Anorgasmia is a common problem that affects between 24 percent and 37 percent of women.¹ It can be divided into primary orgasmic disorder, in which a woman has never experienced orgasm through any means of sexual stimulation, and secondary orgasmic disorder, in which a woman is anorgasmic after a period of time when she was orgasmic. The latter can be classified as situational (e.g., when a woman can reach orgasm via masturbation but not with a partner) or generalized.

Diagnostic Criteria

The second American Foundation for Urologic Disease panel defines female sexual orgasmic disorder as follows: “Despite the self-report of high sexual arousal/excitement, there is either lack of orgasm, markedly diminished intensity of orgasmic sensations, or marked delay of orgasm from any kind of stimulation.”² The panelists felt that previous definitions of orgasmic disorder were lacking because they often ignored the criterion of “high” or “adequate” sexual arousal. This definition clarifies that the patient has no problem becoming aroused. As before, the lack of ability to achieve orgasm is a disorder only if the patient is distressed by the problem.

With aging, the duration of orgasm may be shorter and less intense than when a woman was younger.³ There is no evidence that problems experiencing orgasm increase with age as long as arousal is sufficient.⁴

Difficulties with orgasm have been associated with interpersonal and marital distress, psychological distress, psychiatric disorders, and use of antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs).^5,6 Other sexual disorders, such as sexual arousal disorders and sexual pain disorders, also may preclude sufficient arousal and orgasm.

TABLE 12. Treatment of Orgasmic Disorders

Encourage/educate about appropriate arousal techniques and duration If SSRIs are associated with problem, consider alternative medications Treat dyspareunia Counsel or refer for: Step-wise masturbation therapy Sensate focus Systematic desensitization Sex therapy Relationship therapy

Treating and Managing Orgasmic Disorders

Management of orgasmic disorders focuses primarily on teaching women and their partners about appropriate arousal techniques (see Table 12). For many women, sociocultural influences may lead to inhibitions about receiving pleasurable sexual stimuli, which can be overcome with education about how women become aroused, the amount of time needed for arousal, and the types of stimulation commonly needed for orgasm to occur. Most women are unable to experience orgasm from intercourse alone and require extended clitoral stimulation.^7,8

Women who are suffering from sexual side effects from SSRIs may benefit from a change to a medication such as bupropion.⁵ All women can be helped by pelvic-floor muscle exercises such as Kegels. Older women can be helped by the use of vaginal weights, pelvic-floor physical therapy, vaginal lubricants or topical estrogen therapy, and treatments for dyspareunia, as appropriate, to make intercourse more pleasurable.⁵

References

1. Rosen RC. Prevalence and risk factors of sexual dysfunction in men and women. Curr Psychiatry Rep 2000;2:189-195.

2. Basson R, Leiblum S, Brotto L, et al. Definitions of women’s sexual dysfunction reconsidered: advocating expansion and revision. J Psychosom Obstet Gynecol 2003;24:221-229.

3. Bachmann GA, Leiblum SR. The impact of hormones on menopausal sexuality: a literature review. Menopause 2004;11:120-130.

4. Avis NE, Stellato R, Crawford S, et al. Is there an association between menopause status and sexual functioning? Menopause 2000;7:297-309.

5. Anastasiadis AG, Salomon L, Ghafar MA, et al. Female sexual dysfunction: state of the art. Curr Urol Rep 2002;3:484-491.

6. Walton B, Thorton T. Female sexual dysfunction. Curr Wom Health Rep 2003;3:319-326.

7. Whipple B, Brash-McGreer K. Management of female sexual dysfunction. In: Sipski ML, Alexander CJ, eds. Sexual Function in People with Disability and Chronic Illness. A Health Professional’s Guide. Gaithersburg, MD: Aspen Publishers, Inc.; 1997.

8. Phillips NA. Female sexual dysfunction: Evaluation and treatment. Am Fam Physician 2000;62:127-136, 141-142.