In the final phase of lovemaking — after desire and sufficient arousal — a woman often achieves orgasm. But a persistent delay in, or complete absence of, orgasm that causes the woman marked distress has been labeled "female orgasmic disorder" (FOD).

The condition can be primary, meaning that the woman has never reached an orgasm, or secondary — the woman can no longer achieve orgasm.

Primary FOD is the most challenging of all female sexual dissatisfactions to treat, says Jennifer Berman, M.D., a urologist and one of the nation's leading experts on sexual health.

Both primary and secondary FOD can be caused by:

• Emotional trauma or sexual or physical abuse: There is no doubt that women with a history of abuse are at greater risk for all sorts of emotional and physical problems — especially depression and anxiety — that can ruin their sex lives. "Feelings of guilt, shame, anger, fear anxiety, and isolation" are quite common for these women, write the Bermans in their book, For Women Only: A Revolutionary Guide to Overcoming Sexual Dysfunction and Reclaiming Your Sex Life. For some, the feelings manifest in an inability to be present or connected while making love. Other women report being on the verge of orgasm and then hitting a wall.
• Medications and surgery can contribute to FOD: Excessive amounts of alcohol, drugs that reduce blood pressure, the class of antidepressants know as selective serotonin reuptake inhibitors (Prozac, Zoloft, Paxil) and anti-anxiety drugs like Xanax and sedatives such as Halcion can delay or impede orgasm. Severed pelvic nerves as a result of surgery can inhibit the engorgement of the genitals — a precondition for building to a climax.
• Inadequate Sex: You simply can't talk about orgasm without mentioning sexual techniques. Making love is not something we are born knowing; we have to learn how to give and receive sexual stimulation and satisfaction. Due to a variety of reasons — cultural, religious and personal — some women are uncomfortable discussing and exploring the sexual techniques that might bring on or intensify an orgasm.
• Pelvic floor prolapse: This condition occurs with the loosening of the muscles that support internal pelvic organs. Prolapse can result from childbirth, aging, surgery and spinal cord injury. Women suffering from prolapse often experience an urge to urinate and complain of pressure in the vagina or rectum, report the Bermans.

Overcoming Female Orgasmic Disorder
We are conditioned to believe in sex = intercourse = orgasm. Such high-pressure expectation alone can prevent orgasm from occurring. Furthermore, as the Bermans frequently acknowledge, there is much more to sex than orgasm.