For some women, reaching orgasm can be difficult. Fortunately, there are steps you can take to address the problem and have a more satisfying sex life.

Problems reaching orgasm are fairly common among women. About 3 out of 4 women say they can’t orgasm through vaginal penetration alone. But there is a difference between an occasional issue and a more persistent problem—female orgasmic disorder, or FOD.

What makes the problem rise to the level of FOD? There are specific criteria for diagnosing the disorder in women:

• A woman will rarely—or never—be able to reach orgasm, even when she is sexually aroused
• These symptoms last for six months or more
• The problem causes significant distress and problems in her relationships
• Orgasm difficulties are not exclusively caused by another medical condition or medication

The problem affects a sizable number of women. In the largest US study of female sexual dysfunction, including responses from over 30,000 women, the prevalence of FOD was approximately 21%.

What causes FOD?

There are many physical and psychological factors that may be involved in FOD.

• As mentioned above, there are medical conditions that can make it more difficult for a woman to achieve orgasm. In particular, conditions that affect the nervous system such as multiple sclerosis or spinal cord injuries that affect the nerves of the pelvis can make reaching orgasm more difficult. Arthritis, thyroid problems, and asthma have also been associated with FAD. But research has found that is often isn’t the medical condition alone—it’s also the stress of managing a chronic illness and pain the effect of this on a woman’s emotional wellbeing.
• Certain medications can affect a woman’s ability to reach orgasm. Antidepressants (serotonin reuptake inhibitors, or SSRIs, in particular) antipsychotics, antihistamines and drugs high blood pressure are some of the medications who may inhibit orgasm in women.
• There are a number of psychological factors that may affect a woman’s ability to orgasm. Fatigue, stress, anxiety, and depression all can contribute to the problem. Poor body image can also cause anxiety and discomfort and affect a woman’ ability to reach orgasm.
• Relationship issues are another common cause. Problems in the relationship, including anger and mistrust, communications problems, or other sexual problems can interfere with sexual pleasure and orgasm.
• A woman’s cultural or religious beliefs may be factor. For example, a woman may have been raised with the belief that a woman shouldn’t seek out or enjoy sex, and may feel embarrassed or guilty about enjoying sex.

How can it be treated?

Treatment will depend on the cause of the problem. If a medical condition or medication is to blame, a healthcare provider can look at ways to address the underlying issue or explore a medication change. When psychological or relationship factors are the cause, therapy or counseling may be the answer. Sex therapy can teach you to understand your own body better and learn what gives you pleasure. Couples counseling can also help couples improve communication skills and address any conflicts that may be entering with trust and intimacy. Couples might also explore a technique called sensate focus, which involves a series of exercises that focus on both nonsexual and sexual touching to improve intimacy and understand what produces pleasure in each partner.

For any woman having problems reaching orgasm, there are also some steps they can take toward a more satisfying sex life:

• Communicate. Make sure to tell your partner what you like and what feels good.
• Experiment. See what turns you on and what kind of clitoral stimulation feels best. Most women need some direct clitoral stimulation to reach orgasm. Try sex toys or vibrators as part of the experiment, with or without a partner.
• Use mental imagery and fantasy. Fantasy can be a powerful motivator and help bring about orgasm.
• Let go of expectations. While reaching orgasm is great and an important goal, focusing on orgasm exclusively can create pressure and anxiety and make it more difficult to achieve. Instead, focus on mutual pleasure and intimacy as a goal.

Listen to ASHA’s three-part conversation with sociologist and sexual health expert Dr. Pepper Schwartz on female sexual difficulties. She discusses the range of female sexual difficulties, the impact of sexual difficulties on a relationship, and offers practical advice and resources for women (and their partners). You can listen on ASHA’s website or via iTunes.