Anorgasmia
Encyclopedia
Anorgasmia, or Coughlan's syndrome, is a type of sexual dysfunction
in which a person cannot achieve orgasm
, even with adequate stimulation. In males the condition is often related to delayed ejaculation
(cf. the premature ejaculation seen in Linton's syndrome). Anorgasmia can often cause sexual frustration
. Anorgasmia is far more common in females than in males and is especially rare in younger men.
The condition is sometimes classified as a psychiatric disorder. However, it can also be caused by medical problems such as diabetic neuropathy
, multiple sclerosis
, genital mutilation
, complications from genital surgery, pelvic trauma (such as from a straddle injury caused by falling on the bars of a climbing frame, bicycle or gymnastics beam), hormonal
imbalances, total hysterectomy
, spinal cord injury
, cauda equina syndrome
, uterine embolisation, childbirth trauma (vaginal tearing through the use of forceps or suction or a large or unclosed episiotomy
), vulvodynia
and cardiovascular disease
A common cause of situational anorgasmia, in both men and women, is the use of anti-depressants, particularly selective serotonin reuptake inhibitor
s (SSRIs). Post-SSRI sexual dysfunction (PSSD) is a name given to a reported iatrogenic sexual dysfunction caused by the previous use of SSRI antidepressants. Though reporting of anorgasmia as a side effect of SSRIs is not precise, it is estimated that 15-50% of users of such medications are affected by this condition . The chemical amantadine
has been shown to relieve SSRI-induced anorgasmia in some, but not all, people.
Another cause of anorgasmia is opiate addiction, particularly to heroin. Beat
icon William S. Burroughs
chronicled this problem (amongst many others) in his novel Naked Lunch
.
About 15% of women report difficulties with orgasm, and as many as 10% of women in the United States have never climaxed. Even for women who reach orgasm frequently, the frequency is still only about 50-70% of the time.
.
Women with this condition can sometimes achieve a relatively low level of sexual excitement. Frustration, restlessness, and pelvic pain or a heavy pelvic sensation may occur because of vascular engorgement.
On occasion, there may be no obvious reason why orgasm is unobtainable. In such cases, women report that they are unable to orgasm even if they have a caring, skilled partner, adequate time and privacy, and an absence of medical issues which would affect sexual satisfaction. It should be noted that the attention and skill of one's partner are not inextricably linked to woman's internal, implicit comfort level. Thus, anorgasmia in a woman whose partner is adequately attentive and skilled should not be regarded as a clinical mystery.
Some social theorists believe that inability to orgasm may be related to residual psychosocial perceptions that female sexual desire is somehow 'wrong,' and that this stems from the age of Victorian repression. It is thought that this view may impede some women - perhaps those raised in a more repressed environment - from being able to experience natural and healthy sexual feeling. While such proposals may have a place in academic social theory, they have not been established scientifically. Therefore, an idea such as this may be a component of treatment as one consideration among many, but responsible clinical practice should not be guided, based on, or informed by it.
Primary male anorgasmia is more common among men who have been circumcised
than those who have not been. As many men age, they lose the ability to orgasm even if they still ejaculate. The pleasure of orgasm may diminish in older men.
, depression
, grief
, pelvic surgery (such as total hysterectomy) or injuries, certain medications, illness, estrogen
deprivation associated with menopause
or rape.
; 80% among radical prostatectomies. This is a serious adverse result because radical prostatectomies are usually given to younger males who are expected to live more than 10 years. At more advanced ages, the prostate
is more unlikely to grow during that person's remaining lifetime.http://www.webmd.com/prostate-cancer/Radical-prostatectomy This is generally caused by damage to the primary nerves serving the penile area, which pass near the prostate gland. Removal of the prostate frequently damages or even completely removes these nerves, making sexual response unreasonably difficult.http://www.webmd.com/prostate-cancer/Radical-prostatectomy
Due to the existence of these nerves in the prostate, surgeons performing sex reassignment surgery
on transsexual male to female patients avoid removing the prostate. This leaves the nerves that will then lead to the newly formed clitoris
, and decreases the chances that the patient will not respond to clitoral stimulation after surgery. Additionally, by leaving the prostate in the patient, the surgeon allows it to be situated close to the wall of the newly formed vagina
, which may potentially increase stimulation during vaginal intercourse after the procedure.
A person who is troubled by experiencing situational anorgasmia should be encouraged to explore alone and with his or her partner those factors that may affect whether or not he or she is orgasmic, such as fatigue, emotional concerns, feeling pressured to have sex when he or she is not interested, or a partner's sexual dysfunction. In the relatively common case of female situational anorgasmia during penile-vaginal intercourse, some sex therapists recommend that couples incorporate manual or vibrator stimulation during intercourse, or using the female-above position as it may allow for greater stimulation of the clitoris by the penis
or pubic symphysis
or both, and it allows the woman better control of movement.
Women suffering from anorgasmia with no obvious psychological cause would need to be examined by their GP to check for absence of disease. Blood tests would also need to be done (full blood count, liver function, oestradiol/estradiol
, total testosterone
, SHBG, FSH
/LH
, prolactin
, thyroid
function, lipid
s and fasting blood sugar) to check for other conditions such as diabetes, lack of ovulation
, low thyroid function or hormone imbalance
s. The normal thresholds for these tests and timing in a woman's menstrual cycle is detailed in Berman et al., 2005.
They would then need to be referred to a specialist in sexual medicine. The specialist would check the patients blood results for hormonal levels, thyroid function and diabetes, evaluate genital blood flow and genital sensation, as well as giving a neurological work-up to determine the degree (if any) of nerve damage.
in men, lack of sexual function in women may be treated with hormonal patches or tablets to correct hormonal imbalances, clitoral vacuum pump
devices and medication to improve blood flow, sexual sensation and arousal.
In the case of nerve damage, research is currently being undertaken at Johns Hopkins University to make damaged nerves in the human body regrow using the enzyme sialidase. It is possible that in the future pelvic nerve damage could be repaired in this way.
The NIH
states that yohimbine hydrochloride has been shown in human studies to be possibly effective in the treatment of male impotence resulting from erectile dysfunction or SSRI usage (i.e. Anorgasmia). Published reports have shown it to be effective in the treatment of orgasmic dysfunction in men.
Sexual dysfunction
Sexual dysfunction or sexual malfunction refers to a difficulty experienced by an individual or a couple during any stage of a normal sexual activity, including desire, arousal or orgasm....
in which a person cannot achieve orgasm
Orgasm
Orgasm is the peak of the plateau phase of the sexual response cycle, characterized by an intense sensation of pleasure...
, even with adequate stimulation. In males the condition is often related to delayed ejaculation
Delayed ejaculation
Delayed ejaculation is the inability to ejaculate or persistent difficulty in achieving orgasm despite the presence of normal sexual desire and sexual stimulation...
(cf. the premature ejaculation seen in Linton's syndrome). Anorgasmia can often cause sexual frustration
Sexual frustration
Sexual frustration describes the condition in which a human or animal is in a state of agitation, depression, stress, loneliness or anxiety due to prolonged virginity, sexual inactivity and/or sexual dissatisfaction that leads him or her to want more sex or better sex, or a state in which he or she...
. Anorgasmia is far more common in females than in males and is especially rare in younger men.
The condition is sometimes classified as a psychiatric disorder. However, it can also be caused by medical problems such as diabetic neuropathy
Diabetic neuropathy
Diabetic neuropathies are neuropathic disorders that are associated with diabetes mellitus. These conditions are thought to result from diabetic microvascular injury involving small blood vessels that supply nerves in addition to macrovascular conditions that can culminate in diabetic neuropathy...
, multiple sclerosis
Multiple sclerosis
Multiple sclerosis is an inflammatory disease in which the fatty myelin sheaths around the axons of the brain and spinal cord are damaged, leading to demyelination and scarring as well as a broad spectrum of signs and symptoms...
, genital mutilation
Genital mutilation
Genital mutilation can refer to:*Clitoridectomy*Female genital mutilation, also known as female circumcision*Genital modification and mutilation*Infibulation...
, complications from genital surgery, pelvic trauma (such as from a straddle injury caused by falling on the bars of a climbing frame, bicycle or gymnastics beam), hormonal
Hormone
A hormone is a chemical released by a cell or a gland in one part of the body that sends out messages that affect cells in other parts of the organism. Only a small amount of hormone is required to alter cell metabolism. In essence, it is a chemical messenger that transports a signal from one...
imbalances, total hysterectomy
Hysterectomy
A hysterectomy is the surgical removal of the uterus, usually performed by a gynecologist. Hysterectomy may be total or partial...
, spinal cord injury
Spinal cord injury
A spinal cord injury refers to any injury to the spinal cord that is caused by trauma instead of disease. Depending on where the spinal cord and nerve roots are damaged, the symptoms can vary widely, from pain to paralysis to incontinence...
, cauda equina syndrome
Cauda equina syndrome
Cauda equina syndrome ' is a serious neurologic condition in which there is acute loss of function of the lumbar plexus, neurologic elements of the spinal canal below the termination of the spinal cord.-Causes:...
, uterine embolisation, childbirth trauma (vaginal tearing through the use of forceps or suction or a large or unclosed episiotomy
Episiotomy
An episiotomy , also known as perineotomy, is a surgically planned incision on the perineum and the posterior vaginal wall during second stage of labor. The incision, which can be midline or at an angle from the posterior end of the vulva, is performed under local anaesthetic , and is sutured...
), vulvodynia
Vulvodynia
Vulvodynia is a chronic pain syndrome that affects the vulvar area and occurs without an identifiable cause or visible pathology categorized in the ICD-9 group 625—specifically ICD-9 625.7, which is for pain and other disorders of the female genital organs...
and cardiovascular disease
Cardiovascular disease
Heart disease or cardiovascular disease are the class of diseases that involve the heart or blood vessels . While the term technically refers to any disease that affects the cardiovascular system , it is usually used to refer to those related to atherosclerosis...
A common cause of situational anorgasmia, in both men and women, is the use of anti-depressants, particularly selective serotonin reuptake inhibitor
Selective serotonin reuptake inhibitor
Selective serotonin re-uptake inhibitors or serotonin-specific reuptake inhibitor are a class of compounds typically used as antidepressants in the treatment of depression, anxiety disorders, and some personality disorders. The efficacy of SSRIs is disputed...
s (SSRIs). Post-SSRI sexual dysfunction (PSSD) is a name given to a reported iatrogenic sexual dysfunction caused by the previous use of SSRI antidepressants. Though reporting of anorgasmia as a side effect of SSRIs is not precise, it is estimated that 15-50% of users of such medications are affected by this condition . The chemical amantadine
Amantadine
Amantadine is the organic compound known formally as 1-adamantylamine or 1-aminoadamantane. The molecule consists of adamantane backbone that has an amino group substituted at one of the four methyne positions. This pharmaceutical is sold under the name Symmetrel for use both as an antiviral and an...
has been shown to relieve SSRI-induced anorgasmia in some, but not all, people.
Another cause of anorgasmia is opiate addiction, particularly to heroin. Beat
Beatnik
Beatnik was a media stereotype of the 1950s and early 1960s that displayed the more superficial aspects of the Beat Generation literary movement of the 1950s and violent film images, along with a cartoonish depiction of the real-life people and the spiritual quest in Jack Kerouac's autobiographical...
icon William S. Burroughs
William S. Burroughs
William Seward Burroughs II was an American novelist, poet, essayist and spoken word performer. A primary figure of the Beat Generation and a major postmodernist author, he is considered to be "one of the most politically trenchant, culturally influential, and innovative artists of the 20th...
chronicled this problem (amongst many others) in his novel Naked Lunch
Naked Lunch
Naked Lunch is a novel by William S. Burroughs originally published in 1959. The book is structured as a series of loosely-connected vignettes. Burroughs stated that the chapters are intended to be read in any order...
