Female Orgasmic Dysfunction Female Orgasmic

Female Orgasmic Dysfunction

Female orgasmic disorder (FOD) has been a controversial and often confusing issue in the annals of medicine and especially with regard to counseling treatment. Over the years the condition has been associated with a highly medicalized ideology and has also been discounted by some in its entirety. (Lavie-Ajayi, 2005) to step away from the debate regarding the disorder, by accepting that the disorder exists to the extent that it affects lives and can require therapeutic counseling intervention is the point of this work, rather than to debate the existence, non-existence or the physical clinical nature of the disorder. For the purpose of this work a basic definition of the disorder will be offered, to illuminate the scope of the disorder.

The basic definition of Female Orgasmic Disorder is the reported and actual inability of a female to achieve orgasm during the sexual act, either alone or with a partner or the inconsistency of ability to achieve orgasm or finally the inability to recognize orgasm when and if it does occur and therefore to enjoy it to the degree that she believes she should. (Kelly, Strassberg, & Turner, 2006) the severity and type of the disorder can range anywhere from the total lack of ability to achieve orgasm, i.e. The inability of completion of the sexual response cycle, referred to as primary orgasmic dysfunction (Andersen, 1983) to an inability to achieve orgasm with only vaginal or coital, intercourse associated stimulation. In the strictest sense primary female orgasmic disorder refers to the inability to achieve orgasm with any stimulation and is estimated to affect 10-15% of the female population (McMulle & Rosen, 1979, p. 912) with percentages increasing to up to 75% when the definition of FOD expands to its broadest point. (Sotile & Kilmann, 1977, p. 619)

Furthermore, from a counseling perspective the degree of affect has almost entirely to do with the perception on the part of the woman as to how this lack of achievement affects her and her relationships;

…the absence of orgasm in the lives of self-defined inorgasmic women is experienced by them not simply as an absence of physical sensation. For them it also carries profound personal and relational meanings, which are of central importance to their sense of self and subjectivity. (Lavie-Ajayi, 2005, p. 59)

Additionally, it must be noted that there are many women who do not seek counseling or other intervention when FOD is present, in large part related to the subjectivity of the affect of the disorder and the degree to which it affects their lives. In one article, associated with self-report interviews of women who report with and without self determined "problems" with Orgasm the researcher found that;

The consequences that problems with orgasm had on their lives varied from one woman to another. For some of them, it played a meaningful role in their lives. With others, its importance was negligible. However, all of the women interviewed drew, almost universally, on the dominant social discourse to make sense of their sexual lives. (Lavie-Ajayi, 2005, p. 61)

Furthermore, female orgasmic disorder can be related to a physical condition, though this is rare, (McMulle & Rosen, 1979) or it can be associated with psychological and/or communication issues within a sexual relationship (Kelly, Strassberg, & Turner, 2006) or many times it is associated with the lack of knowledge of the body and/or nature of the sexual response cycle on the part of the female or her partner or any combination of the above. In other words the FOD can be something that is easily resolved with education on the part of the woman (and possibly her partner) or it could be something much more persistent that fundamentally affects the woman and her intimate relationships. Again the degree of affect is subjective and it is likely that those who seek counseling intervention see the presence of the disorder as affective enough to be addressed and possibly to work toward a resolution.

It is also important at this stage to understand more completely the nature of the sexual response cycle as any interruption and/or delay in the cycle can create the real or potential experience of FOD and can have profound effects on the counseling treatment intervention offered to the individual. As one can see form the following diagram the cycle consists of four main segments; excitement, plateau, orgasm and resolution. If the excitement phase is inactive and/or lacking then the individual will be unlikely to move on to the plateau phase and if the plateau phase is lengthened or interrupted orgasm may not be achieved and finally if the resolution period is interrupted (say by continued rigorous stimulation) the perception of orgasm may be lacking. Again, one must point out that this is a purely physiological diagramming, of a highly subjective, individual and potentially emotional experience, but again the phase of interruption or interference can effect education and/or communication of the individual and/or her partner in a counseling treatment plan. The most important message here is that a great deal of the sexual response cycle is dependent on the psychological state of the individuals involved and therefore any given phase of physical response may interrupt and create a failure of the ability of the woman to achieve and/or perceive an orgasm, which may or may not be important to her fundamental satisfaction regarding sex and/or intimacy. (Lavie-Ajayi, 2005) Yet, again if there is no perceived, problem the individual woman is unlikely to seek out counseling intervention.

