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Absent Orgasm

 

It is a condition in which women does not gets orgasm even after prolong sexual intercourse &when she gets orgasm after prolong sex then it is called inhibited orgasm. In some women even after normal sex desire, excitation & enjoyment, they do not achieve peak o sexual enjoyment i.e. orgasm. As against many women get multiple orgasm during same sexual act. Some women get orgasm during clitoral stimulation during manual stimulation or masturbation, but do not orgasm during vaginal sex. The orgasm is divided into clitoral orgasm & vaginal orgasm. In one study approximately 10% never experienced the orgasm in their lifetime & rest few percent women achieve the orgasm occasionally. The absence of orgasm is classified as either primary means she has never experienced the orgasm. Secondary or acquired anorgasmia is called when inhibited orgasm develops later in life. Due to absence of orgasm coitus is not very pleasurable for such ladies. 
But luckily this problem is very easily amenable to treatment with newer drugs & advent of modern sex therapy techniques. It may be generalized i.e. absence orgasm with masturbation as well as no coital orgasm also. It can be situational also in which she gets orgasm with masturbation not during sex. In some women orgasm occurs only after very prolong stimulation to wife so that couple is always under pressure to achieve orgasm rather than enjoying the sexual act. This kind of inhibited orgasm is very frustrating for the couple

Absence of orgasm is most common sexual dysfunction in women whether married or unmarried.

 

Causes of Lack of Orgasm Are


(1) Hormones Disorder :
Hypogonadotropic hypogonadism (hypothalamic or pituitary deficiencies)
Hypogonadisms, Hypothyroidisms, Testosterone deficiency, hyperprolactinemias, 
Hypogonadotropics states: Hypothalamic - pituitary deficiencies: Idiopathic GnRH deficiency, Kallman syndromes, Prader-Willi syndromes, Laurence-Moon-Biedl syndromes, pituitary hypoplasia, 
Ovarian Dysfunctions
Hypothyroidisms
Untreated endocrinopathies & Diabetics
Glucorticoids excess, Cushings disease, Addisons disease
2) Absence of proper excitation of G. spot by her partner
3) Weak P. C. Muscles
4) Wrong techniques of jerks & other sex techniques.
5) Due to fears due to various sexual myths
6) Any guilt or negative thinking about her sexuality
7) Excess asthenia i.e. chronic asthenia is a also a significant cause of absent orgasm.
8) Defect of spinal cord
9) After an abdominal or uterine disorder requiring surgical procedure
10) Any radiation exposure
11) Any major surgery on genitals
12) Multiple sclerosis

13)Addiction as chronic alcoholism, chronic smoker, heroin or cannabis use.
14) Due to Drugs: Sedative: Narcotics, tranquillizers, amphetamine, cocaine, many antidepressant, and 
      anti-psychotics, anti -hypertensives, alprazolam, diazepam, many other drugs.
15) Due to Psychiatric disorder as depression, neurosis, & many other psychiatric disorders.
16) Any kind of sexual dysfunction in man leading to non-enjoyment of sexual act by female may lead to low desire 
      in women.
17) Any cause of painful sexual intercourse (as due to vaginismus or dyspaerunia) will also lead to secondary loss of interest in sex in females whether married or unmarried.

 

Disorders of Sex Centre

n the brain there is a particular center in the hippocampus part of fore brain, which regulates the enjoyment achieved during sex. When this peak excitation reaches a particular threshold, the muscles around vagina starts contracting. This phenomenon is called orgasm. Sex center has some well-defined portion, which control different component of normal sexuality. These are as follows as one part of sex center controls sexual desire other parts controls excitation i.e. lubrication in response to sexual excitation, time taken in orgasm & enjoyment of sexual act including enjoyment of orgasm. So any disorder of sex center due to various causes can lead to absent orgasm in females. This occurs due to orgasm controlling portions of sex center does not achieves the peak of sexual excitation & final orgasm so that in spite of \not having any physical or mental disorders the patient either does not getting orgasm or getting it after long delay. Beside absent orgasm patient may be sexually otherwise fit or patient may be suffering with low desire or some other sexual dysfunctions.

The causes of sex centre dysfunction can be divided into two groups:
(1) immediate cause, and (2) remote causes. Such a classification is helpful in the treatment of decreased libido. If the loss of desire is due to immediate causes, a removal of these factors results in adequate sexual desire. If it is due to remote causes, then detailed sex therapy may be necessary for a more lasting cure.

2) Sexual Performance anxiety means development of anxiety before sex. Patient develops obsessive concern for her orgasm i.e. whether or not She'll get orgasm. Due to this anxiety She tries to concentrate more on getting it & contracting the pelvic & leg muscles rather than allow it to occur in natural response to erotic pleasure. But unluckily most ladies do not know that orgasm occurs spontaneously & automatically in response to more & more enjoyment she gets in touching & loving by her partner. Thus the more she tries to get orgasm, but the just opposite happens i.e. she never gets it. Thus this anxiety to get orgasm every time where as it really further worsens the prospects of getting orgasm. This performance anxiety can be cured by sex therapy in few sittings.