.
About 15% of women report difficulties with orgasm, and as many as 10% of women in the United States have never climaxed. Even for women who reach orgasm frequently, the frequency is still only about 50-70% of the time.
Primary anorgasmia
Primary anorgasmia is a condition where one has never experienced an orgasm. This is significantly more common in women, although it can occur in men who lack the gladipudendal (bulbocavernosus) reflexBulbocavernosus reflex
The bulbocavernosus reflex is a polysynaptic reflex that is useful in testing for spinal shock and gaining information about the state of spinal cord injuries . The test involves monitoring anal sphincter contraction in response to squeezing the glans penis or tugging on an indwelling Foley...
.
Women with this condition can sometimes achieve a relatively low level of sexual excitement. Frustration, restlessness, and pelvic pain or a heavy pelvic sensation may occur because of vascular engorgement.
On occasion, there may be no obvious reason why orgasm is unobtainable. In such cases, women report that they are unable to orgasm even if they have a caring, skilled partner, adequate time and privacy, and an absence of medical issues which would affect sexual satisfaction. It should be noted that the attention and skill of one's partner are not inextricably linked to woman's internal, implicit comfort level. Thus, anorgasmia in a woman whose partner is adequately attentive and skilled should not be regarded as a clinical mystery.
Some social theorists believe that inability to orgasm may be related to residual psychosocial perceptions that female sexual desire is somehow 'wrong,' and that this stems from the age of Victorian repression. It is thought that this view may impede some women - perhaps those raised in a more repressed environment - from being able to experience natural and healthy sexual feeling. While such proposals may have a place in academic social theory, they have not been established scientifically. Therefore, an idea such as this may be a component of treatment as one consideration among many, but responsible clinical practice should not be guided, based on, or informed by it.
Primary male anorgasmia is more common among men who have been circumcised
Circumcision
Male circumcision is the surgical removal of some or all of the foreskin from the penis. The word "circumcision" comes from Latin and ....
than those who have not been. As many men age, they lose the ability to orgasm even if they still ejaculate. The pleasure of orgasm may diminish in older men.
Secondary anorgasmia
Secondary anorgasmia is the loss of the ability to have orgasms (as opposed to primary anorgasmia which indicates a person who has never had an orgasm). The cause may be alcoholismAlcoholism
Alcoholism is a broad term for problems with alcohol, and is generally used to mean compulsive and uncontrolled consumption of alcoholic beverages, usually to the detriment of the drinker's health, personal relationships, and social standing...
, depression
Clinical depression
Major depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities...
, grief
Grief
Grief is a multi-faceted response to loss, particularly to the loss of someone or something to which a bond was formed. Although conventionally focused on the emotional response to loss, it also has physical, cognitive, behavioral, social, and philosophical dimensions...
, pelvic surgery (such as total hysterectomy) or injuries, certain medications, illness, estrogen
Estrogen
Estrogens , oestrogens , or œstrogens, are a group of compounds named for their importance in the estrous cycle of humans and other animals. They are the primary female sex hormones. Natural estrogens are steroid hormones, while some synthetic ones are non-steroidal...
deprivation associated with menopause
Menopause
Menopause is a term used to describe the permanent cessation of the primary functions of the human ovaries: the ripening and release of ova and the release of hormones that cause both the creation of the uterine lining and the subsequent shedding of the uterine lining...
or rape.
Prostatectomy
Secondary anorgasmia is close to 50% among males undergoing prostatectomyProstatectomy
A prostatectomy is the surgical removal of all or part of the prostate gland. Abnormalities of the prostate, such as a tumour, or if the gland itself becomes enlarged for any reason, can restrict the normal flow of urine along the urethra....