From a counseling perspective one of the first goals will be to assess the degree, etiology and potentially the resolutions of the disorder to create an appropriate and logical treatment plan be it individual education, couples communication counseling, group therapy or any combination of the above. Finally it must also be made clear that sex and sexuality are often highly personal and emotionally charged issues and a proper patient history and diagnosis of the individual or compounded difficulties must be achieved for every individual woman. This full and complete assessment will be addressed later in this work as an important aspect of the literature review, as research in this area is limited and assessment tools are minimal but absolutely essential in this area of treatment. Tools such as the Female Sexual Function Index or FSFI are not only accessible to the clinician but are necessary for the development of a full diagnosis and treatment plan, including but certainly not limited to recognizing medical and/or health issues that though rare might exist and be in need of address by a medical doctor. (Meston, 2003)

Review of Literature

The approach of this literature will be to address each body of work chronologically, as it is important to understand that the counseling issues associated with FOD are fundamentally interlaced with the logical progression of the perception of disorder over time. Barring a reinvestment in a more that perfunctory mention of the fact that the disorder has been highly controversial the progression over the last four decades as to the seriousness and/or nature of the disorder is important on a broader scale, as this progression affects the individuals' perception of the disorder and its importance. Though this approach to a literature review is fundamentally unorthodox the ability of the research to both affect the issue in a clinical manner and to specifically contribute in both the positive and negative to the counseling treatment modalities of the disorder over time creates a desire in this author to approach the research in this manner.

Sotile & Kilmann in Treatments of Psychogenic Female Sexual Dysfunction (1977) begin with a discussion of the contemporary lack of concensus with regard to the definitions and standards associated with research as well as treatment modalities for the broader disorder known at the time as female sexual dysfunction. The period marked much expeiementation and the utilization of research and treatment modalities that were untested and unfounded and the diagnosis was compleletly lacking in definative standards which clearly did not meet the needs of the growing female popualtion seeking treatment and intervention for many of the various forms of female sexual dysfunction. Ultimately, the period was marked by a transistion that was leaving the old ideologies of "frigidity" which was a nealy all inclusive term associated with female sexual dysfunction to defining and characterizing different types of disorders and attempting to coem to some concensus on just how wide spread these types of disorders were. According to Sotile & Kilmann the only real concensus was that there were two distincly different types odf sexual dysfunction in women, psychogenic and physiological. The authorsmthen go on to review research regarding treatment modalities in seven different categories; individual verbal psychtherapy, couple reeducation, systematic desensitization, extensive retaining programs, combination approaches, group therapy, and vaginal exercise.What the researchers found was disturbing in its scientific reliabilty but the most important finidng of the review is that the various types of disfunction are better addressed by different counseling treatment modalities, orgasmic dysfunction was most effectively treated by various forms of systematic desensatization and retraining programs and that most other treatment modalities seemed to lack effect or were researched and/or documented in such a way that their efficacy for FOD was unknown. (Sotile & Kilmann, 1977) the only real exception to Sotile & Kilmann's assessmernt of scientific innacuracy and ineficiency was the now famed Masters and Johnson research which cooencided with a very effective treatment modality in a large sample and with reported success over a relatively short period of time, using a combiantion systematic desensatization and retraining regimen. (1977, pp. 626-627)

McMulle & Rosen in Self-Administered Masturbation Training in the Treatment of Primary Orgasmic Dysfunction (1979) the authors assess the use of self-administered masturbation training in a comparative model between written instruction programs and video instruction programs. The researchers found that the method was as effective as other models for counseling intervention treatment (about 60% effective for inorgasmic women) it was cost effective in that it allowed a single treatment session to serve as a resolution, rather than an extensive counseling regimen. The written and video formats also had no significant difference. One of the focuses of the work was on the transition of orgasm to coital activity post treatment, as this was the mark of success for the participants. The assumption being that if the individual inorgasmic woman were simply taught how to have an orgasm that the orgasm would begin to occur with some regularity during intercourse alone as a result of her new ability to recognize the sensations and/or needs for achievement associated with the event. The researchers also point out that the goal of the treatment plan was ultimately coital female orgasm, and yet they also acknowledge that some treatment researchers are seeing any orgasmic achievement, no matter the mode as success. Additionally the researchers discuss partner knowledge and communication as a main reason for the inability of newly orgasmic women to transition to achieve orgasm with coital intercourse stimulation alone. The most important acknowledgement that may be seen to be particular for the feminization of this issue is that information was the key to success, rather than the traditional claims that video or visual aid was more effective as written instruction was equally effective for the treatment of primary orgasmic disorder in women. (McMulle & Rosen, 1979) This is reflective of the more modern therapeutic intervention, as much work has been done that supports coital stimulation may not be physiologically adequate for many women to achieve orgasm. This is also supported by the more modern take on the expansion of the idea of sexuality to include much more than the simple act of heterosexual penile penetrative intercourse. (Lavie-Ajayi, 2005)

