Arousal disorder is an inability to experience sexual pleasure. According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), the essential feature is a persistent or recurrent inability to attain, or to maintain until completion of the sexual activity, an adequate lubrication-swelling response of sexual excitement. Orgasmic disorder, according to DSM-IV-TR, is a persistent or recurrent delay in or absence of orgasm after a normal sexual excitement phase.
Arousal and orgasmic disorders are considered primary if they exist in a female who has never experienced sexual arousal or orgasm; they’re secondary when some physical, mental, or situational condition has inhibited or obliterated a previously normal sexual function. The prognosis is good for temporary or mild disorders resulting from misinformation or situational stress but is guarded for disorders that result from intense anxiety, chronically discordant relationships, psychological disturbances, or drug or alcohol abuse in either partner.
Any of these factors, alone or in combination, may cause arousal or orgasmic disorder:
❑ certain drugs, including central nervous system depressants, alcohol, street drugs and, rarely, hormonal contraceptives
❑ general systemic illnesses, diseases of the endocrine or nervous system, or diseases that impair muscle tone or contractility
❑ gynecologic factors, such as chronic vaginal or pelvic infection or pain, congenital anomalies, and genital cancers
❑ stress and fatigue
❑ inadequate or ineffective stimulation
❑ psychological factors, such as performance anxiety, guilt, depression, or unconscious conflicts about sexuality
❑ relationship problems, such as poor communication, hostility or ambivalence toward the partner, fear of abandonment or of independence, or boredom with sex.
All these factors may contribute to involuntary inhibition of the orgasmic reflex. Another crucial factor is the fear of losing control of feelings or behavior. Whether or not these factors produce sexual dysfunction and the type of dysfunction depend on how well the woman copes with the resulting pressures. Physical factors may also cause arousal or orgasmic disorder.
The female with arousal disorder has limited or absent sexual desire and experiences little or no pleasure from sexual stimulation. Physical signs of this disorder include lack of vaginal lubrication or absence of signs of genital vasocongestion.
Females with orgasmic disorder report an inability to achieve orgasm, either totally or under certain circumstances. Many females experience orgasm through masturbation or other means but not through intercourse alone. Others achieve orgasm with some partners but not with others.
A thorough physical examination, laboratory tests, and a medical history rule out physical causes of arousal or orgasmic disorder. In the absence of such causes, a complete psychosexual history is the most important tool for assessment. Such a history should include:
❑ detailed information concerning the patient’s level of sex education and previous sexual response patterns
❑ level of family stress or fatigue
❑ the patient’s feelings during childhood and adolescence about sex in general and, specifically, about masturbation, incest, rape, sexual fantasies, and homosexual or heterosexual practices
❑ contraceptive practices and reproductive goals
❑ the patient’s present relationship, including her partner’s attitude toward sex
❑ assessment of the patient’s self-esteem and body image
❑ a history of psychotherapy.
When the disorder causes marked distress or interpersonal difficulty, it may fulfill the diagnostic criteria for a DSM-IV-TR diagnosis.
Arousal disorder is difficult to treat, especially if the female has never experienced sexual pleasure. Therapy is designed to help the patient relax and become aware of her feelings about sex and to eliminate guilt and fear of rejection. Specific measures usually include sensate focus exercises similar to those developed by Masters and Johnson, which emphasize touching and awareness of sensual feelings all over the body — not just genital sensations — and minimize the importance of intercourse and orgasm. Psychoanalytic treatment consists of free association, dream analysis, and discussion of life patterns to achieve greater sexual awareness. One behavioral approach attempts to correct maladaptive patterns through systematic desensitization to situations that provoke anxiety, partially by encouraging the patient to fantasize about these situations.
The goal in treating orgasmic disorder is to decrease or eliminate involuntary inhibition of the orgasmic reflex. Treatment may include experiential therapy, psychoanalysis, or behavior modification.
Treatment of primary orgasmic disorder may involve teaching the patient self-stimulation. Also, the therapist may teach distraction techniques, such as focusing attention on fantasies, breathing patterns, or muscle contractions to relieve anxiety. The patient learns new behavior through exercises she does privately between sessions. Gradually, the therapist involves the patient’s sexual partner in the treatment sessions; some therapists treat the couple as a unit from the outset.
Treatment of secondary orgasmic disorder is designed to decrease anxiety and promote the factors necessary for the patient to experience orgasm. Sensate focus exercises are commonly used. The therapist should communicate an accepting attitude and help the patient understand that satisfactory sexual experiences don’t always require coital orgasm.
❑ Be alert for clues to arousal or orgasmic disorder when taking a health history.
❑ Maintain an open, nonjudgmental attitude toward the patient and her problem.
❑ Instruct the patient in anatomy and physiology of the reproductive system and in sexual response patterns.
❑ Refer the patient to a physician, nurse, psychologist, social worker, or counselor trained in sex therapy. Inform the patient that the therapist’s certification by the American Association of Sex Educators, Counselors, and Therapists or by the Society for Sex Therapy and Research usually ensures quality treatment.
❑ If the therapist isn’t certified by these organizations, advise the patient to ask about the therapist’s credentials.
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Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2008 Williams & Wilkins.
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Title: Professional Guide to Diseases (Eighth Edition)
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2005
ISBN: 1-58255-370-X
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