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Orgasm Disorders

(I) Female Orgasmic Disorder (Inhibited Female Orgasm or Anorgasmia):

It is defined as a women’s inability to achieve orgasm by masturbation or coitus.

Classifcation:

1. Lifelong Female Orgasmic Disorder:

Patients with lifelong female orgasmic disorder have never experienced orgasm by any kind of stimulation. It is more common among unmarried than married women.

2. Acquired Female Orgasmic Disorder:

They have previously experienced at least one orgasm, regardless of the circumstances or means of stimulation, whether by maturbation or while dreaming during sleep.

Prevalence:

Prevalence = about 30%

Factors on which Female Orgasmic Disorder depends :

  1. Fear of Impregnation
  2. Fear of rejection by a sexual partner
  3. Fear of damage to vagina
  4. Hostility towards men
  5. Poor body image
  6. Feeling of guilt about sexual impulses.

***Inhibition of arousal & orgasmic problems often occur together.

Consequences:

Anorgasmic women may be symptom free but may experience frustration, irritability, fatigue, lower abdominal pain, itching & vaginal discharge.

(II) Delayed Ejaculation:

In delayed ejaculation, man achieves ejaculation during coitus with great difficulty. It is rarely present with masturbation but appears as a problem during partnered sex.

Prevalence:

Prevalence = about 5%

Comorbidity:

Delayed ejaculation is more common in men with Obsessive Compulsive Disorder.

Classification:

1. Lifelong Delayed Ejaculation:

Patients with lifelong delayed ejaculation have never been able to ejaculate during partnered sexual activity.

This usually occurs in men from a rigid, puritanical background. They may preceive sex as sinful & the genitals as dirty. They usually have difficulty with closeness in areas beyond those of sexual relations.

2. Acquired Delayed Ejaculation:

It develops after previously normal functioning.

Causes:

  • Antidepressant treatment.
  • High use of pornography
  • Interpersonal difficulties
  • loss of sexual attraction to the partner.

(III) Premature Ejaculation:

Premature ejaculation is diagnosed when a man regularly ejaculates before or within approximately 1 minute after penetration.

Classification:

1. Mild Premature Ejaculation:

If ejaculation occurs within approximately 30 seconds to 1 minute of vaginal penetration.

2. Moderate Premature Ejaculation:

If ejaculation occurs within approximately 15 to 30 seconds of vaginal penetration.

3. Severe Premature Ejaculation:

If ejaculation occurs at the start of sexual activity or within approximately 15 seconds of vaginal penetration.

Epidemiology:

  • Premature ejaculation is seen more commonly among college educated men than among men with less education. This could be due to relation of Premature ejaculation to the concern of partner satisfaction.
  • Premature ejaculation is the common symptom of about 35-40% of men attending sexual wellness clinics.

Factors on which Premature Ejaculation depends :

  1. Anxiety regarding sexual act.
  2. Unconscious fears about the vagina.
  3. Pre-marital sexual contact with sex workers.
  4. Stressful married life.

Orgasmic Anhedonia:

In orgasmic anhedonia, a person has no physical sensation of orgasm, even though the physiological component (e.g. ejaculation) remains intact.

Causes:

These patients usually have extreme guilt about experencing sexual pleasure. These feelings produce a dissociative response that isolates the affective components of the orgasmic experience from consciousness.

***Before making the diagnosis of orgasmic anhedonia, organic causes such as sacral & cephalic lesions must be ruled out.

Reference:

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