How to define the female orgasm?
It is difficult to clearly define the female orgasm, as it is a much more varied experience compared to that experienced by men. In general, it can be said that the female orgasm:
- is a diverse phenomenon and can be experienced differently by individual women
- is a fleeting experience of peak, intense sexual pleasure and is associated with an altered state of consciousness
- may be accompanied by involuntary, rhythmic contractions of the pelvic muscles, urethra, and anus
- leads to the reversal of changes in genital blood flow associated with sexual arousal,
- is associated with feelings of satisfaction and well-being.
How common are female orgasmic disorders?
Statistics on the frequency of reported difficulties in achieving orgasm show significant variation across different parts of the world (populations, cultures). In Northern Europe and Poland, this problem affects less than 20% of women. Overall, it is estimated that about 10% of women have never experienced an orgasm, 10% experience it occasionally and depending on their partner, 50% during clitoral stimulation and vaginal intercourse, and the remaining 30% only during vaginal intercourse.
What are the symptoms of female orgasmic disorders?
Symptoms most commonly reported by women:
- I have never had an orgasm.
- I can have an orgasm during masturbation, but never with a partner.
- I can have an orgasm with a partner, but only through clitoral stimulation, never during intercourse.
- I can reach orgasm, but only through a specific form of masturbation (e.g., by moving my pelvis with my legs together or through stimulation with a water jet).
- I feel intense pleasure but do not physically experience an orgasm, or conversely: I feel muscle contractions or relaxation but do not feel pleasure.
- Orgasm is significantly delayed, or the sensations during orgasm are very weak.
How should one deal with sexual dysfunction?
First and foremost, you should consider whether the conditions for sexual intercourse allow you to freely experience pleasure and orgasm. Is there a sufficiently intimate atmosphere? Do I feel closeness and a sense of security when I am with my partner? Does this form of sexual stimulation suit me, and have various alternative forms of stimulation been exhausted (e.g., oral sex, changing sexual positions)? If, despite ensuring that the above requirements are met, difficulties with achieving orgasm persist, and especially if they become a source of suffering or conflict in the relationship, this is a sign that it is worth seeking help from a specialist (sexologist).
How does a doctor make a diagnosis?
The doctor aims to determine the nature of the orgasmic disorder by seeking answers to more detailed questions, such as: Is the problem congenital or acquired? Is it partner-dependent or not? Does it occur consistently or intermittently? Is it related to specific preferences regarding sexual stimulation or attitudes toward sex? Is it a consequence of other sexual disorders involving, for example, desire or arousal? The doctor’s task is to determine to what extent difficulties in achieving orgasm may be related to coexisting medical conditions (such as diabetes, hormonal, neurological, or vascular disorders) and medications being taken, mental health, traumatic past experiences, relationship problems, etc. A physical examination or ordering additional laboratory tests may be helpful.
How are female orgasmic disorders treated?
Treatment may involve a wide range of interventions, including modifying attitudes toward sex that block the experience of pleasure, lifestyle changes, hormone supplementation, switching medications that negatively affect sexual function, pelvic floor exercises, or psychosexual therapy. The duration of treatment depends on the factors blocking orgasm, responsiveness to intervention, the treatment method, and commitment to therapy. For some patients, a few sessions are sufficient, while others require therapy lasting several months.
Is a complete cure possible? How can one maintain the ability to experience sexual pleasure (orgasm)?
It is important to distinguish between the ability to experience orgasm—which, once acquired, is permanent—and the actual experience of orgasm, its frequency, and intensity. Whether we experience sexual pleasure depends on many factors (listed above), which can undergo dynamic changes over the course of a lifetime.
To maintain a satisfying sex life, it is essential to take care of one’s health, nurture the relationship, and pay attention to the conditions and nature of the sexual activity itself. Some women value the predictability of tried-and-true forms of stimulation, while others prefer variety and change. An important skill is pursuing your desires together and having an open conversation about them.
Author: Michał Lew-Starowicz, MD, PhD
