Anorgasmia is the medical term for regular difficulty reaching orgasm after ample sexual stimulation. The lack of orgasms distresses you or interferes with your relationship with your partner.

Orgasms vary in intensity, and women vary in the frequency of their orgasms and the amount of stimulation needed to trigger an orgasm. Most women require some degree of direct or indirect clitoral stimulation and don't climax from penetration alone. Plus, orgasms often change with age, medical issues or medications you're taking.

If you're happy with the climax of your sexual activities, there's no need for concern. However, if you're bothered by the lack of orgasm or the intensity of your orgasms, talk to your doctor about anorgasmia.

An orgasm is a feeling of intense physical pleasure and release of tension, accompanied by involuntary, rhythmic contractions of your pelvic floor muscles. But it doesn't always look — or sound — like it does in the movies. The way an orgasm feels varies among women, and in an individual, it can differ from orgasm to orgasm.

By definition, the major symptoms of anorgasmia are the inability to have an orgasm or long delays in reaching orgasm that's distressing to you. But there are different types of anorgasmia:

• Lifelong anorgasmia. You've never had an orgasm.
• Acquired anorgasmia. You used to have orgasms, but now have difficulty reaching climax.
• Situational anorgasmia. You're able to have an orgasm only in certain circumstances, such as during oral sex or masturbation or only with a certain partner.
• Generalized anorgasmia. You aren't able to have an orgasm in any situation or with any partner.

When to see a doctor

Talk to your doctor if you have questions about orgasm or concerns about your ability to reach orgasm.

Orgasm is a complex reaction to various physical, emotional and psychological factors. Difficulties in any of these areas can affect your ability to orgasm.

Physical causes

A wide range of illnesses, physical changes and medications can interfere with orgasm:

• Diseases. Serious illnesses, such as multiple sclerosis and Parkinson's disease, and their associated affects on psychological well-being can hamper orgasm.
• Gynecological issues. Gynecologic surgeries, such as hysterectomy or cancer surgeries, can affect orgasm. Also, lack of orgasm often goes with other sexual concerns, such as uncomfortable or painful intercourse.
• Medications. Many prescription and over-the-counter medications can inhibit orgasm, including blood pressure medications, antipsychotic drugs, antihistamines and antidepressants — particularly selective serotonin reuptake inhibitors (SSRIs).
• Alcohol and smoking. Too much alcohol can hamper your ability to climax. Smoking can limit blood flow to your sexual organs.
• Aging. As you age, normal changes in your anatomy, hormones, neurological system and circulatory system can affect your sexuality. Waning estrogen levels as you transition to menopause and menopausal symptoms, such as night sweats and mood changes, can have an impact on sexuality.

Psychological causes

Many psychological factors play a role in your ability to orgasm, including:

• Mental health problems, such as anxiety or depression
• Poor body image
• Stress and financial pressures
• Cultural and religious beliefs
• Embarrassment
• Guilt about enjoying sex
• Past sexual or emotional abuse

Relationship issues

Couples' problems outside of the bedroom can affect their sexual relationship. Issues might include:

• Lack of connection with your partner
• Unresolved conflicts
• Poor communication of sexual needs and preferences
• Infidelity or breach of trust
• Intimate partner violence

A medical evaluation for anorgasmia usually consists of:

• A thorough medical history. Your doctor might ask about your sexual history, surgical history and current relationship. Don't let embarrassment stop you from giving candid answers. These questions provide clues to the cause of your problem.
• A physical exam. Your doctor will probably conduct a general physical exam to look for physical causes of anorgasmia, such as a medical condition. Your doctor might also examine your genital area to see if there's some obvious physical or anatomical reason for lack of orgasm.

Treatment for anorgasmia will depend on the cause of your symptoms. It might include lifestyle changes, therapy and medication.

Lifestyle changes and therapy

For most women, a key part of treatment includes addressing relationship issues and everyday stressors. Understanding your body and trying different types of sexual stimulation also can help.

