Anorgasmia

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Anorgasmia
Specialty Psychiatry, gynecology, urology

Anorgasmia is a type of sexual dysfunction in which a person cannot achieve orgasm despite adequate sexual stimulation. Anorgasmia is far more common in females (4.6 percent) [1] than in males and is especially rare in younger men. The problem is greater in women who are post-menopausal. [1] In males, it is most closely associated with delayed ejaculation. Anorgasmia can often cause sexual frustration.

Contents

Causes

The condition is sometimes classified as a psychiatric disorder. However, it can also be caused by physiological problems such as diabetic neuropathy, multiple sclerosis, Parkinson's disease, [2] genital mutilation on any gender, complications from genital surgery, pelvic trauma (such as from a straddle injury caused by falling on the bars of a climbing frame, bicycle or gymnastics beam), hormonal imbalances, total hysterectomy, spinal cord injury, cauda equina syndrome, uterine embolisation, childbirth trauma (vaginal tearing naturally or through the use of forceps or suction or a large or unclosed episiotomy), vulvodynia and cardiovascular disease. [3]

Drugs-induced

A common cause of anorgasmia, in both women and men, is the use of antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs). Though reporting of anorgasmia as a side effect of SSRIs is not precise, studies have found that 17–41% of users of such medications are affected by some form of sexual dysfunction. [4] [5]

Another cause of anorgasmia is cocaine use [6] and opiate addiction, particularly to heroin. [7]

Primary anorgasmia

Primary anorgasmia is a condition where one has never experienced an orgasm. This is significantly more common in women, although it can occur in men who lack the gladipudendal (bulbocavernosus) reflex. [8] Women with this condition can sometimes achieve a relatively low level of sexual excitement. Frustration, restlessness, and pelvic pain or a heavy pelvic sensation may occur because of vascular engorgement. On occasion, there may be no obvious reason why orgasm is unobtainable. In such cases, women report that they are unable to orgasm even if they have a caring, skilled partner, adequate time and privacy, and an absence of medical issues which would affect sexual satisfaction.

About 15% of women report difficulties with orgasm, and 10% of women in the United States have never climaxed. [9] [10] 29% of women always have orgasms with their partner. [11]

Some social theorists [ who? ] believe that inability to orgasm may be related to residual psychosocial perceptions [12] that female sexual desire is somehow 'wrong', and that this stems from the age of Victorian repression. It is argued that this view may impede some women – perhaps those raised in a more repressed environment – from being able to experience natural and healthy sexual feeling. [13]

A significant genetic influence was seen with an estimated heritability for difficulty reaching orgasm during intercourse of 34% (95% confidence interval 27–40%) and 45% (95% confidence interval 38–52%) for orgasm during masturbation. [14]

Secondary anorgasmia

Secondary anorgasmia is the loss of the ability to have orgasms (as opposed to primary anorgasmia which indicates a person who has never had an orgasm) or loss of the ability to reach orgasm of past intensity. The cause may be alcoholism, depression, grief, pelvic surgery (such as total hysterectomy) or injuries, certain medications, death-grip, illness, estrogen deprivation associated with menopause, or rape.

Prostatectomy

The prostate and surrounding organs. Prostatelead.jpg
The prostate and surrounding organs.

Secondary anorgasmia is close to 50% among males undergoing prostatectomy; [15] 80% among radical prostatectomies. [16] This is generally caused by damage to the primary nerves serving the penile area, which pass near the prostate gland. Removal of the prostate frequently damages or even completely removes these nerves, making sexual response unreasonably difficult. [17] Radical prostatectomies are usually given to younger males who are expected to live more than 10 years. At more advanced ages, the prostate is less likely to grow during that person's remaining lifetime. [17]

Situational anorgasmia

People who are orgasmic in some situations may not be in others. A person may have an orgasm from one type of stimulation but not from another, achieve orgasm with one partner but not another, or have an orgasm only under certain conditions or only with a certain type or amount of foreplay. These common variations are within the range of normal sexual expression and should not be considered problematic.

