Anorgasmia (often related to delayed ejaculation in males) is a form of sexual dysfunction, sometimes classified as a psychiatric disorder, where the patient cannot achieve orgasm, even with "adequate" stimulation. Anorgasmia is far more common in females than in males and is especially rare in younger men.
A common cause of anorgasmia, in both men and women, is the use of anti-depressants, particularly the selective serotonin reuptake inhibitors (SSRIs). Though reporting of anorgasmia as a side-effect of SSRIs is not precise, it is estimated that 15-50% of users of such medications are affected by this condition. Some popular SSRIs are Effexor, Lexapro, Paxil, Prozac and Zoloft. The chemical amantadine has been shown to cure SSRI-induced anorgasmia in some people, though not in all people.
One proposed — and disputed — cause of anorgasmia during intercourse in younger men is a particular masturbation style — according to two doctors and one psychologist who have coined the term traumatic masturbatory syndrome.
The rest of this article primarily discusses anorgasmia in women, since male anorgasmia has had very little study compared to female anorgasmia. Two types of anorgasmia have been defined: primary anorgasmia and secondary anorgasmia.
Primary Anorgasmia
Primary anorgasmia is a condition where one cannot physically orgasm. This is by far most common in women, although it can occur in men who lack the gladipudendal reflexes.
Women with this condition can sometimes achieve a relatively low level of sexual excitement and may think of intercourse or other sexual activities as pleasant despite their inability to orgasm. They may get most of their reward from touching, holding, kissing, caressing, attention, and approval. However, women who regularly achieve high levels of sexual response without orgasmic release of tension may find the experience frustrating. Emotional irritability, restlessness, and pelvic pain or a heavy pelvic sensation may occur because of vascular engorgement.
Women who have not yet had an orgasm usually have some combination of the following:
- Sociocultural inhibitions that interfere with normal sexual response
- Unresolved feelings towards a traumatic sexual experience as in sexual abuse or rape
- A lack of knowledge about sex and sexuality, which interferes with normal sexual development
- A lack of opportunity to practice in a safe, secure, socially acceptable, and private atmosphere (alone or in a relationship) in a situation that offers approval and support
- A partner who ejaculates prematurely
- A partner who has primary or secondary difficulty in achieving an erection
- Dyspareunia, or painful intercourse
- Genital mutilation ("female circumcision") that removes part or all of the clitoris, scars the genital area, or constricts the opening to the vagina. Often, vaginal intercourse is painful not only because of scarring from this procedure but also because of associated infection.
Often, though, there is no obvious reason why orgasm is unobtainable. Regardless of having a caring, skilled partner, having adequate time and privacy, and having no medical issues which would affect sexual satisfaction, some women are unable to orgasm. This situation is extremely frustrating because with no discernible cause, a plausible solution is difficult to discover.
In many contexts, many people have been able to find effective relief from anorgasmia despite a physical factor through a mental process of conditioning, as such hypnosis can have a positive impact.
Primary male anorgasmia is very uncommon, and thus has been studied very little. Given the social climate where males are just expected to be able to orgasm, it is possible that they feel ashamed, and refuse to discuss it, or distance themselves sexually. Either way, primary anorgasmia is largely considered a "female only" condition, which can be extremely frustrating to males who are left feeling alone by an affliction that few if any acknowledge.
Secondary Anorgasmia
Secondary anorgasmia is the loss of the ability to have orgasms. The cause may be alcoholism, depression, grief, certain medications, illness, estrogen deprivation associated with menopause or an event that has violated the patient's sexual value system.
Secondary anorgasmia is also very common among males undergoing prostatectomy, being close to 50%; with a rate as high as 80% with a radical prostatectomies. This is very alarming considering that radical prostatectomies are usually given to younger males who are expected to more easily recover from the entire removal of their prostate. This is caused by the fact that the primary nerves serving the penile area pass through the actual prostate gland itself, and removal frequently damages or even completely severs the nerves, making sexual feeling impossible. Interestingly, the fact that these nerves are present is also a factor in the surgery involving many transsexual male to female patients, leaving the surgeon to decide usually that the presence of the prostate gland in the newly formed wall of the vagina will result in stimulation of the nerves in the prostate gland, providing a source of pleasure for the post-op transsexual.
Situational Anorgasmia
Women who are orgasmic in some situations may not be in others. A woman may have an orgasm from one type of stimulation but not from another. Or a woman may 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.
Doctors believe that a woman with situational anorgasmia should be encouraged to explore alone and with her partner those factors that may affect whether or not she is orgasmic, such as fatigue, emotional concerns, feeling pressured to have sex when she is not interested, or her partner's sexual dysfunction.
The same doctors believe that family planners should consider recommending the female-above position for penile-vaginal intercourse, as it may allow for greater stimulation of the clitoris by the penis or symphysis pubis or both, and it allows the woman better control of movement. Bridging is the combining of a successful method for sexual stimulation with a desired technique so that the body learns to associate orgasm with that technique. If, for example, the woman is readily orgasmic with manual stimulation but not with penile-vaginal thrusting, she is encouraged to combine those two regularly until her body has learned to associate high levels of excitement and orgasm with penile-vaginal thrusting.
Random Anorgasmia
Some women are orgasmic but not in enough instances to satisfy their sense of what is appropriate or desirable. Often such women have trouble giving up control and allowing themselves to respond fully. Therapy can be aimed at helping them give up the need to keep their sexual feelings under control at all times.
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