Orgasmic Disorder
Orgasmic disorder is the delay in or absence of sexual climax (orgasm) despite sufficiently long and intense sexual stimulation.
The amount and type of stimulation required for orgasm varies greatly from woman to woman. Most women can reach orgasm when the clitoris is stimulated, but only about half of women regularly reach orgasm during sexual intercourse. About 1 of 10 women never reach orgasm. Orgasmic disorder occurs when problems with orgasm are persistent and frequent, interfering with sexual function and causing distress.
Usually, women who have learned how to reach orgasm do not lose that ability unless poor sexual communication, conflict in a relationship, a traumatic experience, or a physical or psychologic disorder intervenes. Physical and psychologic causes are similar to those of sexual arousal disorder. Depression is a common cause.
Orgasmic disorder may result from lovemaking that consistently ends before the woman reaches orgasm. The woman may not reach orgasm because foreplay is inadequate, because one or both partners do not understand how the genital organs function, or because ejaculation is premature. Such lovemaking produces frustration and may result in resentment and occasionally in distaste for anything sexual. Some women who become aroused may not reach orgasm because they fear "letting go," especially during intercourse. This fear may be due to guilt after a pleasurable experience, fear of abandoning oneself to pleasure that depends on the partner, or fear of losing control.
Certain drugs, particularly selective serotonin reuptake inhibitors such as fluoxetine (see Section 7, Chapter 101), may inhibit orgasm.
Orgasmic disorder may be temporary, may occur after years of normal sexual function, or may be lifelong. It may occur all the time or only in certain situations. Most women who have a problem reaching orgasm also have a problem being aroused.
Diagnosis and Treatment
The diagnosis is based on the woman's description of the problem. To identify the cause, a doctor asks the woman about her sexual and medical history, including use of drugs, and performs a physical examination.
If the cause is psychologic, counseling for the woman, usually with her partner, often helps. Psychotherapy for the woman or the couple may be recommended. Physical disorders, if present, are treated.
Other useful measures include sensate focus exercises for couples, information about how the genital organs function, and Kegel exercises.
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