Orgasmic disorder is defined as the persistent or recurrent difficulty of, or delay in, or absence of attaining orgasm following sufficient sexual stimulation & arousal, which causes personal distress.

Etiology

Etiology of orgasmic disorder can be neurologic, psychosexual, muscular, vascular or endocrinologic.

Therapy

Exercise

Brisk physical activity (> 20 minutes) of the large muscles of the thighs and buttocks increase vasocongestion of the genital area. This often results not only in heightened sexual arousal (increased sensitivity & lubrication), but also in heightened intensity of orgasm.

Distraction techniques & non-coital behaviors

The mental context within which women experience orgasm is often more important than the physical change. Distraction techniques & non-coital behaviors often are helpful in increasing relaxation & alleviating the anxiety present in anorgasmic women.
Pelvic muscle contraction & relaxation exercises during intercourse, use of erotic fantasies as well as background audio-visual stimulation, are few of the easiest & most efficient distraction techniques.

Non-coital behaviors are meant to promote comfort & communication between partners. They include sensate-focus exercises (sensual massage with no involvement of sexual areas, where one partner provides the massage & the receiving partner provides feedback as to what feels good), sensual massages, and oral & non-coital stimulation.

Medications

Viagra (Sildenafil) inhibits the metabolism of cGMP, prolonging clitoral tumescence, genital vasocongestion and vaginal lubrication. It seems therefore to be helpful, not only in enhancing sexual arousal but also inhibited orgasm.

L-arginine, a precursor of nitric oxide, enhances genital vasocongestion, clitoral engorgement and vaginal lubrication, thus heightening sexual arousal & facilitating orgasm. It exists as an oral supplement (Arginmax), or menthol cream base (Viacreme). Significant improvement in sexual responsiveness has been reported after 4 weeks of daily use. (perpetuation of oral & genital herpes may occur).

Mechanical devices

EROS-CTD, one of the first FDA-approved treatments of female sexual dysfunction, is a small hand-held, battery-operated device, with a small cup that stimulates clitoral and labial vasocongestion through vacuum suction. Clinical studies have shown a significant increase in arousal and ability to achieve orgasms.