bubble_chart Overview

The sexual response cycle is divided into four stages: excitement, plateau, orgasm, and resolution. Sexual arousal is triggered by physical or psychological stimuli. In females, sexual arousal is characterized by engorgement of the vaginal walls, secretion of lubricating fluid into the vagina, expansion of the inner two-thirds of the vagina, elevation of the cervix and uterine body, and nipple erection. Male sexual arousal is marked by penile erection. During the plateau phase, significant vascular congestion occurs in the outer third of the vagina, narrowing the vaginal opening and forming the "orgasmic platform." At orgasm, females experience rhythmic contractions (at 0.8-second intervals) of the uterus, orgasmic platform, and anal sphincter, while males exhibit a series of coordinated rhythmic contractions of the accessory sex organs, perineal muscles, and penis, culminating in ejaculation. Orgasm is a whole-body response, with notable changes in breathing, heart rate, and peripheral muscle groups. During resolution, individuals often feel relaxed or experience post-tension relief. Orgasmic dysfunction refers to the inability or significant delay in ejaculation for men, making it difficult to reach orgasm, or the lack of orgasmic experience for women during intercourse. The exact prevalence of this condition in the general population is unclear, but reports suggest approximately 6–17% of women experience orgasmic dysfunction, while it is less common in men.

bubble_chart Etiology

The causes of orgasmic dysfunction can be divided into physical factors (such as physical illness, excessive alcohol consumption, fatigue, use of inhibitory drugs, chronic inflammation of sexual organs, etc.) and psychological factors. The vast majority are psychological, and unfortunate sexual experiences are often a significant cause of orgasmic dysfunction. Women who have been raped or humiliated before marriage and carry long-term self-blame may view intercourse as a daunting experience. Those who consider sex to be dirty or filthy may go without orgasm for extended periods. Hostility toward a spouse, fear of pregnancy, or a desire to remain childless can also contribute to orgasmic dysfunction. Many cases stem from marital discord, such as a lack of emotional communication, mutual dissatisfaction, distrust, or disagreements about views and methods of lovemaking. Additionally, psychological barriers and the influence of religious or mystical beliefs can also be causes of orgasmic dysfunction.

bubble_chart Diagnosis

The diagnosis of orgasmic dysfunction first requires the exclusion of organic causes. A detailed medical history should be taken, and a comprehensive physical examination should be conducted to avoid missing organic conditions such as fistula disease or sexually transmitted diseases due to inadequate pelvic examination. If necessary, a glucose tolerance test or steroid level measurement may be performed.

The diagnostic criteria for anorgasmia according to CCMD-2-R are as follows: ① Lack of orgasmic experience during intercourse, often accompanied by no ejaculation or significantly delayed ejaculation in males; ② Persistence for at least three months; ③ Not caused by organic factors.

bubble_chart Treatment Measures

This disease should primarily be treated with psychotherapy, which may include sensate focus exercises and other therapies.

(1) Psychotherapy: First, understand the patient's views on sex, teach them about the anatomy, physiology, and psychological aspects of sexual health, reduce sexual anxiety, and change their traditional views on sex, the relationship dynamics between spouses, and past sexual habits. Deepen their correct understanding of sexual life, helping them recognize that sexual activity is a joint participation by both spouses, not an activity where the male participates alone or on behalf of the female.

(2) Sensate Focus Exercises: Enhance physical pleasure through the spouse's touch and mutual hand friction, experiencing sexual climax responses during mutual stimulation, and then gradually transition to sexual intercourse. Before intercourse, increase non-genital stimulation to evoke emotions and sensory experiences. When both parties are mentally and physically prepared, begin intercourse, continuing to touch each other in ways the patient finds pleasurable. This method is the foundation for reducing anxiety, enhancing sensations, and transitioning from verbal to non-verbal communication.

It is worth noting that sexual climax is a natural psychophysiological response to increased sexual excitement in neuromuscular tissues. If sexual activity occurs in a pleasant atmosphere, climax will naturally occur. This perspective is crucial for the patient. A single success can permanently alter sexual dysfunction.

(3) Other Methods: Many other methods have been reported in foreign literature, such as marital therapy, bibliotherapy, communication skills relaxation training, systematic conceptualization, sensory awareness techniques, sexual feedback training, etc., combined with progressive homework exercises. The expected goal of treatment is not merely to increase the frequency of sexual climax but to focus on resolving conflicts between spouses, alleviating deep-seated psychological issues, balancing family power and control needs, shifting the context of sexual techniques and intercourse, and enhancing psychological sexual arousal levels, aiming for both spouses to find pleasure in sexual activities.