Difficulty Achieving Orgasm And What Your Pelvic Floor May Have to Do With It
If you’ve ever struggled to reach orgasm, felt like it takes forever or requires a specific set of circumstances, or it’s just entirely unattainable, you’re not alone.
Anorgasmia is a topic that doesn’t get enough attention, partly because it feels personal, and partly because a lot of women have quietly assumed that this is just how it is for them. Difficulty with orgasm is common, often has identifiable and multifactorial causes, and in many cases, it's something that can improve over time.
In this blog post, we’re going to dive into the prevalence of anorgasmia, some common causes of orgasm challenges, as well as talk through the female arousal cycle and your pelvic floor’s role in orgasms.
How common is anorgasmia?
First - let’s define anorgasmia. Anorgasmia can mean a delayed ability to achieve orgasm, reduced orgasm intensity, or a complete inability to achieve an orgasm, and it’s quite common. In the United States, it’s estimated that this affects 10-42% of women and that it goes significantly under-reported and under-treated as a result of anxiety and embarrassment.
It's worth noting that prevalence data varies widely across studies, but the consistent finding across the literature is that a substantial proportion of women experience this, most don't talk about it, and far fewer seek help.
Common causes of orgasm difficulties
Anorgasmia is rarely the result of a single cause. While anorgasmia is often treatable, progress can be slow as a result of the multifactorial nature of this condition.
Let’s get into some of the most common causes.
Medications
Antidepressants are frequent offenders here. This includes SSRIs, SNRIs, and TCAs. One study reports that up to 73% of people taking SSRIs report adverse sexual side effects. Other medications that can interfere with sexual function are certain blood pressure medications, anti-psychotics, and hormonal medication. If your anorgasmia coincides with a change in medication, this is something to consider.
Psychological Factors
Pleasure is driven by your brain and anything impacting your psychological state can influence your ability to feel pleasure. Anxiety, depression, pressure, body image concerns, shame, a history of trauma… these can all interfere with your ability to stay present and experience sexual pleasure. A 2018 study that followed 53 women with Sexual Interest/Arousal disorder found that “key factors inhibiting the response cycle included distractions (31% of women), memories of past experiences (26%), and body image issues (25%).”
Lifestyle
Chronic stress, smoking, alcohol use, poor sleep, and lack of physical exercise can all blunt sexual response, making it both more challenging to experience arousal as well as orgasm. Addressing these factors helps to improve overall health, creating significant and lasting changes, however it can be incredibly challenging to make big lifestyle shifts.
Relationship Factors
Feeling rushed, under-appreciated, disconnected, or resentful towards your partner can make intimacy difficult, and orgasm much harder to achieve. Emotional safety is a requirement for many in order to have satisfactory sexual experiences.
Physical Factors
Hormonal changes brought on by pregnancy, lactation, perimenopause and menopause can impact sexual sensation, arousal, and orgasm and can also contribute to pelvic pain. Scar tissue affecting mobility and sensitivity of the vulvovaginal tissue can impact how it feels to be touched. Pelvic floor dysfunction stemming from any of the above, as well as muscular and nerve dysfunction can influence the ability to achieve orgasm. We’re going to get into the pelvic floor components in a bit.
Understanding what factors into arousal and orgasm can be helpful as you try to understand your body and which factors may be impacting you.
Understanding the female arousal cycle
The original sexual response cycle was developed in the 1960s by William Masters and Virginia Johnson. At the time, this four-staged, linear model was applied to both women and men. It included the initial phase of excitement, the intensified plateau phase, the orgasm phase which was considered the peak, followed by the resolution phase where the body returned to it's unaroused state. This model was groundbreaking at the time, but had significant limitations. It treated the male and female arousal cycle as the same experience, and it centered orgasm as the goal.
In the early 2000s, a new model of the female sexual response cycle was created by Dr. Rosemary Basson, PhD. Rather than a linear path, Dr. Basson proposed a true cyclical pattern that better suited the female sexual response. It's worth acknowledging the limitation that, like most sexual health research, this model was developed primarily with cisgender heterosexual women in mind.
The Basson Sexual Response Model acknowledges that sexual desire can be responsive rather than spontaneous and that this cycle isn’t reliant on an orgasm. Her cyclical model leaves more room for psychological and social factors, and allows for a sexual encounter to begin without spontaneous arousal, and for the arousal to come later through various entry points as a result of context, stimuli, and connection. You can see a helpful visual of this cycle here.
