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Orgasm Disorders: Delay or Absence of Orgasm


Orgasm disorders are disorders where an orgasm cannot be achieved at all or is not achieved in the time frame a person would like. An orgasm can be reached too quickly, delayed, or not be achieved at all. While orgasms are not needed to enjoy sex, the inability to do so can significantly diminish a person's well-being. There are two types of delayed or absent orgasm disorders, delayed ejaculation and female orgasmic disorder.

Delayed Ejaculation

Delayed ejaculation is the absence of ejaculation or the prolonged time to reach ejaculation. Research into delayed ejaculation is limited, but it is suspected that it occurs in around 1% to 4% of men. Interestingly, around 97% of people with delayed ejaculation only experience the disorder during partnered sex and are able to achieve ejaculation through masturbation. There is no specific time period that men should reach ejaculation to be diagnosed with the disorder. However, some experts believe it to be around 25 to 30 minutes.

Causes

There are many different causes of delayed ejaculation. These include.

Mental health: Stress, depression, anxiety, trauma, and shame and guilt surrounding sex.

Relationship problems: Inability to communicate sexual desires with a partner, the partner is unwell or feels pain during sex, concerns about pregnancy, and ambivalence towards their partner.

Hormones: hormonal abnormalities.

Illness: Multiple sclerosis, diabetes, spinal cord injuries, pelvic region surgeries.

Medication: Antidepressants, antipsychotics, and blood pressure medication.

Substance abuse: Abuse of drugs and alcohol.

Cultural: Lack of sex education, religious beliefs.

Diagnostic criteria

To meet the diagnostic criteria for delayed ejaculation, a man must experience the following criteria for a period of over six months in almost all of their partnered sexual activity. These symptoms must cause the man to experience significant distress to be diagnosed and can not be explained by another disease or disorder.

  • Delay in ejaculation
  • Infrequent or absent ejaculation

Delayed ejaculation can be either lifelong or acquired. For men with lifelong delayed ejaculation, the delay or inability to ejaculate has been present since they became sexually active. For men with acquired delayed ejaculation, ejaculation has been present throughout their lifetime, but there is now a noticeable delay or absence. Additionally, delayed ejaculation can be either generalized or situational. Men who experience a generalized delayed ejaculation experience it in all contexts and with all sexual partners. In contrast, men who experience situational delayed ejaculation experience it in specific situations or with certain partners.

Treatment

Treatment of delayed ejaculation is done by a sex therapist or psychologist who will work with the individual alone or together with their partner to address the underlying issues. The majority of cases can be treated through therapy. If the cause is medical in nature, the therapist will work alongside a medical doctor, typically a urologist, to combine treatments. There are no approved medications for the treatment of delayed ejaculation.

Female orgasmic disorder

Female orgasmic disorder is the inability to achieve orgasm through sexual activity. This disorder is very common, with around 40% of women having difficulty achieving orgasm.

Causes

There are many different causes of female orgasmic disorder. These include.

Mental health: Stress, depression, anxiety, distractions, trauma, low self-esteem, poor body image, and shame and guilt surrounding sex.

Relationship problems: Lack of trust or communication with a partner and other relationship difficulties.

Hormones: Low levels of hormones, hormonal contraceptives, and decrease in hormones through aging.

Illness: Cardiovascular diseases, multiple sclerosis, hypertension, overactive bladder, asthma, and thyroid problems.

Medication: Antidepressants.

Substance abuse: Abuse of drugs and alcohol.

Cultural: Lack of sex education (commonly the false belief that orgasms should be vaginal) and religious beliefs.

Diagnostic criteria

To meet the diagnostic criteria for female orgasmic disorder, a woman must experience the following criteria for a period of over six months. These symptoms must cause the woman to experience significant distress to be diagnosed and can not be explained by another disease or disorder.

  • Delayed, infrequent, or absent orgasm.
  • Reduced intensity of orgasmic sensations

Female orgasmic disorder can be either lifelong or acquired. For women with lifelong female orgasmic disorder, the delay or inability to orgasm has been present since they became sexually active. For women with acquired female orgasmic disorder, the ability to orgasm has been present throughout their lifetime, but there is now a noticeable delay or absence. Additionally, female orgasmic disorder can be either generalized or situational. Women who experience a generalized female orgasmic disorder experience it in all contexts and with all sexual partners. In contrast, women who experience situational female orgasmic disorder experience it in specific situations or with certain partners.

Treatment

Multiple causes of female orgasmic disorder exist, and treatment is individualized to address the underlying cause. Treatment often consists of a combination of psychotherapy, healthy communication practices, mindfulness practices, biological therapies, such as changing medication, as well as sex education. Sex education helps women understand the science behind orgasms, including that most women do not orgasm through vaginal stimulation or penetration, and shifts the woman's focus onto clitoral stimulation.

Conclusion

There are two types of delayed or absent orgasm disorders, delayed ejaculation and female orgasmic disorder. While female orgasmic disorder is extremely common, delayed ejaculation only occurs in a small percentage of men. Both disorders have similar causes, including mental health, relationship, and medical factors. As such, both can be treated similarly by addressing the underlying causes.

Key takeaways

Delayed or absent orgasm disorders are highly prevalent in women, but not men. This is due to several sociocultural factors, mainly the belief that women should be able to orgasm through vaginal stimulation.

Delayed ejaculation is experienced by 1% to 4% of men and mainly occurs in partnered settings. Female orgasmic disorder is highly prevalent and occurs in around 40% of women.

Both disorders are treated through a combination of psychological and physical treatments, as well as sex education.

Resources

Epidemiology of delayed ejaculation - Translational Andrology and Urology

Taxonomy of Ejaculatory Disorders and Definitions of Premature Ejaculation - Springer Milano

Sexual dysfunction--a silent hurt: issues on treatment awareness - The Journal of Sexual Medicine

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