A general look at female orgasm and anorgasmia
Margaret RedelmanA Sydney Centre for Sexual and Relationship Therapy, Bondi Junction, NSW 2022, Australia.
B Email: redels@medemail.com.au
Sexual Health 3(3) 143-153 https://doi.org/10.1071/SH06005
Submitted: 18 January 2006 Accepted: 24 May 2006 Published: 29 August 2006
Abstract
Male and female genital anatomy evolves from the same embryonic tissue. Is it therefore possible that males and females have the same potential for orgasmic response? Have forces external to a woman’s biology influenced her potential enjoyment of this bodily function, or is female orgasm a by-product of that early sameness and variable because it has no or very little functional or evolutionary benefit? In modern times, we continue to study the anatomy and physiology of female sexual responses. The journey now is to understand the similarities and differences between the male and female sexual responses and be respectful of both. Female sexual response models and the classification of female sexual dysfunctions direct the thoughts and treatments of sexual and relationship therapists. The ultimate aim is to allow each woman to have the best possible sex life and orgasm, namely the one she wants. The psychophysiological treatments for female orgasmic dysfunction are on the whole successful. However, in anorgasmia proven to be biological in aetiology, following menopause for example, physiological changes occur that cannot be resolved by these strategies alone. We need to be supportive of the pharmaceutical industry finding medication that we can appropriately and responsibly use for the good of women with sexual difficulties, because good sexuality is a very important quality of life issue for very many women.
[1]
[2] Tiefer L, Hall M, Travis C. Beyond dysfunction: a new view of women’s sexual problems. J Sex Marital Ther 2002; 28(s) 225–232.
| Crossref | GoogleScholarGoogle Scholar |
[3] Meston CM, Hull E, Levin RJ, Sipski M. Disorders of orgasm in women. J Sex Med 2004; 1 66–8.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[4]
[5] Spector IP, Carey MP. Incidence & prevalence of sexual dysfunctions: A critical review. Arch Sex Behav 1990; 19 389–408.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[6]
[7]
[8] Komisaruk BR, Whipple B. The suppression of pain by genital stimulation in females. Annu Rev Sex Res 1996; 6 151–84.
[9]
[10]
[11]
[12] Levin R. The G spot-reality or illusion? Sex Relationship Ther 2003; 18(1): 117–9.
| Crossref | GoogleScholarGoogle Scholar |
[13] O’Connell HE, Hutson JM, Anderson CR, Plenter RJ. Anatomical relationship between the urethra and clitoris. J Urology 1998; 159 1892–7.
| Crossref | GoogleScholarGoogle Scholar |
[14] Kaplan KS. Hypoactive sexual desire. J Sex Marital Ther 1979; 3 3–9.
[15] Garde I, Lunde I. Female sexual behaviour—a study in a random sample of 40-year-old women. Maturitas 1980; 2 240–55.
[16]
[17] Basson R. Using a different model for female responses to address women’s problematic low sexual desire. J Sex Marital Ther 2001a; 27(5): 395–403.
| PubMed |
[18] Basson R. Biopsychosocial models of women’s sexual response: applications to the management of ‘desire disorders’. Sex Relationship Ther 2003; 18(1): 107–115.
| Crossref | GoogleScholarGoogle Scholar |
[19]
[20]
[21] Laumann EO, Paik A, Rosen RC. Sexual dysfunctions in the United States: prevalence and predictors. JAMA 1999; 281 537–44.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[22]
[23]
[24]
[25]
[26]
[27] Bachmann GA, Bancroft J, Braunstein G, Burger H, Davis S, Dennerstein L, Goldstein I, Guay A, Leiblum S, Lobo R, Notelovitz M, Rosen R. Female androgen insufficiency: The Princeton consensus statement on definition, classification and assessment. Fertil Steril 2002; 77(4): 660–5.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[28] Sarrel PM. Sexuality and menopause. Obstet Gynaecol 1990; 75 26S–30S.
[29] Berman JR, Goldstein I. Female sexual dysfunction. Urol Clin North Am 2001; 28 405–16.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[30] Park K, Goldstein I, Andry C, Siroky MB, Krane RJ, Azadzoi KM. Vasculogenic female sexual dysfunction: the hemodynamic basis for vaginal engorgement insufficiency and clitoral erectile insufficiency. Int J Impot Res 1997; 9 27–37.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[31]
[32] Rako S. Testosterone deficiency and supplementation for women: matters of sexuality and health. Psychiatry Annu 1999; 29 23–6.
