On the basis of findings from the National Social and Health Life Survey conducted in the early 1990s (60), orgasmic problems are the second most frequently reported sexual problems in US women. Results from this random sample of 1749 US women indicated 24% reported a lack of orgasm in the past year for at least several months or more. This percentage is comparable to the clinic-based data. Orgasmic problems were noted by 29% of 329 healthy women (ages 18 -73) who attended an outpatient gynecological clinic (66) and by 23% of 104 women (18-65+) attending a UK general practice clinic (67). It is difficult to determine the precise incidence of orgasmic difficulties in women, however, because few well-controlled studies have been conducted and definitions of orgasmic disorder vary widely between studies depending on the diagnostic criteria used. The DSM-IV-TR (68) defines female orgasmic disorder (302.73) using the following diagnostic criteria:
1. 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.
2. The disturbance causes marked distress or interpersonal difficulty.
3. The orgasmic dysfunction is not better accounted for by another Axis I 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. Female orgasmic disorder is further subtyped as lifelong vs. acquired, and generalized vs. situational.
Most studies examining orgasmic dysfunction in women refer to orgasm problems as either "primary orgasmic dysfunction" or "secondary orgasmic dysfunction." In general, the term primary orgasmic dysfunction is used to describe women who report never having experienced orgasm under any circumstances, including masturbation. According to the DSM-IV-TR, this would refer to those women who meet criteria for lifelong and generalized anorgasmia. Secondary orgasmic dysfunction relates to women who meet criteria for situational and/or acquired lack of orgasm. By definition, this encompasses a heterogeneous group of women with orgasm difficulties. It could, for example, include women who were once orgasmic but are now so only infrequently, women who are able to obtain orgasm only in certain contexts, with certain types of sexual activity, or with certain partners. Regarding women who can obtain orgasm during intercourse with manual stimulation but not intercourse alone, the clinical consensus is that she would not meet criteria for clinical diagnosis unless she is distressed by the frequency of her sexual response.
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