Female orgasmic disorder Health Article

Demographics

Inability to have an orgasm, discontent with the quality of orgasms, and the ability to have orgasms only with one type of stimulation are common sexual complaints among women. Some studies have found that about half of all women experience some orgasmic difficulties, but not of all these difficulties are considered FOD. About 50% of women experience orgasm through direct clitoral stimulation but not during intercourse, thus not meeting the criteria for a diagnosis of FOD. About 10% of women never experience an orgasm, regardless of the situation or stimulation. These women are more likely to be unmarried, young, and sexually inexperienced.

Diagnosis

FOD is diagnosed through a medical and psychological history and history of the conditions under which orgasm fails to occur. It is especially helpful for the clinician or sex therapist to understand how long the problem has persisted, and whether it is general or situational. FOD is sometimes found in conjunction with sexual aversion disorderand female sexual arousal disorder, making the diagnosis complex. To be diagnosed with FOD, the lack of orgasmic response must occur regularly over an extended period of time; based on the clinician's judgment, it must be less than would be reasonable based on age, sexual experience, and the adequacy of sexual stimulation. The lack of orgasm must cause emotional distress or relationship difficulties for the woman and be caused either only by psychological factors alone or by a combination of psychological and physical factors. According to the American Psychiatric Association (APA), a diagnosis of FOD is not appropriate if failure to climax is due only to physiological factors. FOD is also not diagnosed if it is a symptom of another major psychological disorder, such as depression.

Treatments

When failure to reach orgasm is caused by a physical problem, the root problem is treated. In other cases, a combination of education, counseling, psychotherapy, and sex therapy are used—often along with directed exercises to increase stimulation and decrease inhibitions—either for the individual or for the couple. As of 2002, clinical trials are under way to investigate the effect of sildenafil (Viagra) on women's sexual response. Sildenafil has already been proved effective in helping men to attain and maintain an erection.

Sex therapists have special training to help individuals and couples focus on overcoming specific sexual dysfunctions. In couples therapy, they often assign "homework" that focuses on relaxation techniques, sexual exploration, improving sexual communication, decreasing inhibitions, and increasing direct clitoral stimulation. Individually, a woman might be encouraged to masturbate either through self-stimulation or with a vibrator. In addition, Kegel exercises, which improve the strength and tone of the muscles in the genital area, may be recommended.

Traditional psychotherapy, or talk therapyalone or in conjunction with sex therapy, can be effective in resolving psychological causes of FOD, especially when those causes are rooted in past sexual or emotional exploitation or cultural taboos. Psychotherapy is also helpful in resolving relationship tensions that develop as a result of frustration from FOD.

Prognosis

Many women with FOD can be helped to achieve orgasm through a combination of psychotherapy and guided sexual exercises. However, this does not mean that they will be able to achieve orgasm all the time or in every situation, or that they will always be satisfied with the strength and quality of their climax. Couples often need to work through relationship issues that have either caused or resulted from FOD before they see improvement. This process takes time and requires a joint commitment to problem solving.

Prevention

There are no sure ways to prevent FOD. However, reducing life factors that cause stresscan be effective. Seeking counseling or psychotherapy for past trauma, or when problems begin to appear in a relationship, can help minimize sexual dysfunction problems.

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders.4th edition, text revised. Washington DC: American Psychiatric Association, 2000.

Berman, Jennifer, M.D., and Laura Berman, Ph.D. For Women Only: A Revolutionary Guide to Overcoming Sexual Dysfunction and Reclaiming Your Sex Life.New York: Henry Holt, 2001.

Sadock, Benjamin J. and Virginia A. Sadock, eds. Comprehensive Textbook of Psychiatry.7th ed. Vol. 2. Philadelphia: Lippincott Williams and Wilkins, 2000.

PERIODICALS

Everaerd, Walter and Ellen Laan. "Drug Treatments for Women's Sexual Disorders." Journal of Sex Research37 (August 2000):195-213.

Phillips, Nancy. "Female Sexual Dysfunction: Evaluation and treatment." American Family Physician(1 July 2000).

ORGANIZATIONS

American Association of Sex Educators, Counselors, and Therapists (AASECT). P. O. Box 238, Mount Vernon, IA 53214-0238. (319) 895-8407. <www.aasect.org>.

Sexual Information and Education Council of the United States (SIECUS). West 42nd Street, Suite 350, New York, NY 10036-7802. <www.siecus.org>.

Tish Davidson, A.M.