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Female arousal and orgasmic disorders
Female arousal and orgasmic disorders are characterized by an inability or persistent delay to achieve orgasm following a phase of normal sexual excitement. They may be classified as (1) primary anorgasmia, when a female has never experienced sexual arousal or orgasm; (2) secondary anorgasmia, when some physical, mental, or situational condition has inhibited or obliterated a female’s previously normal sexual function; and (3) situational anorgasmia, when a female is only able to achieve orgasm in certain situations. For temporary or mild disorders that result from misinformation or situational stress, the prognosis is good; however, for disorders that result from intense anxiety, chronically discordant relationships, psychological disturbances, or drug or alcohol abuse in either partner, the prognosis is guarded.
CAUSES AND INCIDENCE
In the United States, it’s estimated that 15% of women have difficulty achieving orgasm and approximately 10% have never had an orgasm. Problems with arousal and orgasm may result from medical conditions, psychological factors, or a combination of the two; therefore, it may be difficult to isolate the cause of the disorder. In addition, female sexual function and response may decline because of decreasing estrogen levels in the perimenopausal period. This decrease in estrogen affects nerve transmission and response in the peripheral vascular system. As a result, the timing and degree of vasoconstriction during the sexual response is affected, vasocongestion decreases, muscle tension decreases, and contractions are fewer and less intense during orgasm.
Medical conditions that may affect arousal and orgasm include side effects of drugs prescribed to treat other conditions, alcohol and substance abuse, cardiovascular occlusive disease, endocrine disorders, neurologic disorders, genitourinary tract infections and surgery, severe fatigue, and inadequate sexual stimulation.
Psychological factors that may cause arousal and orgasmic disorders include relationship problems, communication problems, unresolved conflict, anxiety, depression, severe stress, fear of pregnancy, fear of sexually transmitted disease, guilt about sexual enjoyment, religious and cultural beliefs, and fear of losing control.
SIGNS AND SYMPTOMS
The female with arousal and orgasmic disorder may experience:
• limited or absent sexual desire
• little or no pleasure from sexual stimulation
• lack of vaginal lubrication
• absence of signs of genital vasocongestion
• inability to achieve orgasm, either totally or under certain circumstances
• ability to achieve orgasm through masturbation or other means but not through intercourse
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