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 for men is erectile dysfunction, premature ejaculation, or delayed ejaculation.
As cataloged by the DSM-5, female orgasmic disorder is characterized by difficulty experiencing orgasm and/or markedly reduced intensity of orgasmic sensations. Women show wide variability in the type or intensity of stimulation that elicits orgasm. Similarly, subjective descriptions of orgasm are varied, suggesting that it is experienced in different ways.
For a woman to have a diagnosis of female orgasmic disorder, clinically significant distress must accompany the symptoms. If interpersonal or significant contextual factors, such as severe relationship distress, intimate partner violence, or other significant stressors, are present, then a diagnosis of female orgasmic disorder would not be made.
Many women require clitoral stimulation to reach orgasm, and a relatively small number of women report that they always experience orgasm during intercourse. It's also important to consider whether orgasmic difficulties are the result of inadequate sexual stimulation and not related to female orgasmic disorder.
Signs and symptoms as cataloged by the DSM-5:
Presence of either of the following symptoms and experienced on almost all or all occasions (approximately 75 percent to 100 percent) of sexual activity:
- Marked delay in, marked infrequency of, or absence of orgasm
- Markedly reduced intensity of orgasmic sensations
The symptoms have persisted for a minimum duration of approximately 6 months.
The symptoms cause clinically significant distress in the individual.
The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress (partner violence) or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition.
Development and course as cataloged by the DSM-5:
Lifelong female orgasmic disorder indicates that orgasmic difficulties have always been present, whereas the acquired subtype would be assigned if the woman's orgasmic difficulties developed after a period of normal functioning.
A woman's first experience of orgasm can occur any time from prepuberty to well into adulthood. Women show a more variable pattern in age at first orgasm than do men, and women's reports of having had orgasms increase with age. Many women learn to experience orgasm as they explore a wide variety of stimulation and acquire more knowledge about their bodies. Women's rates of orgasm consistency (defined as "usually or always" experiencing orgasm) are higher during masturbation than during sexual activity with a partner.
To treat orgasmic dysfunction, the underlying medical condition, medication, or mood disorder needs evaluation and treatment. 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) co-occur, these need to be addressed as part of the treatment plan.
Relationship difficulties sometimes play a role, so treatment may sometimes need to include communication training and relationship enhancement work. A series of 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.
Data on success rates in sex therapy indicates that these interventions are helpful in 65 to 85 percent of cases. 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.