How Are Female Orgasm Problems Assessed In a Clinical Setting?

In order to determine if sexual dysfunction is truly an inability to orgasm, issues with sexual arousal should be explored first. If a woman cannot become sexually aroused, she is not likely to orgasm. In that case, the issue is likely around sexual arousal and not a problem with orgasm.

To assess female sexual arousal, details about sexual repertoire during partnered sex, adequate stimulation being received, and information about the partner’s sexual functioning should be assessed. Some women are not sure if they have had an orgasm.

The clinical interview is the best way to assess orgasm dysfunction, although there are some standardized assessments that do exist.

Questions in a clinical interview are likely to center around:

• Factors that predispose, precipitate and maintain the issue

• Biological, psychosocial and contextual factors

• History of illness, surgery, and medication use

• Information about the woman’s relationship with her partner

• The frequency of masturbation and the type of stimulation used

It is important to determine expectations about orgasm that a woman and her partner can have.

Research found that women ages 19-60 expressed a strong desire to experience orgasm through heterosexual intercourse to please their partner. Rigid sexual beliefs that women should orgasm before a male partner or that men are responsible for bringing women to orgasm can be inconsistent with sexual arousal and response.

A woman’s level of distress about not having an orgasm should be explored.

It has been found that the frequency of orgasm in women is not a predictor of distress. Rather, emotional well-being and a woman’s emotional relationship with her partner during sexual activity is more predictive of whether a woman will be distressed about a lack of orgasm.

For women who have acquired orgasm difficulties, it should be explored whether the change is understandable or adaptive to adverse conditions in life or in the relationship.

Assessment can include a view through multiple lenses.

• First, a woman’s current situation should be explored to determine if there are factors that would have a negative impact on orgasm.

• Second, a woman’s sexual history and sexual inhibition are important to explore. If there is a fear of letting go, a need to maintain control, negative attitudes about sex or past negative sexual experiences, a woman may be less likely to be able to experience orgasm.

• Third, a woman’s mental and physical health are important to explore. There are a wide range of physical illnesses, neurological and gynecological conditions and medications that can impair orgasmic functioning. Sexual side effects of medication can lead to an inability to orgasm. SSRI anti-depressant medication can delay or inhibit orgasm, affecting 30-60% of women taking them.

Treatment for Female Orgasmic Disorder

Psychotherapy and sex therapy offer a viable treatment option for women who have difficulty experiencing orgasm.

• Cognitive-behavioral therapy includes directed masturbation, sensate focus, communication skills training, and Kegel exercises. Cognitive-behavioral therapy can also focus on changing maladaptive thought patterns and sex-negative beliefs. In addition, it can teach anxiety reduction techniques.

• Directed masturbation is a program of sex-positive education with exercises involving self-exploration and self-pleasuring, followed by partner activities. Research has shown that 60-90% of women with primary anorgasmia using directed masturbation exercises were able to experience orgasm during masturbation.

• Sensate focus is a couple’s sex therapy exercise program that can help women and their partners stay present in the moment and connected to body sensations and their sexual experience, thus aiding in sexual arousal and response.

• Mindfulness techniques can be used to increase nonjudgmental, “present moment” awareness and can be foundational to other sex therapy techniques.

Interested in starting your own journey in treating orgasmic disorder? Get in touch with us and we can talk through some options and set up an initial consultation.