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Why Can't I Orgasm

Anorgasmia is the inability to achieve an orgasm. This could be in any person and due to a variety of factors. Anorgasmia can negatively affect your self-perception, your relationship, confidence and emotional state.

If you can achieve an orgasm in some situations, but not others, that is not anorgasmia. For example, you can orgasm through masturbation, only through vaginal penetration, or only in 1 sexual position. In these cases your body is able to achieve an orgasm and the muscles, blood flow and nervous system work properly in those instances. These systems may not be functioning optimally in other situations where you can not achieve orgasm due to position, energy level, fatigue, mindset, arousal or other factors.

True anorgasmia results in not being able to have an orgasm in any situation. This could be long standing and the person has never been able to orgasm or a new onset of anorgasmia. 10-15% of women have never had an orgasm. A majority of the time that’s due to a poor understanding of their own body and what makes them tick, or a partner who is inexperienced, unable or unwilling to learn.

When anorgasmia has a sudden onset, several causes should be evaluated. Systemic causes that need to be assessed include:

  • Changes in medications

  • Changes in cardiac, pulmonary, neurological, and endocrine systems

  • Stress, anxiety, depression and other mental and emotional changes

These factors will need to be addressed either through medication changes, mental health counseling or developing a fitness program to improve cardiovascular fitness. Each of these factors should be considered when working to overcome anorgasmia. If these conditions have been ruled out and deemed not a factor, other concerns can be addressed that are more localized to the pelvis.

Local changes to the pelvis include:

  • Surgery

  • Trauma

  • Pregnancy

  • Muscle injury

  • Hemorrhoids or Fissures

  • UTIs and other infections

  • Workout/fitness changes

Local changes often result in muscle, fascia and nerve mobility changes. These soft tissues are vital for orgasm and when not moving optimally will result in difficulty achieving orgasm. Pelvic health physical therapists are the specialists in addressing these tissue changes. Treatment may include hands-on manual therapy, dry needling, corrective exercises, and desensitization.

We can also begin to identify why an orgasm takes place in some circumstances, but not in others. What is the same and different about these situations? Is it a physical location, position, stimulus, toy or an emotional feeling? For example, it may be more difficult to achieve orgasm when you are stressed or not sleeping well. Can you change these differences to better reproduce a successful orgasm consistently?

Not sure where to start? Try this:

Think about any changes in your life up to 6 months before anorgasmia began to occur.

If you can identify changes:

  • Med changes: Talk with your doctor about meds that changed and alternatives.

  • Mental health: Seek out a psychologist, psychiatrist or counselor.

  • Health changes: Talk with your doctor or PT to make sure you are fully addressing these changes and improving your health and fitness.

  • Local changes: Schedule an appointment with a pelvic health PT to assess neurological, muscular and fascial function.

No changes occurred or have never been able to orgasm. You have a few options to improve your ability to orgasm:

  • Read “She Comes First” by Ian Kerner

  • Read “Come As You Are” by Emily Nagoski, PhD

  • Call your local pelvic health PT to set up an evaluation and develop a plan for your goals! If you’re local to McKinney, TX you can schedule a discovery call with Katy here.

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