormones, nervous system, and circulatory system can affect sexual activity. Decreasing estrogen levels during the transition to menopause can lead to decreased sensation in the clitoris, nipples and skin while impairing blood flow to the vagina and clitoris, which may delay or prevent orgasm altogether.
2- Psychological causes
Many psychological factors play an important role in the ability to reach orgasm, including:
- Cultural and religious beliefs
- Feeling guilty about enjoying a sexual experience
- Fear of pregnancy or sexually transmitted diseases
- Financial stress and pressure
- Mental health problems, such as anxiety or depression
- performance anxiety
3- Marital relationship problems
Many married couples who have problems outside the bedroom also have problems in the bedroom. Relationship issues include:
- Emotional separation from the husband
- Loss of conversation and interaction with the husband
Prepare for an appointment with the doctor
If you rarely or never have an orgasm and it causes you distress, make an appointment with your doctor. You may feel ashamed to talk about sex with your doctor, which is perfectly normal. Your doctor uses his scientific skill to treat sexual problems because he knows the importance of the sexual relationship for happiness in the different life stages of women.
You may have an underlying treatable condition, or you may benefit from lifestyle changes or a combination of treatments. Your doctor may diagnose and treat your problem, or refer you to a specialist who can do this.
Here’s some information to help you get ready for your appointment, and what to expect from your doctor.
Information you write in advance
- Your symptoms: Your doctor will help you know if you’ve had an orgasm before, and under what circumstances.
- Your sexual history: Your doctor will likely ask you about your relationships and experiences since the first time you had sex. Your doctor may ask you about any history of sexual trauma or sexual abuse.
- Your medical history: Write down any medical conditions with which you’ve been diagnosed, including mental health conditions. Also write down the names and strengths of medications you’re currently using or have recently taken, including both prescription and over-the-counter medications.
- Questions to ask your doctor: Formulating a list of questions in approach can help you make the most of your time with your doctor.
Basic questions to ask your doctor
The list below suggests orgasm-related questions to raise with your doctor. Any time you don’t understand anything, don’t hesitate to ask more questions during your meeting with the doctor.
- What could be causing my difficulty reaching an orgasm?
- Do I need medical tests?
- What treatment method do you recommend?
- If you’re going to prescribe medications, are there any potential side effects?
- How much improvement can I expect with treatment?
- Are there any lifestyle changes or self-care steps that might help?
- Do you recommend psychotherapy?
- Should my husband be involved in treatment with me?
- Are there any brochures or other printed stuff that I can take home with me? What websites do you recommend visiting?
What can you expect from your doctor?
Your doctor may ask you some very personal questions and may want to include your partner for the interview. To help your doctor determine the cause of your problem and the best course of treatment, be prepared to answer questions such as:
- When was the first time you had sex?
- How long did you find it difficult to reach orgasm?
- If you have ever had an orgasm, what were the circumstances associated with that?
- Do you feel aroused during sexual interactions with your husband?
- Do you feel any pain when penetration?
- How distressed are you from not feeling orgasm?
- How satisfied are you with your current relationship?
- Do you use any kind of contraceptive? If yes, what is this method?
- What medications do you take, including prescription and over-the-counter medications, vitamins and supplements?
- Do you abuse alcohol or drugs? What is the quantity?
- Have you ever had surgery involving your reproductive system?
- Have you ever been diagnosed with any medical conditions, including mental health conditions?
- What were your family’s beliefs about sex?
- Have you ever experienced violence or sexual harassment?
What you can do in the meantime
While you’re waiting for your appointment with the doctor, talk to your partner about the situation. Continue to be intimate with your partner, and also explore new ways to be intimate. Shifting attention from orgasm to pleasure may be a useful strategy in treating orgasmic insufficiency.
Tests and Diagnosis
A medical evaluation for orgasm failure usually includes:
- Comprehensive medical history: Your doctor may inquire about your sexual history, surgical history, and current relationship. Don’t let shyness stop you from giving candid answers. These questions shed light on the cause of your problem.
- Physical exam: Your doctor may perform a general physical exam to look for physical causes of an orgasm, such as an underlying medical condition. Your doctor may also examine your genital area to look for an obvious physical or organic cause of your lack of orgasm.
Treatments and medicines
Treating orgasm insufficiency can be difficult. Your treatment plan will depend on the underlying cause of your symptoms, but your doctor may recommend a combination of lifestyle changes, psychotherapy and medications.
Lifestyle changes and treatment
For most women, dealing with relationship issues and daily stresses is a major part of treatment. Understanding your body and experiencing different types of sexual arousal can also be helpful.
- Understand your body better: Understanding your body’s anatomy and the way you like touch can lead to better sexual satisfaction. If you need a reminder of the anatomy of your reproductive system, ask your doctor for a diagram or get a mirror and look at it. Spend some time exploring your body on your own or with your partner
- Increased sexual arousal: Most women who have not orgasm before do not get enough sexual arousal. Most women need to stimulate the clitoris directly or indirectly in order to have an orgasm, but not everyone realizes this. Changing sexual positions can lead to greater stimulation of the clitoris during sexual intercourse, and some positions allow you and your partner to gently touch the clitoral area during intercourse. Using a vibrator can also help induce orgasm.
- Seek marital/family counseling: Conflicts and conflict in a relationship can affect the ability to orgasm. A therapist can help you deal with disagreements and tensions and get your sex life back on track.
- Try sex therapy: Sex therapists are specialists who help treat sexual matters. You may feel shy or nervous about consulting a sex therapist, but consulting a sex therapist can be very helpful in treating an orgasm. Treatment usually includes sex education, help with communication skills, and behavioral exercises that you and your partner try at home.
Hormonal treatments aren’t a guaranteed cure for orgasm, but they may be helpful. It may also be helpful to treat underlying medical conditions.
- Treating underlying medical conditions: If you have a medical condition that impedes your ability to orgasm, treating the underlying cause may solve your problem. Changing or adjusting medications known to suppress orgasm can also help relieve your symptoms.
- Estrogen therapy: Estrogen therapy—tablets, patches, or gels—may have a positive effect on brain function and mood factors that influence sexual response. Topical estrogen therapy — in the form of a vaginal cream, slow-release suppository, or ring placed inside the vagina — can increase blood flow to the vagina and help increase arousal. In some cases, your doctor may prescribe a combination of estrogen and progesterone.
- Testosterone therapy: Male hormones, such as testosterone, play an important role in sexual function in women, although testosterone is present in lower amounts in women. As a result, testosterone may help increase orgasm, especially if estrogen and progesterone don’t. However, giving testosterone to women is controversial and has not been approved by the US Food and Drug Administration as a treatment for sexual dysfunctions in women. In addition, testosterone can cause negative side effects, including acne, increased body hair (drizziness), and mood and personality changes. Testosterone appears to be more effective in women whose testosterone levels are low as a result of surgical removal of the ovaries. We do not recommend trying or taking any drugs or hormones without consulting the attending physician.
There are no sure ways to prevent the lack of orgasm in women. Eating healthy food, balanced meals, getting enough rest, regular follow-up with the doctor, and seeking medical advice or psychological treatment at the beginning of marital relationship problems, all of this may help reduce orgasm problems.