3) Spectator Attitude: Those women who suffer with absent orgasm, whenever She goes for sexual activity though engaged love making, her brain is always thinking and involuntarily (unconsciously) trying hard to achieve the vaginal orgasm. This is called spying for her own orgasm. Thus her mind is always preoccupied about whether she'll get the orgasm or not. Thus in place of enjoying the sexual experience , She remains concerned for orgasm, thus sex centre does not reaches the peak & orgasm never occurs. She loses confidence in her capability to achieve the orgasm, and instead of relaxing & enjoying She starts watching her own sexual responses like 'spectators', rather than being involved in what is going on. So that in place of enjoying the partner's touch, She always keeps spying her own sexual response leading to lack of enjoyment of sexual activity thus\leading to repeated failures in getting orgasm.

These all above problems contributes to repeated absent orgasm. So that in all cases of absent orgasmic patients, after proper diagnosis & treatment of primary cause, these secondary problems also need to be tackled by sex therapy then only patient can get permanent cure. So by sex therapy, the patient is taught how to avoid spectator role and become free of performance anxiety.So these problems hinder her in getting orgasm 
Thus the anxiety of failure into getting into orgasm and spectatoring (the patient watching all the time to see if She'll get orgasm or not) are also the important cause. After correcting these causes the normal orgasm starts occurring. If these factors are removed by sex therapy, orgasm starts occurring. The new, intensive team treatment of sexual dysfunction has revolutionized sex therapy. 'In most cases, for cure of absent orgasm detailed sex counseling & sex therapy is necessary.


DIAGNOSIS OF CAUSE

First step in proper treatment of low sex desire is accurate diagnosis of cause of her absent orgasm during sex. So we first try to find out cause. We take detailed history, thorough sex counseling and physical examination by female doctor, examination genitals. After that depending on likelihood of particular, cause relevant tests are done at our centre. Thus you may consult us at our centre & at same time you may get all test done also. The time taken in getting all the reports ready is 36 hours. So if you are from out of Delhi, you may come here for two days.

 

DETAILED HISTORY

For diagnosis of cause of absent orgasm, detailed history is taken. After which thorough physical examination is done for relevant causes.
Onset: We take detailed history, as for duration of absent or delayed orgasm whether it is from the beginning or of recent onset, whether it is mild, moderate or severe. Then we decide whether it occurs all the time or only occasionally. How is the response of previous treatment? Response to previous therapy, any pain during sex, Stress (physical or mental), History of precipitation by some drugs any past history of sexual abuse or painful sex.

 

EXAMINATION OF GENITALS:
We examine whether any Sexual Development defect is present or not. The vagina is examined for some local problem. If the vaginal examination is painful with accompanied spasm is proof of the some local cause. Status of female hormone is assessed by examination of various estrogenic signs. Galactorrhoeas & features of other hormones disorders are checked up. Blood supply of vagina is assessed by, palpating texture of vaginal wall. Nerves supplying the female genitals examined by sensation testing & Deep Tendon reflexes.
Then other systems of body are also examined. 

Diagnostic Tests:
For diagnosis of cause of investigation following tests are required. These tests include
Complete sex hormones profile as Estradiol, SHBG etc. 
Thyroids test
Serum prolactins
Androgen levels
Investigation for systemic diseases
Other tests which may be required depending on likelihood of the any of above causes. 
Detailed Sex Counseling: detailed sex counseling session, in which our male & female sex counselors meet with respective patient, talking in detail resulting in detection of primary cause leading to low sex desire.
In biochemistry Tests as liver function or kidney function tests are done.
These tests confirm the diagnosis of absence of orgasm confirmed. 

TREATMENT OF ABSENT ORGASM
Once the diagnosis of lack of orgasm is confirmed after detailed history, examination, relevant investigations, we start the treatment. It involves giving the sex therapy session, which is focused on eliminating the anxiety & spectatoring for achieving orgasm & hormone therapy or other treatment as indicated. 
The various treatment options are:
1)
Sex Therapy
2) Hormone Therapy 
3) Treatment of any secondary cause found as infection, or local cause or any psychiatric disorder.
4) Sex Therapy: The various sex therapy is offered by sex therapist are structured directed sex therapy sessions leading to elimination of the anxiety that whether She'll achieve the orgasm or not & She becomes confident of her ability. By these exercises she starts getting orgasm regularly. Along with we tell the partner about the various sexually very sensitive areas of her body including G. spot, stimulating which in proper way makes women get a very intense orgasm. Then various vibrators are used which leads to quick discharge. Sex therapy begins with detail sex education about the anatomy of male & female genitals. Then we give the patients specific exercises, which, the couple has to do at their home. After every exercise session lady becomes more confident in her ability to achieve the orgasm. Along with these exercise various orgasmic tools are also used. With these exercises along with behavioral therapy, hypnotherapy, & couple's therapy leads to cure in approximately two months. Certain pelvic exercises also help in getting orgasm quickly. We teach patient how to eliminate excessive focusing on having an orgasm.
Even some women fake the orgasm to please her partner & hide her inadequacy.
4) Hormones Therapy: Hormones therapy is given to cure the hormone problem whenever hormone disorder is found. Estrogen treatment is given when deficiency of hormones are found. Hormones therapy helps n fast cure of this problem & do not have any adverse effects as they given to only those patients in whom some hormone disorder is found.
5) Other drugs found effective are anti-inflammatory, serotonin reuptake inhibitors etc are used when indicated.
Response of Treatment: As we have fully dedicated team of highly qualified, experienced, doctors, sex counselors, sex therapist, who are expert in the treatment of female sexual problems, we get cure in almost all cases. It is cured in most patients by two months treatment.

 

 

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