Inhibited
sexual excitement; Sex - orgasmic dysfunction; Anorgasmia
Information
Orgasmic dysfunction is an inhibition of the orgasmic phase of the sexual
response cycle. The condition is referred to as primary when the female has never
experienced orgasm through any means of stimulation. The problem is called secondary
if the woman has attained orgasm in the past but is currently nonorgasmic.
CAUSES,
INCIDENCE, AND RISK FACTORS
Primary
orgasmic dysfunction, wherein the woman has never experienced an orgasm, appears
to characterize about 10% to 15% of women. Surveys generally suggest that somewhere
between 33% to 50% of women experience orgasm infrequently and are dissatisfied
with how often they reach orgasm.
Performance
anxiety is believed to be the most common cause of orgasm problems, and 90% or
more of orgasm problems appear to be psychological in nature.
Some
drugs may sedate and impair orgasmic responsiveness, including alcohol. SSRI antidepressants
(fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), etc.) are a very
common cause of lack of orgasm, delayed orgasm, or unsatisfying orgasm in both
women and men.
Infrequently,
medical conditions that affect the nerve supply to the pelvis (such as multiple
sclerosis, diabetic neuropathy, and spinal cord injury), hormonal disorders, and
chronic illnesses that affect general sexual interest and health may be factors.
Negative
attitudes toward sex related to childhood experiences may inhibit responsiveness,
as may unresolved feelings associated with experiences of sexual abuse or rape.
In
situations where the woman used to reach orgasm regularly, but is not reaching
orgasm currently, the problem may be related to marital strife and lack of emotional
closeness, which may also cause low sexual desire.
Boredom
and monotony in sexual activity may also contribute to secondary anorgasmia. Frequently,
women are too shy or too embarrassed to ask for the kind of stimulation (and the
timing of stimulation) that works best for them and this, too, can lead to this
condition.
PREVENTION
Education
about sexual stimulation and response, and healthy attitudes toward sex tend to
minimize problems. The principle of taking responsibility for one's own sexual
pleasure is also vitally important.
Couples
who realize that they must verbally and nonverbally guide their partner in providing
them with the stimulation that feels best will undoubtedly experience this problem
less frequently.
It
is also important to realize that one cannot will a sexual response, and the harder
a woman focuses on willing an orgasm to happen, the more elusive the achievement
of orgasm may become.
SYMPTOMS
inability
to reach orgasm in general or with certain forms of sexual stimulation SIGNS
AND TESTS
A
physical examination is almost always normal. If the onset of the problem coincided
with starting a medication, this should be discussed with the prescribing physician.
Interviewing of the couple by a qualified specialist in sex therapy is most likely
to elicit useful information about the causes.
TREATMENT
Treatment
through education about the principles cited above has been found to be helpful.
In the treatment of primary anorgasmia, the initial objective is to be able to
obtain an orgasm under any circumstances.
Most
women require clitoral stimulation to reach an orgasm. Incorporating this into
sexual activity may be all that is necessary. If orgasm difficulties persist,
individual teaching of self masturbation when the partner is not present (to exert
an inhibiting influence) can be helpful in helping the woman understand what she
requires for excitation.
This
may then be followed by a series of couple excercises that minimize performance
anxiety and pressure, and maximize communication, increasingly varied and more
effective stimulation, and playfulness. Gradually, these assignments make it possible
for the woman to achieve orgasm with her partner.
Similar
task assignments are usually part of the therapy for the woman with secondary
or situational anorgasmia, but masturbation has not generally been found to be
helpful as a treatment component with these problems.
In
secondary dysfunction, relationship difficulties sometimes play a role, and thus
treatment may also sometimes need to include communication training and relationship
enhancement work.
It
is also important in treatment to ascertain that the problem is only one of anorgasmia,
and that there is not also a coexisting problem with inhibited sexual desire.
Sometimes hypnosis may also assist in increasing concentration, exploring and
overcoming subconscious conflicts, and minimizing performance anxiety. Women's
therapy groups focused exclusively on this problem have also been found to have
some effectiveness.
EXPECTATIONS
(PROGNOSIS)
Success
rates when orgasmic dysfunction is treated by specialists in sex therapy usually
are in the range of 65% to 85%. In primary orgasmic dysfunction, treatment is
usually successful in 75% to 90% of cases.
A
positive prognosis (probable outcome) is usually associated with being younger,
emotionally healthy, and having a loving, affectionate relationship with a partner.
COMPLICATIONS
When
enjoyment does not accompany sex, it can become a chore rather than a mutually
satisfying, playful, and intimate experience. When anorgasmia persists, sexual
desire usually declines, sexual frequency wanes, and this may create resentments
and conflicts in the relationship.
Last
Reviewed: 9/9/2002 by Angela Smyth, M.D., Department of Psychiatry, University
of Chicago, Chicago, IL. Review provided by VeriMed Healthcare Network.
