DSM-III

In DSM-III, this disorder is called Inhibited Female Orgasm

For more information, see Psychosexual Dysfunctions

Diagnostic Criteria

A. Recurrent and persistent inhibition of the female orgasm as manifested by a delay in or absence of orgasm following a normal sexual excitement phase during sexual activity that is judged by the clinician to be adequate in focus, intensity, and duration. The same individual may also meet the criteria for Inhibited Sexual Excitement if at other times there is a problem with the excitement phase of sexual activity. In such cases both categories of Psychosexual Dysfunction should be noted.

Some women are able to experience orgasm during noncoital clitoral stimulation, but are unable to experience it during coitus in the absence of manual clitoral stimulation. There is evidence to suggest that in some instances this represents a pathological inhibition that justifies this diagnosis whereas in other instances it represents a normal variation of the female sexual response. This difficult judgment is assisted by a thorough sexual evaluation, which may even require a trial of treatment.

B. The disturbance is not caused exclusively by organic factors (e.g., physical disorder or medication) and is not due to another mental disorder.

DSM-IV

For more information, see Sexual Dysfunctions

Diagnostic Criteria

A. Persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase. Women exhibit wide variability in the type or intensity of stimulation that triggers orgasm. The diagnosis of Female Orgasmic Disorder should be based on the clinician's judgment that the woman's orgasmic capacity is less than would be reasonable for her age, sexual experience, and the adequacy of sexual stimulation she receives.

B. The disturbance causes marked distress or interpersonal difficulty.

C. The orgasmic dysfunction is not better accounted for by another mental disorder (except another Sexual Dysfunction) and is not due exclusively to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

Specify type:

  • Lifelong Type
  • Acquired Type

Specify type:

  • Generalized Type
  • Situational Type

Specify:

  • Due to Psychological Factors
  • Due to Combined Factors

Differential Diagnosis

Sexual Dysfunction Due to a General Medical Condition

Female Orgasmic Disorder must be distinguished from a Sexual Dysfunction Due to a General Medical Condition. The appropriate diagnosis would be Sexual Dysfunction Due to a General Medical Condition when the dysfunction is judged to be due exclusively to the physiological effects of a specified general medical condition (e.g., spinal cord lesion). This determination is based on history, laboratory findings, or physical examination. If both Female Orgasmic Disorder and a general medical condition are present but it is judged that the sexual dysfunction is not due exclusively to the direct physiological effects of the general medical condition, then Female Orgasmic Disorder, Due to Combined Factors, is diagnosed.

Substance-Induced Sexual Dysfunction

In contrast to Female Orgasmic Disorder, a Substance-Induced Sexual Dysfunction is judged to be due exclusively to the direct physiological effects of a substance (e.g., antidepressants, bezodiazepines, neuroleptics, antihypertensives, opioids). If both Female Orgasmic Disorder and substance use are present but it is judged that the sexual dysfunction is not due exclusively to the direct physiological effects of the substance use, then Female Orgasmic Disorder, Due to Combined Factors, is diagnosed.

If the sexual dysfunction is judged to be due exclusively to the physiological effects of both a general medical condition and substance use, both Sexual Dysfunction Due to a General Medical Condition and Substance-Induced Sexual Dysfunction are diagnosed.

Another mental disorder

Female Orgasmic Disorder may also occur in association with other Sexual Dysfunctions (e.g., Female Sexual Arousal Disorder). If so, both should be noted. An additional diagnosis of Female Orgasmic Disorder is usually not made if the orgasmic difficulty is better accounted for by another mental disorder (e.g., Major Depressive Disorder). This additional diagnosis may be made when the orgasmic difficulty predates the mental disorder or is a focus of independent clinical attention.

Occasional orgasmic problems

Occasional orgasmic problems that are not persistent or recurrent or are not accompanied by marked distress or interpersonal difficulty are not considered to be Female Orgasmic Disorder. A diagnosis of Female Orgasmic Disorder is also not appropriate if the problems are due to sexual stimulation that is not adequate in focus, intensity, and duration.

DSM-5

Diagnostic Criteria

A. Presence of either of the following symptoms and experienced on almost all or all (approximately 75%-100%) occasions of sexual activity (in identified situational contexts or, if generalized, in all contexts):

  1. Marked delay in, marked infrequency of, or absence of orgasm.
  2. Markedly reduced intensity of orgasmic sensations.

B. The symptoms in Criterion A have persisted for a minimum duration of approximately 6 months.

C. The symptoms in Criterion A cause clinically significant distress in the individual.

D. The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress (e.g., partner violence) or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition.

Specify whether:

  • Lifelong: The disturbance has been present since the individual became sexually active.
  • Acquired: The disturbance began after a period of relatively normal sexual function.

Specify whether:

  • Generalized: Not limited to certain types of stimulation, situations, or partners.
  • Situational: Only occurs with certain types of stimulation, situations, or partners.

Specify if:

  • Never experienced an orgasm under any situation.

Specify current severity:

  • Mild: Evidence of mild distress over the symptoms in Criterion A.
  • Moderate: Evidence of moderate distress over the symptoms in Criterion A.
  • Severe: Evidence of severe or extreme distress over the symptoms in Criterion A.

Differential Diagnosis

Nonsexual mental disorders

Nonsexual mental disorders, such as major depressive disorder, which is characterized by markedly diminished interest or pleasure in all, or almost all, activities, may explain female orgasmic disorder. If the orgasmic difficulties are better explained by another mental disorder, then a diagnosis of female orgasmic disorder would not be made.

Substance/medication-induced sexual dysfunction

Substance/medication use may explain the orgasmic difficulties.

Another medical condition

If the disorder is due to another medical condition (e.g., multiple sclerosis, spinal cord injury), then a diagnosis of female orgasmic disorder would not be made.

Interpersonal factors

If interpersonal or significant contextual factors, such as severe relationship distress, intimate partner violence, or other significant stressors, are associated with the orgasmic difficulties, then a diagnosis of female orgasmic disorder would not be made.

Other sexual dysfunctions

Female orgasmic disorder may occur in association with other sexual dysfunctions (e.g., female sexual interest/arousal disorder). The presence of another sexual dysfunction does not rule out a diagnosis of female orgasmic disorder. Occasional orgasmic difficulties that are short-term or infrequent and are not accompanied by clinically significant distress or impairment are not diagnosed as female orgasmic disorder. A diagnosis is also not appropriate if the problems are the result of inadequate sexual stimulation.

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