Anorgasmia is the absence of orgasm with sufficient sexual stimulation. It is manifested by the impossibility of sexual discharge, the rare onset of sexual satisfaction or the occurrence of orgasm only in the presence of special conditions. The diagnosis is established on the basis of complaints and anamnesis of the disease. To clarify the somatic and psychological causes of this condition, psychodiagnostic techniques are used, laboratory tests and instrumental studies are prescribed. Treatment – psychotherapy, drug therapy, physiotherapy, reflexology. With malformations and scarring of the genitals, surgical intervention is sometimes required.
F52.3 Orgasmic dysfunction
Anorgasmia is a common pathological condition in modern sexology. In the vast majority of cases, it is diagnosed in female patients. According to research data, before the first birth, only 70% of women feel satisfaction with sexual contact. From the lack of orgasm, 10 to 20% of the fairer sex suffer from having regular sexual relations for 10 or more years. The probability of achieving discharge depends on the circumstances of sexual life, the disorder often occurs after prolonged abstinence or when changing sexual partners. The connection of the absence of orgasm with masturbation is usually not traced. The prognosis depends on the causes of the pathology.
Causes of anorgasmia
This condition belongs to the category of polyethological. There are two large groups of causes of its occurrence – somatic and psychological. Psychological factors are more common, include:
- Disorders of psychosexual development. This group includes violation of gender role models of behavior, pathology of sexual identification, distortion of psychosexual orientation and other psychological phenomena that can occur in isolation or combined with each other.
- Personal characteristics. A certain role in the formation of anorgasmia can be played by shyness, excessive shyness, suspiciousness, stiffness, a tendency to “get stuck” in unpleasant experiences, difficulties in switching attention, inability to relax.
- Psychogenic factors. The reason for the lack of a sensual peak during sexual intercourse is sometimes psychological trauma: incestuous relationships in childhood, rape, gross defloration. At the initial stage of sexual life, pathology may be due to the unsuccessful experience of the first relationship. Some patients are afraid of the publicity of a relationship or an unwanted pregnancy.
- Mental disorders. Anorgasmia occurs in connection with disorders of thinking, emotional or intellectual sphere. It often accompanies depression, can be diagnosed with generalized anxiety disorder, panic disorder, dysmorphic phobia, eating disorders, severe diseases with psychotic symptoms.
The somatic causes of this disorder include malformations of the reproductive system, inflammatory processes in the pelvic area, conditions after complicated childbirth, injuries and diseases of the genitals. Anorgasmia is observed in congenital anomalies, injuries and diseases of the spinal cord with impaired innervation, with severe somatic pathology and with asthenia of various genesis (after traumatic injuries, somatic and infectious diseases, against the background of exhaustion). Sometimes the cause of the disorder is insufficient stimulation of erogenous zones, inattention or rudeness of the partner during sexual intercourse.
Anorgasmia can be an independent pathology or combined with frigidity. Taking into account the time of onset , the following types of disorder are distinguished:
- Primary. The experience of orgasmic sensations and emotional experiences caused by these sensations is completely absent.
- Secondary. In the anamnesis, the onset of orgasm with any kind of stimulation is noted, but currently it is impossible to reach a peak during sexual intercourse.
Taking into account the severity and features of the course, there are:
- Total anorgasmia. Sexual relations never end with an orgasm, regardless of the nature of the stimulation.
- Oligoorgasmia (sporadic or partial anorgasmia). The peak of pleasure with various types of stimulation occurs rarely and irregularly.
- Nymphomaniac anorgasmia. There is a high excitability with dissatisfaction and lack of a sense of completeness of coitus.
- Situational anorgasmia. Achieving orgasm is possible in certain circumstances (in one position, with sexual perversions, unusual stimulation, etc.). A type of pathology is coital anorgasmia – a condition in which orgasm is noted during masturbation, but not during sexual intercourse.
