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.