Despite what you see in the movies, orgasm is no simple, sure thing. This pleasurable peak is actually a complex reaction to many physical, emotional and psychological factors. If you're experiencing trouble in any of these areas, it can affect your ability to orgasm.

Physical causes

A wide range of illnesses, physical changes and medications can interfere with orgasm:

  • Medical diseases. Any illness can affect this part of the human sexual response cycle, including diabetes and neurological diseases, such as multiple sclerosis.
  • Gynecologic issues. Orgasm may be affected by gynecologic surgeries, such as hysterectomy or cancer surgeries. In addition, lack of orgasm often goes hand in hand with other sexual concerns, such as uncomfortable or painful intercourse.
  • Medications. Many prescription and over-the-counter medications can interfere with orgasm, including blood pressure medications, antihistamines and antidepressants — particularly selective serotonin reuptake inhibitors (SSRIs).
  • Alcohol and drugs. Too much alcohol can cramp your ability to climax; the same is true of street drugs.
  • The aging process. As you age, normal changes in your anatomy, hormones, neurological system and circulatory system can affect your sexuality. A tapering of estrogen levels during the transition to menopause can decrease sensations in the clitoris, nipples and skin; blood flow to the vagina and clitoris also may be impeded, which can delay or stop orgasm entirely.

Psychological causes

Many psychological factors play a role in your ability to orgasm, including:

  • Mental health problems, such as anxiety or depression
  • Performance anxiety
  • Stress and financial pressures
  • Cultural and religious beliefs
  • Fear of pregnancy or sexually transmitted diseases
  • Embarrassment
  • Guilt about enjoying sexual experiences

Relationship issues

Many couples who are experiencing problems outside of the bedroom will also experience problems in the bedroom. These overarching issues may include:

  • Lack of connection with your partner
  • Unresolved conflicts or fights
  • Poor communication of sexual needs and preferences
  • Infidelity or breach of trust
Feb. 22, 2012

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