ANORGASMIA IN WOMEN

Definition

Anorgasmia is a type of sexual dysfunction in which a person can not achieve orgasm, even with adequate stimulation, causing personal distress.

Awareness and awakening

Anorgasmia, or the failure / inability of a woman to achieve orgasm, was never seen as a problem in the male-focused of the past. The ideal woman of the 1900’s was seen as pure, asexual, and she was expected to engage in sex only to please her husband and / or bear him children. Fortunately, forces of social change such as WW II, and the sexual revolution allowed attention to be redirected from the woman being seen as the sexually positive wife who does her “duty“ as the acceptor of the gift of life; to seeing the woman as a fully sexual being who can share in the experience of pleasure which accompanies a mature sexual relationship.

Researchers such as Alfred Kinsey and Masters and Johnson both reflected the changing sexual attitudes of the time, and acted as catalysts for the change. Thanks to the pioneering work of sex researchers such as these, women who are not able to achieve orgasm no longer must resign themselves to frustration, depression and sexual un-fulfillment.

Incidence

Anorgasmia is actually a very common occurrence, affecting at-least I in 5 women world wide. Orgasms vary in intensity, and women vary in the frequency of their orgasms and the amount of stimulations necessary to trigger an orgasm. In fact, less than a third of women consistently have orgasms with sexual activity plus, orgasms often change with age, medical issues or medications. If one is happy with the climax of sexual activities, there is no need for concern. How ever, if a person is bothered by lack of orgasm or the intensity of orgasm, consult a doctor about anorgasmia.

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Symptoms

An orgasm is a feeling of intense physical pleasure and release of tension, accompanied by involuntary, rhythmic contractions of pelvic floor muscles. Some women actually feel pelvic contraction or a quivering of the uterus during orgasm, but some don’t. Some women describe fireworks all over the body, while others describe the feeling as a tingle.

Types of anorgasmia

Anorgasmia is usually characterized or specified in one of the following three ways.

1. Primary: Primary anorgasmia means that the diagnosed woman has never been able to achieve orgasm at any point in her life.
2. Secondary: A diagnosis of secondary anorgasmia means that the woman was consistently able to have orgasms at one time, but is no longer able to achieve them.
3. Situational: Situational anorgasmia refers to woman who can achieve orgasm in certain sexual situation, bur never orgasm in other specific situation. For example, a woman who can orgasm through masturbation but never during sex in the man on top position.

Causes

Orgasm is no simple, surefire thing. This pleasurable peak is actually a complex reaction to many physical, emotional and psychological factors. If a person is experiencing trouble in any of these areas, it can affect the ability to orgasm.

Physical causes

A wide range of illness, physical changes and medications can interfere with orgasm.

Medical diseases: Any illness can affect this part of one’s sexuality, including diabetes and neurological diseases, such as multiple sclerosis. Orgasm may also be affected by gynecologic surgeries, such as hysterectomy or cancer surgeries. In addition, lack of orgasm often goes hand in hand with other sexual problems, such as painful intercourse.

Medications: Many prescription and over-the counter medications can interfere with orgasm. This includes blood pressure medications,

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antihistamines, and antidepressants – particularly selective serotonin reuptake inhibitors (SSRIS).

Alcohol and drugs: A glass of wine may make a person feel amorous, but too much alcohol can cramp one’s ability to climax, the same is true of street drugs.

The aging process: As a person age, normal changes in anatomy, hormones, neurological system and circulatory system can affect sexuality. The drop in estrogen that occurs during the transition to menopause can be a particularly notable foe of orgasm. Lower levels of this female hormone can decrease sensation in the clitoris, nipples and skin and impede blood flow to the vagina and clitoris, which can delay or stop orgasm entirely. Still anorgasmia is not limited to older women. And many women say sex becomes more satisfying with age.

Emotional factors

Like many sexual dysfunctions, diagnosis of anorgasmia is some what subjective and depends a great deal up on the thoughts, emotions, and desires of the individual experiencing it. Some women may never achieve orgasm through intercourse with their partner and live active, fully satisfying sex lives by achieving in other ways such as partner’s stimulation of her clitoris manually. Other women may be able to achieve orgasm through manual stimulation, yet still feel depressed, inadequate and unfulfilled because they can not reach orgasm during intercourse. Studies show that women who identify with the latter group are not alone. It is estimated that between 10 % and 40 % of adult American women have problems achieving orgasms.

