Some people have never had an orgasm. For others orgasms come relatively easily. But every one either has or will have the experience at some point in their lives when they want to orgasm but don't, or can't.
In the world of sex therapy and sex research, when this happens often enough, and/or is causing enough distress, a person may be diagnosed and treated for orgasmic disorder.
Clinicians who diagnose and treat orgasmic disorders divide them based on a gender binary, describing male orgasmic disorders and female orgasmic disorders. Orgasmic disorders in general can fall into one of several categories:
- Orgasms are non-existent
- Orgasms are delayed/take too long
- Orgasms are too rapid (premature ejaculation in men)
- Orgasms are not as strong as they used to be.
- Orgasms are accompanied by pain.
There is a longer and still needed debate to be had about whether or not there is a significant difference between male orgasm and female orgasm, but it is safe to say that men and women are raised with very different messages about sex and orgasm, and are treated differently in most (perhaps all) societies, and as such their orgasmic disorders may appear quite different.
Male Orgasmic Disorders
Ejaculation and orgasm are two separate events in men, but because they usually happen simultaneously premature ejaculation is often considered an orgasmic disorder for men. Premature ejaculation is considered to be the most common male sexual complaint, and it can lead to a reduction in the pleasure of orgasm, given that it is accompanied by distress, feelings of shame or frustration.
The underlying causes of premature ejaculation are still not understood, but there are a variety of cognitive treatments, and drug companies are also searching for a medication to treat premature ejaculation.
Male orgasmic disorder refers to a condition where a man either cannot have an orgasm or it takes a long time for him to have an orgasm, even when he has enough sexual stimulation that would usually allow him to have an orgasm. There are several reasons men may have difficulty reaching orgasm, including:
- Medications that delay orgasm or eliminate orgasms
- Psychological factors including stress and cognitive and/or emotional issues
- Inability to orgasm in a specific situation may be the result of over stimulation.
The clinical diagnosis of male orgasmic disorder is only made when medication and other health conditions are ruled out, and only when the condition happens frequently and causes a man distress. Men who experience male orgasmic disorder may not disclose it to their partner and instead may fake orgasms.
Female Orgasmic Disorders
Because women’s sexual satisfaction, and even female sexual response, are relatively new topics of study our understanding of the boundaries of female orgasmic disorders are even fuzzier than what we know about male orgasmic disorder.
Women generally are raised with less information about their bodies and their sexual response, and the result can easily translate into not experiencing orgasms. But if a woman is not experiencing orgasms is it because of a lack of stimulation, or because she or her partner is not stimulating the right places, should this be considered a disorder?
To address this, a group of researchers have proposed a new definition of female orgasmic disorder:
Despite the self-report of high sexual arousal/excitement, there is either lack of orgasm, markedly diminished intensity of orgasmic sensations or marked delay of orgasm from any kind of stimulation.
In addition, female orgasmic disorder is present only if it is causing the woman distress.
Anorgasmia is another term used to describe the experience of not having orgasms. It is further broken down into “primary anorgasmia” which refers to a woman never having had an orgasm, and “secondary anorgasmia” where a woman has previously experienced orgasms but isn’t anymore, or where she can only experience orgasms under specific conditions (for example only through masturbation but not during partner sex).
Treatment for female orgasmic disorder has been almost entirely of the cognitive-behavior approach. Most famously women like Lonnie Barbach and Betty Dodson began groups for “pre-orgasmic women” in the 1970s which were designed to teach women about their bodies, how to stimulate themselves to orgasm, and how to talk with partners to make sure that their orgasms were a part of sex with a partner.
Since the pharmaceutical industry has discovered the money to be made in sexual dysfunction treatment there has been an increased interest in finding drug treatments for female sexual dysfunction. On the one hand this is disconcerting, since the “problem” in most cases is likely psychological and educational rather than physical. On the other hand it’s likely that there are women who have difficulty achieving orgasm even after they know everything about their bodies, how to stimulate themselves, and how to sexually communicate with partners.
Basson, R., Althof, S., Davis, S., et al. “Summary of the Recommendations on Sexual Dysfunctions in Women. Journal of Sexual Medicine Volume 1, Number 1 (2004):24-34