Orgasmic disorder involves orgasm that is absent, markedly diminished in intensity, or markedly delayed in response to stimulation despite high levels of subjective arousal.
Women with orgasmic disorder often have difficulty relinquishing control in nonsexual circumstances.
Contextual factors (eg, consistently insufficient foreplay, poor communication about sexual preferences), psychologic factors (eg, anxiety, stress, lack of trust in a partner, fears), physical disorders, and drugs can contribute to orgasmic disorder (see Sexual Dysfunction in Women: Etiology). Lack of knowledge about sexual function may also contribute.
Damage to genital sensory or autonomic nerves (eg, due to diabetes or multiple sclerosis) or, much more commonly, use of SSRIs may lead to acquired orgasmic disorder.
Data support encouraging self-stimulation. A vibrator placed on the mons pubis close to the clitoris may help, as may increasing the number and intensity of stimuli (mental, visual, tactile, auditory, written), simultaneously if necessary. Education about sexual function (eg, need to stimulate the clitoris) may help.
Psychologic therapies including cognitive-behavioral therapy and psychotherapy may help women identify and manage fear of relinquishing control, fear of vulnerability, or issues of trust with a partner.
In women taking an SSRI, symptoms may decrease when bupropion is added. One study supports the use of sildenafil.
Last full review/revision January 2009 by Rosemary Basson, MD, FRCP(UK)
Content last modified February 2012