Orgasm Disorders in Women Chapter 4 CSL6794.01 Fall 2016

Changes and Difficulties in Diagnosis Medical and societal perspectives on female orgasm and about what constitutes a problem have shifted dramatically; the fact that we now recognize and treat lack of orgasm in women has been described as a “cultural accident.”

Researchers and clinicians no longer make distinctions between “clitoral” and “vaginal” orgasms or consider orgasms achieved through one type of stimulation more or less “mature” or healthy than another.

Statistics In research studies, “the prevalence…appears to vary so widely that at the moment there is no conclusive evidence” of percentage of women experiencing this disorder.

Women clearly differ in how important orgasm is to their sexual satisfaction In a U.S. national sample of heterosexual women ages 20-65 years… 29.1% rated having an orgasm as very or extremely important to their sexual happiness. In contrast, 83.2% rated feeling “emotionally close to my partner” as very or extremely important.

It has been suggested that women with orgasm problems present less frequently now than when sex therapy was first introduced in the 1970s. There is evidence of a high degree of comobidity between FOD and other sexual difficulties, particularly problems with arousal, vaginal dryness, and sexual desire

Assessment Issues Clinical Interview – need to discover if arousal has occurred. There is come evidence, for example, that women are more likely to experience orgasm difficulties when their male partners have premature ejaculation.

Questions about attitudes toward masturbation and masturbation history should be included, including the type of stimulation used during masturbation

The Three Window Approach Through the first window (the current situation), the clinician considers to what extend various factors in the woman’s current relationship and life might be relevant to the orgasmic difficulty. Are there circumstances present that would be expected to have an impact on the woman’s ability to experience orgasm? For women presenting with acquired orgasmic difficulties, one crucial task of assessment is to consider to what extent a change in the woman’s experience of orgasm is an understandable and perhaps even adaptive, response to adverse conditions in her life or her relationship

The Second Window Through the second window (“vulnerability of the individual”), the woman’s sexual history is examined, as well as her propensity to become sexually inhibited.

The Third Window Through the third window (“health-related factors”) the clinician considers various health- related factors that can influence sexual functioning.

Approaches to Treatment Directed Masturbation (DM; sometimes called “guided masturbation”) Communication skills training Sensate Focus (SF) Sex Education Kegel Exercises Systematic Desensitization