Many women require clitoral stimulation to reach orgasm, and a relatively small pro- portion of women report that they always experience orgasm during penile-vaginal inter- course. Thus, a woman’s experiencing orgasm through clitoral stimulation but not during intercourse does not meet criteria for a clinical diagnosis of female orgasmic disorder. It is also important to consider whether orgasmic difficulties are the result of inadequate sex- ual stimulation; in these cases, there may still be a need for care, but a diagnosis of female orgasmic disorder would not be made.
Associations between specific patterns of personality traits or psychopathology and orgas- mic dysfunction have generally not been supported. Compared with women without the disorder, some women with female orgasmic disorder may have greater difficulty com- municating about sexual issues. Overall sexual satisfaction, however, is not strongly cor- related with orgasmic experience. Many women report high levels of sexual satisfaction despite rarely or never experiencing orgasm. Orgasmic difficulties in women often co- occur with problems related to sexual interest and arousal.
In addition to the subtypes "lifelong/ acquired” and ”generalized / situational,” the fol- lowing five factors must be considered during assessment and diagnosis of female orgas- mic disorder given that they may be relevant to etiology and/ or treatment: 1) partner factors (e.g., partner’s sexual problems, partner’s health status); 2) relationship factors (e.g., poor communication, discrepancies in desire for sexual activity); 3) individual vul- nerability factors (e.g., poor body image, history of sexual or emotional abuse), psychiatric comorbidity (e.g., depression, anxiety), or stressors (e.g., job loss, bereavement); (4) cul- tural/religious factors (e.g., inhibitions related to prohibitions against sexual activity; attitudes toward sexuality); and 5) medical factors relevant to prognosis, course, or treat- ment. Each of these factors may contribute differently to the presenting symptoms of dif- ferent women with this disorder.
Reported prevalence rates for female orgasmic problems in women vary widely, from 10% to 42%, depending on multiple factors (e.g., age, culture, duration, and severity of symp- toms); however, these estimates do not take into account the presence of distress. Only a proportion of women experiencing orgasm difficulties also report associated distress.
Variation in how symptoms are assessed (e.g., the duration of symptoms and the recall pe- riod) also inﬂuence prevalence rates. Approximately 10% of women do not experience or- gasm throughout their lifetime.
By definition, lifelong female orgasmic disorder indicates that the orgasmic difficulties have always been present, whereas the acquired subtype would be assigned if the woman’s or- gasmic difficulties developed after a period of normal orgasmic functioning.
A woman’s first experience of orgasm can occur any time from the prepubertal period to well into adulthood. Women show a more variable pattern in age at first orgasm than do men, and women’s reports of having experienced orgasm increase with age. Many women learn to experience orgasm as they experience a wide variety of stimulation and acquire more knowledge about their bodies. Women’s rates of orgasm consistency (defined as ”usually or always” experiencing orgasm) are higher during masturbation than during sexual activity with a partner.
Temperamental. A wide range of psychological factors, such as anxiety and concerns about pregnancy, can potentially interfere with a woman’s ability to experience orgasm.
Environmental. There is a strong association between relationship problems, physical health, and mental health and orgasm difficulties in women. Sociocultural factors (e.g., gender role expectations and religious norms) are also important inﬂuences on the expe- rience of orgasmic difficulties.