A person who is troubled by experiencing situational anorgasmia should be encouraged to explore alone and with their partner those factors that may affect whether or not they are orgasmic, such as fatigue, emotional concerns, feeling pressured to have sex when they are not interested, or a partner's sexual dysfunction. In the relatively common case of female situational anorgasmia during penile-vaginal intercourse, some sex therapists recommend that couples incorporate manual or vibrator stimulation during intercourse, or using the female-above position as it may allow for greater stimulation of the clitoris by the penis or pubic symphysis or both, and it allows the woman better control of movement.

Diagnosis

Effective treatment for anorgasmia depends on the cause. In the case of women with psychological sexual trauma or inhibition, psychosexual counselling might be advisable and could be obtained through general practitioner (GP) referral. [18]

Women with anorgasmia with no obvious psychological cause would need to be examined by their GP to check for absence of disease. Blood tests would also need to be done (full blood count, liver function, oestradiol/estradiol, total testosterone, SHBG, FSH/LH, prolactin, thyroid function, lipids and fasting blood sugar) to check for other conditions such as diabetes, lack of ovulation, low thyroid function or hormone imbalances. [3] The normal thresholds for these tests and timing in a woman's menstrual cycle is detailed in Berman et al., 2005.

They would then need to be referred to a specialist in sexual medicine. The specialist would check the patient's blood results for hormonal levels, thyroid function and diabetes, evaluate genital blood flow and genital sensation, as well as giving a neurological work-up to determine the degree (if any) of nerve damage.

Recently, it has been proposed to add a subtype of female orgasmic disorder (FOD), called reduced orgasmic intensity, and field trials are underway to assess the suitability of this proposal. [19]

Treatment

Just as with erectile dysfunction in men, lack of sexual function in women may be treated with hormonal patches or tablets to correct hormonal imbalances, clitoral vacuum pump devices and medication to improve blood flow, sexual sensation and arousal. [3]

Many practitioners today treat both men and women who have SSRI-induced anorgasmia with sildenafil, more commonly known as Viagra. While this approach is known to work well in men with sexual dysfunction, it is only recently that the effectiveness of sildenafil in women with sexual dysfunction is coming to light. A 1999 study by H. G. Nurnberg et al. showed a complete or very significant reversal of their sexual dysfunction upon taking sildenafil one hour prior to sexual activity. [20] In this study, eight out of the nine women required 50 mg of sildenafil while the 9th woman required 100 mg of sildenafil.

Another option for women who have SSRI-induced anorgasmia is the use of vardenafil. Vardenafil is a type 5 phosphodiesterase (PDE5) inhibitor that facilitates muscle relaxation and improves penile erection in men. However, there is controversy about the efficiency of the drug used in the reversal of female sexual dysfunction. [21] Vardenafil is similar to sildenafil, but vardenafil is less expensive and may be covered under some insurance plans. A study by A.K. Ashton M.D. has shown that in the case of one particular woman, the effects of vardenafil as opposed to sildenafil have not only been comparable in the effectiveness, but that vardenafil is cheaper and reversal of sexual dysfunction requires a smaller dose. [22] So far, vardenafil has been approved by the Food and Drug administration only for use in men.

The NIH states that yohimbine hydrochloride has been shown in human studies to be possibly effective in the treatment of male impotence resulting from erectile dysfunction or SSRI usage (e.g., anorgasmia). [23] Published reports have shown it to be effective in the treatment of orgasmic dysfunction in men. [24]

Cabergoline, an agonist of dopamine D2 receptors which inhibits prolactin production, was found in a small study to fully restore orgasm in one third of anorgasmic subjects, and partially restore orgasm in another third. Limited data has shown that the drug amantadine may help to relieve SSRI-induced sexual dysfunction. [25] [26] [27] Cyproheptadine, buspirone, stimulants such as amphetamines (including the antidepressant bupropion), nefazodone and yohimbine have been used to treat SSRI-induced anorgasmia. [28] Reducing the SSRI dosage may also resolve anorgasmia problems.

