Definition and Diagnosis
Orgasmic disorder, commonly termed anorgasmia, is a persistent or recurrent delay in, or absence, infrequency, or reduced intensity of, orgasm following a normal sexual excitement phase, despite adequate stimulation, causing significant distress.
Epidemiology
It is one of the more common female sexual complaints, with situational or acquired forms more frequent than lifelong anorgasmia; the condition can also occur in men, though less commonly, often in association with certain medications or neurological conditions.
Risk Factors
Risk factors include anxiety, depression, relationship difficulties, inadequate or unskilled sexual stimulation, a history of sexual trauma, certain medications (notably SSRIs), and neurological or hormonal conditions affecting sexual response.
Symptoms and Subtypes
Presentation ranges from a marked delay in reaching orgasm to complete absence of orgasm despite subjectively adequate arousal and stimulation, often accompanied by frustration, reduced sexual satisfaction, or avoidance of sexual activity.
Diagnosis
Diagnosis relies on a detailed sexual history establishing the pattern, context, and duration of orgasmic difficulty (at least six months in most presentations), ruling out inadequate stimulation as the sole explanation, and identifying contributing medical, medication-related, or psychological factors.
Treatment
Treatment typically combines sex therapy techniques such as directed masturbation training and sensate focus exercises with treatment of underlying psychological or relationship factors. Where medication (particularly SSRIs) is a contributing cause, dose adjustment or switching agents may help.
Prognosis
Outcomes are generally good with structured sex therapy, particularly for acquired or situational forms. Lifelong anorgasmia can be more resistant to treatment but often still improves with sustained therapeutic work.
Reference
American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.).