by Dr. Maureen Whelihan
This post will address orgasm disorders in women. Let’s begin by describing it. This definition by an International Collaborative Group gathering in 2004 to discuss orgasm defined it as this; “a variable, transient peak sensation of intense pleasure creating an altered state of consciousness, usually accompanied by involuntary, rhythmic contractions of the pelvic striated circumvaginal musculature, often with concomitant uterine and anal contractions and myotonia that resolves the sexually induced vasocongestion with an induction of well-being and contentment”. Now that I have your attention, I suspect you can almost feel it based on this detailed description!
It is well-known that women can be multi-orgasmic. But many are unaware that women can achieve orgasm without genital stimulation through visual or fantasy and more often by breast stimulation. I have seen patients that could easily reach orgasm with nothing but breast stimulation. The problem was that her husband had not even gotten her undressed before getting her to climax and she would then decide she had no energy for intercourse and was not interested! Not good.
Orgasm disorders are a close second behind arousal disorders, however hypoactive sexual desire disorder still prevails as the number one complaint. The general feeling is that PRIMARY ANORGASMIA (never had an orgasm) is more an anxiety condition and a sex therapy consult should begin. However, SECONDARY ANORGASMIA is where she has reached orgasm previously and cannot now. The etiology of this is a broad range of things.
Keep in mind that in the initial evaluation, one needs to address lack of adequate stimulation as this is the number one cause of secondary anorgasmia. Many women (as high as 70-90%) report an inability to reach orgasm with penetration only. Clitoral stimulation in whatever form preferred by the woman is necessary.
Ok, so we are clear that clitoral stimulation should always occur. When, you ask? My recommendation is always – FIRST! For several reasons this is beneficial. One of the most common causes of sexual pain is vaginal dryness. This can be due to inadequate arousal, among other things. Women climaxing first will engorge the vulva, lubricate the introitus, expand the vagina and make it a happy place to penetrate. Furthermore, many men are concerned about firing too soon; they will have NO WORRIES, because she has already had at least one orgasm. Everyone is happy. I have had this very discussion with male clinic patients who are concerned that they have premature ejaculation. Many last 4-10 minutes on average – plenty of time. HOWEVER, they never made sure their wives climaxed first. So now, when he quickly gets soft after 4 minutes, she has no time to get there. Angry woman….not good.
Often the women are to blame, here, because when they are not interested in trying to get aroused, they simply give him a “pass” to dive in and go for it while they create the grocery list and choose new wallpaper for the bedroom in their head. By doing this, they plant a message of “sex is no fun for me” in their own brain and a vicious cycle begins. I strongly encourage women to figure out how they get to orgasm the fastest or easiest and make sure this happens nearly every time.
I posted previously on bringing vibration into a partnered sexual encounter and this is generally a home run for all. She gets her “O”, he feels that he has done his job and can enjoy penetration without guilt and she stays focused on the moment rather than the cobwebs on the ceiling. Everyone is happy.
Chronic illness such as multiple sclerosis, chronic renal failure on dialysis, diabetes, atherosclerosis, smoking and depression are some of the most frequent conditions interfering with orgasm.
Medications, especially antidepressants (SSRIs), and antipsychotics, are culprits; however serotonin-norepinephrine reuptake inhibitors (SNRI’s) may be less negative in these patients. Some are better than others.
Estrogen deficiency and testosterone deficiency can play a role either directly due to atrophy of the tissue or indirectly due to lack of arousal and desire.
Although the general thought is that anxiety/mood disorders, shame, guilt, poor body image, past abuse, and poor genital image are the some causes of PRIMARY anorgasmia, some recent studies suggest genetic factors. One study suggests that a single nucleotide polymorphism in glutamatergic receptor genes has been found in those with difficulty achieving orgasm.
This discussion is too long to post here, but modify the medications as needed by adding buspirone (Buspar) or bupropion (Wellbutrin XL) or even yohimbine (Yocon). I have mentioned milnacipran (Savella) as my new favorites for this if tolerated.
Other things to be studied in the future are midodrine, oxytocin and bremelanotide for women.
Without saying, behavioral or sex therapy as needed is a mainstay to the approach of this topic. Happy hunting….
Dr Whelihan can be reached at www.BestSexualAdvice.com or 888 569-3374
Tags: anorgasmia, arousal disorder, erectile dysfunction, female sexual dysfunction, low desire, orgasm, orgasm disorder, premature ejaculation, primary anorgasmia, sexual satisfaction