Anorgasmia, also known as Coughlan's syndrome, occurs when a person is unable to achieve an orgasm despite adequate sexual stimulation. It affects both males and females but is far more common in females.
There are many possible causes of anorgasmia, some of which overlap. In females, anorgasmia commonly occurs after menopause when estrogen levels drop. In males, anorgasmia is seen to be an extension of delayed ejaculation. Psychological distress, medications, and chronic health issues can contribute.
This article describes the types and causes of anorgasmia in females and males. It also explains how anorgasmia is diagnosed and treated and ways to cope if the inability to orgasm is affecting your relationship, well-being, or ability to have children.
Physiology of Female and Male Orgasms
An orgasm is a complex physiological and psychological process involving not only the genitals and brain but also the nerves and hormones that direct the sexual response. An orgasm is the third of four phases of the sexual response cycle described as:
- Desire (libido)
- Arousal (excitement)
- Orgasm (climax)
- Resolution (feelings and sensations immediately after sex)
In females, the most common way to achieve orgasm is by stimulating the clitoris either directly (with masturbation) or indirectly (such as during vaginal intercourse). In some females, orgasm may be accompanied by the emission of fluids (referred to as "female ejaculation").
In males, the most common way of achieving orgasm is by stimulating the penis. This is usually accompanied by ejaculation (the emission of semen) but can also occur without (known as "dry ejaculation").
In addition to physical stimulation, orgasm can be achieved from psychological arousal, such as nocturnal emissions, or "wet dreams," that can affect both males and females.
Types of Anorgasmia
Anorgasmia may be a lifelong condition, one that develops gradually over time, or one that occurs suddenly. There are four broad categories:
- Primary anorgasmia: A person has never been able to achieve an orgasm, often due to a congenital issue you are born with.
- Secondary anorgasmia: A person has been able to orgasm in the past but suddenly can't for any number of medical or psychological reasons.
- Situational anorgasmia: An orgasm can be reached only under specific conditions, such as during oral sex or masturbation.
- Drug-induced anorgasmia: A medication directly interferes with your ability to achieve orgasm.
Causes of Anorgasmia
The causes of anorgasmia can be described as being either physiological (related to the biological functions of the body) or psychological (related to the mind). Many cases involve both.
Many of the physiological causes of anorgasmia are shared by females and males. But there are some that are specific to each sex.
Physiological Causes in Females and Males
The physiological causes of anorgasmia common to both females and males include:
- Medical conditions that affect nerves that sensitize the genitals, including multiple sclerosis, diabetic neuropathy, and spinal cord injury
- Thyroid disease (which can lower testosterone levels and affect sexual function in both males and females)
- Hyperprolactinemia (a group of conditions marked by high levels of the hormone prolactin, which causes a drop in testosterone levels)
- Alcohol and substance abuse (including illicit drugs like heroin and cocaine)
- Certain prescription medications (such as selective serotonin reuptake inhibitors, or SSRIs, used to treat depression)
- Pelvic radiation (used to treat bladder cancer, colon cancer, and other pelvic cancers)
- Lack of the bulbocavernosus reflex (a congenital condition that prevents contractions of the anal sphincter and the ability to orgasm)
Physiological Causes in Females
Anorgasmia is not uncommon in females. In fact, some studies suggest that anywhere from 10% to 15% of females have never had an orgasm.
Physiological causes specific to females include:
- Menopause (characterized by a steep drop in estrogen levels)
- Complications of hysterectomy (the surgical removal of the uterus)
- Chronic pelvic pain (such as caused by endometriosis)
- Pelvic floor prolapse (when the pelvic organs bulge into the vagina)
Physiological Causes in Males
Anorgasmia is thought to affect roughly 3% of sexually active males. Although older age plays a role, anorgasmia can affect males of any age.
