Orgasmic disorder is lack of or delay in sexual climax (orgasm) or orgasm that is infrequent or much less intense even though sexual stimulation is sufficient and the woman is sexually aroused mentally and emotionally.
Some women do not have or have trouble having an orgasm.
Women may not have an orgasm if there is consistently insufficient foreplay, early ejaculation by the partner, or poor communication about sexual activity preferences.
Women with orgasmic disorder may have other types of sexual problems, such as pain during sex and involuntary contraction of the muscles around the opening of the vagina when entry into the vagina is attempted.
Doctors diagnose orgasmic disorder based on the woman's description of the problem and specific criteria.
Women are encouraged to try self-stimulation (masturbation), and for some women, psychological therapies are helpful.
(See also Overview of Sexual Dysfunction in Women.)
The amount and type of stimulation required for orgasm varies greatly from woman to woman. Most women can reach orgasm when the clitoris is stimulated, but fewer than half of women regularly reach orgasm during vaginal intercourse. About 1 of 10 women never reaches orgasm, but some of them nonetheless consider sexual activity to be satisfactory.
Many women with orgasmic disorder cannot have an orgasm under any circumstances, even when they masturbate and when they are highly aroused. However, if a women does not have an orgasm because she is not sufficiently aroused, the problem is considered an arousal disorder, not an orgasmic disorder. Inability to have an orgasm is considered a disorder only when the lack of orgasm distresses the woman.
Causes of Orgasmic Disorder in Women
Situational and psychological factors can contribute to orgasmic disorder, such as
Contextual factors, those specific to a woman’s current situation (for example, consistently insufficient foreplay, early ejaculation by the partner, poor communication about sexual preferences)
Psychological factors (such as anxiety, stress, lack of trust in a partner)
Cultural factors (for example, lack of recognition of or attention paid to female sexual pleasure)
In one or both partners, lack of knowledge about how sexual function
Physical disorders can also contribute to orgasmic disorder. They include nervous system damage (as results from diabetes, spinal cord injuries, lichen sclerosus, or multiple sclerosis), and abnormalities in genital organs.
Certain medications, particularly selective serotonin reuptake inhibitors (SSRIs, a type of antidepressant), may specifically inhibit orgasm.
Symptoms of Orgasmic Disorder in Women
Some women with orgasmic disorder have never been able to have an orgasm. Others have had orgasms but no longer do or have difficulty having an orgasm.
Other women with this disorder have orgasms, but the orgasms are infrequent or much less intense even though sexual stimulation is sufficient and the women are sexually aroused mentally and emotionally.
Women with orgasmic disorder may have other types of sexual problems, such as pain during sexual intercourse (dyspareunia) and involuntary contraction of the muscles around the opening of the vagina when entry into the vagina is attempted (levator ani syndrome, previously called vaginismus).
Anxiety disorders and depression are common in women with orgasmic disorder.
Diagnosis of Orgasmic Disorder in Women
A doctor's evaluation based on specific criteria
Doctors interview the woman and, sometimes, her partner. They ask the woman to describe the problem in her own words.
Doctors diagnose orgasmic disorder based the following criteria:
Orgasm that is delayed, infrequent, absent, or much less intense after normal sexual arousal during all or almost all sexual encounters
Distress or interpersonal problems due to problems with orgasm
No other disorder or substance that accounts for the problems with orgasm dysfunction
Symptoms must have been present for at least 6 months.
Treatment of Orgasmic Disorder in Women
Self-stimulation (masturbation)
Psychological therapies or sex therapy
Doctors may encourage women to learn what type of touch is pleasurable and arousing by trying self-stimulation (masturbation).
Doctors may also suggest increasing the type and intensity of other stimuli, including fantasy, role playing, videos, pictures, written materials, and sounds.
Other techniques that may help include relaxation techniques and sensate focus exercises. In sensate focus exercises, partners take turns touching each other in pleasurable ways. Couples may try using more or different stimuli, such as a vibrator, fantasy, or erotic videos. A vibrator may be especially useful when there is nerve damage.
Learning more about the woman's anatomy and ways to arouse her may help. For some women, incorporating stimulation of the clitoris may be all that is needed.
Psychological therapies may help women identify and manage anxiety about sexual performance and issues of trusting a partner. These therapies include psychotherapy, cognitive-behavior therapy, mindfulness-based cognitive therapy, and sex therapy.
Psychotherapy and cognitive-behavior therapy may be useful for women with a history of sexual trauma or who have psychological disorders. These therapies may help women identify and manage fear of vulnerability and issues of trust with a partner.
Practicing mindfulness (focusing on what is happening in the moment) can help women pay attention to sexual sensations, without making judgments about or monitoring what is happening.
Sex therapy often helps women and their partner deal with issues that affect their sexual life, such as specific sexual problems and their relationship with their partner.
If a selective serotonin reuptake inhibitors
There is no recommended medication for female orgasmic disorder.
