Major Female Sexual Problems (Part 2)

Failure to Achieve Orgasm & Sexual Pain

Failure to achieve orgasm (anorgasmia) is more common in younger women, suggesting that sexual response is a learned response – often achieved through masturbation, or experimentation with a trusted partner. This could be a constant problem or one that arises with a specific partner. Personal factors, such as the inability to lose control and cultural reasons surrounding the female enjoyment of intercourse can all be factors surrounding anorgasmia. Penetrative intercourse alone is not sufficient to achieve orgasm in most women. Failure to communicate her wishes during intercourse can lead to a woman’s dissatisfaction and failure to achieve orgasm.

Sexual pain disorders include vaginismus and vulval vestibulitis. Vaginismus is defined as the persistent or recurrent difficulties of a woman to allow vaginal entry of any object, despite her expressed wish to do so. There is involuntary contraction of pelvic muscles with anticipation, fear or experience of pain. It can arise as a conditioned response to adverse physical or psychological experiences in the past. Previous traumatic sexual experiences can make pelvic examination and intimate sexual contact distressing and painful. Painful childbirth and previous gynecological procedures or examinations may have created anxiety around any intimate contact.

Vulval vestibulitis is characterized by pain at the introitus on penetration leading to tenderness and erythema. After dermatological conditions such as lichen sclerosus, psoriasis and dermatoses, have been ruled out, this diagnosis is to be considered. Patient may find this reassuring when this is explained and acknowledged. The recognition of this pain being valid can in itself be therapeutic to women.


Considering the very intimate and delicate nature of these problems, it is easy to see how women tend to reveal the true nature of their complaints. Therefore, it can easily be overlooked when assessing a woman’s symptoms. Confident, sensitive and routine asking about sexual function (without prurience) can reduce the patient’s embarrassment of revealing these problems to a clinician.


(gynaecology by Ten Teachers. Nineteenth edition)

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