Female anorgasmia

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

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

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

• Pattern 4C: impaired muscle performance1

Description

• 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

Essentials of Diagnosis

• Thorough medical history
• Physical examination to rule out underlying medical cause
• Generalized vs. situational
• Psychological factors should be considered

General Considerations

• 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

Demographics

• 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

Signs and Symptoms

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

Functional Implications

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

Possible Contributing Causes

• General medical condition
• Psychogenic
• Drug induced
• Severe depression
• Social anxiety
• Underactive, overactive, or non-functioning pelvic floor muscles
• Pelvic organ prolapse

Differential Diagnosis4

• 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

Imaging

• 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

Diagnostic Procedures

• Perineal and vaginal examination
• Rule out other medical pathology
• EMG/nerve conduction

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

Medication

• Systemic or local estrogen therapy
• Testosterone therapy

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

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

• 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

• Pelvic floor muscle exercises/training
  • Kegel ...