Trouble reaching orgasm? Why it happens and what can help

You are far from alone

When trouble reaching orgasm is ongoing and it bothers you, doctors call it anorgasmia, also known as female orgasmic disorder. According to the Cleveland Clinic’s overview of anorgasmia, that can mean orgasm doesn’t happen at all, takes much longer than you’d like, happens only rarely, or feels weaker than you want, even when you are aroused. Some women have always found it hard. For others it is new, perhaps after starting a medicine, during a stressful stretch or around menopause. It can also happen only in certain situations, such as with a partner but not alone.

The numbers alone can be a relief. MedlinePlus, the US National Library of Medicine’s health site, says 10 to 15% of women have never had an orgasm, and surveys suggest up to half of women aren’t satisfied with how often they reach one. The American College of Obstetricians and Gynecologists (ACOG) puts it more broadly: about 4 in 10 women have problems with sex at some point in their lives.

There is also a gap between women and men. In one large US online survey of more than 52,000 adults, 65% of heterosexual women said they usually or always had an orgasm during sex, compared with 95% of heterosexual men.

Part of the reason may be simple. In a nationally representative survey of 1,055 US women aged 18 to 94, published in 2018, only about 18% said intercourse alone was enough for them to reach orgasm. About 37% said they needed clitoral stimulation during intercourse, and another 36% said it made orgasm feel better. MedlinePlus goes further and says most women need clitoral stimulation to reach orgasm. So if intercourse on its own doesn’t get you there, you are describing how many women’s bodies work, not a flaw.

Why orgasm can be hard to reach

There is rarely a single cause. These are the ones doctors and researchers mention most, grouped so you can spot the one or two that sound like you.

• Not enough time or arousal. In a 2018 study of 452 women who had trouble reaching orgasm with a partner, the reasons they gave most often were stress or anxiety (about 58%), not feeling aroused enough (nearly half) and not having enough time (40%). It was an online survey, not a national sample, but those three themes also run through the advice from ACOG and the Cleveland Clinic.
• A busy or worried mind. Stress, tiredness, distraction, depression and anxiety can all get in the way. So can worries about how your body looks, a history of abuse or trauma, and negative messages about sex absorbed growing up.
• The relationship and the conversation. Tension or trust problems with a partner, boredom, and shyness about asking for the kind of touch that works all appear on the MedlinePlus and Cleveland Clinic lists.
• Body changes. The Cleveland Clinic notes that orgasm problems become more common with age and are most common after menopause. Falling estrogen around perimenopause and menopause can also bring vaginal dryness. Pain with sex, conditions such as endometriosis, pelvic floor muscles that are too tight or too weak, diabetes, multiple sclerosis, nerve damage, pelvic surgery and cancer treatment can all play a part.
• Medicines, alcohol and smoking. SSRI antidepressants are a well-known cause. ACOG also lists some heart and blood pressure medicines, hormone medicines including birth control pills and hormone therapy, and anticholinergic drugs, along with alcohol, marijuana and opioids. The Cleveland Clinic adds smoking. If a medicine might be involved, talk to the person who prescribed it. Never stop or change a prescribed medicine on your own.

Orgasm trouble often travels with other issues, such as low desire, dryness or pain. If those sound familiar too, our guide to common sexual problems women face looks at them side by side.

Gentle things that often help

None of these is a guarantee, and you don’t need to try them all. Most come straight from ACOG’s self-help list. Pick two or three that fit your situation and be patient with them.

Slow down and make time

Arousal takes time, and not having enough of it is one of the reasons women name most often. Set aside time when you aren’t watching the clock, spend longer on foreplay, and let things build before any penetration. It also helps to drop the idea that every encounter has to end in orgasm. Pressure tends to pull you out of the moment.

Get to know what you like

Learning about your own body, including through self-touch, is something both ACOG and MedlinePlus suggest. It is a normal, healthy way to find out what kind of touch, pace and pressure work for you, and that knowledge is easier to share once you have it. Women’s preferences vary a lot, so there is no “right” way to be touched. If you are comfortable with them, sex toys such as vibrators are another option both sources mention.

