Orgasmic Disorder

Orgasmic disorder refers to difficulty experiencing orgasm and/or reduced intensity of orgasmic sensations among women.

Definition

Orgasmic disorder, now referred to as female orgasmic disorder, is the difficulty or inability for a woman to reach orgasm during sexual stimulation. This disturbance must cause marked distress or interpersonal difficulty for it to be diagnosed. The diagnosis given to men is not orgasmic disorder but rather erectile dysfunction, premature ejaculation or delayed ejaculation. 

For women with female orgasmic disorder, orgasm is either absent or significantly reduced in intensity on almost all or all occasions of sexual activity. This condition can either be lifelong or acquired, meaning the disturbance began after a period of relatively normal sexual function. The condition can also be generalized, meaning it's not limited to certain types of stimulation, situations or partners, or it can be situational, meaning the difficulty with orgasm only occurs with certain types of stimulation, situations, or partners. 

Women report wide variability in the type or intensity of stimulation that causes orgasm, and orgasms themselves are extremely varied across women and on different occasions by the same woman. For a woman to have a diagnosis of female orgasmic disorder, significant distress must accompany symptoms and must be present for a minimum of six months. It is also important to consider whether the difficulty with reaching orgasm is a result of inadequate sexual stimulation. 

Reported prevalence rates for female orgasmic problems vary from 10 percent to 42 percent, depending on age, culture, duration and severity of symptoms. Only a proportion of women experiencing orgasmic difficulties, however, experience associated distress. Approximately 10 percent of women do not experience orgasm throughout their lifetime. 

Symptoms

Female orgasmic disorder refers to the significant delay in, infrequency of, or absence of orgasm on almost all or all occasions of sexual activity. Additionally, this disorder includes the potential for a significant reduction in the intensity or orgasmic sensations.

For a diagnosis of female orgasmic disorder to apply, the symptoms must be present for a minimum duration of approximately six months and must cause significant distress in the individual. Additionally, this disturbance cannot be better accounted for by another psychological condition, severe relationship distress (such as partner violence), the direct physiological effects of a substance or another general medical condition.

Causes

A woman's first experience of orgasm can occur any time from the prepubertal period to later in adulthood. Many women learn to experience orgasm as they experience a wide variety of stimulation and learn more about their bodies. It is common for a woman to be more likely to experience orgasm during masturbation than during sexual activity with a partner. 

A wide variety of factors can impact a woman's ability to experience orgasm, including anxiety and concerns about pregnancy, relationship problems, physical health, and mental health. Sociocultural factors, such as gender role expectations and religious norms, also influence the experience of orgasm. 

Drugs and alcohol may lessen orgasmic responsiveness. Less commonly, medical conditions that affect the nerve supply to the pelvis (spinal cord injury, multiple sclerosis and diabetic neuropathy), hormone disorders and chronic illnesses that affect general sexual interest and health may be factors. Negative attitudes toward sex in childhood may affect a person's responsiveness, as may experiences of sexual abuse or rape. The problem may be related to marital difficulties and low sexual desire. Boredom and monotony in sexual activity may serve as contributing factors to orgasmic disorder. Other factors can be shyness or embarrassment about asking for whatever type of stimulation works best as well as strife or lack of emotional closeness within the relationship.

Treatments

Medical problems, new medications, or untreated depression may need evaluation and treatment for orgasmic dysfunction to improve. The role of hormone supplementation in treating orgasmic dysfunction is controversial and the long-term risks remain unclear. If other sexual dysfunctions (such as lack of interest and pain during intercourse) are happening at the same time, these need to be addressed as part of the treatment plan. Interviewing of the couple by a qualified sex therapist is a helpful way to elicit useful information about the situation.

Marital difficulties sometimes play a role, so treatment may sometimes need to include communication training and relationship enhancement work. A series of couple exercises to practice communication, more effective stimulation, and playfulness can help. 

Incorporating clitoral stimulation into sexual activity may be all that is necessary for a woman to achieve orgasm. Masturbation when the partner is not present (which could cause inhibition) usually results in success. Working with a partner to decrease performance anxiety and maximize communication can make it possible for a woman to achieve orgasm with a partner. 

It is also important to ascertain that the problem is only one of orgasmic disorder, and not a coexisting problem with inhibited sexual desire. Sometimes hypnosis and women's therapy groups may help with increasing concentration, exploring and overcoming subconscious conflicts, and minimizing performance anxiety.

Success rates in sex therapy tend to range from 65 to 85 percent. In primary orgasmic dysfunction, treatment is usually successful in 75 to 90 percent of cases. A positive prognosis is usually associated with being younger, emotionally healthy and having a loving, affectionate relationship with a partner.

Complications

When sex is not enjoyable, it can become a chore rather than a mutually satisfying, playful and intimate experience. When orgasmic disorder persists, sexual desire usually declines and frequency of intercourse wanes, often causing resentment and conflict in the relationship.

Prevention

Healthy attitudes toward sex as well as education about sexual stimulation and response tend to minimize problems. The principle of taking responsibility for one's own sexual pleasure is also vitally important. Couples who understand that they must verbally and nonverbally guide their partner experience this problem less frequently. It is also important to realize that one cannot force a sexual response, and the harder a woman focuses on trying to have an orgasm, the more difficult it may be to attain.

References

  • American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
  • National Institutes of Health (NIH), U.S. National Library of Medicine

Last reviewed 03/30/2017