Vilified for what they do and what they can’t do, women have been targeted without reason. Female sexual arousal has been a problematic issue for women, a matter of shame and inadequacy, and included a lot of name-calling. Because more than half the women in one survey indicated an inability to orgasm, we know it’s not uncommon.

About 10% to 15% of women have never had an orgasm. Surveys suggest that up to one-half of women are not satisfied with how often they reach orgasm. Spare me Jerry Hall’s comments on this.

Sex and sexuality is a topic that can bring fame and fortune (remember those infamous sex tapes of Kimmy?), but not all researchers were clear about their research. Kinsey, a biologist, and an expert on insects, touted himself as an expert on male sexuality. Freud made specific types of female orgasms acceptable and others not. What was he thinking?

To many, Kinsey’s personal life was quite shocking, but I’ll leave that to your further exploration of the subject. Masters & Johnson studied human physiologic sexual responses extensively. But there’s more to response than the apparent physiologic response and more reasons for the inability to orgasm in women.

The Wonder Pill

The golden fleece for any pharmaceutical company is the equivalent of female Viagra. One company claimed to have developed a women’s pill that would lead to sexual fulfillment and satisfaction for all — or almost all.

The product (originally developed to treat depression) had a name change (Addyi), got an impressive boost from marketing efforts, and was renamed as addressing a medical condition, low female libido. Its original pharmaceutical firm didn’t do well with it as an antidepressant, so the owner sold it to the Addyi folks.

The new owners looked into off-label adoptions to see if it could be marketed for some other disorder. Presto, they found some women taking the drug were experiencing an increase in sex drive. But not so fast. What kind of increase?

Not a significant change in orgasms, but some women had an orgasm once a month. We don’t know how many instances of sexual intimacy they had during that month, but I would suspect it might have been more than once a month. I have known some women who enjoy sexual intimacy with their partners five times a week. How many orgasms did they have in a month?

But not all couples are capable of such activity. A psychology professor once told me he hadn’t had sex with his wife for 12 years, and he was only in his early 60s.

Before I forge ahead and explore a few reasons a woman may experience anorgasmia or lack of libido, let’s consider the original use for Addyi; relief from depression. Depression includes lack of motivation, lack of interest, lack of energy, loss of libido, and many other deficiencies. Anxiety usually accompanies it, too.

Relieving a woman from some of these symptoms might have enabled her to experience her sexuality again—no miracle drug here like Viagra. Female orgasms still hold a few mysteries about how they work.

The company (Sprout) sold Addyi to a more prominent firm for $1B. The new buyer experienced it as a failed purchase with only about $3M in sales in the entire year after the purchase and unloaded it onto former investors.

The Many Causes

Causes of female lack of libido or sexual dysfunction are varied and have multiple reasons. A pill isn’t the answer. The causes of female lack of libido or anorgasmia may include (according to The Cleveland Clinic):

Physical causes: Many physical and/or medical conditions can cause problems with sexual function. These conditions include diabetes, heart, and vascular (blood vessel) disease, neurological disorders, hormonal imbalances, chronic diseases such as kidney or liver failure, and alcoholism and drug abuse. In addition, the side effects of some medications, including some antidepressant drugs, can affect sexual function.

Psychological causes: These include work-related stress and anxiety, concern about sexual performance, marital or relationship problems, depression, feelings of guilt, concerns about body image and the effects of a past sexual trauma.

In addition to the above causes, one cause that is missing in most listings is the effects of hysterectomy, which may impact delicate nerve connections.

The complaints after a hysterectomy include the loss of libido, decreased frequency of intercourse, decreased sexual responsiveness, difficulty with reaching orgasm, a diminished sensation of the vagina, dyspareunia (painful intercourse), vaginal shortening, and loss of vaginal elasticity and lubrication.

Other researchers have noted that there can be unintentional damage to the fine neural network involved in orgasm or other unresearched changes resulting from the surgery. (CDC) reports that approximately 600,000 hysterectomies are performed in the United States each year. For all those 600K women who thought there was something wrong with them, they may now have a reason for their decreased libido or lack of response.

The lack of a complete physical mapping of the intricacies involved in female sexual response is required. Not realizing there’s more to be learned is an even more significant concern for science.

Science has yet to record and fully understand all the structures in the human body that have remained unknown until the last few decades. The brain is still a significant mystery (with a new drainage system being found). IMHO, the yet-to-be-discovered elusive but fundamental nervous structure of female reproductive anatomy remains to be revealed in its entirety. We now know there is more than one type of orgasm, but the knowledge seems poorly circulated.

And the interplay of structure and chemistry and the psychological involvement are yet to be seen for what it is, too. How many know the presence and purpose of Bartholin’s gland? Sorry, I disagree that sex therapy has it all figured out here. As a result, women are still underserved.

Newer methods of imaging and technology will improve the instruments of discoveries that may amaze us in their simplicity and importance. Until then, we must not be working in lockstep with old beliefs to the detriment of women’s libido and self-esteem. Remediation requires more than blame to be reversed.