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  • Female orgasmic disorder (FOD)
  • Inhibited sexual orgasm
  • Neurogenic anorgasmia

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  • 302.73 Female orgasmic disorder
  • V41.7 Problems with sexual function

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  • F54 Sexual dysfunction not due to a substance or known physiological condition
  • F52.3 Orgasmic disorder
  • F52.31 Female orgasmic disorder

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

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Essentials of Diagnosis

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  • Thorough medical history
  • Physical examination to rule out underlying medical cause
  • Generalized vs. 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

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Demographics

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  • Wide ranges of prevalence reported in the literature
    • Affected 26.3% of 1,200 Iranian women in a 2010 study2
    • Affected 86.6% of married Indian women in a 2009 study3

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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 non-functioning pelvic floor muscles
  • Pelvic organ prolapse

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Differential Diagnosis4

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  • Medical diseases
    • Diabetes
    • Neurological diseases (e.g., multiple sclerosis)
  • Gynecological disorders
  • Medications
    • Blood pressure medications
    • Antidepressants, especially SRRIs (selective serotonin reuptake inhibitors)
  • Alcohol and drugs

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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
  • 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
  • EMG/nerve conduction

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

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Medication

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  • Systemic or local estrogen therapy
  • Testosterone therapy

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  • Pelvic floor physical therapist
  • Certified sex therapist
  • Couples counseling
  • Primary care physicians
  • Gynecologists
    • Women: pelvic exam
  • Acupuncture

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  • PFM dysfunction
    • Overactive
    • Underactive
    • Non-relaxing
    • Non-contracting
  • Incontinence
  • Pelvic pain
  • Pelvic organ prolapse

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  • Changes in sexual functioning questionnaire
  • Female sexual function index
  • Pelvic floor muscle examination and assessment
  • sEMG biofeedback assessment of the pelvic floor muscles
  • Pressure manometry of the pelvic floor muscles

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  • Pelvic floor muscle exercises/training
    • Kegel exercises
    • Contraction
    • Relaxation/bulging
    • Motor control
    • Endurance
    • Power
    • sEMG biofeedback
    • Pressure manometry
    • ...

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