Definition and Overview

Anorgasmia, also known as Coughlan’s syndrome, is a form of sexual dysfunction. It is defined as the inability of a patient to achieve an orgasm even with adequate stimulation. Anorgasmia may also refer to long delays in achieving an orgasm, causing significant concern or stress to the patient. This condition is more commonly seen in women, especially those in the post-menopausal age group. According to studies, this occurs anywhere from 10% to 33% of women.

Some individuals achieve an orgasm under specific conditions, such as a certain kind of stimulation or a specific amount of foreplay. These variations may be normal. However, if an individual is troubled or sees this as a problem, it may be best to consult a doctor or a sex therapist.

Cause of Condition

Anorgasmia can be due to a number of causes such as:

  • Trauma to the genital or pelvic organs; this trauma can be acquired from straddle injuries, for example falling off a balance beam or a bicycle
  • Complications of surgery in the pelvic area
  • Gynecologic operations, difficult childbirth, and prostatic procedures
  • Diseases, such as multiple sclerosis, spinal cord injuries, and diabetes mellitus
  • Psychological conditions such as anxiety, depression or alcoholism
  • Certain kinds of drugs such as antidepressant medications
  • Addiction to heroin and other opiates

In females with no other known disease or history of drug intake that account for the symptoms of this condition, anorgasmia is considered as a kind of female orgasmic disorder, or FOD. FOD is diagnosed when the symptoms have occurred for at least six months.

Occasionally, anorgasmia results from a combination of these causes.

The primary symptom of anorgasmia is the failure to climax during sexual intercourse. Some patients may also experience a decreased intensity of orgasms, take a longer time than usual to achieve orgasms, and experience pain in lower abdomen or pelvic region during sexual intercourse. These symptoms can produce marked distress for the individual.

Experts classify anorgasmia into several different types. Primary anorgasmia, or lifelong anorgasmia, is the type wherein an individual has never experienced an orgasm. Meanwhile, secondary anorgasmia, or acquired anorgasmia, is difficulty in achieving an orgasm in an individual that has previously had normal sexual function. Situational anorgasmia is the most frequently encountered type, wherein an individual can only reach orgasm in specific instances or with specific partners. Finally, general anorgasmia is the type wherein an individual cannot achieve an orgasm, regardless of the circumstances or partner.

Many cases of secondary and situational anorgasmia resolve on their own. However, cases of primary and generalized anorgasmia typically improve with some form of treatment.

Who to See and Types of Treatments Available

Anorgasmia is best managed by a sexual therapist. These experts are specialists in managing sexual dysfunction, and would initially confirm the diagnosis with several blood tests. A thorough neurological examination will be performed, and hormone levels, blood sugar, and genital blood flow will be evaluated. If the condition is caused by medical diseases, addressing or controlling these diseases are of utmost importance in the management of anorgasmia. If the condition is due to damaged nerves or trauma to the genital area, anorgasmia may not be treated completely.

Anorgasmia can be treated with:

  • Changes in lifestyle and sexual practices
  • Minimizing stress and anxiety
  • Trying different techniques of sexual stimulation
  • Kegel exercises
  • Use of several devices, such as vacuum pumps and vibrators
  • Cognitive therapy, a form of behavioral therapy that promotes changes in a person’s ideas and attitude towards sexual activity)
  • Counseling for couples (to allow them to address any issues in the relationship, at home and in the bedroom)

Women may be given hormonal therapy, in order to address any hormonal imbalances. Estrogen therapy has been shown to increase blood flow to the genital area, allowing it to become more sensitive. This may be given as pills taken orally or as a patch that is worn. Testosterone therapy may also be considered.

Several medications, such as phosphodiesterase inhibitors, can also be used to treat the condition. The most popular of these is sildenafil, or more popularly known as Viagra, which is shown to be useful for both males and females. Previous studies have revealed significant improvements in sexual dysfunction when the drug is taken an hour before the intercourse. Another drug of the same class is vardenafil. At present, this drug has only been approved for use in men. Other medications that may be beneficial for this condition include amantadine, amphetamine, bupropion, cabergoline and yohimbine. The positive effects of these medications in the long-term, however, are still uncertain.

In patients with drug-induced anorgasmia, decreasing the dose of the medications or changing the drug may reverse the condition. However, this should be done with caution in patients who are taking SSRIs for depression. In these situations, it is best to coordinate with the patient’s psychiatrist prior to making any changes.

References:

  • Biggs WS. Medical human sexuality. In: Rakel RE, ed. Textbook of Family Medicine 8th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 43.

  • Cowley D, Lentz GM. Emotional aspects of gynecology: depression, anxiety PTSD, eating disorders, substance abuse, "difficult" patients, sexual function, rape intimate partner violence, and grief. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 9.

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