Orgasmic dysfunction (anorgasmia)

• orgasm does not occur or is delayed
• more common in women

Biology

• orgasm involves local spinal mechanisms as well as CNS activity
• EEG shows changes akin to epileptic seizures
• orgasm is similar in both sexes:
• HR and blood pressure increase
• sudden increase in skeletal muscle activity involving almost all parts of the body
• in females, there is transient rhythmical contraction of the uterus and vagina

Epidemiology

• prevalence = 5-10% in females, 4-10% in males
• in females, the prevalence of anorgasmia reduces with increasing age

Aetiology

1. Physical

• in both sexes, the bulbocavernosus reflex has been reported to be absent in some people – this is strongly correlated with treatment failure
• sometimes, local pain can create fear of orgasm
• Drugs:

opiates have a direct inhibitory effect
antiserotonergic drugs inhibit orgasm
SSRIs
MAOIs
TCAs are all associated with female anorgasmia

2. Psychological

• anxiety inhibits orgasm in females, but hastens it in men
• there may be fear of pregnancy or STDs

Management

• direct masturbation training is the treatment of choice
• tasks include relaxation, fantasizing, and masturbation