Say it out loud

Your partner can’t read your mind, and speaking up can feel awkward at first. In the large US survey mentioned above, women who reached orgasm more often were more likely to ask for what they wanted and to include more than intercourse in sex. That doesn’t prove asking is the cause, but it is a hint worth taking. It can be as simple as “slower” in the moment, or a talk outside the bedroom about what you’d like to try.

Make comfort a priority

Dryness and discomfort can stop pleasure in its tracks. A lubricant can help; with condoms, ACOG advises using only water-based or silicone-based types. If dryness is ongoing, for example around perimenopause or menopause, a vaginal moisturizer may help too. Some perfumed products and certain lubricants can irritate, so if one stings, stop using it. Pain during sex is not something to push through. It is a reason to see a doctor.

Look after your body

Kegel exercises, which strengthen the pelvic floor, appear on both the ACOG and MedlinePlus lists. They are meant for muscles that are weak, though. If your pelvic floor is tight instead, a pelvic floor physical therapist is a better guide than doing Kegels on your own. Getting enough sleep, eating well, cutting back on alcohol and not smoking all support sexual health.

Regular exercise is part of the healthy routine the Cleveland Clinic recommends, but be wary of big promises. The research on exercise and sex is small and specific. In a lab study of 47 women taking antidepressants, 20 minutes of exercise shortly beforehand increased measured physical arousal. In a later small trial in the same group, exercising shortly before sex improved desire, but the improvement in orgasm came from scheduling regular sexual activity, not from the exercise itself.

Where desire fits in

ACOG describes problems with desire, arousal and orgasm as separate but overlapping, and it is common to have more than one. If you rarely feel in the mood, it makes sense that the rest can feel harder to reach. If low desire is part of your story, it is worth reading about the biggest myth about women’s desire.

Some women whose main concern is low desire look at herbal supplements. Provestra, the supplement this site covers, is one of them. The maker describes it as an herbal daily supplement for women’s desire, taken as one tablet a day, with 21 listed ingredients including damiana leaf, ginseng and ginkgo biloba. The maker shows the amount of each ingredient per tablet on its Supplement Facts label, and you can see the full ingredient list on our homepage. To be clear, Provestra is not a treatment for orgasm difficulty, and it is no substitute for the steps above or for a doctor’s advice.

Herbal does not automatically mean right for everyone. Check with your doctor or pharmacist before starting any supplement, especially if you are pregnant, nursing or take any medicine. Our guide to Provestra safety and medical questions goes into more detail.

When to talk to a doctor

You don’t need a crisis to bring this up. It is worth booking an appointment if:

• sex hurts, often or badly, or you notice bleeding you can’t explain
• the change is new or sudden, and orgasm used to come more easily
• it started after a new medicine (don’t stop or change it on your own; ask the prescriber about other options)
• you have dryness or other signs of perimenopause or menopause
• you are dealing with low mood, anxiety or past trauma
• or simply, it is upsetting you or straining your relationship

Finding the words isn’t always easy. ACOG suggests simple opening lines, along the lines of telling your ob-gyn that you’ve been having trouble with sex and would like to talk about it. Keeping a short journal of what you notice, including any medicines, can make the visit easier.

A doctor will usually ask about your health, your medicines and your relationship, and may do a pelvic exam. MedlinePlus notes that exam results are almost always normal. That is reassuring, and a normal result doesn’t mean nothing can be done. Depending on the cause, help might include changing a medicine, treating an underlying condition, hormone treatment or a moisturizer for menopause-related dryness, counseling or sex therapy on your own or with a partner, or pelvic floor physical therapy. According to the Cleveland Clinic, most people can orgasm again with proper treatment, though sex therapy can take several months, so patience is part of the plan.

A kinder way to think about it

Orgasm is one part of a good sex life, not the measure of it. ACOG notes that some women find enough satisfaction in closeness, even without orgasm every time, and that is a valid place to land. If you do want to change things, the most useful mindset is curiosity rather than pressure: more time, more comfort, more honesty about what feels good, and help from a doctor when something hurts or has changed. If you’d like the bigger picture of how desire and arousal work, our guide to female sexuality is a good next read.