Orgasmic disorder is lack of or delay in sexual climax (orgasm) even though sexual stimulation is sufficient and the woman is sexually aroused.
The amount and type of stimulation required for orgasm varies greatly from woman to woman. Most women can reach orgasm when the clitoris is stimulated, but less than half of women regularly reach orgasm during sexual intercourse. About 1 of 10 women never reaches orgasm, but many of them nonetheless consider sexual activity to be satisfactory.
Women with orgasmic disorder cannot have an orgasm under any circumstances, even when they masturbate and when they are highly aroused. However, not having an orgasm usually occurs because the woman is not sufficiently aroused and thus is not considered orgasmic disorder. Inability to have an orgasm is considered a disorder only when the lack of orgasm distresses the woman. Lovemaking without orgasm can cause frustration and may result in resentment and occasionally in distaste for anything sexual.
Situational and psychologic factors can contribute to orgasmic disorder. They include the following:
Physical disorders can also contribute to orgasmic disorder. They include nerve damage (as results from diabetes, spinal cord injuries, or multiple sclerosis) and abnormalities in genital organs.
Certain drugs, particularly selective serotonin reuptake inhibitors (SSRIs—see Mood Disorders: Drugs Used to Treat Depression), may specifically inhibit orgasm.
Techniques that may enhance pleasure, such as masturbation and relaxation techniques, may help, as may sensate focus exercises. In sensate focus exercises, partners take turns touching each other in pleasurable ways (see Sexual Dysfunction in Women: Treatment). Couples may try using more or different stimuli, such as a vibrator, fantasy, or erotic videos. A vibrator may be especially useful when there is nerve damage.
Education about sexual function may help. For some women, incorporating stimulation of the clitoris (which corresponds to the penis in men) may be all that is needed.
Psychotherapy may help women identify and manage fear of relinquishing control, fear of vulnerability, or issues of trusting a partner. Psychotherapy may be particularly useful for women who have been sexually abused or have psychologic disorders.
If an SSRI is the cause, adding bupropion (a different type of antidepressant) may help. Or another antidepressant may be substituted. Some evidence suggests that if women stopped having orgasms when they started taking SSRIs, sildenafil may help them have orgasms again.
Last full review/revision November 2008 by Rosemary Basson, MD, FRCP(UK)