Why Can’t I Orgasm? New Research on Learning to Orgasm

If you have never experienced orgasm yet, this conversation is for you.

For decades, women who had never experienced orgasm were described in the research literature as having primary anorgasmia or primary orgasmic dysfunction. Andersen (1983) defined this group as women who had never experienced orgasm under ordinary sexual circumstances and emphasized that women with primary orgasmic dysfunction were not a homogeneous group. They differed in sexual response, anxiety, arousal, experience, and other characteristics.

That distinction matters because female orgasm difficulty has often been discussed as though it were one problem requiring one general set of solutions.

However, the research suggests something more interesting.

What Has Actually Helped Women Who Had Never Experienced Orgasm?

In her landmark review, Andersen (1983) identified several prominent treatment approaches that had been used with women with primary orgasmic dysfunction, including directed masturbation, sensate focus, systematic desensitization, and hypnosis.

These approaches did not have equal empirical support, but collectively they established something important: women who had never experienced orgasm could, in fact, learn to become orgasmic.

Directed Masturbation: Research on Learning to Orgasm

Directed masturbation became particularly important in the treatment literature.

In their 1997 review of empirically validated treatments for sexual dysfunction, Heiman and Meston concluded that directed masturbation met criteria for an empirically validated treatment for primary orgasmic disorders. They also noted that lifelong, global anorgasmia could be usefully conceptualized as a skill deficit that might respond to structured assignments (Heiman & Meston, 1997).

Rather than simply encouraging a woman to relax, directed masturbation involved progressive learning. Treatments included visual and tactile exploration of the body, increased genital stimulation, and, when desired, eventual vibrator use.

Earlier studies summarized by Heiman and Meston documented women who had never previously experienced orgasm subsequently becoming orgasmic through these structured approaches.

The evidence also suggests that directed masturbation may contribute something beyond general sex therapy. In one comparison, 90% of women receiving directed masturbation plus sensate focus achieved orgasm, compared with 53% receiving sensate focus alone. Coital orgasm was reported by 85% of the combined-treatment group compared with 47% of the sensate-focus-only group (Riley & Riley, 1978, as cited in Heiman & Meston, 1997).

Overall, Heiman and Meston concluded that directed masturbation produced better outcomes than systematic desensitization and could enhance, or be enhanced by, sensate focus.

Therefore, one important message emerges from decades of research:

Never having experienced orgasm does not mean orgasm cannot be learned.

What Does the Brain Learn When a Woman Learns to Orgasm?

This may be where the orgasm literature becomes particularly interesting.

Female orgasm has been defined as a variable, transient peak sensation of intense pleasure that “creates an altered state of consciousness,” usually accompanied by characteristic physiological changes and potentially induced through different forms of stimulation (Meston et al., 2004).

Traditionally, that altered state of consciousness has been described as something orgasm creates.

The Orgasmic Learning framework, developed by Dr. Suzanne Mulvehill, raises another possibility:

For some women who have difficulty reaching orgasm, could the transition into an altered, absorbed, or otherwise orgasm-supportive state need to begin before orgasm becomes accessible?

Within this framework, orgasmic response is conceptualized as potentially state-dependent. In other words, orgasmic access may depend partly on whether a woman can enter an altered, absorbed, or otherwise orgasm-supportive state in which the response becomes more accessible (Mulvehill, in press).

Across the evidence reviewed, seemingly different pathways may converge around a shared therapeutic target: facilitating a transition into an altered, absorbed, or otherwise orgasm-supportive state (Mulvehill, in press).

Such transitions may involve reduced self-monitoring, greater attentional absorption, increased sensory salience, greater interoceptive awareness, reduced inhibition, increased excitation, or combinations of these processes (Mulvehill, in press).

Hypnosis Provides an Important Clue

Hypnosis was already being used historically in the treatment of women with orgasm difficulty. Andersen (1983) identified it among the prominent treatment approaches of the period.

Unlike a treatment focused primarily on genital technique, hypnotic induction directly changes attention, absorption, imagery, and subjective state – without any genital stimulation.

More recent research makes that historical treatment especially interesting. Contemporary hypnotic induction research has demonstrated physiological responses associated with orgasm, including hormonal and pelvic-floor changes, supporting the possibility of a top-down, non-genital pathway to orgasmic response (Pfaus et al., 2025; Mulvehill, in press).

This raises an important question:

If orgasmic response can be generated through hypnotic induction without conventional genital stimulation, what does that tell us about the role of state in orgasmic access?

Cannabis Adds a Newer Piece to the Puzzle

Research on cannabis provides another clue.

Cannabis has been used since ancient times to enhance sexual experiences (Aldrich, 1977). Historical cannabis over the last 50 years described women who initially gained orgasmic access while using cannabis and, in some cases, later became able to orgasm without cannabis. These observations raise the possibility that an orgasm-supportive state may initially facilitate access to orgasm and that, through learning and repetition, the response may later become accessible without reinstating the original state (Goode, 1970; Lewis, 1970)

In a 2024 observational study of cannabis use before partnered sex, women with orgasm difficulty reported significant improvements in orgasm-related outcomes, including greater ease, frequency, and satisfaction with orgasm (Mulvehill & Tishler, 2024).

