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Orgasm Disorders in Men and Women

Published on Sep 16, 2022 and last reviewed on Oct 05, 2022   -  6 min read

Abstract

Orgasm disorders in males and females are characterized by the persistent inability to achieve orgasm. Read more on them below.

What Is An Orgasm?

An orgasm is a subjective experience attained at the height of sexual pleasure due to the sudden release of built-up tension and the rhythmic contraction and relaxation of associated muscles. It results in the release of ejaculate in men and sometimes in women; and vaginal wall contractions in women.

What Are Orgasm Disorders?

Orgasm disorders occur when sexual climax or orgasm is not achieved after sexual activity. This may happen even with adequate sexual stimulation.

They can present as:

  • Inability to achieve orgasm.

  • Delay in orgasm.

  • Trouble achieving satisfying orgasm or sexual release.

Who Is Affected By Orgasm Disorders?

Orgasm disorders may occur in both sexes, but women are more prone to experience them than men are. Globally, 11 % - 41 % of women may experience orgasm dysfunction.

What Are the Types of Orgasm Disorders?

  • Primary Orgasmic Disorder- The affected individual has never experienced an orgasm.

  • Secondary Orgasmic Disorder- The affected individual has experienced an orgasm in the past but subsequently experiences difficulty achieving orgasm.

  • General Orgasmic Disorder- The inability to achieve an orgasm applies to all situations, even with adequate stimulation.

  • Situational Orgasmic Disorder- The inability to achieve an orgasm applies only to certain situations or specific types of sexual stimulation (for example, orgasm may only be achieved with masturbation, but not during sexual intercourse).

Apart from these classifications, orgasm disorders are also divided based on gender:

Female Orgasmic Disorder- It has also been termed anorgasmia or orgasmic dysfunction.

Male Orgasmic Disorder- It is also known as Coughlan’s syndrome or anorgasmia (a persistent inability to achieve orgasm despite sufficient sexual stimulation). Other names for it encompass the different types of orgasmic dysfunctions:

  • Delayed ejaculation.

  • Retarded ejaculation.

  • Ejaculatory incompetence.

What Are the Causes of Orgasm Disorders?

Causes of Female Orgasm Disorder-

  • Physical Factors- Pelvic disorders (pelvic floor weakness and nerve damage, spinal cord injury).

  • Illnesses- Diabetes, multiple sclerosis, heart disease, kidney disease.

  • Genetic Factors.

  • Surgeries- Hysterectomy (surgical removal of the uterus), renal transplant.

  • Medications- Psychotropic medications (antidepressants, mood stabilizers).

  • Hormonal Changes- Thyroid dysfunction, menopause, reduced production of estrogen, progesterone, and testosterone.

  • Substance Abuse- Alcohol and drugs.

  • Psychological Factors- Depression, anxiety, stress, poor self-esteem, history of trauma or sexual abuse, body image issues.

  • Interpersonal Factors- Relationship issues, lack of closeness or attraction to partners, communication gap with partners.

  • Cultural and Social Factors- Cultural and religious beliefs, feelings of guilt in relation to sexual activity.

  • Personality Type- Emotionally unstable, introverted women experience orgasmic difficulty more often than their counterparts with higher emotional intelligence.

Causes of Male Orgasmic Disorder-

  • Physiological Factors- Older age.

  • Physical Factors- Hypogonadism (inadequate testosterone production), hormonal conditions, or imbalance.

  • Psychological Factors- Anxiety, depression, stress, history of trauma, or sexual abuse.

  • Illnesses- Penile diseases, pituitary disorder, thyroid dysfunction.

  • Surgeries- Prostatectomy (prostate removal surgery).

  • Medications- Antihypertensives (medications for high blood pressure), antidepressants.

  • Substance Abuse- Drugs and alcohol intake.

  • Interpersonal Factors- Relationship issues, lack of closeness or attraction to partners.

What Are the Signs and Symptoms of Orgasm Disorders?

The chief symptom of an orgasmic disorder, male or female, is the inability to achieve orgasm. This can present as:

  • Complete absence of orgasm.

  • Delay in achieving orgasm.

  • Difficulty in achieving orgasm.

When these symptoms are accompanied by distress and interpersonal conflict, there is a good chance of the individual is suffering from sexual dysfunction. Conducting a thorough analysis and ruling out other possible disorders would help arrive at the correct diagnosis.

How Are Orgasm Disorders Diagnosed?

Diagnosis is dependent on ruling out all other possible factors and sexual disorders. This would require a comprehensive physical, psychosocial, and personal assessment. Assessing the signs and symptoms and etiological factors would lead to an appropriate diagnosis. A few points of note concerning diagnosis are:

  • Personal Distress- The condition cannot be classified as an orgasmic disorder unless the individual experiences significant personal distress about their inability to orgasm.

