Female Orgasmic Disorder: Causes, Myths, Treatment Options, and Sex Therapy
What is Female Orgasmic Disorder?
Orgasms are the peak of sexual arousal where the body involuntarily releases sexual tension through the pleasurable rhythmic contraction of the pelvic floor muscles, and in a female body, the vagina and uterus. To read more information on the experience of orgasm, read here. It is also helpful to understand sexual arousal, given that orgasm is part of arousal. Read about arousal here.
Female Orgasmic Disorder (FOD) is when orgasms are delayed, infrequent, absent, or significantly reduced in intensity, and this is a cause of significant distress. These symptoms must be distressing and have lasted for a minimum of six months, and occur in 75-100% of sexual encounters. FOD is categorised into subtypes of lifelong (never experienced orgasm), acquired (developed after a period of orgasmic function), generalised (occurring all the time) or situation (only in specific situations).
What Causes Female Orgasmic Disorder?
Our experiences of sexuality are deeply influenced by connected biological, psychological, relational, and societal factors.
Biological and Medical: Anything that impacts on the body’s biological capacity for arousal, can also impact the body’s capacity for orgasm (since orgasm is the natural flow on or peak of arousal). Conditions that specifically impact blood flow or nerves can impair orgasmic capacity such as spinal cord injuries, multiple sclerosis, and diabetes. If sex is painful, this can also inhibit orgasm. Sex can become painful due to hormonal changes in menopause. Read more on menopause here.
SSRI antidepressants have a significant effect on overall biological sexual function including overall arousal. 31-57% of women on SSRIs report delayed or absent orgasms.
Psychological: Poor mental health, poor body image, and a history of sexual abuse also impact FOD. Mental arousal is required for a full experience of arousal. These poor mental health factors inhibit the brain from receiving sufficient stimuli for arousal. The brain is primarily responsible for triggering orgasm from both physical touch stimuli and mental stimuli. Without this sufficient stimulation, there is no orgasm.
Individuals may also be afraid of orgasming due to being afraid to “lose control”. Orgasm is an involuntary reflex, inherently one that is out of an individual’s control. The brain turns off certain areas of the frontal cortex (thinking/decision making/control) to facilitate this loss of control. For some individuals there can be fear around how one will look, sound, or react when this happens.
Relational: Situational FOD can often be caused by relationship distress, unresolved conflict, poor communication, or in response to a partner’s sexual dysfunction. In this context, sexual interaction may not be fully desirable, and the body can respond by inhibiting arousal. Often difficulties with arousal in and of themselves are not the issue, but an indicator to explore what is going on beneath the surface, or in this case: the relationship.
Societal Factors: Growing up with negative attitudes towards sex, a lack of positive sex education can disconnect individuals from their body. Their bodies may experience shame rather than pleasure, inhibiting arousal.
Common Myths About Female Orgasmic Disorder
I should be able to orgasm through vaginal intercourse: especially in sexual interactions where intercourse is the goal, this can create a pressured environment which strips away pleasure. This also is not realistic given that it is primarily the clitoris that is a source of pleasure and orgasm for most females. Even when orgasm is experienced during intercourse, it is likely due to the internal clitoral structures which surround the entrance of the vagina. Less than 20% of women reliably orgasm during sexual intercourse, and 38% never or rarely orgasm during penetration. Clitoral stimulation enhances arousal, and without it there may not be sufficient arousal for enjoyable vaginal penetration.
My body is broken: often bodies are over-emphasised and over-medicalised. While there are real biological factors at play, which are important to take into consideration, far more often the significant barrier to sexual interest and arousal are relational and psychological. It may also be that the sexual cues provided by a partner are ineffective or not pleasurable.
What are the Treatment Options for Female Orgasmic Disorder?
Sex Therapy
Sex therapy equips individuals with understanding, education, and sexual skills. Within sex therapy for FOD, the main approaches include the following:
Directed Masturbation. This is about slowing things down and allowing an individual to develop a positive relationship with their own body in a non-pressured, safe environment. To mindfully attune to bodily sensation, arousal signals and bodily response, and what feels pleasurable.
Pros:
- Most effective treatment with success rates between 50-100%
- When an individual learns to orgasm alone, this is often then generalised to partnered sex
- Boosts self-esteem, sexual confidence, includes positive health side effects
- Supporting a healthy connection with self
Cons:
- Significant time commitment
- Emotionally challenging for some women with deep negative body image, or trauma
- Does not address situational FOD where orgasming with a partner is the issue
- May not align with the values of individuals from particular faith and cultural backgrounds. In these circumstances, self-touch treatment will be adapted to what is acceptable for the client.
Sensate Focus Couples Therapy. This introduces couples to step by step touching exercises that are free from pressure, focused in on sensation, nurtures curiosity, openness and connection. Initially genital touch is excluded, and slowly integrated.
Pros:
- Highly effective in reducing pressure, anxiety
- Supports individuals to tune back into physical sensation
- Allows arousal and desire to be nurtured freely, without demand
Cons:
- Most effective when combined with directed masturbation
- Requires a cooperative partner
- High commitment
Medication Adjustments and Prescription
Please speak to your doctor concerning medication.
If FOD is acquired specifically from medication, adjusting medication effectively reverses the side effects. Hormone Replacement Therapy may be prescribed for menopausal women.
Pros:
- If medically induced or primarily biological this can improve overall sexual function
Cons:
- May over-emphasise the biological without considering relational and psychological components, setting up unrealistic expectations of a “magic pill”
- Potential other bodily side effects
Can Sex Therapy Help With Orgasms?
Sex therapy supports the psychological and relational factors that often underpin Female Orgasmic Disorder. While biological factors can play a role, many barriers to orgasm relate to pressure, anxiety, disconnection, or difficulty tuning into sensation.
In therapy, we focus on reducing performance pressure and shifting attention back to pleasure and bodily awareness. This includes developing comfort with sensation, understanding personal arousal patterns, and addressing beliefs or fears that may inhibit orgasm.
For couples, therapy supports communication, shared understanding, and a collaborative approach to intimacy. Rather than striving for a specific outcome, the aim is to create the conditions where arousal and orgasm can emerge more naturally.
I offer online sex therapy across Australia, supporting individuals and couples to reduce pressure, reconnect with their body, and build confidence and enjoyment in sexual intimacy.
Final Reflection
Difficulties with orgasm are more common than many realise and do not mean that something is inherently wrong with your body. Sexuality is influenced by many factors, and when these are understood, there is often significant capacity for change.
Approaching sexuality with curiosity rather than judgement allows space for learning, connection, and pleasure. With the right support, it is possible to experience a more relaxed, confident, and satisfying relationship with your sexual self.
Written by Justine
References
Rellini AH, Clifton J. Female orgasmic disorder. Advances in Psychosomatic Medicine. 2011;31:35-56.
Graham CA. The DSM diagnostic criteria for female orgasmic disorder. Archives of Sexual Behavior. 2010;39:256-270.
Laan E, Rellini A, Barnes T. Standard operating procedures for female orgasmic disorder: Consensus of the International Society for Sexual Medicine. J Sex Med. 2013;10:74-82.
Robinson B, Munns R, Weber-Main A, et al. Application of the sexual health model in the long-term treatment of hypoactive sexual desire and female orgasmic disorder. Arch Sex Behav. 2011;40:469-478.
Vandenberghe L, Oliveira Nasser K, Silva D. Couples therapy, female orgasmic disorder, and the therapist-client relationship: two case studies in functional analytic psychotherapy. Couns Psychol Q. 2010;23:45-53.