[33] Santow G, Bracker M. Correlates of hysterectomy in Australia. Soc Sci Med 1992; 34 929–42.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[34] Burger HG, Dudley EC, Cui JS, Dennerstein L, Hopper JL. A prospective longitudinal study of serum testosterone, dehydroepiandroosterone sulfate and sex hormone binding globulin levels through the menopause transition. J Clin Endocrinol Metab 2000; 85 2832–8.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[35] LoPiccolo J, Stock WE. Treatment of sexual dysfunction. J Consult Clin Psychol 1986; 54 158–67.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[36] Heiman JR, Meston CM. Empirically validated treatment for sexual dysfunction. Annu Rev Sex Res 1997; 8 148–94.
| PubMed |
[37] Meston CM, Frolich PF. Update on female sexual function. Curr Opin Urol 2001; 11 603–9.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[38]
[39] Sherwin BB. Randomised clinical trials of combined androgen–androgen preparations: effects on sexual functioning. Fertil Steril 2002; 77(suppl. 4): 49–54.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[40] Collins A, Landgren BM. Reproductive health, use of estrogens and experience of symptoms in postmenopausal women: a population based study. Maturitas 1994; 20 101–11.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[41] Goldstat R, Briganti E, Tran J, Wolfe R, Davis SR. Transdermal testosterone therapy improves well being, mood and sexual function in premenopausal women. Menopause 2003; 10 390–8.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[42] Basson R. Female sexual response: the role of drugs in the management of sexual dysfunction. Obstet Gynecol 2001b; 98 350–3.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[43] Davis SR. The effects of tibolone on mood and libido. Menopause 2002; 9 162–70.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[44] Fourcroy JL. Female sexual dysfunction: potential for pharmacotherapy. Drugs 2003; 63 1445–57.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[45] Kaplan SA, Reis RB, Kohn IJ, Ikeguchi EF, Laor E, Te AE, Martins ACP. Safety and efficiency of sildenafil in postmenopausal women with sexual dysfunction. Urology 1999; 53 481–6.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[46] Berman JR, Berman LA, Toler SM, Gill J, Haughie S. Safety and efficacy of sildenafil citrate for the treatment of female sexual arousal disorder: a double blind, placebo controlled study. J Urol 2003; 170 2333–8.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[47] Clayton AH, Warnock JK, Kornstein SG, Pinkerton R, Sheldon-Keller A, McGarvey EL. A placebo controlled trial of bupropion SR as an antidote of SSRI induced sexual dysfunction. J Clin Psychiatry 2004; 65(1): 62–7.
| PubMed |
[48] Ginzburg R, Wong Y, Fader JS. Effect of bupropion on sexual function. Ann Pharmacother 2005; 39(12): 2096–9.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[49] Simon JA, Mazer NA, Wekselman K. Safety profile: transdermal testosterone treatment of women after oophorectomy. Obstet Gynecol 2001; 97 S10–S11.
| Crossref | GoogleScholarGoogle Scholar |
[R50] Simon, JA, Nachtigal, LE, Davis, SR, Utian, WH, Lucas, JD and Braunstein, GD (2004) Safety profile: transdermal testosterone treatment of women after oophorectomy. Obstet Gynecol 103, S64.
[51] Alexander JL, Kotz K, Dennerstein L, Kutner SJ, Wallen K, Notelovitz M. The effects of menopausal hormone therapies on female sexual functioning: review of double-blind randomized controlled trials. Menopause 2004; 11(6): 749–795.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[R52] Walton, B and Thorton, T (2003) The effects of menopausal hormone therapies on female sexual functioning: review of double-blind randomized controlled trials. Curr Womens Health Rep 3, 319–26.
[53] Shen WW, Urosevich Z, Clayton DO. Sildenafil in the treatment of female sexual dysfunction induced by SSRI’s. J Reprod Med 1999; 44(6): 535–42.
| PubMed |
[54]
[55] Anderson GL, Limacher M, Assaf AR, Bassford T, Beresford SAA, Black H, Bonds D, Brunner R, Brzyski R, Caan B, Chlebowski R, Curb D. Effects of estrogens plus progestin on gynaecologic cancers and associated diagnostic procedures: The Women’s Health Initiative Randomised Trial. JAMA 2003; 290 1739–48.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[56] Lobo RA. Evaluation of cardiovascular event rates with hormone therapy in healthy, early postmenopausal women: results from 2 large clinical trials. Arch Intern Med 2004; 164 482–4.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[57] Basson R. Are our definitions of women’s desire, arousal and pain disorders too broad and our definition of orgasmic disorder too narrow? J Sex Marital Ther 2002; 28 289–300.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[58]
[59] Hisasue S, Kumamoto Y, Sato Y, Masumori N, Horita H, Kato R, Kobayashi K, Hashimoto K, Yamashita N, Itoh N. Prevalence of female sexual dysfunction symptoms and its relationship to quality of life: a Japanese female cohort study. Urology 2005; 65(1): 143–8.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[60]
[61]