Orgasmic Difficulties in Women

Orgasmic Difficulties in Women

Problems with orgasm are a frequent complaint of women and a large source of sexual dissatisfaction. These complaints can be difficult to assess and women are often resistant to discussing it with their physician. We consider many aspects of orgasm to be similar to a physical reflex to sexual stimulation. Reflexes are normal hardwired responses to stimuli but can be overridden by the brain, medications or other health conditions.

erosdevicePrimary Orgasm Difficulty refers to a woman who has never experienced an orgasm with sexual excitement and has been reported to be as high as 10% in women.

Secondary Orgasm Difficulty often has different causes and refers to women who have experienced an orgasm in the past but are no longer able.

Problems with orgasm can manifest intermittently or can be characterized by orgasms of low intensity or requiring prolonged sexual contact. These conditions can ultimately lead to an aversion to sexual contact, partner dissatisfaction and psychological distress. Orgasm difficulties can also contribute to lubrication and arousal difficulties.

The treatment for orgasm difficulties depends largely on the cause, which can be psychological or physical and often a combination of the two.

Psychological causes include:
•    Previous negative sexual experiences (sexual abuse or trauma)
•    Performance anxiety (especially when trying to please a partner)
•    Relationship problems
•    Boredom or discontent with routine
•    Generalized anxiety

Sex therapy is critically important when psychological causes are suspected. A trained sex therapist can help uncover hidden obstacles to sexual satisfaction and can help teach sexual relaxation and relationship building techniques as well as help you understand the sexual response cycle and how to become orgasmic. Sex therapy can also help break up sexual boredom.  

Physical Causes are often overlooked but amenable to treatment. They include:
•    Diabetes- reduces the sensation of the clitoris and vagina, leading to a muted orgasm.
•    Blood Pressure Medications-reduce the arousal of the clitoris and make orgasms more difficult to obtain.
•    Anti-depressants-often cause orgasms to be lost or delayed.
•    Neurologic Diseases-can lead to reduced sensation, muted orgasms or difficulty with the ejaculatory reflex.  
•    Prior pelvic surgery- can interfere with the nerves that lead to clitoral sensation or blood flow, can cause pain or reduce the intensity of muscle contractions with orgasm.
•    Trauma-such as a bicycle accident to the groin or traumatic birth can lead to nerve damage that impacts orgasm
•    Abnormal hormone levels-such and estrogen, testosterone or prolactin can make it difficult to achieve an orgasm.

Treatment for physical causes can include the use of mechanical devices to provide more intense vibratory stimulation, adjusting medications or hormones or physical therapy to strengthen the muscles of the pelvis.

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