The female orgasm provokes a lot of interest because it truly is a personal, individualized,  subjective experience for every woman. There are many taboo topics in women’s sexual health, but the female orgasm seems to be the most taboo subject among all cultures. It is an uncomfortable topic in many relationships and many women don’t know how to address orgasm related issues with their clinician.

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Female orgasm disorder can be classified as primary (never had an orgasm) or secondary (occurred later in life).  Most women achieve orgasm from direct stimulation of the clitoris. Less than 25% of women experience orgasm through vaginal penetration only, which may be even lower in reality because a woman may experience indirect stimulation of the clitoris during vaginal penetration thereby producing an orgasm. The etiology of female orgasmic disorder is often multifactorial due to causes such as genetics, smoking (reduces blood flow to the genitals), genitourinary syndrome of menopause (GSM) or vulovovaginal atrophy (VVA), lichen sclerosus (can lead to fusing, scarring, and result in a “buried” clitoris or loss of clitoral architecture) other health conditions such as high blood pressure or diabetes, alcohol use, drug use (prescription or illicit), stress, unrealistic expectations from the sexual partner, poor body image, and relationship conflict. Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) can also result in a delayed response or inability to orgasm. Testosterone replacement has been shown to improve response and quality of orgasms as well as improve overall sexual functioning. An additional (or different) antidepressant such as Wellbutrin (bupropion) may be prescribed to counteract the negative sexual side effects from your current antidepressant. Another option is Addyi (flibanserin) which is currently approved for premenopausal hypoactive sexual desire, but it has also been shown to have a positive effect on mood. And finally, the use of a personal device may help facilitate orgasm response. Recommended devices include:

Melissa Dahir has no financial interest or relationship with any of these products or companies.