We know that orgasmic problems continue to be a significant issue amongst women, even in these supposedly sexually liberated days.

Exact data around the percentage of women who are anorgasmic is hard to come by, but it most likely lies in the range between 10 and 20%. This is high, considering that it is every woman's right, and expectation, that she should be able to enjoy orgasms during sexual pleasure easily and reliably. In the past, the issue of anorgasmia - female orgasmic disorder - has been clouded by fruitless debate about the distinction between vaginal and clitoral orgasms. Nowadays, this debate is much less significant since the distinction of the vaginal orgasm as a more mature form of orgasm has been replaced by the understanding that G Spot stimulation produces a rather different orgasmic experience to purely clitoral stimulation. Even so, the triggers which lead to orgasm are not completely understood, just as the distinction between what makes a woman readily orgasmic or non-orgasmic is not understood.

It's also true that there are no drugs to enhance orgasmic function in women (not that there are in men, but male sexual dysfunction in general has been revolutionized by treatment with Viagra).
Conversely, there are many drugs which do interfere with orgasmic function in women in an inhibitory fashion. Inevitably, this means that most treatment methodologies for female anorgasmia center on psychotherapeutic approaches: and there's a wide range of psychodynamic, interpersonal, and cognitive behavioral treatments available. The question is, which of these treatment methodologies is most effective? Assuming that the absence of the female orgasm is indeed a problem that needs clinical attention, where does one start?

Back in 1966 Masters and Johnson published the pioneering and groundbreaking work Human Sexual Inadequacy, in which they put forward the hypothesis that female anorgasmia was the result of inhibition and anxiety. Their basic proposition was that if one removed the anxiety, the natural expression of sexual response would replace it.

This was a revolutionary idea at the time because it included the presumption that factors affecting the likelihood of female orgasm were not purely physiological, but also included physical, cultural and social matters. The most reliable data on the frequency of female anorgasmia comes from the National Social and Health Life Survey conducted in the early 1990s. Almost 1750 women between the ages of 18 and 59 in the United States were studies, coming from a complete range of educational, religious, social, and sexual backgrounds. 24% of the women in the survey reported that for a prolonged period of several months in the previous year they had experienced a lack of orgasms.

In another study, a population of Massachusetts women between the ages of 51 and 61 reported that 10.3% (about one in 10) had difficulty reaching orgasm "all or most of the time". In a study conducted in 1988, 521 British women between the ages of 35 and 59 reveal that 16% experienced "infrequent orgasm". In this study, among the women who had sexual partners, 15.8% had no orgasms, and 22.2% had an orgasm less than half the time, during sexual interaction with their partner in the preceding three months.

For women attending sexual clinics, the rate of orgasmic dysfunction is usually higher. In one study conducted in the outpatient clinic of a gynecological unit, 29% of women reported orgasmic problems, and 38% reported anxiety or inhibition of some kind during sexual activity. In a general practice in the UK, 43% of women between the ages of 18 and 65 reported experiencing anorgasmia. However you look at these figures they are quite startling, particularly since the frequency of orgasmic disorder in men is much lower: around 10 or 12%, though definitive data is hard to come by.

In the case of female anorgasmia, it's customary to distinguish between primary anorgasmia, which means a woman has never had an orgasm, and secondary anorgasmia, which refers to a situation where either a woman is anorgasmic only in certain practices such as masturbation, or where she has infrequent orgasms.

Interestingly enough, it is secondary anorgasmia that's more challenging to treat.  It's certainly important to address this issue because up to 50% of women who have anorgasmia feel considerable distress about their intimate sexual relationship, while up to 43% develop considerable distress about their own feminine sexuality.

What factors affect orgasm in women?

There are many factors that influence a woman's capacity to enjoy orgasm. All kinds of neurological, anatomical, physiological, social, cultural, relationship, and physiological factors have a bearing on a woman's ability to achieve orgasm.

Neurological and physiological factors

Various areas of female genital anatomy are highly innervated: the labia, the entrance to the vagina, and the clitoris most particularly. It's often stated that the vagina is relatively insensitive to stimulation, although the G Spot, an area of variable diameter 2 inches internal, on the anterior wall of the vagina, has a high degree of sensitivity, and when stimulated can result in the expulsion of fluid during orgasm in some women.

Evidently, G. Spot stimulation helps women achieve orgasm, although scientifically gathered supporting evidence for this contention is rather lacking. However, a sufficient body of informally reported evidence exists for us to regard the statement as true. The fact that some women and men can achieve orgasm without any stimulation to the genitals demonstrates very clearly that the brain is a massively important element of the process of sexual arousal and achievement of orgasm in women (ie orgasm is not just a reflex response in the lower part of the spinal column). To illustrate this, think of orgasms stimulated by fantasy alone, or orgasms produced by electrical stimulation of particular regions of the brain; there's also evidence of the role of the brain in the phantom orgasm experienced by paraplegics, both men and women alike.

Whipple and colleagues have put forward the hypothesis that there are several different nerve pathways associated with sexual response in women: the pudendal nerve relates to the clitoris; the hypogastric and pelvic nerves are associated with vaginal stimulation; and the vagus nerve may link the cervix to the brain.

But despite this, few hard facts have been established about the neurological mechanism of female sexual response. Both somatic and autonomic nervous systems innervate the female genital system. It is the pudendal nerve which innervates somatically around the spine's sacral section S2 to S4. The autonomic innervation includes nerve fibers from both the sympathetic and parasympathetic nervous systems. The sympathetic fibers come from the spine between vertebrate T10 and L2,
while parasympathetic fibers emerge from the spine between S2 and S4.

Studies of brain activation during orgasm have revealed that various parts of the cortex, the cerebellum, the ventricular nucleus of the hypothalamus, along with the amygdala, hippocampus and anterior basal ganglia are all activated. However, the most important sites in the brain associated with orgasm are the central gray area of the brain, the cerebellum and the hippocampus. but, fascinating though this information is, it has little relationship to the practical to the treatment of anorgasmia in women.

As most people know, sexual stimulation in a receptive and responsive woman results in increased blood flow to the pelvis associated with vaginal lubrication, a lengthening of the vagina, an increase in the size of the labia, lifting of the uterus to allow the vagina to lengthen, and at a certain stage of sexual arousal, retraction of the clitoris under its hood.

The possibility that there is an association between insufficient blood flow to the genitals and orgasmic disorder is being investigated by researchers, although at the moment there is little evidence in support of this hypothesis. In the broadest terms, serotonergic and dopaminergic factors are both associated with female arousal, orgasm attainment, and sexual desire, as shown by the effect of SSRIs (selective serotonin re-uptake inhibitors) on female sexuality. To be more precise, increased availability of serotonin and decrease in dopamine levels seem to impact on sexual response in a negative way, but the mechanisms by which this interplay is effected are far from clear.

Psychological and social factors affecting the female orgasm

Research has demonstrated that the only demographic factors that have a significant association with anorgasmia are education, age, marital status. This piece of research demonstrated that there was an inverse association between age and lack of orgasmic frequency; equally, lack of education and lack of sexual experience are associated with orgasmic difficulties (at least, that is, if one assumes that in this piece of research, conducted in 1999, being unmarried have a high correlation with lack of sexual experience).

Other risk factors associated with difficulties in achieving sexual arousal or orgasm were sexual molestation, economic difficulties, sexual problems such as low sexual drive and having had a sexually transmitted disease. Emotional problems and stress were also factors associated with arousal disorder. Perhaps rather strangely, high rates of orgasm in women were associated with religious affiliation. (One tends to think of religious teaching as emphasizing the negative side of human sexuality.)

Although this seems like a fairly clear set of associations, just to confuse matters, in another British study, orgasm frequency was associated directly with younger age. The truth is that the psychological factors that may affect the ease with which a woman is able to achieve orgasm are subject to difficulties in research and confirmation. For example, hyperactive sexual desire disorder is associated in many cases with depression: which of these two factors is the main contributor to orgasmic insufficiency? And although sexual abuse need not result in difficulties in achieving orgasm, various studies have reported this association. The mitigating factor here is probably whether or not a woman received adequate therapy, and the level of traumatic impact of the abuse.

Research in the early 1970s demonstrated with some consistency that women who experience anorgasmia have very frequently had unreliable and undependable early love objects - an unreliable father, especially, appeared to be a major cause of later orgasmic difficulties. Women who had had an unreliable love objects in their early lives appeared to feel a greater need for control in situations where sexual arousal was high.

One would think that anxiety around sex was likely to promote anorgasmia. However, enhanced arousal as demonstrated by sympathetic nervous system activity appears to be associated with an increase in sexual arousal. It's certainly true that vaginal response to sexually explicit films increases when there is a non-sexual arousal response in the body. It may be, however, that when this arousal is interpreted as fear certain women experience in inhibition of their ability to achieve orgasm. This emphasizes the delicate balance of arousal and relaxation which is necessary for a woman to achieve orgasm.

There is inconsistent evidence about relationship factors and a woman's ability to achieve orgasm. Almost every aspect of a relationship, such as whether a partner treats a woman well or badly, can be associated with orgasmic frequency. All of this implies that there is a lack of clarity around the factors which lead to ease of orgasm in women, and this does not make the treatment of anorgasmia any easier.

If the cause of anorgasmia is so unclear, how can one treat it?

How to make a woman orgasm

[ How to take a woman to orgasm ] [ How to achieve orgasm ] [ How to give a woman an orgasm ] [ Discover how to give a woman an orgasm easily ] [ What sex means to women ] [ A multi-disciplinary perspective on the female sexual response ] [ Sexual psychotherapy and physical therapy ] [ Classification of female sexual dysfunction and anorgasmia ] [ Unable to orgasm ]