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Female Orgasm Difficulty: Treatment and Causes

What is female orgasmic disorder?

Of the several types of sexual dysfunction, difficult orgasm or female orgasmic disorder may be the least favored by women.  Female orgasmic disorder is “persistent or recurrent delay in or absence of orgasm following sexual arousal and adequate sexual stimulation” (Bradford 2021), to the point that it becomes distressful for the patient.

Female orgasmic disorder can be lifelong or acquired at some point later in life.  Some women may notice difficulty with orgasm with any situation whether penile penetration or masturbation.  Other women may be able to achieve orgasm with masturbation but have difficulty only with partnered sex.


Female orgasmic disorder may be caused by psychosocial problems such as psychosocial beliefs concerning a woman’s sexual experience or stress within the relationship with the partner.  A woman’s anatomy may also be a factor in orgasmic disorder. The clitoris is usually a woman’s most sensitive location during sexual arousal.  However, the clitoris is located 2-3 cm from the vaginal opening (Bradford, 2021).  Depending on the size of the clitoris and the covering clitoral hood this location may not be stimulated during vaginal penetration (Bradford, 2021).  Having a smaller clitoris or a larger clitoral hood, or a greater distance (3cm) from the vaginal opening is a normal variation but can be associated with difficult orgasm.  Lastly, certain medications can also be a factor in difficulty with orgasm.


Treatment options may depend on the cause of the orgasmic disorder.  If there are interpersonal conflicts, these should be resolved.  Often the use of improved communication or couples therapy may help to resolve the conflict.  Other psychosocial factors may be treated with sex therapy focusing on education and touch without actual penetration.  Another treatment option is directed masturbation.  Clinical trials have shown that directed masturbation leads to more successful orgasm compared to sex therapy (Bradford, 2021).  If adequate orgasm is not achieved with directed masturbation, cognitive behavioral therapy can be added.

Recent studies have also shown that platelet-rich plasma (PRP) is highly effective in improving orgasm.  PRP is a natural “revolutionary new nonsurgical outpatient treatment that helps improve orgasmic dysfunction by using a woman's own growth factors” (Dawood & Salem, 2018).  The plasma, rich in platelets, is extracted from the blood and injected into a specific area in the anterior vaginal wall (the O-spot) and in the clitoris (Sukgen, et al., 2019).  This treatment improves orgasm in 82% of cases and is effective within 3 weeks (Runels et al., 2014).  Another advantage of PRP is the improvement in urinary incontinence with coughing, sneezing and laughing. (Long, 2021).   In this manner PRP also provides freedom from panty liners.  For more information on PRP for orgasm or incontinence, go to


Bradford, A., (2021). Female orgasmic disorder: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis. UpToDate, 13 May 2021,

Dawood, A. S., & Salem, H. A. (2018). Current clinical applications of platelet-rich plasma in various gynecological disorders: An appraisal of theory and practice. Clinical and experimental reproductive medicine45(2), 67–74.

Sukgen, G., Ellibeş Kaya, A., Karagün, E., & Çalışkan, E. (2019). Platelet-rich plasma administration to the lower anterior vaginal wall to improve female sexuality satisfaction. Turkish journal of obstetrics and gynecology16(4), 228–234.

Long, C. Y., Lin, K. L., Shen, C. R., Ker, C. R., Liu, Y. Y., Loo, Z. X., Hsiao, H. H., & Lee, Y. C. (2021). A pilot study: effectiveness of local injection of autologous platelet-rich plasma in treating women with stress urinary incontinence. Scientific reports11(1), 1584.

Runels, C., Melnick, H., Debourbon, E. & Roy, L. (2014). A Pilot Study of the Effect of Localized Injections of Autologous Platelet Rich Plasma (PRP) for the Treatment of Female Sexual Dysfunction. Journal of Women's Health Care, 3:169.

Kirstie Cunningham, MD, FACOG President, Metro Health and Wellness, LLC

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