Orgasmic dysfunction is an inhibition of the orgasmic phase of the sexual response cycle. A woman or man may respectively be diagnosed with Female Orgasmic Disorder or Male Orgasmic Disorder though for men it is less common. When men experience difficulty in achieving sexual climax, the cause is usually medical, drug or alcohol-related though these factors can contribute women’s difficulties achieving sexual climax as well. For women, 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. For men, the disorder might present itself as an inability to reach orgasm during sexual intercourse or it might be seen as ejaculation only after prolonged and intense non-intercourse stimulation.
An inability to reach orgasm in general or with certain forms of sexual stimulation.
Some drugs may sedate and impair orgasmic responsiveness, including alcohol. Infrequently, medical conditions that affect the nerve supply to the pelvis (such as multiple sclerosis, diabetic neuropathy, and spinal cord injury), hormone disorders, and chronic illnesses that affect general sexual interest and health may be factors. Negative attitudes toward sex in childhood may inhibit responsiveness, as may experiences of sexual abuse or rape. 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.
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 psychogenic (nonorganic) in nature.
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 will become.
A physical examination is almost always normal. If the onset of the problem coincided with beginning to use 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 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, graduated assignments for masturbation when the partner is not present (to exert an inhibiting influence) usually result in success. This may then be followed by a series of couple assignments 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 person to achieve orgasm with their partner.
Similar task assignments are usually part of the therapy of the woman with secondary or situational anorgasmia, but masturbation has not generally been found to be helpful as a treatment with these problems. In secondary dysfunction, marital 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.
Treatment may also 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. Women’s therapy groups have also been found to have some effectiveness.
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.
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 often creates resentment and conflict in the relationship.
Dr. Gnap is a family practice physician and behavioral medicine specialist in suburban Chicago. Dr. Gnap developed the Inner Control™ Program in 1970 and has worked with thousands of people to improve and correct medical, emotional, behavioral and learning problems including performance. He started the Inner Control program because so many patients asked, “what more can be done along with traditional treatment methods?”