Anorgasmia

Symptoms

An orgasm is a feeling of intense physical pleasure and release of tension, accompanied by involuntary, rhythmic contractions of your pelvic floor muscles. But it doesn't always look — or sound — like that famous scene from "When Harry Met Sally." Some women actually feel pelvic contractions or a quivering of the uterus during orgasm, but some don't. Some women describe fireworks all over the body, while others describe the feeling as a tingle.

By definition, the major symptoms of anorgasmia are inability to experience orgasm or long delays in reaching orgasm. But there are different types of anorgasmia:

• Primary anorgasmia. This means you've never experienced an orgasm.
• Secondary anorgasmia. This means you used to have orgasms, but now experience difficulty reaching climax.
• Situational anorgasmia. This means you are able to orgasm only during certain circumstances, such as during oral sex or masturbation. This is very common in women. In fact, about 80 percent of women experience orgasm only from stimulation of the clitoris.
• General anorgasmia. This means you aren't able to orgasm in any situation or with any partner

Causes

Despite what you see in the movies, orgasm is no simple, surefire thing. This pleasurable peak is actually a complex reaction to many physical, emotional and psychological factors. If you're experiencing trouble in any of these areas, it can affect your ability to orgasm.

Physical causes

A wide range of illnesses, physical changes and medications can interfere with orgasm:

Medical diseases. Any illness can affect this part of your sexuality, including diabetes and neurological diseases, such as multiple sclerosis. Orgasm may also be affected by gynecologic surgeries, such as hysterectomy or cancer surgeries. In addition, lack of orgasm often goes hand in hand with other sexual problems, such as painful intercourse.
Medications. Many prescription and over-the-counter medications can interfere with orgasm. This includes blood pressure medications, antihistamines and antidepressants — particularly selective serotonin reuptake inhibitors (SSRIs). In men, SSRIs can actually result in both anorgasmia and inability to obtain an adequate erection for satisfactory sexual activity (erectile dysfunction).
Alcohol and drugs. A glass of wine may make you feel amorous, but too much alcohol can cramp your ability to climax; the same is true of street drugs.
The aging process. As you age, normal changes in your anatomy, hormones, neurological system and circulatory system can affect your sexuality. The drop in estrogen that occurs during the transition to menopause can be a particularly notable foe of orgasm. Lower levels of this female hormone can decrease sensations in the clitoris, nipples and skin and impede blood flow to the vagina and clitoris, which can delay or stop orgasm entirely. Still, anorgasmia isn't limited to older women. And many women say sex becomes more satisfying with age.

Psychological causes 

Many psychological factors play a role in your ability to orgasm, including:

• Mental health problems, such as anxiety or depression
• Performance anxiety
• Stress and financial pressures
• Cultural and religious beliefs
• Fear of pregnancy or sexually transmitted diseases
• Embarrassment
• Guilt about enjoying sexual experiences

Relationship issues 

Many couples who are experiencing problems outside of the bedroom will also experience problems in the bedroom. These overarching issues may include:

• Lack of connection with your partner
• Unresolved conflicts or fights
• Poor communication of sexual needs and preferences
• Infidelity or breach of trust 

Diagnosis

A medical evaluation for anorgasmia usually consists of:

A thorough medical history. Your doctor may also inquire about your sexual history, surgical history and current relationship. Don't let embarrassment stop you from giving candid answers. These questions provide clues to the cause of your problem.

Physical examination. Your doctor will probably conduct a general physical exam to look for physical causes of anorgasmia, such as an underlying medical condition. Your doctor may also examine your genital area to see if there is some obvious physical or anatomical reason for lack of orgasm.

Treatments and drugs

It can be difficult to treat anorgasmia. Your treatment plan will depend on the underlying cause of your symptoms, but your doctor may recommend a combination of these tactics.

Lifestyle remedies

For most women, treatment means more than medications. It's important to address relationship issues and everyday stressors. Understanding your body and trying different types of sexual stimulation also can help.