Symptoms of anorgasmia
The main complaint is the complete absence or rare onset of orgasm. The psychological perception of the disorder varies significantly. Some patients have a positive attitude to sexual contacts, feel a certain pleasure and relaxation. Others feel indifference, perceive sex life as a duty. Still others feel disgusted, avoid sexual acts. The somatic state also varies. In some cases, there are no symptoms. In others (more often – with the nymphomaniac variant), headaches, insomnia and abdominal pain are observed due to the lack of discharge and stagnant phenomena in the pelvic region.
Anorgasmia can cause depression and neurotic disorders, aggravate existing depressive and neurotic symptoms. Pathology often provokes cooling, and in some cases even the emergence of aversion to a partner, which negatively affects all aspects of family relations, leads to conflicts and becomes another factor that increases the likelihood of neuroticism. Experts point out that anorgasmia increases the likelihood of varicose veins of the pelvis, accompanied by pain in the lower abdomen, heaviness, discomfort and pain in the area of the external genitals.
Diagnosis, as a rule, does not cause difficulties. Anorgasmia is diagnosed taking into account complaints and anamnesis data. To clarify the causes of pathology, various examination programs are prescribed, compiled taking into account the data obtained during the survey and external examination of the patient:
- Gynecological examination. It is produced if there are suspected developmental abnormalities and acquired pathology of the reproductive organs. It includes consultation with a gynecologist, examination on a chair, ultrasound of the pelvic organs, tests to exclude specific and non-specific infectious diseases, etc.
- Endocrinological examination. It is indicated in the detection of hirsutism, infantilism, infertility, disorders of fat metabolism, menstrual cycle disorders. It provides consultation with an endocrinologist, hormonal studies, ultrasound of the endocrine glands, etc.
- Psychiatric or psychological examination. It is necessary to identify signs of depression, emotional instability, increased anxiety, excessive fixation on issues related to sexual dissatisfaction, complaints of unusual sensations in the genital area, strange interpretations of anorgasmia. It includes consulting a psychologist or psychiatrist, conducting special tests, a pathopsychological examination and other methods.
If another somatic pathology is detected, the patient is referred to specialists of the appropriate profile. Differential diagnosis is carried out with pseudoanorgasmia – a condition in which a woman experiences multiple mildly pronounced orgasms or a wave-like peak of pleasure.
Treatment of anorgasmia
Therapeutic tactics are determined individually. In the presence of causal pathology, therapy of identified mental disorders and somatic diseases is carried out. According to indications (for example, with congenital malformations of the reproductive system), surgical interventions are performed. The treatment plan may include:
- Medications. Patients are prescribed antidepressants, tranquilizers, sedatives of synthetic and vegetable origin, vitamins, biogenic stimulants, general restorative drugs. If necessary, hormone therapy is used.
- Physiotherapy procedures. During the treatment of anorgasmia, various types of massage, reflexology, electrical stimulation, electroson, vibro- and hydrostimulation are used.
- Psychotherapy. Individual and family consultations are conducted to work out traumatic situations, correct neurotic disorders, resolve conflicts, increase the level of trust in relationships and improve the psychological climate in the family.
The most important role in the therapy of anorgasmia is played by the treatment of a sexologist. The specialist helps to overcome psychological prohibitions and sexual fears, reduce the level of anxiety about their sexual viability and attractiveness. In the course of therapy, the patient learns to better understand the needs of her body, her partner – to take into account these needs during sexual intercourse, both members of the couple – to openly discuss problems in sexual relations.
Prognosis and prevention
The prognosis is determined by the causes of anorgasmia. In the absence of severe mental or somatic disorders that prevent orgasm, an important role is played by the willingness of partners to change sexual behavior, revise the boundaries of acceptable actions during sexual intercourse, and pay attention to each other’s desires and needs. Prevention consists in adequate sex education, the formation of correct gender role models, increasing the level of sexual literacy, creating a comfortable relationship in a couple, observing the work and rest regime, preventing and treating diseases of the sexual sphere.