Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Female orgasmic disorder (FOD)Inhibited sexual orgasmNeurogenic anorgasmia ++ 302.73 Female orgasmic disorderV41.7 Problems with sexual function ++ F54 Sexual dysfunction not due to a substance or known physiological conditionF52.3 Orgasmic disorderF52.31 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 desireNormal libido and sexual excitementPrimarily due to being preorgasmicSecondary orgasmic disorder: was previously able to reach orgasm, but is no longer able +++ Essentials of Diagnosis ++ Thorough medical historyPhysical examination to rule out underlying medical causeGeneralized vs. situationalPsychological factors should be considered +++ General Considerations ++ Orgasm is a complex phenomenon following sexual arousal that depends on a variety of objective and subjective factorsLifelong—usually more psychogenicAcquired—can be due to relationship discord +++ Demographics ++ Wide ranges of prevalence reported in the literatureAffected 26.3% of 1,200 Iranian women in a 2010 study2Affected 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 conditionPsychogenicDrug inducedSevere depressionSocial anxietyUnderactive, overactive, or non-functioning pelvic floor musclesPelvic organ prolapse +++ Differential Diagnosis4 ++ Medical diseasesDiabetesNeurological diseases (e.g., multiple sclerosis)Gynecological disordersMedicationsBlood pressure medicationsAntidepressants, especially SRRIs (selective serotonin reuptake inhibitors)Alcohol and drugs +++ Imaging ++ Ultrasound imaging to identify abnormalitiesBladderUrethraPelvisBladder neck position and mobilityPelvic floor functionActivity of levator aniDescent of pelvic organsSphincter integrityMRI to examine soft tissue structures of the pelvic support apparatusPelvic/abdominal ultrasoundRule out other pathologies +++ Diagnostic Procedures ++ Perineal and vaginal examinationRule out other medical pathologyEMG/nerve conduction ++ EMG/nerve conduction can show if the cause is neurogenic anorgasmia +++ Medication ++ Systemic or local estrogen therapyTestosterone therapy ++ Pelvic floor physical therapistCertified sex therapistCouples counselingPrimary care physiciansGynecologistsWomen: pelvic examAcupuncture ++ PFM dysfunctionOveractiveUnderactiveNon-relaxingNon-contractingIncontinencePelvic painPelvic organ prolapse ++ Changes in sexual functioning questionnaireFemale sexual function indexPelvic floor muscle examination and assessmentsEMG biofeedback assessment of the pelvic floor musclesPressure manometry of the pelvic floor muscles ++ Pelvic floor muscle exercises/trainingKegel ... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth