In order to effectively treat anorgasmia, it is important to identify the cause. A mental status examination may be performed on women suspected of suffering from primary anorgasmia, who exhibit a mild, anxious or depressed mood. In such a case, the doctor will need to clarify the temporal relationship between sexual problems and mood changes, as anorgasmia can be both a cause and a manifestation of anxiety or depression. Psychosexual counseling is recommended for women who suffer from psychological sexual trauma or inhibition. This may be obtained by a simple referral from a GP.
Women who suffer from anorgasmia yet show no obvious psychological cause will need to be examined by their doctor to check for the presence of disease. Blood tests may be conducted including full blood count, oestradiol/estradiol, liver function, total testosterone, FSH/LH, SHBG, thyroid function, prolactin, lipids and fasting blood sugar. This is required to check for other possible underlying conditions such as diabetes, no ovulation, hormonal imbalances and low thyroid function. Thereafter, the woman may be referred to a specialist in sexual medicine who will check the blood results for thyroid function, diabetes, hormonal levels, genital sensation, evaluate genital blood flow, as well as provide a neurological work-up to determine the degree of nerve damage if any.
Laboratory work should include blood glucose levels, a chemistry panel that includes calcium levels which will rule out electrolyte abnormalities, as well as a hormonal panel including estrogen, androgen, testosterone, thyroid and prolactin hormones levels. In order to rule out a peripheral neuropathy, your full blood count and B12 and folate levels will also need to be checked. A primary care office can perform most of these tests. However, the more specialized ones such as vaginal PH and local vascular function assessment through the use of photoplesmography and vagina thermal clearance will require referral to a specialist. A CBC count and serum chemistry panel including BUN, electrolytes, glucose, creatinine and liver function are recommended as this could confirm a clinical suspicion of an underlying systemic issue such as liver or renal disease, malignancy, inflammatory disease or even nutrient deficiency.
An informative hormone panel entails a thyroid test for free T4 an thyroid stimulating hormone, in order to rule out hypo- or hyperthyroidism; estradiol will rule out decreased levels of estrogen; follicle-stimulating hormone and LH; as well as prolactin which rules out hyperprolactinemia. Additional laboratory tests may be carried out to establish a lipid profile for patients at risk of cardiovascular or metabolic disease, as well as urinalysis for glucosuria and infection.
Medical and Sexual History
A typical medical evaluation for anorgasmia will entail a thorough medical history. Your doctor may also inquire into you sexual history, surgical history and present relationship. Don’t be embarrassed and shy away from answering candidly, as these questions are designed to offer clues as to the cause of your issues. In order to understand the context and details of sexual dysfunction in women, as well as rule out other underlying medical conditions, a comprehensive medical history is required. This will include a history of both acute and chronic illnesses, including psychiatric conditions such as depression and anxiety. This history will also entail listing anorgasmia medications – both past and present, supplements, and over-the-counter medications used. Your doctor will also need a history detailing any patterns of substance abuse such as alcohol, nicotine and illicit drugs.
In most cases, patients will not voluntarily divulge their intimate sexual details or complaints, even when sexual concerns are what led them to seek help to begin with. It is therefore up to the clinician to ask you questions about your sexual history so as to gather information that is necessary for effective treatment. In most cases, doctors will explain the rationale behind asking you for intimate details concerning your sex life. This should be no cause for alarm as your doctor will understand and sympathize with your reluctance to discuss such personal issues. After this introduction, the doctor will ask you general, open-ended questions concerning your overall level of sexual interest and satisfaction, while gradually introducing the subject of your sexual issues. A good physician will strive to develop a good rapport with their patient before progressing towards asking the more specific, close-ended questions such as details of sexual activity, sexual preference, commitment status, frequency, number of partners, and quality of sexual performance for the couple, as well as the risk or protective factors for sexual dysfunction such as anorgasmia.
Diagnosis of anorgasmia is based on the following 3 criteria:
- The woman’s capacity to orgasm is less than what is reasonable for her age, adequacy of sexual stimulation and sexual experience. The key symptoms of anorgasmia are the inability to experience orgasm or long delays in reaching orgasm. Diagnosis of anorgasmia is subjective and largely dependent on the emotions, thoughts and desires of the individual experiencing it.
- The condition has caused marked distress or difficulties in her interpersonal relationships.
- The condition is not as a result of another disease or due to the physiological effects of substances such as alcohol, drugs or medication.
It is likely that your doctor will also conduct a general physical exam to look for physical causes of anorgasmia, in particular an underlying medical condition. They may also examine your genital area to establish whether there is an obvious anatomical or physical reason for failure to orgasm. When checking for anorgasmia, the woman will have to undergo a general physical examination that involves careful pelvic, cardiac and neurologic examinations to eliminate any underlying causes for sexual dysfunction.
The different types of anorgasmia are as follows:
Primary anorgasmia: This is a condition in which a woman has never experienced an orgasm at any point in her life. Such women may sometimes enjoy a relatively low level of sexual excitement. Vascular engorgement may result in frustration, restlessness, pelvic pain or heavy pelvic sensation. This condition is believed to mainly stem from sexual repression in the woman. Therefore, it is common for treatment of primary anorgasmia to include tackling psychological factors that may be hindering the woman’s ability to fully enjoy sexual activity.
Secondary anorgasmia: This condition is present in women who used to consistently experience orgasms but now have difficulties reaching climax. This loss of the ability to orgasm may be as a result of depression, alcoholism, pelvic surgery, grief, injuries, illness, medication, menopause or rape.
Situational anorgasmia: This condition occurs in women who are orgasmic only in certain situations and from one type of stimulation, but not from any other such as during masturbation or oral sex. Situational anorgasmia is common during penile-vaginal intercourse. This is because most women will only orgasm from stimulation of the clitoris, but never in the man-on-top position. Other women will achieve orgasm with one partner but not another or only with a certain amount of foreplay. These variations are common and therefore should not be a cause for alarm as they fall well within the definition of normal sexual expression. Some women may never achieve orgasm during intercourse but may enjoy active, fully satisfying sex lives by achieving orgasm in other ways such as by having their partner manually stimulate their clitoris. This should not be a cause of depression, feelings of inadequacy or the lack of fulfillment as studies show that 17-40% of adult women experience problems achieving orgasm. Situational anorgasmia is commonly treated by encouraging the woman to explore alone or with her partner the factors that may be impacting her ability to be orgasmic.These factors may include emotional issues, fatigue, feeling pressured to have sex when she is not in the mood, or sexual dysfunction in her partner. In addition, it is recommended that during intercourse the couple incorporate stimulation manually or through the use of a vibrator, as well as use the woman-on-top position which allows for greater clitoral stimulation by the penis or pubic symphysis or both, while also enabling the woman to control movement.
General Anorgasmia: This is the inability to orgasm in any situation or with any partner.
Random Anorgasmia: Some individuals are orgasmic, although not frequently enough to satisfy their needs. With therapy, such individuals are able to explore and reframe their expectations of climax and sexual activity in general. Therapy is important in helping such individuals become more comfortable with giving up control of their bodily responses momentarily.