• Understand your body better. Understanding your own anatomy and how you like to be touched can lead to better sexual satisfaction. If you need a refresher course on your genital anatomy, ask your doctor for a diagram or get out a mirror and look. Then take some time to explore your own body. Masturbating or using a vibrator can help you discover what type of touching feels best to you, and then you can share that information with your partner. If you're uncomfortable with self-exploration, try exploring your body with your partner.
• Increase sexual stimulation. Many women who've never had an orgasm aren't getting enough effective sexual stimulation. Most women need direct or indirect stimulation of the clitoris in order to orgasm, but not all women realize this. Switching sexual positions can produce more clitoral stimulation during intercourse; some positions also allow for you or your partner to gently touch your clitoris during sex. Using a vibrator during sex can also help trigger an orgasm.
• Seek couples counseling. Conflicts and disagreements in your relationship can zap your ability to orgasm. A counselor can help you work through disagreements and tensions and get your sex life back on track.
• Try sex therapy. Sex therapists are therapists who specialize in treating sexual problems. You may be embarrassed or nervous about seeing a sex therapist, but sex therapists can be very helpful in treating anorgasmia. Therapy often includes sex education, help with communication skills and behavioral exercises that you and your partner try at home. For example, you and your partner may be asked to practice "sensate focus" exercises, a specific set of body-touching exercises that teach you how to touch and pleasure your partner without worrying about orgasm. Or you and your partner may learn how to combine a situation that allows you to achieve orgasm — such as clitoral stimulation — with a situation in which you want to achieve orgasm, such as intercourse. By using these techniques and others, you may learn to view orgasm as one pleasurable part of sexual intimacy, not the whole goal of every sexual encounter.

Medical treatments

Hormone therapies aren't a guaranteed fix for anorgasmia. But they can help. So can treating underlying medical conditions.

• Treating underlying conditions. If a medical condition is hindering your ability to orgasm, treating the underlying cause may resolve your problem. Changing or modifying medications known to inhibit orgasm also may eliminate your symptoms.
• Estrogen therapy. Systemic estrogen therapy — by pill, patch or gel — can have a positive effect on brain function and mood factors that affect sexual response. Local estrogen therapy — in the form of a vaginal cream or a slow-releasing suppository or ring that you place in your vagina — can increase blood flow to the vagina and help improve desire. In some cases, your doctor may prescribe a combination of estrogen and progesterone.
• Testosterone therapy. Male hormones, such as testosterone, play an important role in female sexual function, even though testosterone occurs in much lower amounts in a woman. As a result, testosterone may help increase orgasm, especially if estrogen and progesterone aren't helping. However, replacing testosterone in women is controversial and it's not approved by the Food and Drug Administration for sexual dysfunction in women. Plus, it can cause negative side effects, including acne, excess body hair (hirsutism), and mood or personality changes. Testosterone seems most effective for women with low testosterone levels as a result of surgical removal of the ovaries (oophorectomy). If you choose to use this therapy, your doctor will closely monitor your symptoms to make sure you're not experiencing negative side effects. 

Alternative medicine

Natural products are available that may help some women who have difficulty reaching orgasm. These oils and supplements work by increasing sensation in the clitoris and surrounding tissue.

The following products may benefit some women with anorgasmia:

• Zestra. This botanical massage oil helps warm the clitoris and may increase sexual arousal and orgasm.
• ArginMax. This oral nutritional supplement contains L-arginine, a substance that relaxes blood vessels and increases blood flow to the genital area, and the clitoris in particular.

Talk with your doctor before trying any natural therapies. These products can cause side effects and may interact with other medications. Your doctor can help determine if they are safe for you.

Coping and support

If you're experiencing difficulty reaching orgasm, it can be frustrating for you and your partner. Plus, concentrating on climax can make the problem worse.

Most couples aren't experiencing the headboard-banging, van-rocking intercourse that appears on TV and in the movies. So try to reframe your expectations. Focus on mutual pleasure, instead of orgasm. You may find that a sustained pleasure plateau is just as satisfying as real climax.

References:

https://sexualmed.org/known-issues/male-orgasmic-disorder/

https://en.wikipedia.org/wiki/Anorgasmia

http://anorgasmia.net/treatment/

http://www.issm.info/education-for-all/sexual-health-qa/what-causes-anorgasmia-in-men

http://www.issm.info/news/sex-health-headlines/cabergoline-for-treatment-of-male-anorgasmia

http://emedicine.medscape.com/article/2185837-overview

http://emedicine.medscape.com/article/2184956-overview