Female Orgasmic Disorder Differential Diagnoses

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

By definition, the diagnosis of female orgasmic disorder (FOD) requires that the following criteria be met:

  • Another disorder does not account for the orgasmic dysfunction better than FOD does

  • The dysfunction is not exclusively due to a direct physiologic effect of a substance (eg, a drug of abuse or medication) or a general medical condition (see Overview)

If the aforementioned criteria are not met, FOD is ruled out, and a secondary orgasmic disorder is diagnosed instead. Therefore, the first steps in clarifying the diagnosis and establishing a treatment plan are taking a good medical history, carrying out a comprehensive examination (including neurologic examination), and performing appropriate laboratory testing (including evaluations of estrogens and testosterone levels, as well as of thyroid function).

Possible contributors include hormonal disorders (notably, hypothyroidism, Cushing syndrome, Addison disease, hypopituitarism, hyperprolactinemia, decreased estrogen and androgen levels [19] ), as well as chronic illnesses that affect general sexual interest and health.

Both depression and anxiety disorders can result in sexual dysfunction in general and FOD in particular. If these disorders are diagnosed, they should be treated before FOD is diagnosed and targeted for treatment. In depressed women, lower extraversion and higher neuroticism have been correlated with disorders of arousal and orgasm. [20]

Various prescribed medications (eg, narcotics, antidepressants, anxiolytics, barbiturates, and anticonvulsants) and many illicit drugs (eg, marijuana, cocaine, amphetamines, and heroin) may affect sexual functioning indirectly, by causing sedation (before or after use), or directly, by impairing orgasmic responsiveness. Depending on the dose, alcohol can affect the orgasmic response both directly and indirectly (see Alcohol and Substance Abuse Evaluation.) Excessive tobacco or alcohol use may induce vascular and possibly neurologic damage affecting sexual function.

Anorgasmia has been reported in at least one third of patients treated with antidepressants, including selective serotonin reuptake inhibitors (SSRIs), or venlafaxine. [21] Decreased libido that might progress to anorgasmia is a common adverse effect of D2-blocking antipsychotics that increase prolactin levels via dopamine antagonism.

In one meta-analysis, the across-gender rate of sexual dysfunction, including orgasm dysfunction, was 16-27% for aripiprazole, quetiapine, perphenazine, and ziprasidone and 40-60% for clozapine, haloperidol, olanzapine, risperidone, and thioridazine. [22] Case studies of decreased libido or anorgasmia have been reported for benzodiazepines, carbamazepine, phenytoin, gabapentin, topiramate, and pregabalin. [21] Antihypertensives (especially beta-blockers) are common causes of orgasm difficulties in both women and men. [23]

Medical conditions that affect the blood and nerve supply to the pelvis, ranging from hypertension [23] to multiple sclerosis to Parkinson disease to diabetic neuropathy, can sometimes result in anorgasmia. Evidence regarding anorgasmia secondary to spinal cord injury is mixed.

If FOD is determined to be lifelong or generalized, an inquiry should be made about negative attitudes toward sex that might be the result of childhood sexual experiences or unresolved feelings associated with early experiences of sexual abuse or rape.

It is appropriate to designate FOD as acquired or situational if a woman previously achieved orgasm on a regular basis but is not doing so at present or if the problem is limited to a specific relationship.