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ORGASMIC DISORDER
Orgasmic disorder is the persistent or recurrent difficulty, delay in, or absence of attaining orgasm after sufficient sexual stimulation and arousal, which causes personal distress.5 This disorder can be classified as primary or secondary. Primary anorgasmia is defined as never having achieved orgasm and can be associated with medical/physical factors or may be the result of emotional trauma or sexual abuse.50 Secondary anorgasmia is likely the result of surgery, physical trauma, medications, or hormonal deficiencies. Unfortunately, orgasmic disorder is a common problem, with 10% of women reporting that they have never experienced orgasm and 50% of women reporting intermittent or situational difficulty achieving orgasm.51 However, some women mistakenly believe that they suffer from true orgasmic disorder when, in fact, the lack of orgasm is subsequent to disorders of desire or arousal. Therefore, treatment of these previously discussed disorders may subsequently alleviate orgasmic dysfunction.
It is important for the healthcare provider to take a detailed history in order to determine whether the patient has never had an orgasm, has experienced one only under certain circumstances, or is simply not satisfied with her current experiences. If the problem is psychologic, education, psychotherapy, and counseling may be useful. If the problem is exacerbated by medications such as SSRIs, tricyclic antidepressants, antihypertensives, or antipsychotic agents, consideration should be given to changing the medication or decreasing the dose. Unfortunately, trauma to nerves associated with pelvic surgery or spinal cord injury or neurologic disorders such as multiple sclerosis can make orgasmic dysfunction difficult or impossible to treat.27
For most women, maximizing stimulation and minimizing inhibition is the key to effective orgasm; however, the amount of stimulation required to achieve orgasm varies from woman to woman.52 The majority of women have the physical capability of achieving orgasm, but may not be able to do so during intercourse. In fact, 1 study showed that 70% of women were not able to achieve orgasm with intercourse, but only 4% were not able to do so with masturbation.53 These women should be encouraged to talk with their partners and to apply direct clitoral stimulation during intercourse. Kegel exercises (alternating contracting and relaxing the pelvic muscles during sexual arousal) may also be useful for some women. Methods used to minimize inhibition include fantasizing or listening to music.52
Ragucci KR, Culhane NS.
Treatment of female sexual dysfunction.
Ann Pharmacother. 2003 Apr;37(4):546-55
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