Tripet Dodge, Glasgow & O'Neill in Bibliotherapy in the Treatment of Female Orgasmic Disorder (1982) consisted of a relatively small sample assize assessment (n 13) where a comparison was made between minimal therapy contact and no therapy contact programs where each individual was given a the same information regarding female sexual stimulation and achievement of orgasm and one group, serving as the control group was offered a post treatment follow up and the other group was offered 6 half hour sessions where the counselor met with the client to review success and address questions and/or concerns. Again like the above comparison study (McMulle & Rosen, 1979) the researchers found little differnce between the two groups and no statistical differnce in success for the achievement of orgasm, though for counseling purposes the study group regimen of periodic review was more effective for the treatment research and for the sake of the counselor. Again the researchers support th idea that information is the key and mode of infromation delivery is irrelivant. The work also supported treatmetn fo primary (unable to achieve in any form) and secondary (able to achieve most often with masterbation but rarely with intercourse) but did not compare the two groups as a result of the limited sample size. (Tripet Dodge, Glasgow, & O'Neill, 1982)

Andersen in Primary Orgasmic Dysfunction: Diagnostic Considerations and Review of Treatment (1983) points out a significant change in the development of treatment modalities for primary orgasmic dysfunction, and that is the addition of the disorder with emphasis on inorgasmia being included in the Diagnostic and Statistical Manual III, (DSM III) and how this has changed the diagnostic abilities of the therapist. (Andersen, 1983, p. 106) This is a significant change as it acknowledges that the disorder exists and affects the psychological health of the individual. The work then goes on to review, rather than compare and contrast the current treatment modalities available to women for primary orgasmic dysfunction; systematic desensitization, sensate focus, directed masturbation and hypnosis. Among the four treatment types reviewed Andersen points out the variances coming to the conclusion that more research needs to be done with regard to the contributions and needs of clients, therapists, researchers and others before any clear better or worse assessment can be made about any given treatment modality, but sex therapy including guided masturbation and systematic desensitization seem to be treatment modalities with the best reported outcomes. (Andersen, 1983)

At this point it must be noted that there seems to be a lack of chronological research for the 1990s. The reason for this is unknown but it may be associated with a lag in feminist research and a quiet internal review of efficacy and treatment for the definitions and standards of FOD. That being said Winton in Gender, Sexual Dysfunctions, and the Journal of Sex & Marital Therapy (2001) discusses the research trend of refocussing on male erectile dysfunction, as apposed to female sexual disorders, by reviewing journal article frequency. Which cooencides with pharmacological treatments that have recently been releised into the market to treat erectile dysfunction. Winton points out that the implications of this research refocus is that FOD and other female centered sexual disorders seem to have been set asside, either as a result of the fact that the disorders are considdered effectively treated with current treatment modalities or as a result of the trend to study altrnatives and drug therapy in combination with any given counseling therapy. This reviewer also points out that the sistribution of estimated frequency disorders does not warrant a reduction in discussion regarding FOD and other female sexual dysfunctions; "Epidemiological findings indicate that 18.8% of women have trouble becoming lubricated; 10.4% of men have trouble obtaining or maintaining an erection; 24.1% of women are unable to have an orgasm; and 28.5% of men reach orgasm too quickly (Laumann, Gagnon, Michael, & Michaels, 1994)." (Winton, 2001, pp. 333-334) Winton calls for refocus on the part of the major sexuality journal son multi-disciplinary focuses that are broader rather than dependant on the trends of medicalization. (Winton, 2001)

Meston in Validation of the Female Sexual Function Index (FSFI) in Women with Female Orgasmic Disorder and in Women with Hypoactive Sexual Desire Disorder (2003) strategically assess the diagnostic tool called the Female Sexual Function Index (FSFI) as both valid and effective for as a diagniostic tool associated witht the development of effective treatment planning for individuals women wuth FOD or hypoactive sexual desire disorder, where previous validity tests had only been done for women with female sexual arousal disorder a broader diagnostic disorder. The work establishes that the FSFI, a self report sexual function questionair translates to more defined diagnostic disorders, as well as for assessing treatment induced changes and will seriously aide in the crucial development of patient histories, with regard to sexual function and in measurement of post intervention change. The work marks a new and intense focus on universalization and the application of scientific method to these disorders, an essential step in treatment efficacy development. (Meston, 2003)