If the earlier stages of the cycle are disrupted, if context isn't right, stress is high, there's pain present, or the body never fully enters an aroused state, the stage won’t be set for an orgasm. Physiologically, there are preconditions for an orgasm as well: increased blood flow to the genitalia resulting in vasocongestion, vaginal lubrication, lengthening and dilation of the vagina, and clitoral engorgement from increased blood flow to the clitoral and labial arteries. A disruption in any part of this process will blunt the orgasm response.
Where your pelvic floor fits in
Your pelvic floor muscles are directly involved in orgasm. These muscles help to facilitate blood flow to the clitoris and vaginal tissue, maintain the clitoral erection, and rhythmically contract, causing the physical sensation of orgasming. Pelvic floor muscle weakness or hypertonicity, also known as tension, can result in reduced orgasm intensity and other sexual dysfunctions.
As pelvic floor physical therapists, we work alongside your medical and mental health team to address the physical factors which may be interfering with your ability to achieve a satisfactory orgasm.
When muscles are hypertonic
When muscles are held in a chronically tight state, they have a harder time contracting further. Think about trying to clench your fist if it’s already closed versus closing your hand from an open position. You’re able to generate much more power if you start from a relaxed state.
Hypertonicity of the pelvic floor muscles can:
Make the rhythmic contraction required for orgasm more challenging
Cause pain during penetration and external stimulation
Compress or irritate the pudendal nerve, the main nerve of the pelvic floor, which can create pain; significantly affect sensation in the clitoris, perineum, and vaginal tissue; and dull or intensify the signals needed for arousal and orgasm to progress.
Orgasmic dysfunction is frequently associated with suboptimal pelvic floor tone, and anorgasmia can be the result of either overactive or underactive pelvic floor muscles or restriction in the non-contractile connective tissues.
When muscles are too weak or poorly coordinated
On the other hand, muscles that lack strength or neuromuscular coordination may not generate or sustain the rhythmic contractions needed for orgasm. A 2010 study by Lowenstein et al. looked at 176 women, 40% of whom experienced anorgasmia. This study found that stronger pelvic floor muscles correlated with higher orgasm and arousal domain scores. Another 2014 study by Martinez et. al found the same thing.
Weakness is common postpartum, after periods of inactivity, or in perimenopause as hormonal changes affect tissue quality. Pelvic floor strength can also vary depending on position. Your pelvic floor may be stronger - and orgasm more achievable - when lying down versus in upright positions when the muscles are working against gravity.
The fix isn’t just about doing kegels. Coordination and timing matter just as much as strength.
How can pelvic floor PT help?
A pelvic floor physical therapist can do a thorough assessment of your pelvic floor muscle tone, coordination, strength, tissue health, scar mobility, and functional patterns that may be contributing to anorgasmia. We can also help begin to identify other important factors contributing to your symptoms while directing you towards the providers who can help.
A 2024 systematic review and meta-analysis of 21 randomized controlled trials found that pelvic floor muscle training improved arousal, orgasm, satisfaction, pain, and overall sexual function scores in women. Treatment performed varies based on your individual presentation.
For some, that might mean manual therapy to address tight muscles or improve scar tissue mobility. For others, this may mean targeted movement to improve blood flow and mobility in any impacted nerves. Others may require breath work, nervous system regulation strategies, and progressive lifestyle changes.
Pelvic floor PT isn't a replacement for addressing psychological contributors, medication side effects, or relationship dynamics. Finding the right medical doctor, sex therapist, or couples therapist is often also necessary.
You don’t have to accept this as your normal
Addressing anorgasmia can feel overwhelming. Because it's rarely caused by one thing, knowing where to even start can feel daunting.
But deciding to start somewhere is a huge first step. Whether that's booking an appointment with a pelvic floor PT, reaching out to a sex therapist, or having an honest conversation with your OB/GYN about medication side effects, these are all great places to begin. You don't have to tackle everything at once. Addressing one contributing factor at a time is a fantastic approach.
If you're wondering whether your pelvic floor might be part of the picture, we'd love to help you figure that out. Send us a message or give us a call to get started today.
This post was written by Dr. Rebecca Maidansky, PT, DPT, owner and founder of Lady Bird Physical Therapy. Rebecca is a pelvic floor physical therapist in Austin, TX and founded Lady Bird Physical Therapy in 2019. She is the creator of Birth Preparation and Postpartum Planning, Baby Steps Fitness and the head writer and editor of The Pelvic Press.
Rebecca is a passionate writer and vocal advocate for pelvic health and the importance of improving access to perinatal care. She believes strongly that many common pregnancy pains and postpartum symptoms can be eased or even prevented with basic education and care.
She created this blog to help all birthing people manage common pregnancy pains, prepare for birth and recover postpartum.