Gender and Sexual Disorders 501
Orgasmic Disorders
Anorgasmic disorder is diagnosed when a clinician determines that the individual
has experienced normal excitement and adequate stimulation for orgasm in normal
circumstances (based on the person’s age and other factors)—but fails to have an
orgasm. If a man or woman cannot achieve orgasm with intercourse but can do
so through other types of sexual stimulation, the individual is not necessarily con-
sidered to have an orgasmic disorder. Like sexual arousal disorders, DSM-IV-TR
includes separate diagnoses for males and for females who have diffi culty reaching
orgasm: female orgasmic disorder and male orgasmic disorder. A third disorder in
this category, called premature ejaculation, is characterized by the opposite problem
in males—coming to orgasm too quickly, with little stimulation. Disorders in this
category may involve neurological (and other biological), cognitive, and emotional
components.
Female Orgasmic Disorder
Female orgasmic disorder is diagnosed when a woman’s normal sexual excitement
does not lead to orgasm or when orgasm is delayed following a normal amount of
stimulation (see Table 11.5). Women who experience occasional diffi culty achiev-
ing orgasm do not have this disorder. The problem with achieving orgasm must be
persistent and must exceed what would be expected based on the woman’s age and
sexual experience. Moreover, the clinician should make sure that the problem with
orgasm is not caused by inadequate sexual stimulation. As with all sexual dysfunc-
tions, female orgasmic disorder is only diagnosed if the problem concerning orgasm
causes relationship problems or distress. Approximately 5–24% of women may
have adequate sexual desire and excitement but nonetheless have female orgasmic
disorder (Laumann et al., 1994; Spector & Carey, 1990).
Clinicians distinguish between two types of female orgasmic disorder: abso-lute and situational. If female orgasmic disorder is absolute, the woman does not
have an orgasm in any circumstance. If female orgasmic disorder is situational, the
woman may have an orgasm only in certain circumstances, for example, when mas-
turbating. Lola, described in Case 11.11, has the absolute type of female orgasmic
disorder.
Male Orgasmic Disorder
Male orgasmic disorder is a delay or absence of orgasm in men; Table 11.5 lists the
specifi c criteria. Male orgasmic disorder is different from female orgasmic disorder
in several respects: (1) Male orgasmic disorder typically involves problems reaching
orgasm with a partner, even though the man can easily reach orgasm during mas-
turbation (Apfelbaum, 1989, 2000); (2) male orgasmic disorder typically involves
problems with orgasm only during vaginal intercourse (some men, however, cannot
Male Orgasmic Disorder
CASE 11.11 • FROM THE OUTSIDE: Female Orgasmic Disorder
Lola, a 25-year-old laboratory technician, has been married to a 32-year-old cabdriver for 5
years. The couple has a 2-year-old son, and the marriage appears harmonious.
The presenting complaint is Lola’s lifelong inability to experience orgasm. She has never
achieved orgasm, although during sexual activity she has received what should have been
suffi cient stimulation. She has tried to masturbate, and on many occasions her husband has
manually stimulated her patiently for lengthy periods of time. Although she does not reach
climax, she is strongly attached to her husband, feels erotic pleasure during lovemaking, and
lubricates copiously. According to both of them, the husband has no sexual diffi culty.
Exploration of her thoughts as she nears orgasm reveals a vague sense of dread of some
undefi ned disaster. More generally, she is anxious about losing control over her emotions,
which she normally keeps closely in check. She is particularly uncomfortable about express-
ing any anger or hostility.
(Spitzer et al., 2002, pp. 238–239)
Female orgasmic disorder
A sexual dysfunction characterized by a
woman’s persistent problem in progressing
from normal sexual excitement to orgasm,
such that orgasm is delayed or does
not occur, despite a normal amount of
appropriate stimulation.Male orgasmic disorder
A sexual dysfunction characterized by a man’s
delay or absence of orgasm.