Orgasmic Disorders

Orgasm refers to the peak sexual excitement or feeling of very intense pleasure during the course of a sexual encounter. Orgasmic disorders, as the name suggest refers to conditions that interferes with an individual’s capacity to achieve orgasm, despite adequate sexual stimulation.Orgasmic disorders are fairly common in the general population. According to a new survey conducted by researchers of Brown University, the prevalence is much higher in females (approximately one out of every three females admit to orgasmic dysfunction during sexual encounters).

Causes of Orgasmic Dysfunction

The pathophysiology of Organismic dysfunction (also referred to as anorgasmia) can be classified under:

• Physical problem
• Mental disturbance
• Emotional distress or a combination of these three factors

It is often difficult to ascertain the underlying cause of orgasmic dysfunction, but a detailed history and physical examination can help a great deal in formulating the diagnosis and prognosis.Certain risk factors that are strongly linked to orgasmic dysfunction are:

• Age of the individual: Physiological aging increases the risk of orgasmic dysfunction due to fluctuations in the serum level of reproductive hormones (however there is no clear-cut age where anorgasmia is considered normal).
• Longstanding diseases or illnesses
• Social or religious norms about sex
• Fear of embarrassment, shame or humiliation in enjoying sex
• History of sexual abuse
• Ailments like diabetes or other neurologic diseases (such as multiple sclerosis, stroke, spinal cord injuries etc.)
• History of use of medicines like selective serotonin reuptake inhibitors for depression or other medications like thiazide diuretics, hypoglycemic agents and antipsychotics
• Performance fear or anxiety
• Problematic relationships
• Chronic Stress disorders
• Hypogondism (a condition marked by sub-normal production of sex hormones such as low testosterone levels in males).
• Endocrinopathies – imbalance of one or more hormones in the body can also affect the ability to achieve orgasm by interfering with hormonal/ biochemical balance. Most notable endocrinopathies are; thyroid dysfunction, adrenal dysfunction, prolactinomas etc.)

Symptoms of Orgasmic Dysfunction

Orgasms are strong feelings felt while releasing in a state of sexual excitement. The duration, strength and frequency of orgasms is highly variable, depending upon the nature of relationships, intimacy and personal factors. However, in individuals who are living with orgasmic dysfunction, the chief complaint is an inability to attain the sexual peak. Other symptoms may include inadequate orgasms or delayed orgasms.

The key to the diagnosis of orgasmic dysfunction is the fact that these individuals never experience orgasms while masturbating or engaging in other forms of sexual pleasures.The orgasmic dysfunction is primarily classified in four types:

• Primary Anorgasmia: The individual has never experienced an orgasm in his/ her life.
• Secondary Anorgasmia: The individual has experienced orgasms before but is not able to achieve anymore orgasms.
• Situational Anorgasmia: Can only attain orgasm in specific pleasure situations like masturbation or oral sex. It is the most frequently reported variety of orgasmic dysfunction.

Diagnosis of Orgasmic Dysfunction

Orgasmic dysfunction is a recognized sexual dysfunction that requires medical consultation and management to ensure optimal sexual enjoyment. Unfortunately, a lot of individuals are too shy to share their problems with their partner or a healthcare professional that significantly increases the risk of interpersonal difficulty and psychological distress.Diagnosis of orgasmic dysfunction is usually made on the basis of a proper history and some physical examinations.

Treatment Options of Orgasmic Dysfunction

The management of orgasmic dysfunction rests on the proper identification of the causative agents. Most healthcare professionals utilize a step-wise approach to identify and manage orgasmic dysfunction; such as:

• Treatment of underlying conditions
• Switching pharmacological regimens or dose adjustments

• Psychotherapy such as cognitive behavioural therapy
• Perception of direct excitation of clitoris/ penis during masturbation and sex
• Therapy for couples in which they are counselled on intimacy. It also helps in rectifying the relationship issues.
• Treatment with hormones helps in elevating the desire and also enhances the flow of blood to the genital organs. This directly helps in increasing the sensitivity of genitals to sexual stimulation. Hormonal therapies are available in the form of tablets, skin patches or topical regimens.
• Other medications include over-the-counter nutritional supplements, oils like Zestra which helps to make the genitals warm and easily stimulated. These oils are used during intercourse as well as masturbation.

Prior to their use, proper consultation with a physician is advised as they may interact with other drugs to cause unfavourable reactions.

Coping – Ways to Live With Orgasmic Dysfunction

Orgasmic dysfunction can be very depressing and damaging for the relationships. Nonetheless, with proper management, orgasmic disorders can be treated with medical as well as psychological help. In this regard, self-assurance and patience is very crucial.Couple therapy and counselling emphasizes on explainviewpoint on sex. Emotions can be channelled effectively in many ways to show your physical capacity for an adequate orgasm. A therapist is assigned to help both the partners know each other’s sexual preferences and tactics to handle them efficiently.References:

1. Ismail, A. H., Baw, R., Sidi, H., Guan, N. C., Midin, M., Jaafar, N. R. N., ... & Manaf, M. R. A. (2014). Orgasmic dysfunction among Malay diabetic women in Malaysia. Comprehensive psychiatry, 55, S29-S33.
2. Paduch, D. A., Bolyakov, A., Beardsworth, A., & Watts, S. D. (2012). Factors associated with ejaculatory and orgasmic dysfunction in men with erectile dysfunction: analysis of clinical trials involving the phosphodiesterase type 5 inhibitor tadalafil. BJU international, 109(7), 1060-1067.
3. Taylor, M. J., Rudkin, L., Bullemor-Day, P., Lubin, J., Chukwujekwu, C., & Hawton, K. (2013). Strategies for managing sexual dysfunction caused by antidepressants. Health.