Psychological causes

Many psychological factors play a role in a person’s ability to orgasm including-

• Mental health problems such as anxiety or depression.
• Performance anxiety.
• Stress and financial pressures.
• Social, cultural and religious beliefs.
• Fear of pregnancy or sexually transmitted diseases.
• Embarrassment.
• Guilt about enjoying sexual experiences.

Relationship Issues

Many couples who are experiencing problems out side the bed room will continue to experience in the bed room. These issues may include-

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• Lack of connection with the partner.
• Unresolved conflicts or fights.
• Poor communication of sexual needs and preferences.
• Infidelity or breach of trust.

Treatment

Women suffering from any sexual dysfunction, including anorgasmia, should be evaluated by a gynecologist before delving too far in to sex therapy. For most women treatment means more than medications.

Counseling for anorgasmic women will most likely focus on three areas. First, women are usually encouraged to attend sex therapy with their primary sexual partner. There are several reasons for this, but the primary one is that anorgasmia, like many sexual dysfunctions, can not be seen solely as the woman’s problem. There are many relationship variables which affect the symptom and, therefore, need to be treated in couple’s therapy. Counseling often begins with an element of sexual education for the couple. The couple is taught the mechanisms of sexual arousal in women and, most importantly, they are taught the differences in the male and female sexual response cycles

Female inhibited orgasm is often treated with specific therapeutic techniques Couple will often be taught to use sensate focus exercises at home, and females will often be taught and encouraged to use systematic desensitization, and directed masturbation to treat their orgasm problem. Directed masturbation is a technique whereby the woman is educated as to how she can bring herself to orgasm. The hope is that through her increased body awareness and comfort with orgasm, the woman transfer this knowledge and take charge in directing her partner during intercourse,  thereby, achieving orgasm with her partner. Beyond education and techniques, counseling will likely focus on the emotional or situational factors, of both the individual, and the couple, that are, contributing to the lack of orgasm in the woman. How these sensitive and all important issues are dealt with in therapy will depend a great deal on the theoretical orientation of each individual counselor.

Prognosis

If the problem of anorgasmia is treated by a qualified sex therapist who takes time to consider the many variables which can contribute to the problem,

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then the couple can expect a positive outcome. And although successful treatment of this condition depends a great deal on the specific nature of the diagnosis (primary vs secondary, age of woman effected, willingness of partner to attend counseling, depth of emotional cause, level of anxiety associated with becoming orgasmic etc.), research has shown a success rate of 80- 90 % for treatment of primary anorgasmia; and between 10-75 % success rate for treatment of secondary anorgasmia. These successful treatment rates are encouraging for the millions of women who live with the frustration of not being able to reach orgasm in their sexual lives. It appears that our society has finally come to the realization that women too are sexual beings, beings who desire, need, and deserve similar pleasure from the act of sex as men have enjoyed for centuries. Fortunately, sex therapists have evolved along with society in their ability to help women live fully satisfying sex lives if they so desire.

ANORGASMIA IN MEN

Definition

Male orgasm is defined as a subjective, perceptual cognitive event of peak sexual pleasure that in normal conditions coincides with the moment of ejaculation. Anorgasmia is defined as a failure to experience an orgasm.

Delayed ejaculation is a medical condition in which a male can not ejaculate, either during intercourse or by manual stimulation with a partner. Ejaculation is when semen is released from the penis.

Incidence

Most men ejaculate with in a few minutes of starting to thrust during intercourse. Men with delayed ejaculation may be unable to ejaculate (for example, during intercourse) or may only be able to ejaculate with great effort after having intercourse for a long time (for example 30 to 45 minutes)

The presence of a normal sexual excitement phase is a prerequisite for male orgasmic disorder. In other words, if the absence of orgasm follows a decreased desire for sexual activity, an aversion to genital sexual contact, or a decreased lubrication swelling response, diagnoses such as hypoactive sexual desire disorder, sexual aversion disorder, or male erectile disorder might be more appropriate even if they all have a final common outcome

( ie anorgasmia )

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Patients with male orgasmic disorder can achieve firm erections and have normal sexual intercourse with penetrations. Some patients reporting male orgasmic disorder with intercourse can achieve orgasm through manual or oral stimulation or at least report orgasm through nocturnal emission (ie wet dreams). A report of generalized life long male orgasmic disorder with no orgasm at all (across an array of stimulative technique) suggests an organic etiology.

