Anorgasmia – Lack of orgasm in women and men

Anorgasmia is a sexual disorder that prevents full satisfaction from sexual intercourse or makes it difficult to achieve orgasm - lack of orgasm - both during intimacy with a partner and individually. This problem affects both women - lack of orgasm in women - and men and can depend on many different factors. Regardless of the cause of the problem, it leads to frustration and many other, sometimes serious, complications.

So, how to recognize or diagnoze anorgasmia? What criteria should be met to classify one's problems in achieving pleasure as a disorder? And also, how to cope when we are sure that this problem concerns us?"

Spis treści:

• Czym jest anorgazmia?
  • Czym jest orgazm?
  • Anorgazmia w ICD-10
• Podział anorgazmii
• Objawy anorgazmii
• Co prowadzi do anorgazmii?
  • Czynniki somatyczne anorgazmii
  • Czynniki psychogenne anorgazmii
  • Czynniki kulturowe anorgazmii
• Anorgazmia u kobiet i mężczyzn - pryzczyny
• Leczenie
• Wpływ teorii poliwagalnej na anorgazmię
• Bibliografia

What is Anorgasmia?

Anorgasmia is a sexual dysfunction involving disorders related to the occurrence of orgasm, specifically the inability to achieve it during intercourse, foreplay with a partner, or masturbation, or a significant reduction in its frequency, despite the presence of signs of sexual arousal. This disorder is also discussed in cases where orgasm occurs but with a delay or does not bring pleasure.

What is an Orgasm?

An orgasm, by definition, is the climactic moment of sexual activity. It is characterized by a feeling of peak pleasure, combined with maximum excitement. It is at this moment that a person experiences the greatest pleasure. This is accompanied by a range of psychological reactions (feelings of pleasure, happiness, fulfillment, relaxation) and physical responses (muscle contractions, increased blood pressure, accelerated heart rate).

To achieve orgasm, skillful and sufficiently long stimulation of erogenous zones is necessary, particularly the genital organs (i.e., the vagina, cervix, clitoris, penis). In some individuals, reaching this state is difficult or even impossible.

Anorgasmia, ICD-10, and Lack of Orgasm in Women and Men

Anorgasmia is described in the International Statistical Classification of Diseases and Related Health Problems ICD-10 (code F52.3). It occurs in both women and men, but is significantly more common in the former, as lack of orgasm in women is most prevalent. This dysfunction is not associated with male conditions such as impotence or complete lack of erection, as these are circumstances that altogether prevent intercourse. To be considered a sexual disorder, problems with achieving orgasm must persist for at least 6 months.

Another important factor that must be present to diagnose anorgasmia is the affected individual's statement that:

this situation causes dissatisfaction or even frustration in them, and reduces the level of satisfaction with their sexual life.

Classification of Anorgasmia

This disorder can be divided into primary and secondary anorgasmia. We speak of the first type of disorder if a woman or man has never experienced an orgasm, while in the second case, it has been achieved in the past.

We also distinguish situational anorgasmia, which occurs only in specific moments or during intimacy with certain partners. This is the most commonly occurring type of the disorder.

Symptoms of Anorgasmia

Anorgasmia is a disorder that is easy to define and recognize. If orgasm cannot be achieved or its achievement is significantly difficult despite meeting the following conditions, then we are dealing with anorgasmia as a disorder:

• accompanying feeling of sexual arousal;
• sufficiently long and skillful stimulation of erogenous zones;
• the occurrence of physical symptoms of sexual arousal, such as penile erection, increased blood flow to female genital organs, increased vaginal lubrication;
• experiencing sexual desire, that is, a normal level of libido. Consequently, if such a state persists over time, then partners (or a partner) experience a constant lack of satisfaction from sexual relations and unrelieved, continually present sexual tension. This, in turn, can lead to avoiding intimate situations and withdrawing for fear of further disappointment, thus increasing frustration with such a state of affairs. A person affected by this problem may also complain about decreased self-esteem and emotional disturbances.

What leads to Anorgasmia? Lack of orgasm in women and men

Among the factors leading to anorgasmia, we distinguish:

• somatic factors,
• psychogenic, and
• cultural.

Somatic factors of Anorgasmia

Somatic factors include congenital or acquired defects of the genital organ, such as uterine static defects or congenital vaginal anomalies, hormonal disorders leading to decreased libido like thyroid dysfunction, hypoestrogenism, neurological disorders - such as damage to the pudendal nerve, complications following surgical procedures, postpartum changes, inflammatory conditions within the urogenital organ, or lack of Kegel muscle contractility.

Psychogenic factors of Anorgasmia

As psychogenic factors, we primarily identify anxiety states accompanying intercourse (e.g., fear of pregnancy, lack of intimacy in initiating closeness), temporary decrease in sexual desire due to bad mood or physical and/or psychological exhaustion, lack of emotional and sexual compatibility between partners, conflict in the relationship, low erotic culture, unsuccessful partner selection or different sexual needs of partners and inability to satisfy them, aversion to the partner (conscious if the reasons for the aversion are known, or hidden if the affected person is unable to define them), any psychological-based disorders, conditioned sexual response syndrome (the possibility of achieving sexual satisfaction only under specific stimuli) or in extreme cases, traumatic sexual experiences in childhood. In this case, Havening trauma therapy is worth considering.

Cultural factors of Anorgasmia

Cultural factors that influence the development of disorders include, for example, rigorous upbringing in a conservative environment, lack of proper knowledge about sexuality, or the overestimated role of orgasm in the satisfaction of a partnership. If anorgasmia coexists with a strong sexual need, it can lead to numerous secondary disorders of a psychological and somatic nature, which involve prolonged passive hyperemia in the areas around the organs of the lesser pelvis, which in turn can lead to hypertrophy in the muscular part of the cervix and hypertrophy of the connective tissue of the parametrium.

Anorgasmia and lack of orgasm in women and men - Causes

The causes of anorgasmia can also be differentiated by gender.

For women, anorgasmia may be the result of factors such as:

• Endocrinological disorders, especially concerning the concentration of sex hormones (progesterone and estrogens), which in turn are the result of various actions or diseases, such as the use of hormonal contraception or occurring as a result of menopause;
• Dysfunction of the Kegel muscles, i.e., the contractility of the pelvic floor muscles;
• Improper structure or acquired injuries of the genital organs;
• Damage within the central nervous system (brain or spinal cord);
• Various somatic diseases, such as diabetes or different types of inflammatory states;
• Emotional problems, among which, in the case of women, include fear of unwanted pregnancy or, conversely, fear of another failure during attempts to conceive, past traumas, or exhaustion and prolonged exposure to stress factors;
• Low self-esteem or lack of attraction to the partner;
• Feelings of boredom and routine, especially in long-term relationships;
• Poor, conflictual relationships with the partner;
• Unfavorable circumstances for intimacy, such as uncomfortable living conditions (lack of privacy, bad associations);
• Abuse of alcohol, smoking cigarettes, drug use.

In men, it is worth paying attention to factors such as:

• Low levels of the male sex hormone, testosterone and its derivatives;
• Low self-esteem, particularly undervalued self-assessment in the realm of sexual skills, body structure, or physical attractiveness;
• Psychological disorders of an anxious nature (generalized anxieties or concerning the sexual sphere, often associated with unsuccessful intimate experiences in the past);
• Using condoms, especially if they are poorly fitted, for example, too thick or poorly sized, limiting the scale of physical sensations.

Treating Anorgasmia - Treatment for lack of orgasm in women and men

Many people wonder how to achieve orgasm. Undoubtedly, it requires action. The goal of treating anorgasmia is to restore optimal conditions for achieving orgasm. The treatment of anorgasmia should begin with identifying the cause of the problem. Once the specialist diagnoses the disorder and determines its cause, actions can be taken to improve sexual life or completely eliminate the problem.

