A consistent finding in the literature has been that only about half of the women experiencing orgasm difficulties also report associated distress. This may suggest that orgasms are less important for women's sexual satisfaction than they are for men. Evidence is provided to suggest that orgasms are important for women's sexual satisfaction. The lack of distress seems related to women's lesser consistency of orgasm during partnered sexual activity and not to orgasms being less important per se. In contrast to current suggestions that inability to orgasm during vaginal intercourse points to psychological immaturity, data are presented that imply that women's orgasm consistency in all forms of partnered sexual activity is associated with sexual autonomy (i.e., the extent to which one feels that one's sexual behaviours are self-determined). This paper ends with a brief overview of organic and psychosexual factors associated with problems with sexual excitation and sexual inhibition and reviews evidence-based treatment of anorgasmia. For orgasm problems that are related to problems with sexual excitation, effective treatments are available. We recommend that more effort is given to studying factors associated with sexual inhibition.