Female Orgasmic Disorder
Introduction
In this paper I will be examining female orgasmic disorder, orgasmic disorder, 302.73 found on page no. 361 in DSM IV.
Body
Female orgasmic disorder is among the most significant sexual dysfunctions. Women suffering from this disorder rarely disclose it since they feel uncomfortable discussing about it. Female orgasmic disorder has been historically known as frigidity in women which was thought to be an inherent defect with those suffering from the disorder. According to a study published in Kinsey et al. (1953) 10 of all women had never had orgasm. Later in 1976, Levine and Yost reported that 5 of these women had female orgasmic disorder. Overall in the more recent years population studies have suggested 4 to 24 is the range of women with female orgasmic disorder in different countries. Rosen et al. (1993) claims that the percentage of women with female orgasmic disorder rose as high as to 15 in United States whereas estimates from sexuality clinics rise to 41 according to Jindal and Dhall, 1990. Kinsey et al. (1956) also suggested that unmarried women often experience dysfunctions more frequently than married ones. (Cited in Wincze and Carey 2001)
As of today, female orgasmic disorder is diagnosed through the description of patients who might not be accurate in confirming evidences and might relate illusionary experiences. There is less evidence yet to be supported of orgasmic disorders among women relating to age groups, races, cultures, relationship status, and countries.
While female orgasm is something that majority of women have reported to not have had during every sexual activity, never having it points to having a disorder. Also the traditional view is accepted that a womans simple transition from the stages of desire, excitement, orgasm and response is not that simple to evaluate and several intervening factors are present. The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) defines female orgasmic disorder (FOD, formerly inhibited female orgasm) as a persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase. Another variability that we find is the intensity of stimulation that can drive a woman to orgasm.
Therefore DSM IV defines that there are three criteria for diagnosis of female orgasmic disorder. A normal sexual excitement phase is present in the woman after which there is a recurrent postponement or total absence of orgasm. The judgment is made for the disorder when in these women the capacity for having the orgasm is less than women their age, sexual experience and the right amount of stimulation given. This is criterion A. The second diagnosis is that this disorder will lead to an observable stress and interpersonal problem (criterion B). Criterion C states that female orgasmic disorder is not exclusively because of the physiological effects caused by medication or drug abuse. In such a case diagnosis of Axis I disorder is more appropriate. In other cases, while female orgasmic disorder might be the obvious diagnosis, one cannot confirm until the possibility of hypoactive sexual desire disorder, sexual aversion disorder, or female sexual arousal disorder is counted and called off. There can be a low desire for sexual activity, for sexual contact and reduced lubrication-swelling effect.
Associated features have not been found in precise patterns. There is no specific relation between personality types, psychopathology and orgasmic dysfunctions. Female orgasmic disorder not only affects the confidence of a woman in relationships, but also affects the inner satisfaction and esteem levels. There are several diagnoses which can be mixed with diagnosing female orgasmic disorder which is why in order to rule them out one has to take care when taking patient history, conducting a complete exam and lab tests. Studies show that a womans capacity to orgasm is not related to her pelvic muscle strength or vaginal size. Though females who have spinal cord lesions, vulva removed, vaginal removal and reconstruction have reported to still reaches orgasms, many female orgasmic disorder cases are reported with the same conditions. Also while general medical conditions such as diabetes or cancer can disrupt arousal states they relatively leave the orgasm capacity unharmed. (Female Orgasmic Disorder, 2006, Oct 15)
DSM IV describes that there are subtypes of female orgasmic disorder owning to whether the disorder is lifelong or acquired, generalized or situational, and if psychological or combined factors are involved. Lifelong and acquired types are also known as primary and secondary orgasmic disorder respectively. Lifelong or primary orgasmic disorder is where the patient has never had orgasm while secondary or acquired orgasmic disorder refers to the condition where female had orgasms before but now has a problem reaching it. Charlene falls in the primary orgasmic disorder category as she has never had an orgasm. Those with lifelong and generalized specifiers, have mostly negative attitudes towards this whole sexual activity which might be due to their past experiences or confused feelings relating to bad memories of abuse or rape. Secondary orgasmic disorder or situational type specifiers, where orgasm was previously reached with only one type of stimulation, can be a problem of a specific relationship, lack of emotional ties or lower desire. (Carroll, 2009)
As Charlenes age says, orgasmic capacity increases with age and experience therefore the disorder is more common in younger women. Moreover, disorder is also found to be lifelong rather than acquired as is the case with Charlene because once a female learns her orgasmic capacity seldom does she forget how to reach it if some traumatic or medical condition doesnt intervene.