One of the ways to treat anorgasmia is to undertake therapy (either couple or individual). This solution is primarily chosen when the problem has a psychological basis, but it often turns out to be a way of dealing with the disease even when it arises from other causes.

Proper therapy selection is possible once other diseases that could contribute to the disorder are ruled out, and possibly changing pharmacotherapy, if it is used and the doctor determines it has a significant impact on the situation of the person affected by the disorder. An extremely important aspect is the analysis of sexual responses and the partner relationships of the patient.

It often turns out that the cause of the disorder is improper partner relationships. Therefore, treatment usually begins with repairing these relationships and introducing or expanding sexual education. It is very important that both partners show a willingness to start therapy. In treatment and education, particular emphasis is placed on imparting knowledge about, for instance, stimulating the G-spot (Grafenberg space), vaginal and clitoral stimulation (simultaneously), or cervical stimulation. Couples training and desensitization exercises often find their application here.

The therapy itself is a complex process and usually relies on cognitive-behavioral therapy. The therapist focuses on increasing the patient's self-acceptance and self-awareness. If necessary, correction of erroneous beliefs and assumptions related to the sexual sphere is also conducted.

During the treatment of anorgasmia, masturbatory training can be useful, which facilitates the discovery of one's body and patterns of stimulating erogenous zones. In the case of weakened Kegel muscles (otherwise part of the pelvic floor muscles), which are responsible for supporting the bladder and organs in the abdominal cavity, exercises consisting of rhythmic tensing and relaxing of the pelvic floor muscles can be helpful. It's important to remember that not only women but also men need to be aware of this. Kegel muscles in men sometimes also require strengthening, which is unfortunately not often talked about. Knowledge in this area is still insufficient. In this case, prevention is necessary, which can begin independently, thanks to visits to a physiotherapist and then practicing pelvic floor exercises at home.

Somatic causes of anorgasmia are treated according to the principles known from gynecology, endocrinology, neurology, etc. Depending on the cause of the problem, the specialist doctor selects the appropriate treatment. It's important to keep in mind that it's valuable to visit a urogynecological masseur or physiotherapist to assess muscle strength, as it is also mistaken to assume that the muscles are weak. In many cases, learning to contract the muscles without proper training in relaxing the Kegel muscles can cause more problems than benefits.

Recently, sexual therapy based on the principles of neotantra is also gaining popularity. Many people, especially women, are increasingly signing up for tantric massages with symptoms of anorgasmia - in this case, lack of orgasm in women, with the intention of increasing body sensation or enhancing the feeling in intimate areas. Tantric massages, when performed correctly, can help increase body sensation and improve feeling in intimate areas. This process occurs thanks to two key elements:

• Yoni mapping and lingam mapping - Yoni mapping is a technique of mapping the genital area, which allows for neuro-routing and the creation of new neural connections in the nervous system. This makes it possible to increase sensitivity and pleasure sensation in the intimate areas
• A safe approach to the body and intimacy - Tantric massages utilize breathing techniques, meditation, and intention to help the person being massaged immerse in their body and connect with their intimacy. This allows for a safe way to achieve greater self-confidence and a positive attitude towards intimate areas, which in turn can contribute to alleviating anorgasmia.

Polyvagal Theory and Anorgasmia

The polyvagal theory proposes that human emotional life has a biological basis, and our psychological experiences are closely linked to processes occurring in the body. It discusses how what happens in our body affects our behavior and ability to relate to other people. It is extremely important due to its role in regulating the nervous system and its overall impact on our physical and mental well-being.

Stephen Porges, the director of the Body and Brain Research Center at the Department of Psychiatry at the University of Illinois, created a map that shows the impact of psychophysiological systems on our behavior, ability to interact with others, sense of safety, and well-being.

The human nervous system, its emotions, and behavior operate based on three fundamental parts of the nervous system: the parasympathetic system - here the dorsal branch of the vagus nerve, the parasympathetic system - here the ventral branch of the vagus nerve, and the sympathetic system. The first two branches make up the vagus nerve.

