Survey. Persons of both sexes undergo a standard sexological examination. Particular attention is paid to the collection of sexological history (features of psychosexual development, sexual debut, subsequent experience, understanding of the norm, physiology and psychology of sexual life, identifying latent trends of sexual desire, finding out the presence of orgasm with other types of stimulation – masturbation, petting, with erotic dreams). Women collect a detailed obstetric-gynecological history (to exclude the organic nature of the disorder – hormonal imbalance, inflammatory diseases, etc.); determine erogenous zones and their reactivity.
Additional examination: paired psychological testing to clarify the relationship between partners, their value orientations; consultations of the gynecologist, neurologist.
Anorgasmia therapy. The main method of treating primary anejaculatory disorders in men is psychotherapy with a course of vibrostimulation of the penis prior to ejaculation and orgasm.
In women, the treatment of anorgasmia is carried out taking into account the mechanisms of its development. In psychogenic forms in both men and women, the main role belongs to the methods of psychotherapeutic correction. Identification of organic pathology that impedes the occurrence of orgasm, involves the conduct of appropriate treatment. The goal of treatment is to restore or acquire the ability to experience orgasm during sexual intercourse. With anorgasmia against the background of an organic pathology or mental disorder, the treatment of the underlying disease is carried out.
In psychogenic (neurotic) anorgasmia in women, individual and pair psychotherapy, aimed at increasing interest in sexual life and sexual enterprise, improving interpersonal and sexual relations with a partner. Of particular importance is the identification, processing and neutralization of traumatic experience (the fact of detection of adultery, the trauma of sexual violence, the statements of the actual partner, offensive to a woman, etc.). Often, successful processing of key psychotraumas in a trance model (using age regression) or in the technique of DPDG (working with a separate traumatic memory) rather quickly leads to the elimination of a kind of functional kinesthetic block and the restoration of the specific sensitivity of the erogenous zones of a woman. If necessary, sex therapy can be applied using sensory focusing, vibrostimulation of erogenous zones, etc.).
In women with psychogenic anorgasmia due to “inadequately developed sexuality,” therapeutic measures focus on the development of adequate orgasmic skills. For this purpose, sex therapy is used (see below), body-oriented therapy techniques, biosynthesis techniques. Among the latter are techniques designed to relieve tension of strongly “squeezed” muscles, work with touches and their positive interpretation, stimulate harmonious breathing patterns leading to emotional balance, work with eye contact, eyes, voice, giving a couple experience in non-verbal expression of emotions and relationships fostering mutual understanding. In some cases, adaptogens, creams that increase erogenous sensitivity and reactivity, methods of reflexology (acupuncture, auriculotherapy, traditional oriental massage) are used.
X. Kaplan (1987) recommends sex therapy for all women experiencing problems with achieving orgasm. It should be noted that for some of them, including their husbands, clitoral self-stimulation is quite an acceptable form for a woman to achieve satisfaction, and in such cases it is quite possible to confine yourself to consulting a couple. But for a number of women, the absence of orgasm during sexual intimacy is the result of the suppression of the orgasmic reaction or the result of poor sex technique. Their sex therapy can be very effective.
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