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Condition/Disorder Synonyms

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  • Female orgasmic disorder (FOD)

  • Inhibited sexual orgasm

  • Neurogenic anorgasmia

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ICD-9-CM Codes

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  • 302.73 Female orgasmic disorder

  • V41.7 Problems with sexual function

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ICD-10-CM Codes

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  • F54 Sexual dysfunction not due to a substance or known physiologic condition

  • F52.3 Orgasmic disorder

  • F52.31 Female orgasmic disorder

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Preferred Practice Pattern

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Key Features

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Description

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  • Inability to achieve sexual orgasm during sexual intercourse or other sexual activity despite adequate stimulation and desire

  • Normal libido and sexual excitement

  • Primarily due to being preorgasmic (never having achieved an orgasm)

  • Secondary orgasmic disorder: Was previously able to reach orgasm but is no longer able to

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Essentials of Diagnosis

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  • Thorough medical history.

  • Physical examination to rule out underlying medical cause.

  • Generalized versus Situational.

  • Psychological factors should be considered.

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General Considerations

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  • Orgasm is a complex phenomenon following sexual arousal that depends on a variety of objective and subjective factors.

  • Lifelong—usually more psychogenic.

  • Acquired—can be due to relationship discord, hormonal imbalance, or pain.

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Demographics

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  • Wide ranges of prevalence reported in the literature:

    • - Affected 26.3% of 1200 Iranian women in a 2010 study2

    • - Affected 86.6% of married Indian women in a 2009 study3

    • - Rates of sexual activity and function are not different between women with and without pelvic floor disorders4

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Clinical Findings

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Signs and Symptoms

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  • Persistent or recurrent delay in or absence of orgasm following a normal sexual excitement phase

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Functional Implications

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  • May cause dissatisfaction, concerns, and/or distress about sexual relationships

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Possible Contributing Causes

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  • General medical condition

  • Psychogenic

  • Drug induced

  • Severe depression

  • Social anxiety

  • Underactive, overactive, or nonfunctioning pelvic floor muscles

  • Pelvic organ prolapse

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Differential Diagnosis

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  • Medical diseases5

    • - Diabetes

    • - Neurologic diseases (eg, multiple sclerosis)

  • Gynecologic disorders

  • Medications

    • - Blood pressure medications

    • - Antidepressants, especially selective serotonin reuptake inhibitors (SRRIs)

  • Alcohol and drugs

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Means of Confirmation or Diagnosis

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Imaging

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  • Ultrasound imaging to identify abnormalities

    • - Bladder

    • - Urethra

    • - Pelvis

    • - Bladder neck position and mobility

    • - Pelvic floor function

    • - Activity of levator ani

    • - Descent of pelvic organs

    • - Sphincter integrity

  • Magnetic resonance imaging (MRI) to examine soft tissue structures of the pelvic support apparatus

  • Pelvic/abdominal ultrasound

    • - Rule out other pathologies

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Diagnostic Procedures

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  • Perineal and vaginal examination

  • Rule out other medical pathology

  • Electromyography (EMG)/nerve conduction

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Findings and Interpretation

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  • EMG/nerve conduction can show if the cause is neurogenic anorgasmia.

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