See also

Related Research Articles

<span class="mw-page-title-main">Antidepressant</span> Class of medication used to treat depression and other conditions

Antidepressants are a class of medications used to treat major depressive disorder, anxiety disorders, chronic pain, and addiction.

An anxiolytic is a medication or other intervention that reduces anxiety. This effect is in contrast to anxiogenic agents which increase anxiety. Anxiolytic medications are used for the treatment of anxiety disorders and their related psychological and physical symptoms.

Erectile dysfunction (ED), also referred to as impotence, is a form of sexual dysfunction in males characterized by the persistent or recurring inability to achieve or maintain a penile erection with sufficient rigidity and duration for satisfactory sexual activity. It is the most common sexual problem in males and can cause psychological distress due to its impact on self-image and sexual relationships.

In psychology, libido is psychic drive or energy, usually conceived of as sexual in nature, but sometimes conceived of as including other forms of desire. The term libido was originally used by the neurologist and pioneering psychoanalyst Sigmund Freud who began by employing it simply to denote sexual desire. Over time it came to signify the psychic energy of the sexual drive, and became a vital concept in psychoanalytic theory. Freud's later conception was broadened to include the fundamental energy of all expressions of love, pleasure, and self-preservation.

<span class="mw-page-title-main">Escitalopram</span> SSRI antidepressant

Escitalopram, sold under the brand names Lexapro and Cipralex, among others, is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class. Escitalopram is mainly used to treat major depressive disorder and generalized anxiety disorder. It is taken by mouth, available commercially as an oxalate salt exclusively.

<span class="mw-page-title-main">Citalopram</span> SSRI antidepressant

Citalopram, sold under the brand name Celexa among others, is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class. It is used to treat major depressive disorder, obsessive compulsive disorder, panic disorder, and social phobia. The antidepressant effects may take one to four weeks to occur. It is typically taken orally. In some European countries, it is sometimes given intravenously to initiate treatment, before switching to the oral route of administration for continuation of treatment. It has also been used intravenously in other parts of the world in some other circumstances.

Persistent genital arousal disorder (PGAD), originally called persistent sexual arousal syndrome (PSAS), is spontaneous, persistent, unwanted and uncontrollable genital arousal in the absence of sexual stimulation or sexual desire, and is typically not relieved by orgasm. Instead, multiple orgasms over hours or days may be required for relief.

Sexual dysfunction is difficulty experienced by an individual or partners during any stage of normal sexual activity, including physical pleasure, desire, preference, arousal, or orgasm. The World Health Organization defines sexual dysfunction as a "person's inability to participate in a sexual relationship as they would wish". This definition is broad and is subject to many interpretations. A diagnosis of sexual dysfunction under the DSM-5 requires a person to feel extreme distress and interpersonal strain for a minimum of six months. Sexual dysfunction can have a profound impact on an individual's perceived quality of sexual life. The term sexual disorder may not only refer to physical sexual dysfunction, but to paraphilias as well; this is sometimes termed disorder of sexual preference.

<span class="mw-page-title-main">Serotonin–norepinephrine reuptake inhibitor</span> Class of antidepressant medication

Serotonin–norepinephrine reuptake inhibitors (SNRIs) are a class of antidepressant medications used to treat major depressive disorder (MDD), anxiety disorders, social phobia, chronic neuropathic pain, fibromyalgia syndrome (FMS), and menopausal symptoms. Off-label uses include treatments for attention-deficit hyperactivity disorder (ADHD), obsessive–compulsive disorder (OCD), and migraine prevention. SNRIs are monoamine reuptake inhibitors; specifically, they inhibit the reuptake of serotonin and norepinephrine. These neurotransmitters are thought to play an important role in mood regulation. SNRIs can be contrasted with the selective serotonin reuptake inhibitors (SSRIs) and norepinephrine reuptake inhibitors (NRIs), which act upon single neurotransmitters.

<span class="mw-page-title-main">Vardenafil</span> Chemical compound

Vardenafil, sold under the brand name Levitra among others, is a medication that is used for treating erectile dysfunction. It is a PDE5 inhibitor. It is taken by mouth.