A subsequent systematic review found that studies examining cannabis use before sexual activity repeatedly reported improvements in female orgasm-related outcomes, including ease, frequency, intensity, quality, satisfaction, and multiorgasmic capacity (Mulvehill & Tishler, 2025).

The potential significance of cannabis may extend beyond genital stimulation itself.

Within the Orgasmic Learning framework, cannabis is conceptualized as a potential state facilitator. Cannabis-associated states may influence sensory salience, cognitive inhibition, attention, affective regulation, bodily awareness, and altered perception (Mulvehill, in press).

From Learning Sexual Stimulation to Learning an Orgasm-Supportive State

Taken together, the research begins to tell a different story about female orgasm difficulty.

Several approaches provide different pieces of the picture:

• Directed masturbation demonstrates that orgasmic response can be learned through structured experience (Heiman & Meston, 1997).
• Sensate focus redirects attention toward sensory experience and away from performance demands (Andersen, 1983; Heiman & Meston, 1997).
• Hypnotic induction offers evidence relevant to the possibility that orgasmic response can be accessed through top-down, absorbed, or altered attentional states (Pfaus et al., 2025).
• Cannabis may provide another state-associated pathway through which orgasmic access becomes easier for some women, although the available evidence remains largely observational (Mulvehill & Tishler, 2024, 2025).

In addition, fantasy and imagery, pelvic-floor training, breath-based practices, tantric practices, and other non-genital pathways provide examples of how orgasmic access may be influenced through learning, sensory processing, attention, and state (Mulvehill, in press).

The pathways are different, and the evidence supporting them varies considerably.

But a possible common denominator is beginning to emerge: state transition.

State Transition: A Different Way to Understand Orgasmic Learning

The Orgasmic Learning framework proposes that learning to orgasm may involve more than learning what stimulation to use.

It may also involve learning how to access the state in which orgasm becomes possible.

Depending on the individual, that state may be altered, absorbed, deeply sensory, imaginal, hypnotic, cannabis-facilitated, somatic, or otherwise orgasm-supportive.

Importantly, this does not mean that one particular state or pathway will work for every woman.

Rather, the framework proposes that multiple pathways may facilitate the regulatory, attentional, sensory, and state-dependent conditions under which orgasmic response becomes accessible (Mulvehill, in press).

This remains a proposed explanatory and treatment framework, not proof that every approach works through the same mechanism.

Nevertheless, it changes the question.

Instead of asking only:

“Why can’t I orgasm?”

Perhaps we should also be asking:

“What does my brain and body need to learn, experience, or access for orgasm to become possible?”

For women who have never experienced orgasm yet, that may be one of the most hopeful questions the research allows us to ask.

References

Aldrich, M. R. (1977). Tantric cannabis use in India. Journal of Psychedelic Drugs, 9(3), 227–233. https://doi.org/10.1080/02791072.1977.10472053 

Andersen, B. L. (1981). A comparison of systematic desensitization and directed masturbation in the treatment of primary orgasmic dysfunction in females. Journal of Consulting and Clinical Psychology, 49(4), 568–570.
https://doi.org/10.1037/0022-006X.49.4.568

Andersen, B. L. (1983). Primary orgasmic dysfunction: Diagnostic considerations and review of treatment. Psychological Bulletin, 93(1), 105–136.
Andersen 1983 – PubMed Central

Goode, E. (1970). The marijuana smokers. Basic Books.

Heiman, J. R., & Meston, C. M. (1997). Empirically validated treatment for sexual dysfunction. Annual Review of Sex Research, 8(1), 148–194.
https://doi.org/10.1080/10532528.1997.10559921 Taylor & Francis Online

Lewis, B. (1970). The sexual power of marijuana. Wyden.

Marchand, E. (2021). Psychological and behavioral treatment of female orgasmic disorder. Sexual Medicine Reviews, 9(2), 194–211.
10.1016/j.sxmr.2020.07.007

Meston, C. M., Levin, R. J., Sipski, M. L., Hull, E. M., & Heiman, J. R. (2004). Women’s orgasm. Annual Review of Sex Research, 15(1), 173–257.
https://doi.org/10.1080/10532528.2004.10559820

Mulvehill, S., & Tishler, J. (2024). Assessment of the effect of cannabis use before partnered sex on women with and without orgasm difficulty. Sexual Medicine, 12(2), qfae023.
https://doi.org/10.1093/sexmed/qfae023

Mulvehill, S., & Tishler, J. (2025). Cannabis for female orgasmic disorder/difficulty: A systematic review. Sexual Medicine, 13(4), qfaf061.
https://doi.org/10.1093/sexmed/qfaf061

Mulvehill, S. (in press). Orgasmic learning as a treatment framework for female orgasmic disorder/difficulty: A review using Perelman’s Sexual Tipping Point® model. Current Sexual Health Reports. 

Pfaus, J. G., Nerenberg, A., Sonshine, M., Kosařová, A., Nováková, M., & Novák, J. (2025). Hypnotic induction of orgasm increases plasma prolactin in women. The Journal of Sexual Medicine, 22(Supplement_1), qdaf068.054. https://doi.org/10.1093/jsxmed/qdaf068.054 

Riley, A. J., & Riley, E. J. (1978). A controlled study to evaluate directed masturbation in the management of primary orgasmic failure in women. The British Journal of Psychiatry, 133(5), 404–409. https://doi.org/10.1192/bjp.133.5.404