Female orgasmic disorder (FOD) is characterized by delayed, infrequent, or absent orgasm despite sufficient stimulation and adequate emotional and mental sexual arousal during at least 75% of sexual experiences for women. This term is also used to describe a marked decrease in orgasm intensity.

What are the symptoms of FOD?

The symptoms of FOD can be:

• Never having had an orgasm.
• Having had orgasms in the past, but now having trouble reaching orgasm.
• Having trouble reaching orgasm in certain situations.
• Having markedly less frequent and less intense orgasms than previously experienced.

What are the different types of FOD?

FOD can be lifelong or acquired, generalized or situational, mild, moderate, or severe. Lifelong FOD (primary anorgasmia) describes cases in which individuals have never experienced orgasm, whereas acquired FOD (secondary anorgasmia) describes women who once had orgasms but now have difficulty doing so. Generalized FOD refers to the inability to orgasm with any partner or in any situation (including during masturbation), and situational FOD refers to the ability to orgasm only in specific situations or with certain partners.

How long do orgasm difficulties have to last to be considered FOD?

Occasional difficulty reaching orgasm is common and likely nothing to be concerned about. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), FOD describes cases in which orgasm difficulties last for at least six months.

Is a lack of orgasms something to be concerned about?

A lack of orgasms is not a problem in and of itself. If you enjoy your sexual experiences and are not bothered by the frequency or intensity of your orgasms, there is no cause for concern. Sexual connection encompasses much more than orgasm, and many individuals who do not experience orgasm still have fulfilling and satisfying sex lives. On the other hand, if a lack of orgasms or a decline in orgasm intensity/frequency is causing you distress, it may be a good idea to bring up the matter with a health care provider or sex therapist. Unfortunately, there is a documented disparity in the frequency of orgasms between heterosexual men and heterosexual women, with men achieving orgasm more frequently during partnered sexual activity. This phenomenon is referred to as “the orgasm gap,” which is an issue that dedicated researchers and activists in the field of female sexual health are working to address.

What causes FOD?

FOD may stem from physical, psychological, or relationship issues. As women age, their estrogen and testosterone levels decrease, which can lead to a decline in orgasm intensity. Chronic conditions and gynecological diseases/disorders may change the sensations a woman experiences during sex, potentially making it more painful and decreasing the likelihood of orgasm. Medications such as antidepressants like selective serotonin reuptake inhibitors (SSRIs) may dampen the body’s sexual response, hindering orgasm.

Psychologically speaking, women may be more likely to experience FOD if they feel guilty about having sex, struggle with depression or anxiety, are under a lot of stress, or have experienced sexual or emotional abuse.

Finally, a woman’s relationship with her sexual partner(s) can contribute to FOD if the relationship in question involves unresolved issues, a lack of mutual attraction, poor communication, distrust, or past experiences of infidelity or abuse.     

What treatments are available for FOD?

Treatment strategies for FOD vary greatly, depending on the cause of the condition. Certainly, any physical issues (i.e., gynecological problems, chronic condition symptoms) should be managed medically to prevent painful sex. Women who believe that their medications are negatively impacting their sensation during sex should speak to their providers about modifying their dosage. Postmenopausal women might consider speaking with a sexual health specialist about using a local hormone therapy to improve their sexual experiences.

Sex therapists and psychologists can help patients who are dealing with stress, depression, anxiety, past trauma, and guilt or shame about sexual activity. Couples who are looking to overcome FOD may decide to attend sex therapy together to learn strategies for increasing the likelihood of orgasm.

Sometimes, FOD can be the result of insufficient stimulation or a lack of communication between partners about what feels good during sex. In these cases, exploring your sexual interests (with or without a partner) and then discussing your preferences with a partner could be beneficial. It may also be helpful to incorporate a sex tool such as a vibrator into a sexual experience.

Resources:

• Marchand, E. (2021). Psychological and behavioral treatment of female orgasmic disorder. Sexual Medicine Reviews, 9(2), 194-211. DOI: https://doi.org/10.1016/j.sxmr.2020.07.007
  
  
• Mayo Clinic. (2020, March 28). Anorgasmia in Women. https://www.mayoclinic.org/diseases-conditions/anorgasmia/symptoms-causes/syc-20369422