Diagnoses

According to the Diagnostic and Statistical Manual of Mental Disorders, 4^th Edition, Test Revision (DSM IV-TR), the diagnostic criteria for male orgasmic disorder (MOD) is as follows-

• Persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase during sexual activity that, taking in to account the person’s age, is thought to be adequate in focus, intensity, and duration.
• The disturbance causes marked distress or interpersonal difficulty.

DSM IV –TR male orgasmic disorder specifiers include the following types

• Life long or acquired.
• Generalized or situational.
• Due to psychological or combined factors.

DSM IV –TR does not distinguish between disorders of orgasm and disorders of ejaculation (with the notable exception of premature ejaculation), which suggests an implicit assumption that orgasm and ejaculation are overlapping events (not only from a temporal perspective but also from a physiological perspective). Yet, some researchers distinguish between disorders of orgasm and disorders of ejaculation the latter including deficient and delayed ejaculation, retrograde ejaculation, and ejaculatory insufficiency. Such distinctions might have merit because not only can ejaculation occur with out concomitant orgasm, but orgasm can also occur with out ejaculation (as seen in both pre-pubertal children and adults practicing coitus reservatus).

Delayed ejaculation can have psychological or physical causes.

Common psychological causes include-

• A strict religious background that makes the person view sex as sinful.
• Lack of attraction for a partner.

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*   Conditioning caused by a habit of unusual masturbation.

*   Traumatic events (such as being discovered masturbating or having   illicit sex or learning one’s partner is having an affair)

Some factors, such as anger toward the partner, may be involved.

Physical causes may include-

• Use of certain drugs ( such as prozac, mellaril, and guanethidine)
• Nervous system disease, such as a stroke or nerve damage in the spinal cord or back.

Complications

If the problem is not addressed and treated the following may occur.

• Avoidance of sexual contact.
• Inhibited sexual desire.
• Marital stress,
• Sexual dissatisfaction.

If the person and his partner are trying to get pregnant, sperm may have to be collected using other methods because of lack of ejaculation.

Prevention

Having a healthy attitude about sexuality and genitals helps prevent delayed ejaculation. Realize that one can not be forced to have a sexual response, just as one can not be forced to go to sleep or to perspire. The harder you try to have a certain sexual response, the harder it becomes to respond. To reduce pressure, one should absorb in the pleasure of the moment. The person should not worry about whether or when the ejaculation will take place. The person’s partner should create a relaxed atmosphere and should not pressurize about whether or not ejaculated. Openly discuss any fears or anxieties, such as fear of pregnancy or disease, with the partner.

Signs and Tests

Stimulating the penis with a vibrator or other device may determine whether the person have a physical (often nervous system) problem. A nervous system (neurological) examination may reveal other nervous problems that are associated with delayed ejaculation.

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Treatment

• If the person has never ejaculated through any form of stimulation (such as wet dreams, masturbation or intercourse) may see an urologist to determine if the problem has a physical cause.
• If the person is able to ejaculate in a reasonable period of time by some form of stimulation, may see a therapist who specializes in ejaculation problems. Sex therapy usually includes both partners. The therapist will usually teach them about the sex response, and how to communicate and guide the partner to provide the right stimulation.
• Therapy often involves a series of “home work” assignments. In the privacy of their home the partners engage in sexual activities that reduce performance pressure and focus on pleasure.
• Typically, the person will not have sexual intercourse for a certain period of time, while he gradually study to enjoy ejaculation through other types of stimulation.
• In cases where there is a problem with the relationship or a lack of sexual desire, the person may need therapy to improve his relationship and emotional intimacy.
• Some times hypnosis may be a helpful addition to therapy, especially if one partner is not willing to participate in the therapy. Trying to self-treat this problem is often not successful.
• If a medication is believed to be the cause of the problem, discuss other medication options with the health care provider. Never stop taking any medicine with out first talking to the health provider.

Prognosis

Treatment commonly requires about 12 to 18 sessions. The average success rate is 70 to 80 %.

The person will have a better out come if-

• The person has a past history of satisfying sexual experiences.
• The problem has not been occurring for a long time.
• The person has feelings of sexual desire.
• The person feels love toward his sexual partner.
• The person is motivated to get treated.
• The individual does not have serious psychological problems.

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If medications are causing the problem, the health care provider may recommend switching or stopping the medicine (if possible). A full recovery is possible if this can be done.

D.RETNAMONY, B.COM; M.SC (C & P);

Psychological counselor and psychotherapist

and flower medicine practitioner.