Anorgasmia, also known as Coughlan’s syndrome, is a sexual disorder in which an individual cannot reach an orgasm.
Causes
The inability to achieve an orgasm is much more common in women than men.
Anorgasmia can be primary (somebody has never had an orgasm) or secondary (somebody who has had orgasms in the past but can no longer do so).
The disorder of orgasm or anorgasmia is the absence or delay of orgasm, persistently or recurring, after a regular excitation phase.
There can be physical or psychological reasons for the inability to reach an orgasm. Physical damage, for example, that resulting from childbirth, may be a problem.
The removal of the prostate gland is often associated with anorgasmia or impotence in men.
Damage to vital nerves can occur during the operation. Hormone imbalance is another possible physical cause.
Sometimes women fail to reach orgasms merely because they are not being stimulated enough.
It may be that the women can achieve orgasm using a vibrator, but not with their partner, who may need some wise advice about what to do.
Some prescription medicines, particularly SSRIs (selective serotonin reuptake inhibitors, a class of antidepressants), can cause anorgasmia in both men and women. However, depression itself can also cause anorgasmia.
When all physical reasons have been ruled out, it can still be the case that women (or much more rarely a man) can fail to achieve orgasms, in spite of having plenty of stimulation.
There may be psychological problems or problems in the relationship that are holding things back.
A tired or resentful woman, or one who feels pressurized into having sex by her partner, is far less likely to reach orgasms than a happy woman in a healthy relationship.
When sexual intercourse is not pleasurable, it can become a task rather than an intimate and satisfying experience for both people.
Sexual desire often decreases, and sexual intercourse occurs less frequently. This can create resentment and conflict in a relationship.
Is it frequent?
The orgasm disorder is more frequent in the female sex, with a range of 16% to 30% in the general population. In males, it is a frequency of 8%.
Anorgasmia is one of the most common sexual dysfunctions in women and is the second sexual problem they consult (behind the lack of sexual interest).
Symptoms.
Symptoms of orgasmic dysfunction include:
- Being unable to reach an orgasm.
- Taking longer than desired to reach an orgasm.
- Only having unsatisfactory orgasms.
Many factors can create problems for an orgasm. These include:
- History of sexual abuse or rape.
- Boredom with sexual activity.
- Fatigue and stress or depression.
- Lack of knowledge about sexual function.
- Negative attitudes towards sex (usually learned in childhood or adolescence).
- Shyness or grief about requesting any stimulation that works best.
Treatments
- Hormone patches are an effective treatment where the hormonal imbalance is the problem.
- Sildenafil (Viagra) is used to treat male impotence. A study on its use in anorgasmic women showed that it gave them no benefit. However, sildenafil does seem to benefit women who can’t reach orgasm because they’re on SSRI medication.
- Sex Therapy is often successful in enabling women to achieve orgasm. The “Betty Dodson” method has been shown to work in many cases. The emphasis is on getting the woman into the right psychological frame of mind, before teaching her to reach orgasm using a vibrator.
- Cabergoline is a pharmaceutical compound that seems to reduce anorgasmia and delay orgasm in men. These results need to be confirmed.
Tests and exams.
A complete medical history and physical examination are necessary, but the results are almost always standard.
If the problem started after starting a drug, tell the healthcare provider who prescribed it. A qualified sex therapy specialist can help.
Premature Ejaculation / Premature Female orgasm
Causes
Many men reach orgasm far quicker than they wish. Psychological factors are sometimes to blame, such as “performance anxiety.”
Physical elements may also be present, but current research has not reached any consensus on what these are.
Premature orgasm can also occur in women but is less frequent. Experts still know very little about the causes.
Treatment
- Sex Therapy can be helpful. Couples can learn various techniques that help a man to slow down the ejaculation. Tensions in the relationship can be explored and overcome.
- SSRIs (selective serotonin uptake inhibitors) are usually used to treat depression, but also help to delay orgasms. Examples of such inhibitors include fluoxetine (Prozac) and sertraline (Lustral). Dapoxetine (Priligy) is a new SSRI explicitly designed to treat premature ejaculation, rather than as an antidepressant.
- Condoms Containing Anesthetic can be used to slow down a man. The downside is a reduction in sensation.
At the time of writing several SSRIs have not yet been approved for use in the USA, although it is available in some other countries.
These drugs all have various side-effects, so patients should consult a doctor before using them.
Anorgasmia is a sexual dysfunction with a good prognosis because it is cured in 95%. Psychological treatment, combined with sexual therapy, is most advisable.
The first attempts to modify the problems caused by the person’s internal conflicts concerning sexuality while the sexologist will orient the person on the correct sexual models as well as a series of intimate exercises to overcome anorgasmia.
Psychological aspects to take into account.
Ignorance of male sexual physiology and false beliefs about ejaculatory control may lead some men to self-assess for premature ejaculators.
For this reason, many of the men who come to the clinic expressing complaints about the speed of their response do not respond to the diagnosis of sexual dysfunction but may have exaggerated expectations about their ejaculatory control.
Sexual symptoms have a very different degree of intensity, as well as the circumstances in which may manifest themselves to a greater or lesser extent.
This is why it should be assessed to what extent the man or the couple have one or more sexual dysfunctions or just need information, reassuring clarifications.
In particular, in the face of premature ejaculation, we may encounter couples or young boys, with little experience and exaggerated expectations about sexual performance.
Expectations (prognosis).
Women have better outcomes with treatment that involves learning sexual techniques or a method called desensitization.
This treatment works gradually to reduce the response that causes the lack of orgasms. Desensitization is useful for women with significant sexual anxiety.