Sexual medicine or psychosexual medicine as defined by Masters and Johnsons in their classic Textbook of Sexual Medicine, is "that branch of medicine that focuses on the evaluation and treatment of sexual disorders, which have a high prevalence rate." Examples of disorders treated with sexual medicine are erectile dysfunction, hypogonadism, and prostate cancer. Sexual medicine often uses a multidisciplinary approach involving physicians, mental health professionals, social workers, and sex therapists. Sexual medicine physicians often approach treatment with medicine and surgery, while sex therapists often focus on behavioral treatments.

Female sexual arousal disorder (FSAD) is a disorder characterized by a persistent or recurrent inability to attain sexual arousal or to maintain arousal until the completion of a sexual activity. The diagnosis can also refer to an inadequate lubrication-swelling response normally present during arousal and sexual activity. The condition should be distinguished from a general loss of interest in sexual activity and from other sexual dysfunctions, such as the orgasmic disorder (anorgasmia) and hypoactive sexual desire disorder, which is characterized as a lack or absence of sexual fantasies and desire for sexual activity for some period of time.

Sex and drugs refers to the influence of substances on sexual function and experience. Sex and drugs date back to ancient humans and have been interlocked throughout human history. Sexual performance is known as the execution of the act of sex and the quality of sexual activity. This includes elements such as libido, sexual function, sensation . Drugs are termed as any chemical substance that produces a physiological and or psychological change in an organism. Drugs categorized as psychoactive drugs, antihypertensive drugs, antihistamines, cancer treatment, and hormone medication have a significant impact on sexual performance. Various drugs result in different effects, both positive and negative. Negative effects may include low libido, erection issues, vaginal dryness and anorgasmia. Positive effects usually address these issues, overall enhancing sexual performance and contributing to a more enjoyable sexual experience. It is crucial to know that the impact of drugs on sexual performance varies among individuals, especially among different genders.

Delayed ejaculation (DE) is a man's inability or persistent difficulty in achieving orgasm, despite typical sexual desire and sexual stimulation. Generally, a man can reach orgasm within a few minutes of active thrusting during sexual intercourse, whereas a man with delayed ejaculation either does not have orgasms at all or cannot have an orgasm until after prolonged intercourse which might last for 30–45 minutes or more. Delayed ejaculation is closely related to anorgasmia.

A spontaneous orgasm, or spontaneous ejaculation when it occurs in males, is an orgasm which occurs spontaneously and involuntarily without sexual stimulation. Nocturnal emissions may be considered a normal/physiological form of spontaneous orgasm. Pathological spontaneous orgasms can be experienced as pleasurable, non-pleasurable, or unpleasant, and can be distressing. Causes of pathological spontaneous orgasms include spinal cord lesions, psychological causes, rabies, and medications. Some cases may have no identifiable cause. Spontaneous orgasms may have no trigger or may be triggered by various non-sexual circumstances. They may occur in both males and females. Treatment of spontaneous orgasms include psychotherapy, selective serotonin reuptake inhibitors (SSRIs), the alpha-1 blocker silodosin, and anxiolytics.

<span class="mw-page-title-main">Vortioxetine</span> Serotonin modulator antidepressant

Vortioxetine, sold under the brand name Trintellix among others, is an antidepressant of the serotonin modulator and stimulator (SMS) class. Its effectiveness is viewed as similar to that of other antidepressants. It is taken orally.

<span class="mw-page-title-main">Selective serotonin reuptake inhibitor</span> Class of antidepressant medication

Selective serotonin reuptake inhibitors (SSRIs) are a class of drugs that are typically used as antidepressants in the treatment of major depressive disorder, anxiety disorders, and other psychological conditions.

