Orgasmic Disorders

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Orgasmic Disorders - The Climax Conundrum

Persistent/recurrent difficulty, delay, or absence of orgasm despite adequate sexual stimulation, causing significant distress.

  • Types & Key Features:
    • Female Orgasmic Disorder (FOD): Marked delay, infrequency, or absence of orgasm; or markedly reduced intensity of orgasmic sensations. Can be lifelong, acquired, generalized, or situational.
    • Male Orgasmic Disorder (MOD) / Delayed Ejaculation (DE): Marked delay, infrequency, or absence of ejaculation during partnered sexual activity.
    • Substance/Medication-Induced Sexual Dysfunction: Orgasmic difficulties attributable to substance intoxication/withdrawal or medication side effects (e.g., SSRIs, antihypertensives, antipsychotics).
  • Epidemiology Snapshot:
    • FOD: Common, prevalence estimates vary widely, affecting ~10-40% of women.
    • DE: Less common in men, estimated ~1-10%.

⭐ SSRIs are a well-documented and frequent cause of medication-induced anorgasmia or delayed orgasm in both men and women. Management may involve dose reduction, switching medication, or adjunctive therapy (e.g., bupropion).

Orgasmic Disorders - Unraveling the Roots

  • Biological Factors:
    • Neurological: Spinal cord injury (SCI), multiple sclerosis (MS), peripheral neuropathy (diabetes).
    • Hormonal: ↓Estrogen (menopause), ↓testosterone, hyperprolactinemia, thyroid disorders.
    • Vascular: Atherosclerosis, pelvic arterial insufficiency.
    • Systemic: Diabetes, chronic kidney disease (CKD); post-pelvic surgery/radiation.
  • Psychological Factors:
    • Mental health: Anxiety (performance), depression, stress.
    • Trauma: History of sexual abuse/negative experiences.
    • Personal: Negative body image, guilt, fear of intimacy/losing control.
  • Medications: 📌 Sex Sucks Really Intensely (SSRIs)
    • SSRIs (e.g., fluoxetine) - most common drug cause.
    • Antipsychotics, some antihypertensives (e.g., beta-blockers), opioids.
  • Relationship & Sociocultural:
    • Interpersonal: Partner conflict, poor communication, lack of attraction.
    • Contextual: Cultural/religious inhibitions, inadequate sex education.

⭐ SSRIs are the most common medication class causing anorgasmia; bupropion may be a suitable alternative if psychotropics are needed.

Orgasmic Disorders - Pinpointing the Problem

  • Clinical Manifestations (DSM-5/ICD-11 Criteria):
    • Marked delay, infrequency, or absence of orgasm.
    • Markedly reduced intensity of orgasmic sensations.
    • Symptoms present for ≥6 months.
    • Causes clinically significant distress.
    • Not better explained by nonsexual mental disorder, severe relationship distress, other stressors, or substance/medication effects.
  • Diagnostic Approach:
    • History: Sexual, medical, psychosocial history. Assess libido, arousal, pain. Medication/substance use.
    • Examination: Pelvic exam to rule out anatomical/pathological causes (e.g., endometriosis, PID).
    • Assess for comorbid conditions: depression, anxiety, relationship issues.

⭐ In women, anorgasmia is often situational rather than global; inquire about orgasm with self-masturbation vs. partnered sex. This helps differentiate primary vs. secondary, and generalized vs. situational anorgasmia.

Orgasmic Disorders - Charting the Course

  • Foundation: Psychosexual education, CBT, Sensate Focus.
  • FOD: Directed masturbation, clitoral stimulation techniques.
  • DE: Penile Vibratory Stimulation (PVS), anxiety management.
  • Medication-Induced OD:
    • Adjust primary drug (↓dose, switch).
    • Augment: Bupropion for SSRI-induced anorgasmia.
  • Key Adjunctive Pharmacotherapy:
    • Bupropion
    • Sildenafil (for DE / male SSRI-OD)
    • Cyproheptadine (for SSRI-OD)

⭐ Bupropion is a common choice for treating SSRI-induced anorgasmia due to its dopaminergic and noradrenergic effects.

High‑Yield Points - ⚡ Biggest Takeaways

  • Orgasmic disorders: persistent difficulty, delay, or absence of orgasm despite adequate stimulation.
  • Types: Primary (lifelong), Secondary (acquired); Generalized, Situational.
  • Etiology: Multifactorial - psychological (anxiety, trauma), medical (SSRIs, diabetes), relationship, sociocultural factors.
  • SSRIs are a key iatrogenic cause of anorgasmia.
  • Diagnosis: Clinical, based on detailed sexual/medical history.
  • Management: Psychosexual therapy (sensate focus, CBT); address underlying causes.
  • For SSRI-induced anorgasmia: consider switching antidepressant or adding Bupropion.

Practice Questions: Orgasmic Disorders

Test your understanding with these related questions

A 42-year-old man with sexual interest in children (pedophilia) is given an electric shock each time he is shown a videotape of children. Later, he feels tense around children and avoids them. Which of the following management techniques does this example illustrate?

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Flashcards: Orgasmic Disorders

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Bartholin glands are stimulated by _____

TAP TO REVEAL ANSWER

Bartholin glands are stimulated by _____

sexual arousal

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