DIAGNOSIS CHECKLIST
for Lack of orgasm

Why: to determine if lack of orgasm has existed since the onset of adult sexual function (lifelong) or may have been preceded by a period of unimpaired function (acquired). This differentiation is ultimately needed to give proper therapeutic direction.

Why: must determine if the lack of orgasm exists under all (generalized) or just some (situational) sexual circumstances. Generally a problem that appears only sometimes (e.g. with one sexual partner but not with another) can be thought of as arising from psychosocial origins.

Why: gradual onset may suggest an organic cause (i.e. due to medical problems) while sudden onset often suggests a psychological cause (i.e. depression, bereavement, stress, fatigue, performance anxiety, anger and relationship problems).

Why: Orgasm problems in women are common. Ejaculation problem are common in men (especially premature ejaculation) but orgasm problems in men are uncommon. It is important to note that in men ejaculation and orgasm are distinct phenomenon. It may be mystifying to differentiate the terms ejaculation and orgasm because the two phenomenon usually occur simultaneously. However sometimes there is a problem with one and not the other.

Why: Sexual function involves a partner and thus any sexual dysfunction is also partner related.

Why: worries about a sexual problem can become an important perpetuating factor.

Why: some positions are more likely to achieve orgasm in females.

Why: this is one of the key factors for causing sexual problems. Stress lowers the levels of some male body chemicals and thus may have the effect of reducing sexual desire and reducing the ability to perform when you do try.

Why: problems in a relationship can cause sexual dysfunction. e.g. are you and your partner sexually attracted to each other?, how often do you argue with your partner?, do you talk things over with your partner?, how is your love for your partner?

Why: spinal cord injury, injury to sex organs or broken bones in the pelvic area may cause nerve damage that interrupts the connection between the nervous system and the genitals.

Why: many erection and ejaculation problems are associated with other physical conditions e.g. high blood pressure, stroke, heart disease, diabetes, peripheral vascular disease, multiple sclerosis, hormonal disorders ( hyperthyroidism, hypothyroidism, hypogonadism, high prolactin levels), kidney disease, liver disease, prostate enlargement or cancer, Peyronie's disease.

Why: surgery to organs such as prostate, bladder or colon may damage nerves that interrupt the connection between the nervous system and the penis.

Why: some medications may cause interference with orgasm in women including methadone, methyldopa, phenelzine, imipramine, clonidine; SSRI antidepressant may cause difficulty with erections in males and also difficulty with ejaculation if erection is achieved.

Why: e.g. Vaginismus causes strong, involuntary tightening of the vaginal muscles which can make penetration extremely painful and impossible.

Why: Vaginal lubrication is, from a functional point of view, the equivalent of erections in a man in that both are evidence of sexual arousal. Problems relating to lubrication in the absence of diminished desire are common in postmenopausal women usually due to the result of estrogen deficiency or vaginal pathology.

Why: e.g. sadness, crying spells, lack of interest in activities, poor energy, poor concentration and attention span, poor sleep, reduced libido, poor self esteem and sometimes suicidal thoughts - if you are depressed it is common to have problems with erection and ejaculation due to the physical and emotional state of your body when you are depressed. Treating the depression may alleviate the erection problems as well. It is important to remember that sexual dysfunction due to a physical cause can also increase the risk of developing depression.

Why: e.g. nervousness, shakiness, tremor, restlessness, irritability, insomnia, poor concentration, heart palpitations, racing heart, sweating, dizziness, diarrhea, lump in throat and frequency of urination - anxiety and worry can affect your sexual function.