<span class="mw-page-title-main">Dapoxetine</span> Medication used to treat premature ejaculation

Dapoxetine, marketed as Priligy, among others, is a selective serotonin reuptake inhibitor (SSRI) used for the treatment of premature ejaculation (PE) in men 18–64 years old. Dapoxetine works by inhibiting the serotonin transporter, increasing serotonin's action at the postsynaptic cleft, and as a consequence promoting ejaculatory delay. As a member of the selective serotonin reuptake inhibitor (SSRI) family, dapoxetine was initially created as an antidepressant. However, unlike other SSRIs, dapoxetine is absorbed and eliminated rapidly in the body. Its fast-acting property makes it suitable for the treatment of PE, but not as an antidepressant.

Sexual anhedonia, also known as pleasure dissociative orgasmic disorder, is a condition in which an individual cannot feel pleasure from an orgasm. It is thought to be a variant of hypoactive sexual desire disorder.

A neurosteroidogenesis inhibitor is a drug that inhibits the production of endogenous neurosteroids. Neurosteroids include the excitatory neurosteroids pregnenolone sulfate, dehydroepiandrosterone (DHEA), and dehydroepiandrosterone sulfate (DHEA-S), and the inhibitory neurosteroids allopregnanolone, tetrahydrodeoxycorticosterone (THDOC), and 3α-androstanediol, among others. By inhibiting the synthesis of endogenous neurosteroids, neurosteroidogenesis inhibitors have effects in the central nervous system.