• Understand your body better. Understanding your anatomy and how and where you like to be touched can lead to better sexual satisfaction. If you need a refresher course on your genital anatomy, ask your doctor for a diagram or explore your body in a mirror.

  Self-stimulation with your hand or a vibrator can help you discover what type of touch feels best to you and can provide information you can share with your partner. If you're uncomfortable with self-exploration, try exploring your body with your partner.

• Increase sexual stimulation. Women who've never had an orgasm might not be getting enough sexual stimulation. Most women need direct or indirect stimulation of the clitoris to orgasm.

  Switching sexual positions can produce more clitoral stimulation during vaginal penetration. Using a vibrator or fantasizing during sex also can help trigger an orgasm.

  For some women, a device called a clitoral vacuum can improve blood flow and increase stimulation. This device is battery operated and hand-held, with a cup that fits over the clitoris.

• Seek couples counseling. A counselor can help you work through conflicts in your relationship that can affect your ability to orgasm.
• Try sex therapy. Sex therapists specialize in treating sexual concerns. Therapy often includes sex education, help with communication skills and behavioral exercises that you and your partner try at home.

Medical treatments

• Treating underlying conditions. If a medical condition is hindering your ability to orgasm, treating the cause might resolve your problem. Changing or modifying medications known to inhibit orgasm also might eliminate your symptoms.

• Estrogen therapy for postmenopausal women. If anorgasmia is associated with menopausal symptoms, such as night sweats and hot flashes, systemic estrogen therapy — by pill, patch or gel — might relieve those symptoms and improve sexual response.

  Local estrogen therapy — in the form of a vaginal cream or a slow-releasing suppository or ring that you place in your vagina — can increase blood flow to the vagina and help improve sexual arousal.

• Testosterone therapy. Testosterone plays a role in female sexual function, but how big a role is uncertain. Replacing testosterone in women is controversial, and it's not approved by the Food and Drug Administration (FDA) for sexual dysfunction in women.

  Additionally, it can cause side effects, including acne, excess body hair (hirsutism) and male-pattern baldness. Testosterone seems most effective for women with low testosterone levels as a result of surgical removal of the ovaries (oophorectomy).

  If you choose to use this therapy, your doctor should monitor its effects on you.

Natural products, such as those made with L-arginine, are marketed for improving women's sex lives. But these supplements haven't been well-studied for this use, and they're not regulated by the FDA.

Talk with your doctor before trying natural therapies, which can cause side effects and interact with other medications.

Your difficulty reaching orgasm can be frustrating for you and your partner. Plus, concentrating on climax can make the problem worse.

Most couples aren't having the headboard-banging, earth-shaking sex that appears on TV and in the movies. So try to reframe your expectations. Focus on mutual pleasure and intimacy instead of orgasm. You might find that a sustained pleasure plateau is just as satisfying as orgasm.

If your lack of orgasm from sexual activity distresses you, make an appointment with your family doctor or your gynecologist.

Here's some information to help you prepare for your appointment.

What you can do

Make a list of:

• Your symptoms, when they began and under what circumstances they occur
• Your sexual history, including relationships and experiences since you became sexually active and any history of sexual trauma or abuse
• Medical conditions you have, including mental health conditions
• Medications, vitamins and other supplements you take, including doses
• Questions to ask your doctor

For anorgasmia, basic questions to ask your doctor include:

• What might be causing my difficulty to orgasm?
• What tests do I need?
• What treatment approach do you recommend?
• Are there any lifestyle changes or self-care steps that may help me?
• Do you recommend therapy?
• Should my partner be involved in treatment?
• Are there brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor might ask you questions, including:

• At what age did you become sexually active?
• How long have you had difficulty reaching orgasm?
• Do you become sexually aroused during sexual interactions with your partner?
• Do you have pain with vaginal penetration?
• How satisfied are you with your current relationship?
• What form of birth control do you use?
• Do you use alcohol or recreational drugs? How much?
• What messages about sex did you get growing up?

What you can do in the meantime

Be open with your partner. Continue sexual activity, and also explore other ways of being intimate. Shifting the focus from orgasm to pleasure might help.