Female Orgasmic Disorder

Orgasmic dysfunction, the inability to reach orgasm when desired, may be primary, with the patient never having experienced orgasm, or secondary, with the dysfunction manifesting after previous satisfactory orgasmic functioning. Some women may believe they have primary inhibited-orgasm disorder because, unlike many men, they do not reach orgasm solely with vaginal intercourse. Portrayals of female orgasm in novels and films are often overstated or misleading. A basic description of physical orgasm (i.e., pleasurable sensation in genital area and contractions of vagina, followed by a feeling of physical and psychological relaxation) may facilitate discussion of orgasm. Many women prefer simultaneous vaginal and clitoral stimulation, oral-genital sex, or clitoral stimulation alone to have an orgasm and do not have an orgasmic disorder.

In both primary and secondary orgasmic dysfunction, it is important to ask about past or current experiences of violence, victimization. and abuse. Social factors also affect a woman's experience of orgasm. Women taught negative messages regarding sexuality or with strict religious or cultural prohibitions on sexual attraction and thoughts may experience orgasmic difficulty, even if the specified conditions for sexual behavior (e.g., marriage) have been fulfilled. Women who were born later in the 20th century are more likely to experience orgasm than those born earlier, likely reflecting social changes. Secondary inhibited orgasm can be caused by other medical illnesses and contributing contextual factors.

The clinical history in secondary inhibited orgasm should focus on the patient's perception of this dysfunction: time and circumstances of onset, possible causes, effect on relationship(s), and treatment goals. Physiologic functioning during sexual stimulation, including adequacy of lubrication and ability to sustain states of high arousal, should be explored. Contributing factors such as fatigue, depression, postpartum physical and social changes, preoccupation with other life issues, substance abuse, and other medical illnesses should be considered. Contextual and relationship issues, including lack of tenderness or interest in non-intercourse stimulation by the partner, early ejaculation, problems regarding contraceptive responsibility, lack of privacy, relationship conflicts, and the possibility of abuse, should be discussed. In most cases of orgasmic dysfunction, no specific physical examination or laboratory testing is necessary. As with other sexual dysfunctions, neurologic, gynecologic, or other examination may be suggested by the clinical history.

Treatment of orgasmic dysfunction usually involves increasing knowledge and sexual options for the patient and partner. Masturbation (self-pleasuring) may provide information about sexual responsiveness and preferred stimulations, which can then be transferred to sexual situations with the partner. Partner education regarding clitoral stimulation and adequate pre-intercourse lovemaking (foreplay) can change the focus from intercourse to mutual pleasuring, spontaneity, and sexual satisfaction. Referral for more in-depth therapy is indicated if the evaluation reveals significant relationship dysfunction, past abuse, or other severe medical or psychosocial complications.

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