Genetic and physiological. Many physiological factors may inﬂuence a woman’s expe- rience of orgasm, including medical conditions and medications. Conditions such as mul- tiple sclerosis, pelvic nerve damage from radical hysterectomy, and spinal cord injury can all inﬂuence orgasmic functioning in women. Selective serotonin reuptake inhibitors are known to delay or inhibit orgasm in women. Women with vulvovaginal atrophy (charac- terized by symptoms such as vaginal dryness, itching, and pain) are significantly more likely to report orgasm difficulties than are women without this condition. Menopausal status is not consistently associated with the likelihood of orgasm difficulties. There may be a significant genetic contribution to variation in female orgasmic function. However, psychological, sociocultural, and physiological factors likely interact in complex ways to inﬂuence women’s experience of orgasm and of orgasm difficulties.
The degree to which lack of orgasm in women is regarded as a problem that requires treat- ment may vary depending on cultural context. In addition, women differ in how important orgasm is to their sexual satisfaction. There may be marked sociocultural and generational differences in women’s orgasmic ability. For example, the prevalence of inability to reach or- gasm has ranged from 17.7% (in Northern Europe) to 42.2% (in Southeast Asia).
Although measurable physiological changes occur during female orgasm, including changes in hormones, pelvic ﬂoor musculature, and brain activation, there is significant variability in these indicators of orgasm across women. In clinical situations, the diagnosis of female orgasmic disorder is based on a woman’s self—report.
Functional Consequences of Female Orgasmic Disorder
The functional consequences of female orgasmic disorder are unclear. Although there is a strong association between relationship problems and orgasmic difficulties in women, it is unclear whether relationship factors are risk factors for orgasmic difficulties or are conse- quences of those difficulties.
Nonsexual mental disorders. Nonsexual mental disorders, such as major depressive disorder, which is characterized by markedly diminished interest or pleasure in all, or al- most all, activities, may explain female orgasmic disorder. If the orgasmic difficulties are better explained by another mental disorder, then a diagnosis of female orgasmic disorder would not be made.
Substance/medication-induced sexual dysfunction. Substance/medication use may explain the orgasmic difficulties.
Another medical condition. If the disorder is due to another medical condition (e.g., multiple sclerosis, spinal cord injury), then a diagnosis of female orgasmic disorder would not be made.
Interpersonal factors. If interpersonal or significant contextual factors, such as severe relationship distress, intimate partner violence, or other significant stressors, are associ- ated with the orgasmic difficulties, then a diagnosis of female orgasmic disorder would not be made.
Other sexual dysfunctions. Female orgasmic disorder may occur in association with other sexual dysfunctions (e.g., female sexual interest/ arousal disorder). The presence of another sexual dysfunction does not rule out a diagnosis of female orgasmic disorder. Occasional or- gasmic difficulties that are short-term or infrequent and are not accompanied by clinically sig- nificant distress or impairment are not diagnosed as female orgasmic disorder. A diagnosis is also not appropriate if the problems are the result of inadequate sexual stimulation.
Women with female orgasmic disorder may have co-occurring sexual interest/arousal difficulties. Women with diagnoses of other nonsexual mental disorders, such as major de- pressive disorder, may experience lower sexual interest/arousal, and this may indirectly increase the likelihood of orgasmic difficulties.
Diagnostic Criteria 302.72 (F5222)
A. Lack of, or significantly reduced, sexual interest/arousal, as manifested by at least three of the following: 1. Absent/reduced interest in sexual activity.
2. Absent/reduced sexual/erotic thoughts or fantasies.