When the Climax Just Won’t Come: Understanding Orgasm Challenges

“Stress, shame, and scripts can steal your climax—compassion brings it back.” --Marla Renee Stewart

bunch of different medication pills

Let’s talk about it: orgasms can be elusive. Whether it’s a slow or dull fade, a total no-show, or that frustrating “I was almost there but lost it” moment, orgasm challenges are way more common than people think. But most folks don’t talk about it—especially not the real root causes behind orgasm difficulties.

So today, let’s unpack the layered reality of orgasm challenges: the medications, the stressors (internal and external), and the quiet shame that can keep folks from the pleasure they deserve.

Medications That Might Be Blocking Your Bliss

Your body might be turned on, but your brain might be getting in the way—literally.

Here are some common medications that are known to inhibit orgasm or reduce sexual response (meaning that you have a dull or uneventful orgasm):

1. Antidepressants (SSRIs and SNRIs)

These are big culprits. Medications like fluoxetine (Prozac), sertraline (Zoloft), or venlafaxine (Effexor) can decrease libido and delay or prevent orgasm. Some people say they can feel everything leading up to it—but the release never comes. This can be very frustrating, but these meds are all too common with a lot of my clients and the impact that it has on your orgasms.

2. Antihypertensives (Blood Pressure Meds)

Beta-blockers and diuretics may interfere with arousal and orgasm. They can reduce blood flow, which impacts sensation and climax, especially for those with penises. Having erectile issues is not fun and because the blood flow is reduced, it means that it's reduced everywhere on the body, including those with penises.

3. Antipsychotics

These can raise prolactin levels in the body, a hormone that reduces libido and makes orgasm less likely. This can be very frustrating when you are receiving pleasure, but can't get all the way to your climax.

4. Hormonal Medications (Including Birth Control)

Certain hormonal birth control methods can affect estrogen and testosterone levels, both of which play a role in sexual arousal and orgasmic potential. Always ask your provider about the side effects of the type of birth control that you are using because it could really throw your body off its game.

5. Opioids & Some Muscle Relaxers

These medications slow down your nervous system and can dull not only pain but also pleasure pathways. This means that these meds can dull your orgasm, which can make a big impact on you, especially if you have experienced really vibrant orgasms.

👀 If you’re struggling with orgasm, a check-in with your prescribing provider is a great first step. You might be able to switch medications or add strategies to support your pleasure physiology.

Check out this website if you're using different meds to ensure that you are not blocking those pleasure pathways.

External Stressors That Block Your Body’s Yes

Stress is the ultimate buzzkill. Your body can't go into "pleasure mode" if it’s still stuck in "survival mode." That’s nervous system basics—when cortisol is high, desire and orgasm can flatline. In other words, the more stressed you are, the less likely an orgasm is going to occur.

Here are some external stressors that may be standing in your way:

• Job or financial anxiety: It's hard to surrender into sensation when you're worried about rent, bills, or deadlines. A lot of us are worried about money these days, so it's super important to find the financial resources to eliminate this particular anxiety.

• Family pressures or caregiving: Especially for femmes and parents, caregiving responsibilities can drain energy needed for sexual engagement. If you're constantly worried about your parents or children and taking care of them, these things can drain you, leaving no sexual energy for yourself or for your lover.

• Lack of privacy or physical space: You’re not imagining it—being constantly interrupted or in shared spaces makes it harder to relax. The more you can be alone with only your lover, the better. What I've found with my clients is that when they eliminate the extra people in the house (parents, grandparents, kids, family members, etc.), they find that their sex life improves dramatically.

• Relationship tension: Unspoken resentment, lack of trust, or miscommunication can create emotional distance that blocks arousal. If you can't resolve your relationship issues, they fester and it turns into a downward spiral that you can't get out of. This is the last thing that you want to occur.

• Cultural or religious shame: Early messages around sex being “dirty” or “bad” can unconsciously inhibit your ability to fully let go. Unlearning religious trauma or sexual scripts that don't serve you, can you keep your orgasm at bay.

Internal Stressors: The Mind Gets in the Way

Even in the most relaxed environment, sometimes the internal chatter takes over. Your brain is constantly going and then it won't be able to make the steps to orgasm.

These are some of the common internal stressors that affect orgasm:

• Performance anxiety: Worrying about how you look, smell, taste, or whether you're “doing it right.” This can keep you down and take you away from fully enjoying the experience.

• Hyper-focus on orgasm: Ironically, the pressure to orgasm often prevents orgasm. If climax is the goal, you're likely skipping over the pleasure journey that makes it possible. Don't get too focused on the orgasm and focus on the pleasure steps instead that can possibly get you there to get the full intention behind your experience.

• Past trauma: Sexual or non-sexual trauma can cause the body to disassociate or freeze—orgasm requires presence, safety, and security. If you are feeling these things, the more likely you are to have an orgasm.

• Low self-esteem or body dysmorphia: Disconnection from your body makes it hard to tune into sensation or stay aroused. Finding your gender euphoria and acceptance with your body can really make your sex life more vibrant and robust.

When your brain is in “spectator mode” instead of “embodied mode,” it’s like trying to dance while narrating your every move—it just doesn’t flow. It's always important to be more present in your body and fully embrace all the pleasurable feelings you are experiencing.

Orgasm Is a Whole-Body, Whole-Life Experience

If you’re experiencing orgasm challenges, you’re not broken—you’re likely carrying more than your nervous system can process. And believe me, it happens to all of us at some point in our life. The goal is to ensure that you minimize it happening too often.

Here’s what you can try:

• Practice sensual mindfulness (even outside of sex): Feel your sheets, the texture of your food, the sun on your skin. Tune into all your senses and start to take your time with the world around you.

• Take orgasm off the pedestal: Focus on pleasure, not pressure. Think about how you'll get pleasure in all the steps on the journey.

• Explore different Seduction Learning Styles©: Some folks need to hear, some need to see, some need to touch to get turned on. Tune in to which one is going to be the best for you and your lover(s).

• Try outercourse instead of penetration: Sometimes changing the sexual menu opens up new pathways to climax. Getting out of your regular sexual routine and engaging in more outercourse can help you reflect on different pathways to your personal pleasure.

• Experiment with fantasy or erotica: Engaging your imagination can help override self-consciousness. When your mind is on the erotic and you are engaging in the stories of your mind, this can sidetrack you so that you can engage in your own pleasure.

• Use breath, sound, and movement: These are free tools that ground you in your body and amplify pleasure. Tap into your erotic breathwork to feel more present in your body, play your favorite music, and even dancing can get those happy hormones going for you.

And if nothing’s helping, working with a sex-positive therapist or coach can open doors you didn’t know existed.

Final Thought

Orgasm isn’t a prize—it’s a process. And when we let go of shame, stigma, and the stressors, and start listening to the wisdom of our bodies, pleasure can return with full force. The goal isn't just orgasm—it's liberation of the mind and body.

Cheers to your sexual success!