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The Missing O! Why Some Women Can’t Orgasm

by Lyndsey Harper, MD

Would you be surprised if I told you that one of the most common sexual problems that women experience is trouble with orgasm. This is not surprising to us, as we know that in one study more than 20% of women reported difficulty with orgasm. So, if you're thinking "why can't I orgasm?" you are not alone.

It is helpful to think about trouble with orgasm in two categories. The first category is women who have never had an orgasm or are not sure if they’ve ever had an orgasm. The second category are women who have previously experienced an orgasm but now experience a less intense or absence of orgasms.

So you’ve never had an orgasm?

For women who fall into this category, the first thing to address is how to have an orgasm! Many people think that penis in vagina sex is the only way to a woman’s pleasure. This is NOT TRUE. While it may feel quite nice to have penetrative sex for many women, the key to orgasm is CLITORAL STIMULATION! More than 75% of women require clitoral stimulation to have an orgasm, not penetrative sex. This could happen by rubbing the clitoris with your or your partner’s hand, receiving oral sex, or with a vibrator. If you are expecting an orgasm to happen from penetrative sex, you might be waiting your whole life!

This is completely normal and nothing is wrong with you. Many times in this case, we recommend masturbation, or self-exploration for those that are uncomfortable with that:) This can help you understand your body without the anxiety of a partner watching or expecting a certain outcome. For more information on this topic, check out our Class by Dr. Laurie Mintz called Sex 101, her book Becoming Cliterate, or the awesome website

Where’d it go?

For women who have previously experienced orgasm but now have less intense orgasms or none at all, it’s important to be aware of some issues that can lead to this. Many women experience diminshed or lack of orgasm as a result of injury to the nerves that supply the clitoris. This could happen in the brain, spine, or pelvis as a result of traumatic injury, chronic disease, or childbirth. Another cause can be issues involving your pelvic floor muscles. If the muscles of the pelvic floor are too tense or too relaxed, this can affect orgasm. Other common culprits can be medications, (antidepressants, antihistamines, and seizure medications are frequent culprits ), infections, and chronic illness. Hormonal changes due to lactation, menopause, birth control, or cancer treatments can also interfere with your ability to have an orgasm.

For women in either category, other things that can interfering with the ability to have an orgasm include stress, history of sexual trauma, domestic violence or other relationship problems, lack of adequate arousal (women usually need 20 minutes of erotic play to get adequately aroused), anxiety about loss of control or vulnerability, sexual dysfunction in the partner, or negative cultural or religious messages about sex and pleasure.

If you are having trouble with orgasm, there is hope! Depending on the cause of your problem, there are likely multiple solutions. It’s time to discuss your concerns with a healthcare professional who can map out a game plan to get you back on the path to the pleasure you deserve.

Lyndsey Harper, MD is the Founder & CEO of Rosy, a Board Certified Ob/Gyn and sex medicine expert.