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Female Orgasmic Disorder

Lorraine Benuto, Ph.D., edited by C. E. Zupanick, Psy.D.

In previous versions of the DSM, Orgasmic Disorder could be applied to either women or men. However, in the DSM-5, it has been changed to now be Female Orgasmic Disorder. For a diagnosis of this new disorder to be made, there must be 1 of the following 2symptoms on almost all or all (75-100%) occasions of sexual activity over a period of at least 6 months:

  • marked delay in, marked infrequency of, or absence of orgasm
  • marked reduced intensity of organismic sensations

These symptoms must cause significant stress in the female's life.

The sexual dysfunction also cannot be the result of a mental disorder, severe relationship distress (such as partner violence), a medical condition, or because of a substance or medication.

The clinician should specify whether the condition is:

  • Lifelong - the problems have been present since the person became sexually active
  • Acquired - the problems began after a period of relatively normal sexual function

It should also be noted whether it is:

  • Generalized - not limited to certain types of stimulation, situations or partners
  • Situational - only happens with certain types of stimulation, situations or partners

Finally, the condition can be mild, moderate or severe depending on the level of stress over the symptoms that are happening.

Because orgasm can be quite variable, it is important to note the factors that might impact it. Even though an individual may report high sexual arousal and excitation they may report a lack of orgasm, decreased intensity of orgasm, or delay of orgasm when stimulated. Thus, it is not recommended that Female Orgasmic Disorder be diagnosed without considering the individual's age, sexual experience, and amount of sexual stimulation received.

As discussed previously, many believe that women can achieve orgasm through penetration alone. It is not uncommon for men to incorrectly believe it must somehow be their fault, and their inadequate "technique," that keeps their female partner from achieving an orgasm through penetration alone. Women may also feel like a failure. For many women, clitoral stimulation is a must when it comes to achieving an orgasm. Thus, a woman that cannot orgasm through intercourse alone, but is able achieve an orgasm when clitoral stimulation is present, would not be considered to have Female Orgasmic Disorder.

When considering Female Orgasmic Disorder, it is important to keep in mind that for some women this problem may be lifelong and happens in all situations. For these women, psychoeducation regarding sexuality may be helpful as well as a directed masturbation program where women receive instructions on how to masturbate. When a woman reports that she is able to have an orgasm through solitary masturbation, but is unable to achieve an orgasm in the presence of her partner, it may be worthwhile to consider whether she trusts her partner enough to orgasm in his presence. Orgasm can be considered a momentary loss of control. If a woman has difficulty trusting her partner, she may not feel safe and comfortable enough to lose control (orgasm) in the presence of her partner. In such situations therapy may prove beneficial (Basson et al., 2004).