Diagnosis and management of female Orgasmic disorder

Abstract

Orgasm is a sensation of intense pleasure creating an altered consciousness state accompanied by pelvic striated circumvaginal musculature and uterine contractions that induces a state of well-being and contentment. Women’s orgasms can be prompted by erotic stimulation of a variety of genital and nongenital sites. Some women, however, do not reach orgasm despite different partners and different instruments used. These women are the focus of this chapter. While the etiology of FOD remains uncertain, literature has shown multiple risk factors related to FOD classified as: psychological, physiological, sociodemographic, hereditary, and comorbid medical conditions. Multiple psychological conditions can interfere with a woman’s ability to reach orgasm. Such conditions include, but are not limited to, anxiety, depression, attention deficit disorder, body image, sexual abuse, and negative religious views on sex. It is important to rule out insufficient and/or inadequate stimulation before assigning an FOD diagnosis. In addition, comorbidities like vascular disease, diabetes, multiple sclerosis, spinal cord injury, and other pelvic conditions can all exacerbate symptoms of FOD. Lastly, medications such as selective serotonin reuptake inhibitors (SSRIs) and antipsychotics can negatively impact orgasmic potential. With regard to treatment, cognitive and behavioral techniques have been used in cases where the orgasm problems are acquired or manifest themselves only during partnered sex. A number of studies have also shown that androgen and nonhormonal treatments can have beneficial effects in the setting of FOD. Due to the high level of comorbidity with other sexual disorders, most women with FOD will present with a complex combination of problems, requiring a comprehensive assessment that takes into consideration the known correlates of FOD. The diagnosis of FOD should be based on the clinician’s judgment that the woman’s orgasmic capacity is less than would be reasonable for her age, sexual experience, and the adequacy of sexual stimulation she receives.