Female Arousal And Orgasmic Disorder

Arousal disorder (an inability to experience sexual pleasure) is one of the severest forms of female sexual dysfunction. Orgasmic disorder, the most common type of female sexual dysfunction, is an inability to achieve orgasm. Unlike the woman with arousal disorder, the woman with orgasmic disorder may desire sexual activity and become aroused but feels inhibited as she approaches orgasm.

Arousal and orgasmic disorder are considered primary if they exist in a woman who has never experienced sexual arousal or orgasm; they're considered secondary when some physical, mental, or environmental condition inhibits or obliterates previously normal sexual functioning.

The prognosis is good for temporary or mild dysfunction that results from misinformation or situational stress but guarded for dysfunction that results from intense anxiety, chronically discordant relationships, psychological disturbances, or drug or alcohol abuse in either partner.

Causes

One or more of the following factors may cause arousal or orgasmic disorder:

• drug use -central nervous system depressants, antidepressants, alcohol, illegal drugs and, rarely, oral contraceptives
• disease - general systemic illness, diseases of the endocrine or nervous system, and diseases that impair muscle tone or contractility
• gynecologic factors - chronic vaginal or pelvic infection or pain (from endometriosis), congenital anomalies, and genital cancers
• stress and fatigue
• inadequate or ineffective stimulation
• psychological factors - performance anxiety, guilt, depression, unconscious conflicts about sexuality, or fear of losing control of feelings or behavior
• discordant relationships - poor communication, hostility or ambivalence toward the partner, fear of abandonment or of asserting independence, or boredom with sex.

The likelihood of sexual dysfunction and the type of dysfunction depend on how well the woman copes with the pressures imposed by these factors.

Treatment

Arousal disorder is difficult to treat, especially when the woman has never experienced sexual pleasure. Therapy is designed to help the patient relax, become aware of her feelings about sex, and eliminate guilt and fear of rejection.

Specific measures usually include sensate focus exercises similar to those developed by Masters and Johnson, which emphasize touching and awareness of sensual feelings over the entire body - not just genital sensations - and minimize the importance of intercourse and orgasm.

Psychoanalytic treatment consists of free association, dream analysis, and discussion of life patterns to achieve greater sexual awareness. One behavioral approach attempts to correct maladaptive patterns through systematic desensitization to situations that provoke anxiety, partially by encouraging the patient to fantasize about these situations.

The goal in treating orgasmic disorder is to decrease or eliminate involuntary inhibition of the orgasmic reflex. Treatment may include experiential therapy, psychoanalysis, and behavior modification.

Treatment of primary orgasmic disorder may involve teaching the patient self-stimulation. Also, the therapist may teach distraction techniques, such as focusing attention on fantasies, breathing patterns, or muscle contractions to relieve anxiety. Thus, the patient learns new behavior through exercises she does in the privacy of her home between sessions. The therapist gradually involves the patient's sexual partner in the treatment sessions, although some therapists treat the couple as a unit from the outset.

Treatment of secondary orgasmic disorder aims to decrease anxiety and promote the factors necessary for the patient to experience orgasm. The therapist should communicate an accepting and permissive attitude and help the patient understand that satisfactory sexual experiences don't always require coital orgasm.