Aetiology

The major aetiologic contributions to

anorgasmia can be grouped broadly
under four headings:
Physical/Biological
Psychological
Interpersonal
Sociocultural

Physical/Biological Factors
Certain prescription drugs, including common drugs used
to treat depression, such as fluoxetine (Prozac), paroxetine
(Paxil), and sertraline (Zoloft)
Hormonal disorders, hormone changes due to menopause,
and chronic illnesses that affect health and sexual interest
Fatigue and stress
Medical conditions that cause chronic pelvic pain, such as
endometriosis
Medical conditions that affect the nerve supply to the
pelvis, such as multiple sclerosis, diabetic neuropathy, and
spinal cord injury
Anatomy - it is the outermost third of the vagina that is
most suffused with nerve endings

Psychological Contributions
No particular psychiatric diagnosis has been found to correlate with
FOD. Neither depression nor a history of sexual trauma appears to
directly affect orgasmic ease, although both can cause desire and
arousal difficulties. Depressed women most often report a
diminished desire for sex.
Sexual abuse histories contribute indirectly to orgasmic dysfunction
through the impairment of both desire and arousal by posttraumatic symptoms such as flashbacks and dissociation,
particularly when the sexual activity replicates the abusive
situation.
Fisher (1973) found that women who have orgasmic difficulty have
significant histories of absent or undependable fathers. Fisher
postulated that these women's histories of abandonment or neglect
produced a premature need for emotional control and a fear of
letting go in the presence of a lover, which made orgasm difficult.
Fisher S: The Female Orgasm, pp 227 289. New York, Basic Books,
1973

Interpersonal Contributions
Theorists have increasingly noted the importance of
intimate relationships for a woman's sense of selfesteem and happiness, a finding that supports current
evidence that orgasmic ease correlates with a
woman's overall sense of happiness in life. (Michael,
1994 & Miller, 1987)
Considerable research confirms that a woman's sense
of safety and pleasure in her relationship is related to
her orgasmic response.( Heiman, 1989)
Blumstein and Schwartz refer to the shared intimacy
women look for in sexual relationships.
Michael RT, Gagnon JH, Lauman EO, Kolata G: Sex in America: A Definitive Survey, pp 123 126.
Boston, Little Brown, 1994
Miller JB: Toward a New Psychology of Women. Boston, Little Brown, 1987
Heiman JR, Grafton-Becker V: Orgasmic disorder in women. In Leiblum SR, Rosen RC (eds): Principles
and Practice of Sex Therapy: Update for the 1990s, pp 51 88. New York, Guilford Press, 1989

Sociocultural Perspectives
Before the 1960s, many women were
embarrassed and anxious about seeking sexual
pleasure because of the prevailing social view
that a 'good' woman simply tolerated her
husband's sexual advances.
For years, the leading sociocultural theory of
female orgasmic problems was that it resulted
from sexually restrictive cultural messages. This
theory has now been challenged because:
i. Sexually restrictive histories are equally
common in women with and without disorders
ii. Cultural messages about female sexuality have
been changing while the rate of female sexual
dysfunction stays constant