Chapter 44 Sexual Dysfunction: Libidinal and Orgasmic Dysfunction (Anorgasmia)
INTRODUCTION
Description: Sexual dysfunction/anorgasmia is a lack of interest in sexual expression or sexual contact or the inability to achieve orgasm. Most studies indicate that only 30% to 40% of women are able to experience orgasm during intercourse and up to 15% of sexually active women have never experienced sexual release.
Prevalence: Most experience libidinal dysfunction episodically. Of sexually active women, 10% to 15% experience orgasmic failure; most experience it episodically. In “happy” or “very happy” marriages, sexual dysfunction occurs in almost two thirds of women, with three fourths reporting sexual difficulties that fall short of true dysfunction (such as lack of interest or inability to relax). In one survey, almost one half the women reported trouble becoming sexually excited, one third had trouble maintaining excitement, and one third were completely disinterested in sex. Almost half of the women reported difficulties in achieving orgasm, and 15% had never been able to have an orgasm at all.
CLINICAL CHARACTERISTICS
Signs and Symptoms
Causes: The most common causes of sexual dysfunction are relationship problems, intrapsychic factors, and medical factors. Relationship problems are an obvious source for sexual problems, but both the patient and her doctor often overlook them. Marital or relationship stresses may be acted out by sexual distancing, orgasmic failure, or exploitation. Anger, hidden agendas, lack of trust, or infidelity may be expressed through the withdrawal of intimacy. Libidinal mismatches are common, but when combined with poor communication, they lead to dysfunction. Dual-income families may not realize the impact fatigue and a fast-paced lifestyle may be having on their ability to express warmth and be sexually expressive. Medical factors that influence sexual performance include drug and alcohol use, depression, anxiety, chronic illness, pregnancy, untreated menopause, and the effects of surgical therapies.
Once proximation (the process of courting, flirting, and desire that begins progress toward physical sexual expression) and arousal have occurred, orgasmic success requires effective stimulation, of a sufficient quality over a sufficient time, provided in a supportive environment. Failures in any of these areas may present as orgasmic problems. Medical factors that influence sexual performance include drug and alcohol use, depression, anxiety, chronic illness, pregnancy, untreated menopause, and the effects of surgical therapies.