Perspective
A womans psychological perspective is said to play a significant role in diagnosing the female orgasmic disorder. There are two sides to this perspective which will be discussed. As Charlenes case specifically points out that she is afraid of losing men in partnerships and doesnt trust them either therefore this leads to lack of orgasm which causes her frustration and stress. According to Sigmund Freuds psychological work it can be determined that the female orgasmic disorder occurs at the genital stage. At this stage, adult sexuality comes across early childhood memories which would possibly include relationship problems particularly ego issues. The fear surrounding Charlene for instance has been a result of this perspective that she has never been sexually satisfied in her relationships. This has led her to think less of herself and has also given birth to the fear that no man would ever be able to satisfy her and would eventually leave her. Although she has been proactive and has continued dating but the feelings of shame, remorse and failure have been major obstacles in her fight to overcome her fear and to give a normal sexual response. This has put immense on her and instead of enjoying the pleasure of having sex she has to act as a constant watchdog on her feelings. (Stockwell and Holtje, 2005).
Apart from that repression could be another aspect which could have lead to the disorder. Repression usually emerges from a persons socio-cultural perspective. It may have been repressive attitudes towards sexuality in family which could have led to the problem. Throughout, more emphasis has been laid on personal traits rather than on cognitive and affective factors. It was later found out that there really are two types of orgasmic dysfunction found in women. One subtype in psychology relates to biological or interpersonal perspective. Here women are more open in their sexual relationships, have higher desires and fantasies and have a more flexible attitude regarding relationships. These women also possess greater knowledge of their needs and desires. On the other hand is the second subtype which relates to the psychogenic perspective. Here women are prone to have low self esteems, higher level of stress, depressing body image and inferiority complex. Studies have found out those women who had more cognitive distractions during sexual activity resulted in having lower orgasms, less self esteem and satisfaction. ( Cited in Wincze and Carey 2001).
As discussed above former relationships can have a huge negative impact on a females emotional activity during sexual responsiveness. Having a history of abuse, rape, or family trauma, absence of a male figure or fear of constant failure in relationships can lead to reduced orgasms. Between the specified types of lifelong and acquired orgasmic disorder, when comparison is made, acquired specified tend to get depressed more than those females who have lifelong disorder and are much more dissatisfied in relationships. Moreover when a further study was conducted, couples who had females with orgasmic disorder, females reported of lower self acceptance as well as men and surprisingly the men had very less knowledge of what their partners sexual preferences were. This obviously points out to the fact that once the fear sets in, the female is prone to talk very less openly about her ways of satisfaction because she is afraid she wont get any. Since in acquired orgasmic disorder, women can have an orgasm if specifically one way of attaining it is followed (Cited in Wincze and Carey 2001).
Another rather hypothetical perspective is related to society. Important social and cultural factors such as equality, traded norms and in general a less oppressive surrounding for woman lead to more liberal grounds for women to open themselves up. The male figures have been dominating the society for centuries which has undoubtedly resulted in abuse and rapes. This and the fear of being rejected can emotionally drain a woman out of responses. While treatment with antidepressants and general medication for stress is thought to bring vitality back, it isnt so in the true minds of women. Communication with the other sex, openness regarding her intimate feelings and erasing the fear out of memory are important factors to regard in relationships to eliminate any sort of stress. (Sadock, Kaplan and Sadock, 2007).
Treatment Methods
Here, the cause of the problem is to be treated when it is due to a physical problem. In other areas, sex therapy can provide an effective means to cure the disorder. Specialized trainings are given to sex therapists that help couples and individual patients to overcome the problems by means of relaxation techniques and increasing the stimulations. (Female orgasmic disorder, n.d)
Charlene may be recommended to increase the act of masturbation through self-stimulation. She can start the act by touching various parts of her body which gives her intense pleasure and if it does not lead her to an orgasm a vibrator can be used. However in some cases masturbation is ruled out by most of the therapists and sexual intercourse is more often preferred by women because it provides them the nearness and intimacy with their partners. Kegel exercises help to increase the tone and provide strength to the muscles located in the genital area.