; 80% among radical prostatectomies. This is a serious adverse result because radical prostatectomies are usually given to younger males who are expected to live more than 10 years. At more advanced ages, the prostate
Prostate
The prostate is a compound tubuloalveolar exocrine gland of the male reproductive system in most mammals....
is more unlikely to grow during that person's remaining lifetime.http://www.webmd.com/prostate-cancer/Radical-prostatectomy This is generally caused by damage to the primary nerves serving the penile area, which pass near the prostate gland. Removal of the prostate frequently damages or even completely removes these nerves, making sexual response unreasonably difficult.http://www.webmd.com/prostate-cancer/Radical-prostatectomy
Due to the existence of these nerves in the prostate, surgeons performing sex reassignment surgery
Sex reassignment surgery
Sex reassignment surgery is a term for the surgical procedures by which a person's physical appearance and function of their existing sexual characteristics are altered to resemble...
on transsexual male to female patients avoid removing the prostate. This leaves the nerves that will then lead to the newly formed clitoris
Clitoris
The clitoris is a sexual organ that is present only in female mammals. In humans, the visible button-like portion is located near the anterior junction of the labia minora, above the opening of the urethra and vagina. Unlike the penis, which is homologous to the clitoris, the clitoris does not...
, and decreases the chances that the patient will not respond to clitoral stimulation after surgery. Additionally, by leaving the prostate in the patient, the surgeon allows it to be situated close to the wall of the newly formed vagina
Vagina
The vagina is a fibromuscular tubular tract leading from the uterus to the exterior of the body in female placental mammals and marsupials, or to the cloaca in female birds, monotremes, and some reptiles. Female insects and other invertebrates also have a vagina, which is the terminal part of the...
, which may potentially increase stimulation during vaginal intercourse after the procedure.
Situational anorgasmia
People who are orgasmic in some situations may not be in others. A person may have an orgasm from one type of stimulation but not from another. Or a person may achieve orgasm with one partner but not another, or have an orgasm only under certain conditions or only with a certain type or amount of foreplay. These common variations are within the range of normal sexual expression and should not be considered problematic.A person who is troubled by experiencing situational anorgasmia should be encouraged to explore alone and with his or her partner those factors that may affect whether or not he or she is orgasmic, such as fatigue, emotional concerns, feeling pressured to have sex when he or she is not interested, or a partner's sexual dysfunction. In the relatively common case of female situational anorgasmia during penile-vaginal intercourse, some sex therapists recommend that couples incorporate manual or vibrator stimulation during intercourse, or using the female-above position as it may allow for greater stimulation of the clitoris by the penis
Penis
The penis is a biological feature of male animals including both vertebrates and invertebrates...
or pubic symphysis
Pubic symphysis
The pubic symphysis or symphysis pubis is the midline cartilaginous joint uniting the superior rami of the left and right pubic bones. It is located anterior to the urinary bladder and superior to the external genitalia; for females it is above the vulva and for males it is above the penis...
or both, and it allows the woman better control of movement.
Random anorgasmia
Some people are orgasmic but not in enough instances to satisfy their sense of what is appropriate or desirable. Therapy can help such people examine and realign their expectations of orgasm and of sexual activity. For some people, therapy can help people become more comfortable with momentarily giving up control to bodily responses.Diagnosis
Effective treatment for anorgasmia depends on the cause. In the case of women suffering from psychological sexual trauma or inhibition, psychosexual counselling might be advisable and could be obtained through GP referral.Women suffering from anorgasmia with no obvious psychological cause would need to be examined by their GP to check for absence of disease. Blood tests would also need to be done (full blood count, liver function, oestradiol/estradiol
Estradiol
Estradiol is a sex hormone. Estradiol is abbreviated E2 as it has 2 hydroxyl groups in its molecular structure. Estrone has 1 and estriol has 3 . Estradiol is about 10 times as potent as estrone and about 80 times as potent as estriol in its estrogenic effect...
, total testosterone
Testosterone
Testosterone is a steroid hormone from the androgen group and is found in mammals, reptiles, birds, and other vertebrates. In mammals, testosterone is primarily secreted in the testes of males and the ovaries of females, although small amounts are also secreted by the adrenal glands...
