Orgasmic Disorder

Orgasmic disorder is the inability to achieve climax during sexual stimulation.

Definition

Orgasmic dysfunction is the inability for an individual to reach orgasm during sexual stimulation. This disturbance must cause marked distress or interpersonal difficulty. This dysfunction is not better accounted for by another psychological condition, the direct physiological effects of a substance or another general medical condition. A person may be diagnosed with Female Orgasmic Disorder or Male Orgasmic Disorder, though it is less common for men. The condition is referred to as primary when the female has never experienced orgasm through any means of stimulation. It is called secondary if the woman has attained orgasm in the past but is currently non-orgasmic.

For men, the disorder might present itself as an inability to reach orgasm during sexual intercourse or as ejaculation only after prolonged intense non-intercourse stimulation.

Symptoms

Inability to reach orgasm in general or with certain forms of sexual stimulation.

Causes

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 secondary anorgasmia. 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.

When men experience difficulty reaching sexual climax, the causes are usually medical, alcohol- or drug-related. These factors can affect a woman's ability to achieve sexual climax as well.

About 10 to 15 percent of women appear to suffer from primary orgasmic dysfunction. Surveys generally suggest that 33 to 50 percent of women experience orgasm infrequently and are dissatisfied. Performance anxiety is believed to be the most common cause of orgasm issues, and 90 percent of orgasm problems appear to be psychogenic (nonorganic).

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 will be to attain.

Treatments

If the onset of the problem coincided with the use of a medication, this should be discussed with the prescribing physician. Interviewing of the couple by a qualified sex therapist is a helpful way to elicit useful information about the situation.

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

Treatment through education about these principles is helpful. In the treatment of primary anorgasmia, the initial objective is to obtain an orgasm under any circumstance. 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 make it possible for a person to achieve orgasm with a partner.

In secondary dysfunction, marital difficulties sometimes play a role, so treatment may sometimes need to include communication training and relationship enhancement work. It is also important to ascertain that the problem is only one of anorgasmia, 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.

Medical problems, new medications, or untreated depression may need evaluation and treatment in order 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.

Complications

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

Sources

  • American Psychiatric Association
  • National Institutes of Health
  • National Library of Medicine
Last reviewed 02/17/2015