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 post-
traumatic 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 self-
esteem 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