| Anorgasmia | |
|---|---|
| Classification and external resources | |
| ICD-10 | F52.3 |
| ICD-9 | 302.73, 302.74 |
| DiseasesDB | 23879 |
| eMedicine | article/295376 article/295379 |
Anorgasmia (often related to delayed ejaculation in males) is a form of sexual dysfunction sometimes classified as a psychiatric disorder in which the patient cannot achieve orgasm, even with adequate stimulation. However, it can also be caused by medical problems such as diabetic neuropathy, multiple sclerosis, genital mutilation, complications from genital surgery, pelvic trauma (such as from a straddle injury caused by falling on the bars of a climbing frame, bicycle or gymnastics beam), hormonal imbalances, total hysterectomy, spinal cord injury, cauda equina syndrome, uterine embolisation, childbirth trauma (vaginal tearing through the use of forceps or suction or a large or unclosed episiotemy), vulvodynia and cardiovascular disease (Berman et al. 2005). Anorgasmia is far more common in females than in males and is especially rare in younger men. Anorgasmia is the medical term for regular difficulty reaching orgasm after ample sexual stimulation, often causing significant sexual frustration. About 15% of women report difficulties with orgasm, and as many as 10% of women in the United States have never climaxed. Many women who orgasm regularly only climax about 50-70% of the time.
A common cause of situational anorgasmia, in both men and women, is the use of anti-depressants, particularly selective serotonin reuptake inhibitors (SSRIs). Post-SSRI sexual dysfunction (PSSD) is a name given to a reported iatrogenic sexual dysfunction caused by the previous use of SSRI antidepressants. Though reporting of anorgasmia as a side effect of SSRIs is not precise, it is estimated that 15-50% of users of such medications are affected by this condition . The chemical amantadine has been shown to relieve SSRI-induced anorgasmia in some, but not all, people.
Another cause of anorgasmia is opiate addiction, particularly to heroin.[1] Beat icon William S. Burroughs chronicled this problem (amongst many others) in his novel Naked Lunch.
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Primary anorgasmia is a condition where one has never experienced an orgasm. This is significantly more common in women, although it can occur in men who lack the gladipudendal (bulbocavernosus) reflex.[2]
Women with this condition can sometimes achieve a relatively low level of sexual excitement and may think of intercourse or other sexual activities as pleasant despite their inability to orgasm. They may get most of their reward from touching, holding, kissing, caressing, attention, and approval. However, women who regularly achieve high levels of sexual response without orgasmic release of tension may find the experience frustrating. Emotional irritability, restlessness, and pelvic pain or a heavy pelvic sensation may occur because of vascular engorgement.
Often, though, there is no obvious reason why orgasm is unobtainable. Regardless of having a caring, skilled partner, having adequate time and privacy, and having no medical issues which would affect sexual satisfaction, some women are unable to orgasm. This situation is extremely frustrating because with no discernible cause, a plausible solution is difficult to discover.
Many people have been able to find effective relief from anorgasmia despite a physical factor; a mental process of conditioning such as hypnosis can have a positive impact. Primary male anorgasmia is very uncommon, and thus has been studied very little.
Secondary anorgasmia is the loss of the ability to have orgasms. The cause may be alcoholism, depression, grief, pelvic surgery (such as total hysterectomy) or injuries, certain medications, illness, estrogen deprivation associated with menopause or an event that has violated the patient's sexual value system.
Secondary anorgasmia is close to 50% among males undergoing prostatectomy;[3] 80% among radical prostatectomies.[4] This is a serious adverse result because radical prostatectomies are usually given to younger males who are expected to live more than 10 years. At more advanced ages, the prostate is more unlikely to grow during that person's remaining lifetime.[1] This is generally caused by damage to the primary nerves serving the penile area, which pass near the prostate gland. Removal of the prostate frequently damages or even completely removes these nerves, making sexual response unreasonably difficult.[2]
Due to the existence of these nerves in the prostate, surgeons performing sex reassignment surgery on transsexual male to female patients avoid removing the prostate. This leaves the nerves that will then lead to the newly-formed clitoris, and decreases the chances that the patient will not respond to clitoral stimulation after surgery. Additionally, by leaving the prostate in the patient, the surgeon allows it to be situated close to the wall of the newly-formed vagina, which may potentially increase stimulation during vaginal intercourse after the procedure.
People who are orgasmic in some situations may not be in others. A person may have an orgasm from one type of stimulation but not from another. Or a person may achieve orgasm with one partner but not another, or have an orgasm only under certain conditions or only with a certain type or amount of foreplay. These common variations are within the range of normal sexual expression and should not be considered problematic.
A person who is troubled by experiencing situational anorgasmia should be encouraged to explore alone and with his or her partner those factors that may affect whether or not he or she is orgasmic, such as fatigue, emotional concerns, feeling pressured to have sex when he or she is not interested, or a partner's sexual dysfunction. In the relatively common case of female situational anorgasmia during penile-vaginal intercourse, some sex therapists recommend that couples incorporate manual or vibrator stimulation during intercourse, or using the female-above position as it may allow for greater stimulation of the clitoris by the penis or symphysis pubis or both, and it allows the woman better control of movement.
Some people are orgasmic but not in enough instances to satisfy their sense of what is appropriate or desirable. Therapy can help such people examine and realign their expectations of orgasm and of sexual activity. For some people, therapy can help people become more comfortable with momentarily giving up control to bodily responses.
Effective treatment for anorgasmia depends on the cause. In the case of women suffering from psychological sexual trauma or inhibition, psychosexual counselling might be advisable and could be obtained through GP referral.
Women suffering from anorgasmia with no obvious psychological cause would need to be examined by their GP to check for absence of disease. Blood tests would also need to be done (full blood count, liver function, oestradiol/estradiol, total testosterone, SHBG, FSH/LH, prolactin, thyroid function, lipids and fasting blood sugar) to check for other conditions such as diabetes, lack of ovulation, low thyroid function or hormone imbalances (Berman et al. 2005). The normal thresholds for these tests and timing in a woman's menstrual cycle is detailed in Berman et al., 2005.
They would then need to be referred to a specialist in sexual medicine. The specialist would check the patients blood results for hormonal levels, thyroid function and diabetes, evaluate genital blood flow and genital sensation, as well as giving a neurological work-up to determine the degree (if any) of nerve damage.
Just as with erectile dysfunction in men, lack of sexual function in women may be treated with hormonal patches or tablets to correct hormonal imbalances, clitoral vacuum pump devices and medication to improve blood flow, sexual sensation and arousal (Berman et al. 2005).
In the case of nerve damage, research is currently being undertaken at John Hopkins University to make damaged nerves in the human body regrow using the enzyme sialidase [5]. It is possible that in the future pelvic nerve damage could be repaired in this way. Further research and testing is urgently needed.
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