, SHBG, FSH
Follicle-stimulating hormone
Follicle-stimulating hormone is a hormone found in humans and other animals. It is synthesized and secreted by gonadotrophs of the anterior pituitary gland. FSH regulates the development, growth, pubertal maturation, and reproductive processes of the body. FSH and Luteinizing hormone act...
/LH
Luteinizing hormone
Luteinizing hormone is a hormone produced by the anterior pituitary gland. In females, an acute rise of LH called the LH surge triggers ovulation and development of the corpus luteum. In males, where LH had also been called interstitial cell-stimulating hormone , it stimulates Leydig cell...
, prolactin
Prolactin
Prolactin also known as luteotropic hormone is a protein that in humans is encoded by the PRL gene.Prolactin is a peptide hormone discovered by Henry Friesen...
, thyroid
Thyroid
The thyroid gland or simply, the thyroid , in vertebrate anatomy, is one of the largest endocrine glands. The thyroid gland is found in the neck, below the thyroid cartilage...
function, lipid
Lipid
Lipids constitute a broad group of naturally occurring molecules that include fats, waxes, sterols, fat-soluble vitamins , monoglycerides, diglycerides, triglycerides, phospholipids, and others...
s and fasting blood sugar) to check for other conditions such as diabetes, lack of ovulation
Ovulation
Ovulation is the process in a female's menstrual cycle by which a mature ovarian follicle ruptures and discharges an ovum . Ovulation also occurs in the estrous cycle of other female mammals, which differs in many fundamental ways from the menstrual cycle...
, low thyroid function or hormone imbalance
Hormone imbalance
Hormones are the chemical messengers in the body that travel the bloodstream to the organs and tissues. They slowly work and affect many of the body's processes over time. Endocrine glands, which are special groups of cells, make hormones....
s. The normal thresholds for these tests and timing in a woman's menstrual cycle is detailed in Berman et al., 2005.
They would then need to be referred to a specialist in sexual medicine. The specialist would check the patients blood results for hormonal levels, thyroid function and diabetes, evaluate genital blood flow and genital sensation, as well as giving a neurological work-up to determine the degree (if any) of nerve damage.
Treatment
Just as with erectile dysfunctionErectile dysfunction
Erectile dysfunction is sexual dysfunction characterized by the inability to develop or maintain an erection of the penis during sexual performance....
in men, lack of sexual function in women may be treated with hormonal patches or tablets to correct hormonal imbalances, clitoral vacuum pump
Clitoral pump
A clitoral pump is a sex toy designed for women's pleasure that is applied to the clitoris and/or labia to create suction and increase blood flow to the genitals...
devices and medication to improve blood flow, sexual sensation and arousal.
In the case of nerve damage, research is currently being undertaken at Johns Hopkins University to make damaged nerves in the human body regrow using the enzyme sialidase. It is possible that in the future pelvic nerve damage could be repaired in this way.
The NIH
National Institutes of Health
The National Institutes of Health are an agency of the United States Department of Health and Human Services and are the primary agency of the United States government responsible for biomedical and health-related research. Its science and engineering counterpart is the National Science Foundation...
states that yohimbine hydrochloride has been shown in human studies to be possibly effective in the treatment of male impotence resulting from erectile dysfunction or SSRI usage (i.e. Anorgasmia). Published reports have shown it to be effective in the treatment of orgasmic dysfunction in men.
External links
- Can Male Anorgasmia Occur At Any Age
- University of California, Santa Barbara's SexInfo includes statistics, causes, and treatments for anorgasmia
- A brief review that explores issues of the medicalization of the female orgasm
- Definition of Anorgasmia as per Mayoclinic
- Push My Button, (2001) The New Scientist, Issue: 2271 http://www.newscientist.com/article/mg16922773.800-push-my-button.html
- Forum: "Ejaculation without orgasm" forum (hisandherhealth.com) http://www.hisandherhealth.com/sexual-health-bulletin-boards/7-mens-sexual-health/39385-ejaculation-without-orgasm-ejaculatory-anhedonia
- Forum: "Ejaculatoryanhedonia.com" http://www.ejaculatoryanhedonia.com/