1) Desire Phase: As mentioned in our sexual health page, without the desire to be sexually active, men are not going to get excited or have orgasms.

2) Excitement: Manifesting by penile erection in men and vaginal lubrication in women.

3) Plateau: Full sexual excitement during intercourse.

4) Orgasm: A highly pleasurable sensation occurring at the peak of sexual excitement. It is associated with ejaculation in men and rhythmic contraction of pelvic floor muscles in women.

5) Resolution: Relief of sexual excitement and a feeling of relaxation after orgasm.

Several factors might interfere with reaching full sexual excitement and thus failure to reach orgasm. Suggested psychological factors include various anxieties & fears. However, in many cases there is no clear cut cause, and anorgasmia may puzzle both the patient and physician. Patients might fall into a performance anxiety trap. Instead of relaxing and enjoying the sexual experience they might focus on their performance and on reaching orgasm. Performance anxiety would thus inhibit sexual excitement and orgasm. Suggested physical factors include hypnotic abuse, narcotic & alcohol abuse and nerve disorders or spinal cord injuries.

Various treatment approaches have been used with varying success. Reduction of performance anxiety and providing a high level of stimulation might be achieved through the sensate focus exercises (relaxed sensual massage). These exercises are prescribed by a sex therapist and include both partners taking turns at giving and receiving stimulation while forbidding genital touching, vaginal penetration and orgasm.

If the patient is able to ejaculate outside the vagina, sex therapists attempt desensitization by prescribing a series of exercises where the patient masturbates up to ejaculation on his own first, then with his wife, then outside the vagina, and finally intravaginally. Electrovibratory stimulation and sexual fantasies might also be helpful.

The general advice given to patients with failure of reaching orgasm is not to concentrate on the outcome of the sexual experience but rather to relax and enjoy giving and receiving stimulation.

Reviewed by Sexual Health Editorial Team