Female Orgasmic Disorder Clinical Presentation

Updated: Jul 24, 2018
  • Author: Adrian Preda, MD; Chief Editor: David Bienenfeld, MD  more...
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Presentation

History

A comprehensive medical history is required in order to understand the context and details of the sexual dysfunction and to rule out other medical conditions that could contribute to female orgasmic disorder (FOD).

The medical history should include a history of both chronic and acute medical conditions, including psychiatric conditions such as anxiety and depression. The history should also include a list of current and, when relevant, past medications (in relation to anorgasmia), over-the-counter drugs, and supplements and should detail any patterns of substance abuse (including abuse of nicotine, alcohol, or illicit drugs).

Many patients are reluctant to volunteer sexual complaints, even when a sexual issue might be the very reason why the patient is seeking help (ie, the chief complaint). Thus, the responsibility of gathering a sexual history lies with the clinician, who should make it a routine component of his or her history taking. A good general strategy might include the following steps:

  • First, explain the rationale for inquiring about sexual topics, while sympathizing with the patient reluctance to discuss intimate topics

  • Next, ask open-ended, general questions about the overall level of sexual interest and satisfaction

  • Gradually introduce the topic of sexual issues

  • As the physician-patient rapport improves, ask more specific, closed-ended questions that address the details of sexual activity (eg, commitment status, sexual preference, number of partners, frequency and quality of sexual performance for both the patient and her partner, and risk and protective factors for sexual dysfunction, including anorgasmia)

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Physical Examination

A general physical examination is necessary. Careful cardiac, pelvic, and neurologic examinations are recommended to eliminate any coexisting medical conditions that might be contributing to the orgasmic dysfunction. [18]

In patients with primary FOD, findings from the mental status examination are usually within normal limits. Mild, anxious, or depressed mood or affect is sometimes noted in women with an orgasmic disorder. If this is the case, the temporal relation between the mood changes and the sexual problems must be clarified. Sexual problems can be either a cause or a consequence of depression and anxiety.

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