Physiological causes specific to males include:
- Hypogonadism (low testosterone)
- Complications from prostatectomy (the surgical removal of the prostate gland)
- Cauda equina syndrome (a rare condition associated with erectile dysfunction that affects nerves of the lower spinal cord)
Psychological Causes
Psychological factors that can cause or contribute to anorgasmia in both males and females include:
- General mental health issues like anxiety, stress, or depression
- Relationship problems
- Sexual performance anxiety
- Negative attitudes about sex due to a repressive religious or cultural upbringing
- Past sexual abuse and trauma (including rape or incest)
- Phobias, such as haphephobia (fear of being touched) and genophobia (generalized fear of sexual intercourse)
- Grief (such as the loss of a partner)
How Anorgasmia Is Diagnosed
The diagnosis of anorgasmia typically starts with a physical exam and a review of your medical history. This may involve a review of all medications you take.
Based on whether the cause is physiological or psychological, you may be referred to a gynecologist (who specializes in the female reproductive tract), a urologist (who specializes in the male reproductive tract), an endocrinologist (who specializes in hormonal disorders), or a psychologist (who specializes in mental health problems).
Tests that may be used to help diagnose anorgasmia in females include:
- Blood tests that measure estrogen, prolactin, follicle-stimulating hormone (FSH), and thyroid-stimulating hormone (TSH) levels
- Clitoral photoplethysmography (used to measure clitoral sensitivity)
- Perineometer (a tampon-like sensor placed in the vagina to measure pelvic floor muscle strength)
- Transvaginal ultrasound (a form of ultrasound used to look for signs of endometriosis and other problems inside the vagina)
Tests that may used to help diagnose anorgasmia in males include:
- Blood tests that measure testosterone and prolactin levels
- Biothesiometry (used to measure penile sensitivity)
- Penile sympathetic skin response (used to measure the response of penile nerves)
- Sacral reflex arc testing (used to measure the response of muscles that enable ejaculation)
Anorgasmia Treatment Options
Anorgasmia can be difficult to treat, and there is no "one-size-fits-all" solution. The specific approach depends on the underlying causes and often requires a multi-provider approach.
Some of the options that may be considered include:
- Dostinex (cabergoline), a drug used to reduce high prolactin levels
- Wellbutrin (bupropion), an antidepressant sometimes used to treat low libido
- Pitocin (oxytocin), a synthetic hormone that may improve pelvic floor muscle and ejaculatory response
- Psychotherapy to overcome sexual performance anxiety or past sexual trauma
- Couples counseling, which may help resolve relationship issues
- Sex therapy to address functional sexual problems
- Viagra (sildenafil), an erectile dysfunction drug that may help counter the effects of SSRI-induced sexual dysfunction in males and females
In some cases, stopping or adjusting the dose of certain medications, like SSRIs, may be all that is needed to restore normal sexual function.
The treatment of anorgasmia in females might also involve:
- Estrogen replacement therapy
- Clitoral vacuum pump (a device that helps engorge the clitoris to increase sensitivity)
- Levitra (vardenafil), an erectile dysfunction drug that can increase clitoral engorgement and sensitivity
Treatments in males might include:
- Testosterone replacement therapy
- Penile vibrators (attached to the underside of the penis just below the head)
- Prostate massage to help stimulate the "male G-spot"
Coping With Anorgasmia
Anorgasmia, like any type of sexual dysfunction, can take a toll on a person's physical, psychological, and emotional well-being. It can have similar effects on their partner.
The most important step is to seek a medical diagnosis; don't allow fear or embarrassment to prevent you from identifying the cause of the problem. In many cases, there are treatments that can help.
Until a solution is found, there are things you can do to better cope with sexual dysfunction:
- Communicate: Tell your partner not only what is happening but how it makes you feel.
- Work together: Involve your partner in the treatment plan to reduce performance anxiety.
- Explore: Focus on intimate touch and expressing how the sensations make you feel without the aim of an erection or having intercourse.
- Experiment: See how you and your partner respond to role-play and fantasy. Incorporate sex toys, or find alternative places for sex rather than the bedroom.
- Rethink the journey: Focus on the experience rather than the climax.
Taking these steps may seem awkward at first, so don't hesitate to seek professional help if needed. A psychologist or sex therapist can help you embrace a healthy sexual lifestyle in ways you may never have considered.
Summary
Anorgasmia is the inability to achieve orgasm despite sexual stimulation. There are both physiological and psychological causes that often intertwine. By seeking a diagnosis, your healthcare provider may be able to find treatments that help, including certain medications, counseling, and sexual aids.