Women complain of three types of orgasm difficulty. Some say that they have never had an orgasm under any circumstances, either by masturbating, or with a partner. We call this Primary Anorgasmia, or Pre-Orgasmia. Women who have had orgasms in the past but can't seem to do it now, with any partner or any situation, have Secondary Anorgasmia. Women who can orgasm in some situations, for example when masturbating, but not in others, for example with intercourse, have Situational Anorgasmia This is a normal state of affairs when the clitoris does not receive the stimulation it needs from the partner's pelvis.

The orgasm comes from the clitoris, either by pressure from the partner's pelvis or from the pulling of the skin over the clitoris during intercourse. If the pelvis doesn't fit, or if the clitoris is too far away from the vagina, then orgasm during intercourse is a physical impossibility.

If you have anorgasmia because you are not aroused enough, therapy will focus on increasing enjoyment and stimulation. If, however, you are anxious about orgasm - perhaps you have a fear of failure that inhibits the result, or you fear loss of control, then therapy will help you work on this fear in a systematic, safe and gradual way. Your work will be carried out as homework, and you will check your progress with your therapist.

There may be other reasons for changes in orgasmic ability, and a therapist could help you decide what they might be and what you need to do to improve things. Sometimes there is a medical reason and that would need help from a doctor.