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Male and female reproductive systems
Male and female reproductive systems


Orgasmic dysfunction

Definition:

Orgasmic dysfunction is when a woman either cannot reach orgasm, or has trouble reaching orgasm when she is sexually excited.

When sex is not enjoyable, it can become a chore instead of a satisfying, intimate experience for both partners. Sexual desire will often decline, and sex occurs less often. This can create resentment and conflict in the relationship.



Alternative Names:

Inhibited sexual excitement; Sex - orgasmic dysfunction; Anorgasmia



Causes:

About 10 to 15% of women have never had an orgasm. Surveys suggest that up to one-half of women are not satisfied with how often they reach orgasm.

Sexual response involves the mind and body working together in a complex way. Both need to function well for an orgasm to happen.

Many factors can contribute to orgasmic dysfunction. They include:

  • A history of sexual abuse or rape
  • Boredom in sexual activity
  • Certain prescription drugs, including common drugs used to treat depression, such as fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft)
  • Hormonal disorders, hormone changes due to menopause, and chronic illnesses that affect health and sexual interest
  • Fatigue and stress
  • Negative attitudes toward sex (often learned in childhood or adolescence)
  • Shyness or embarrassment about asking for the type of stimulation that works best
  • Medical conditions that cause chronic pelvic pain, such as endometriosis
  • Medical conditions that affect the nerve supply to the pelvis, such as multiple sclerosis, diabetic neuropathy, and spinal cord injury


Symptoms:

The symptom of orgasmic dysfunction is being unable to reach orgasm, taking longer than you want to reach orgasm, or having only unsatisfying orgasms.



Exams and Tests:

A complete medical history and physical examination needs to be done, but results are almost always normal. If the problem began after starting a medication, tell the health care provider who prescribed the drug. A qualified specialist in sex therapy may be helpful.



Treatment:

Important goals when treating problems with orgasms are:

  • A healthy attitude toward sex, and education about sexual stimulation and response
  • Learning to clearly communicate sexual needs and desires, verbally or non-verbally

How to make sex better:

  • Get plenty of rest and eat well. Limit alcohol, drugs, and smoking. Feel your best. This helps with feeling better about sex.
  • Do Kegel exercises. Tighten and relax the pelvic muscles.
  • Focus on other sexual activities, not just intercourse.
  • Use birth control that works for both you and your partner. Discuss this ahead of time so you aren’t worried about an unwanted pregnancy.
  • If other sexual problems , such as lack of interest and pain during intercourse, are happening at the same time, these need to be addressed as part of the treatment plan.

Discuss the following with your health care provider:

  • Medical problems, such as diabetes or multiple sclerosis
  • New medications
  • Menopausal symptoms

The role of taking female hormone supplements in treating orgasmic dysfunction is unproven and the long-term risks remain unclear.

Treatment can involve education and learning to reach orgasm by focusing on pleasurable stimulation, and directed masturbation.

  • Most women require clitoral stimulation to reach an orgasm. Including clitoral stimulation in sexual activity may be all that is necessary.
  • If this does not solve the problem, then teaching the woman to masturbate may help her understand what she needs to become sexually excited.

Treatment may include sexual counseling to learn series of couples exercises to:

  • Learn and practice communication
  • Learn more effective stimulation and playfulness


Outlook (Prognosis):

Women do better when treatment involves learning sexual techniques or a method called desensitization. This treatment gradually works to decrease the response that causes lack of orgasms. Desensitization is helpful for women with significant sexual anxiety.



References:

Biggs WS. Medical human sexuality. In: Rakel RE, ed. Textbook of Family Medicine 8th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 43.

Cowley D, Lentz GM. Emotional aspects of gynecology: depression, anxiety PTSD, eating disorders, substance abuse, "difficult" patients, sexual function, rape intimate partner violence, and grief. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 9.




Review Date: 6/11/2014
Reviewed By: Cynthia D. White, MD, Fellow American College of Obstetricians and Gynecologists, Group Health Cooperative, Bellevue, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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