Female Orgasmic Disorder

Persistent or recurrent delay or absence of orgasm (with release of muscular tension) following normal excitement phase of sexual activity that is assessed as adequate in focus, intensity, and duration.

Female orgasmic disorder may occur in women of any age. It can be due to psychologic causes (eg, depression ) but may be due to organic causes or to drugs. (see Table 114-1) For women who have undergone a hysterectomy, the loss of uterine contractions may impair the occurrence or intensity of orgasm. For women with cancer who have undergone a hysterectomy with radiation therapy to the pelvis, female orgasmic disorder may be more pronounced; anorgasmia may be accompanied by or caused by decreased libido, vaginal dryness, and dyspareunia. In contrast, sexual function in women who have had severe pain, cramping, and bleeding related to menstrual periods may improve after a hysterectomy.

Evaluation should include questions regarding history of sexual abuse or rape, presence of difficulties in sexual technique (eg, inadequate foreplay), and problems with a partner. Physical examination assists in the evaluation of an organic cause.

Any psychologic or organic disorder should be treated. Discussion with a counselor or partner, engaging in noncoital stimulation, focusing on foreplay and arousal, and ensuring appropriate lubrication may help alleviate female orgasmic disorder.