Anorgasmia

Anorgasmia is a sexual orgasmic disorder in which there is persistent and consistent inability to achieve orgasm, after adequate stimulation that causes personal distress.

Anorgasmia can occur in both men and women. Anorgasmia is more common in women than in men.

Many factors can affect one's desire and sexual function including physical and psychological causes. Medications, illnesses, surgery, age, pregnancy and menopause (in women), and low testosterone can affect sex.

Treatment varies depending on the cause. Occasional sexual problems are not uncommon. If problems don't go away, or cause anxiety for you or your partner, you should see your healthcare provider.

Symptoms of anorgasmia are persistent and consistent inability to achieve orgasm after adequate stimulation.

There are generally 2 forms of orgasmic dysfunction, primary and secondary.

• Primary anorgasmia is used to define the condition for those who have never experienced orgasm.
• Secondary anorgasmia is used to describe one who once experienced orgasm but lost the ability.

Many things can affect desire and function and lead to anorgasmia. Very often anorgasmia is secondary to both psychologic and physiologic causes.

Factors which can play a role in anorgasmia include:

• A history of sexual abuse or past negative sexual experiences
• A history of rape
• Poor body image
• Fear of losing control
• Certain prescription drugs, examples include fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft)
• Excessive alcohol use
• Erectile dysfunction
• Hormonal disorders or hormonal issues such as low testosterone or low thyroid
• Hormonal changes due to menopause (women)
• Aging
• Physical causes such as diabetes, heart disease, nerve disorders, or hormone problems
• Vaginal infections (women)
• Pregnancy, childbirth, and breastfeeding (women)
• Extreme tiredness 
• Work-related stress and anxiety
• Negative attitudes toward sex (usually learned in childhood or adolescence)
• Shyness or embarrassment about asking for whatever type of stimulation works best
• Problems within the relationship between partners
• Boredom with sexual activity
• Depression

• Medical conditions that affect the nerve supply to the pelvis such as diabetic neuropathy or multiple sclerosis.

• Complications from spinal cord injury, genital surgery, radical prostatectomy
• Pelvic trauma

Approaches to improving orgasmic function focuses on ruling out contributing medical causes, such as switching medications if appropriate or treating irritable urinary symptoms if appropriate.

Your healthcare provider may require a complete medical history, physical examination and a pelvic exam to understand the cause of your anorgasmia.

You may also have a blood test to measure hormone levels as hormonal disorders, testosterone levels, and hormonal changes due to menopause (women).

A good first step in the treatment of anorgasmia is understanding what is causing it.

Treatment may involve one or more of the following:

• education
• changing sexual routine (time of day, foreplay, stimulation, sexual positions)
• treatment of underlying medical problems
• changing existing medications or making dose adjustments
• estrogen therapy for vaginal dryness

Medications that may help with orgasmic function include dopamine agonists (drugs that raise dopamine), oxytocin, phosphodiesterase type 5 inhibitors and alpha-2 receptor blockers such as yohimbine hydrochloride.

Having a good understanding of your body and communicating your needs with your partner is important for a good sexual relationship.

Learn more about your body and how it works. Ask your healthcare provider about how medicines, illnesses, surgery, pregnancy or menopause (women), low testosterone, or age can affect sex.