Other methods include the traditional psychotherapy, sex education, homework assignments and counseling. Also, Talk therapy is a useful way of curing the psychological factors of female orgasmic disorder. It may also help in reconstructing the relationships not working due to frustrations caused by this problem. This talk therapy can also be used in combination with sex therapy to overcome Charlenes problems.
Two more effective treatments are systemic desensitization and bibliotherapy. Systemic desensitization involves imagining the events that lead the patient to develop anxiety and upon reaching the state of anxiety, relaxation techniques help to minimize this. Carrying out this exercise for a number of times eventually causes the factors or the events that had previously produced the state are gone and are no more able to cause the same anxiety effect on the patient. Bibliotherapy makes the patients to realize the problems and manage them. (Carroll, 2009)
If there is no emotional closeness, sexual desire may be lowered, leading to a psychodynamic problem in case of which couple or family therapy is recommended. In addition to this, if there is monotony, no dynamics are involved in a relationship and there is no fun activity involved that may change the ongoing routine from being bore and predictive, then sexual desire may also be lowered and the partners would seek another outlet. Individual or couple sex therapy is recommended where women are embarrassed to talk on a comfortable level with their partner regarding sexual ventures that can give them pleasure and totally satisfy them.
Therapy is an effective way to counter communication problems where both the partners are less responsive in understanding each other. More underlying issues are identified and handled. In the end women have this sense of freedom which is then guided towards a more enjoyable path of sexual fulfillment between the partners and hence, makes them at all times more active and less also afraid. Medications have also been given for the very purpose of treating patients but efficiency of such have yet to be reported off effectively. (Preda, 2009).
Direct Symptomatic treatment comprises of retraining of the couple to witness sexual excitement without undue pressure to perform. Usually this treatment method includes sensate focus exercises. There is a complete ban adhered by the couple on having a sexual intercourse when these exercises are being carried out. Instead the couple is encouraged to do gentle caressing in nude. With the passage of time gradual sex is permitted as prescribed by the therapist but then again there is no performance pressure whatsoever.
Cognitive Psychology and Direct treatment on the other hand focuses on attacking the symptom of the disorder itself. As part of the treatment the therapist explores the moral values, beliefs and life experiences of the couple the purpose of which is to restore the level of trust between the couple. Hence it can be said that cognitive therapy focuses at curing the beliefs and values of the couple which make them hostile towards having sex.
Personal Insights
First of all I couldnt imagine that the physiological and psychological states of the human mind had complexities of such nature. I have always thought sexual dissatisfaction to be related to the human body rather than the human mind. Therefore studying about female orgasmic disorder brought to my knowledge the various aspects related to sexual dissatisfaction. I learned to differentiate between different types of disorders when performing my diagnosis which helped me in determining their respective treatment methods as well. Usually it is believed that this disorder can only be treated through proper medication however research has proven that this disorder can in fact be a result of medication itself. Therefore it is essential to realize that the opposite sex plays a crucial role in curing these psychological disorders along with the personal will of the patient herself. Female orgasmic disorder is not correctly diagnosed in most cases and the reason behind this is the fact it is generally difficult to distinguish from other disorders. When diagnosing a patient for such psychological disorders it is important to list reasons which lead to the dissatisfaction in sexual relationships.
Women tend to feel the same way men do when they feel insecure over their inability to satisfy themselves or their sex partner. This can lead to serious personality issues with frequent mood swings being one of the symptoms. These personality issues can be determine a lot about a persons past and the type of circumstances he has been through. Lack of healthy communication also lead to relationship problems and therefore it is essential that two people in a relationship understand the importance of communication and basic understanding among them. Societies across the globe have witnessed that some of the basic reasons for misunderstandings between two people in a relationship stem from the inability of a person to freely express his or her feelings or the inability to openly express or share his or her fears in front of the other. Moreover the lack of importance shown by a person to the views of his sex partner also adds to relationship problems among two people. On the whole I feel that this has been a thoroughly informative paper and has effectively highlighted the causes and distress symptoms of the female orgasmic disorder. Nevertheless I feel that sexual satisfaction for a female is equally essential when compared to a male and therefore men involved in relationships should ensure this.
Now that I have researched this topic and came across significant facts, I can safely say that women are generally shy in discussing their sexual problems due to which there is little awareness of these psychological disorders. Moreover two people in a relationship should take increased care of their partners and should look for instances where they that the other person is hesitant in discussing an issue and should be more considerate in providing an ear to such issues. Simply putting it both of them should watch out for each other.
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