  • Physical Conditions- Physical conditions or medication intake alone are insufficient for diagnosing an orgasmic disorder. They are only secondary factors that contribute to the condition.

  • No Other Causative Factor- The disorder can only be classified as an orgasmic disorder if no other disorder is deemed responsible (except sexual dysfunction).

How Are Orgasm Disorders Treated?

Treatment of orgasmic disorders should specifically take into account the underlying factors. Treatment of the cause is essential before proceeding to pharmacological and psychological therapy.

Treatment of Causes-

  • Physical Illness- If the underlying cause is a physical illness, then treatment for that illness is pursued.

  • Medication- If medications being taken by the patient are a part of the causative factors, then alternatives can be explored with physician approval. For example, antidepressants are often responsible for sexual dysfunction. Switching to drugs such as Moclobemide and Amineptine, which have fewer sexual side effects, could be beneficial.

  • Drug Holiday- Taking breaks from drug therapy by not taking them for a short time can also help.

  • Adjunctive Drug Therapy- Sildenafil is the preferred adjunctive drug that results in better outcomes with orgasmic disorders.

  • Hormonal Dysfunction- When orgasm disorder occurs due to hormonal deficiency, androgen replacement is helpful for both males and females - this may include testosterone replacement and methyltestosterone replacement. Drugs such as Tibolone, which possess properties of estrogen, progesterone, and testosterone, have also resulted in positive outcomes for women.

Direct Treatment-

1. Pharmacotherapy- Certain drugs have been proven to improve orgasmic function and may be considered treatment options:

In Women

  • Yohimbine.

  • Buspirone.

  • Bupropion.

  • Sildenafil.

  • Cabergoline.

  • Bremelanotide.

In Men

  • Yohimbine.

  • Buspirone.

  • Bupropion.

  • Midodrine.

  • Oxytocin.

  • Anandamide.

  • Cyproheptadine.

2. Medical Devices-

In Women

  • Clitoral Therapy Devices- A vacuum is applied to the clitoris, increasing blood flow and inducing orgasm.

  • Sacral Nerve Stimulation Systems- Surgically-implanted devices that increase orgasmic function.

  • Nerve Stimulation Devices- Battery-operated devices that stimulate genital nerve pathways.

  • Electronic Stimulation- Some electronic stimulation devices worn on the fingers can cause an orgasm.

In Men

  • Penile Vibratory Stimulation (PVS)- Vibrator is applied to the penis to produce mechanical stimulation and cause an orgasm.

  • Electroejaculation (EEJ)- Low-level electric current is delivered using a probe in the rectal area (the terminal portion of the large intestine leading to the anus). This technique is usually performed in cases where the lack of orgasm and consequent lack of ejaculation is a source of distress with regard to fatherhood. EEJ will result in the acquisition of ejaculate, which can then be used in assisted reproduction.

3. Psychotherapy- Psychotherapy and sex therapy can be given in a variety of ways and are common to men and women:

  • Cognitive-Behavioral Therapy (CBT)- Helps direct negative attitudes about sexuality and body image away and focuses on redirecting thoughts towards positive reinforcements and thoughts.

  • Couples Therapy- Takes psychological and interpersonal relationship issues into account while directing sexual practices to achieve better outcomes. This can include techniques that help achieve better penile-vaginal intercourse and orgasms.

  • Guided Fantasy- A guided therapy focusing on situational imagery or fantasy that the therapist suggests to the patient and then leads them through to resolution. The technique elicits psychological feelings and attitudes and helps the therapist treat the patient better.

  • Sensate Focus Exercises- Directing attention to senses felt in the body rather than focusing on mental stimuli, thereby allowing for a better sexual experience.

  • Role-Playing- Role-playing exaggerated orgasms either with a partner or alone.

4. Other-

  • Supplements- While not strictly approved, herbal and dietary supplements can help achieve better sexual satisfaction.

  • Arousal Oils- Arousal oils like Zestra have helped achieve some measure of satisfaction in orgasm in women.

  • Exercises- Pelvic floor exercises or Kegel exercises will provide better pelvic muscle control and contribute to better sexual functioning, including a better chance of orgasming.

Conclusion

Orgasm disorders should never impede sexual pleasure or self-esteem - neither should they be a source of constant worry and distress. Therapy and exercises recommended by doctors can go a long way in improving sexual lives and functioning. Consulting a therapist in case of orgasming difficulty will provide relief - both physical and mental.

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Last reviewed at:
05 Oct 2022  -  6 min read

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