References

  1. 1 2 Nolen-Hoeksema, Susan (2014). Abnormal Psychology Sixth Edition. New York, NY: McGraw-Hill Education. p. 368. ISBN   978-0-07-803538-8.
  2. ↑ "Sexual Effects of Parkinson's | APDA". American Parkinson Disease Association. Archived from the original on 28 November 2021. Retrieved 31 December 2022.
  3. 1 2 3 For Women Only, Revised Edition: A Revolutionary Guide to Reclaiming Your Sex Life by Berman, J. Bumiller, E. and Berman L. (2005), Owl Books, NY. ISBN   978-0-8050-7883-1
  4. ↑ Hu XH, Bull SA, Hunkeler EM, et al. (July 2004). "Incidence and duration of side effects and those rated as bothersome with selective serotonin reuptake inhibitor treatment for depression: patient report versus physician estimate". The Journal of Clinical Psychiatry. 65 (7): 959–65. doi:10.4088/JCP.v65n0712. PMID   15291685.
  5. ↑ Landén M, Högberg P, Thase ME (January 2005). "Incidence of sexual side effects in refractory depression during treatment with citalopram or paroxetine". The Journal of Clinical Psychiatry. 66 (1): 100–06. doi:10.4088/JCP.v66n0114. PMID   15669895.
  6. ↑ Woodhouse, Christopher (2019). "The effects of recreational drug use on the genitourinary tract". Trends in Urology & Men's Health. 10 (4): 18–20. doi: 10.1002/tre.703 . S2CID   199618320.
  7. ↑ "Heroin Addiction and Related Clinical Problems" (PDF). Archived (PDF) from the original on 12 December 2010. Retrieved 6 January 2014.
  8. ↑ Bridley, G. S.; Gillan, P. (1982). "Men and women who do not have orgasms". The British Journal of Psychiatry. 140 (4): 351–6. doi:10.1192/bjp.140.4.351. PMID   7093610. S2CID   33372908.
  9. ↑ Frank JE, Mistretta P, Will J (March 2008). "Diagnosis and treatment of female sexual dysfunction". American Family Physician. 77 (5): 635–42. PMID   18350761.
  10. ↑ Giustozzi AA. Sexual dysfunction in women. In: Ferri FF. Ferri's Clinical Advisor 2010. St. Louis, Mo.: Mosby; 2009. Archived 14 June 2017 at the Wayback Machine
  11. ↑ "Indiana University Bloomington". Archived from the original on 5 January 2012. Retrieved 1 January 2012.
  12. ↑ Lentz, Anna Maree; Zaikman, Yuliana (1 June 2021). "The Big "O": Sociocultural Influences on Orgasm Frequency and Sexual Satisfaction in Women". Sexuality & Culture. 25 (3): 1096–1123. doi:10.1007/s12119-020-09811-8. ISSN   1936-4822.
  13. ↑ Stern and Saunders "Psychosocial Sexual Impediment: a Victorian Legacy? (UNC Chapel Hill, 2007)[ citation not found ]
  14. ↑ Genetic influences on variation in female orgasmic function: a twin study Kate M Dunn,2 Lynn F Cherkas,1 and Tim D Spector1,
  15. ↑ Dunsmuir WD, Emberton M, Neal DE. "There is significant sexual dissatisfaction following TURP". British Journal of Urology (77): 161A.
  16. ↑ Koeman M, Van Driel MF, Weijmar Schultz WC, Mensink HJ (1996). "Orgasm after radical prostatectomy". British Journal of Urology. 77 (6): 861–64. doi:10.1046/j.1464-410x.1996.01416.x. PMID   8705222.
  17. 1 2 "Radical Prostatectomy". WebMD . Archived from the original on 16 December 2017. Retrieved 6 December 2011.
  18. ↑ Humphery, S.; Nazareth, I. (1 October 2001). "GPs' views on their management of sexual dysfunction". Family Practice. 18 (5): 516–518. doi: 10.1093/fampra/18.5.516 . ISSN   0263-2136. PMID   11604374.
  19. ↑ Brotto LA, Bitzer J, Laan E, Leiblum S, Luria M (2010). "Women's Sexual Desire and Arousal Disorders". Journal of Sexual Medicine. 7 (1 Pt 2): 586–614. doi:10.1111/j.1743-6109.2009.01630.x. PMID   20092454.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  20. ↑ H. Geore Nurnberg, M.D.; et al. (1999). "Sildenafil for Women Patients with Antidepressant-Induced Sexual Dysfunction". Psychiatric Services. 50 (8): 1076–78. doi:10.1176/ps.50.8.1076. PMID   10445658.
  21. ↑ J. Angulo; et al. (2003). "Vardenafil enhances clitoral and vaginal blood flow responses to pelvic nerve stimulation in female dogs". International Journal of Impotence Research. 15 (2): 137–141. doi:10.1038/sj.ijir.3900985. PMID   12789394. S2CID   1054938.
  22. ↑ A.K. Ashton (2004). "Vardenafil Reversal of Female Anorgasmia". American Journal of Psychiatry. 161 (11): 2133. doi:10.1176/appi.ajp.161.11.2133. PMID   15514423.
  23. ↑ "Yohimbe: MedlinePlus Supplements". nlm.nih.gov. 19 November 2010. Archived from the original on 1 August 2010. Retrieved 13 December 2010.
  24. ↑ Adeniyi AA, Brindley GS, Pryor JP, Ralph DJ (May 2007). "Yohimbine in the treatment of orgasmic dysfunction". Asian Journal of Andrology. 9 (3): 403–07. doi: 10.1111/J.1745-7262.2007.00276.x . PMID   17486282.
  25. ↑ Shrivastava RK, Shrivastava S, Overweg N, Schmitt M (1995). "Amantadine in the treatment of sexual dysfunction associated with selective serotonin reuptake inhibitors". Journal of Clinical Psychopharmacology . 15 (1): 83–84. doi:10.1097/00004714-199502000-00014. PMID   7714234.
  26. ↑ Balogh S, Hendricks SE, Kang J (1992). "Treatment of fluoxetine-induced anorgasmia with amantadine". The Journal of Clinical Psychiatry . 53 (6): 212–13. PMID   1607353.
  27. ↑ Keller Ashton A, Hamer R, Rosen RC (1997). "Serotonin reuptake inhibitor-induced sexual dysfunction and its treatment: a large-scale retrospective study of 596 psychiatric outpatients". Journal of Sex & Marital Therapy . 23 (3): 165–75. doi:10.1080/00926239708403922. PMID   9292832.
  28. ↑ Gitlin, Michael J. (1998). "Treatment of Antidepressant-Induced Sexual Dysfunction". Medscape Psychiatry & Mental Health eJournal. 3 (3). Archived from the original on 26 July 2017. Retrieved 4 April 2018.

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