The vagus nerve is the tenth of the twelve cranial nerves. It is the longest and has the most functions. It is primarily responsible for innervating the meninges at the back of the skull but also performs several other important roles. It is responsible, among others, for the soft palate, throat, moving the muscles that allow us to eat and speak, thus it operates independently of our will, as it innervates internal organs. It also influences immunity and emotions by conducting nerve impulses from the central nervous system and impulses from the sensory organs to the central nervous system.

The parasympathetic system with the dorsal branch of the vagus nerve (the old one) is the earliest developed of all and is thus the most primitive. Its function is to receive and transmit information from the viscera. It activates a defense strategy based on freezing and immobilization. The dorsal branch of the vagus nerve starts in the dorsal nucleus and is responsible for the innervation of subdiaphragmatic organs. Positive actions of this part of the vagus nerve include harmonious regulation of the digestive and urinary systems. Negative actions, on the other hand, include withdrawal, disturbed digestive functions, reduced metabolic functions, depression, and emotional disengagement.

When the action of the dorsal nerve along with the sympathetic system takes a dominant role, patients may experience irritable bowel syndrome, stroke, heart attack, breathing problems, anxieties and depressions, and behavioral problems along with a mistaken interpretation of signals coming from the body.

The parasympathetic system with the ventral branch of the vagus nerve (the new one) is present only in mammals. The ventral branch originates in the nucleus ambiguus and is responsible for the innervation of supradiaphragmatic organs. It plays a key role in the process of emotional attachment and relationships with other people, and thus for social engagement, empathy level, and a sense of safety. It regulates the heart and lungs. Together with other cranial nerves, such as the trigeminal, oculomotor, optic, facial, hypoglossal, and glossopharyngeal, it forms a functionally connected whole, responsible for swallowing, chewing, and articulation.

The ventral branch can have a positive effect on a person, manifesting as a harmoniously functioning cardiovascular system, digestive system, metabolism, and emotional balance. If this branch functions improperly, it negatively reflects in the release of sympathetic activity and the old part of the nucleus ambiguus of the vagus nerve.

The last component of the nervous system – the sympathetic, is used to manage fight-or-flight behaviors.

Maintaining a balance in the functioning of the sympathetic system and the dorsal nerve helps to increase stress resilience, enhances the secretion of oxytocin, reduces the risk of stroke and diabetes, and decreases the occurrence of inflammatory states.

The polyvagal theory mentioned at the beginning is a very useful tool for observing patients struggling with the problem of anorgasmia, as emotions and the nervous system, working together, play a significant role in the diagnosis and subsequent treatment of the lack of orgasms.

The brain is the center of pleasure, where all information from the body converges. It is thanks to the brain that we know whether something is pleasurable for us or not. Many of our sexual preferences stem from simple physiology, and thus directly from our body structure. Thanks to nerve endings (receptors) located on and under the skin, our body receives a multitude of information and passes it on to the central unit - the brain.

There are four types of nerves responsible for transmitting information to the brain during orgasm:

• Pelvic nerve, which transmits signals from the uterus and cervix (in women) and from the prostate (in men)
• Pudendal nerve, which conveys signals from the vagina and cervix (in women) and from the anus (in both sexes)
• Clitoral nerve transmits data from the clitoris (in women) and from the scrotum and penis (in men)
• Vagus nerve, which carries signals from the cervix, uterus, and vagina.

If the vagus nerve is damaged or its function is disrupted and altered over the years, the person affected may notice a range of health problems, including difficulty achieving orgasm and lack of orgasm in both women and men. A malfunctioning nervous system, particularly the part responsible for transmitting signals necessary to achieve sexual satisfaction, significantly affects sexual life. Therefore, in cases where the source of the problem is difficult to identify, relying on the principles of the polyvagal theory, it is worth focusing on the functioning of the vagus nerve. This confirms the beneficial effect of tantric massage, which through pressures and touches acting in the skin-visceral space and through a specific breathing method supports the regulation of the vagus nerve's function."

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