Orgasm does not occur or is significantly delayed. This may be situational in nature (that is, it occurs only in certain situations), in which case the etiology is most likely psychogenic. In other cases, orgasmic dysfunction is invariant and physical or constitutional factors can be excluded only on the basis of a positive reaction to psychotherapy. Orgasmic dysfunction is more common in women than in men.

It should be noted that physiologically normal in men orgasm is closely associated with ejaculation. Therefore, it is necessary to include in this selection also delays and absence of ejaculation.

Diagnostic criteria.
The absence or lag of orgasm manifests itself in one of the following options:
1) the orgasm was never tested in any situation;
2) the disorder has arisen after some time of normal sexual functioning.

In women, an orgasm disorder (anorgasmia) is a recurring and sustained delay or absence of orgasm after the phase of normal sexual arousal, which the doctor finds adequate in focus, intensity and duration. Anorgasmia is noted: a) in all situations and with each partner; 6) only in certain situations, while in others the ability to orgasm is preserved, for example, during masturbation or with a certain partner.

In men with orgasm disorders, ejaculation during intercourse is achieved with great difficulty or not at all.

The following variants of male orgasmic dysfunction are distinguished:
a) ejaculation occurs only in a dream during pollutions and never in waking state;
b) ejaculation and orgasm never occur in the presence of a partner, but are possible during masturbation;
c) in the presence of a partner, but not intravaginally (with orogenital or manual-genital stimulation);
d) episodic absence of ejaculation and orgasm during intercourse;
e) selective (selective) absence of ejaculation and orgasm with a certain partner or in a certain situation;
e) difficult, requiring great efforts to achieve ejaculation and orgasm during intercourse, which is protracted, exhausting in nature.

Includes:
– Inhibited male orgasm (female);
– psychogenic anorgasmia;
– Inhibited ejaculation in men;
– psychogenic anejaculatory disorder.

Orgasm – the highest degree of sensual pleasure, the culmination of sexual intercourse or other forms of sexual relaxation (masturbation, petting, erotic dreams, etc.). It is the result of an integrative interaction of a number of structural and functional formations of various levels (pelvic, spinal, diencephalic, cortical). The “construction” of sensual enjoyment at the local level in women involves the clitoris, vagina, and uterus, and in men, the penis, prostate, and seminal vesicles. However, the experience of orgasm is primarily associated with the activities of a number of brain structures and the psyche as a whole. Once having experienced a sense of orgasm, the individual seeks new and new repetitions of this ecstatic experience. It is curious that the essence of their orgasmic experiences of a man and a woman describe almost the same. A group of 70 experts could not distinguish between male and female descriptions of an orgasm, from which explicit indications of the subject’s gender were removed.

However, the female orgasm is physiologically and psychologically more complicated than the male one. The ability to experience orgasm in women is variable and depends on many biological and psychological factors. For an adequate assessment of a woman’s orgasticity, it is necessary to take into account her psycho-physiological characteristics, previous sexual experience, ability to experience orgasm with certain forms of stimulation or during sleep, age, gynecological status, presence of a constant and sensitive partner without sexual deviations, etc. early sexual activity may be associated with some delay in psychosexual development and is temporary. Many women have cyclical changes in libido and orgasm, depending on the phase of the menstrual cycle.

For example, in black women, the peak of sexual desire and maximum orgasm are in the period of ovulation, that is, the middle of the cycle; in white women – more often for a period close to menstruation (several days before it starts or immediately after graduation).

N. Shines (1998) identifies a number of psychological factors contributing to the female authentic (completed) orgasmic reaction. These same factors can be defined as decisive for mental health in general, which confirms the leading role of psychological factors for normal female sexuality. Here it is appropriate to recall the statement of J. McDougall:

“There is no doubt that the leading” erogenous zone “of humanity is located in the head.” Consider the most important of them, directly related to sexuality.

1. Successful psychosexual development. Here one can single out the conscious recognition of one’s femininity, the development of the pre-genital stage, the timely development of breast development in the context of individual development. Other factors of psychosexual maturity of a woman are associated with a rather good attitude towards mother and father, with an adequate erotic atmosphere in the parents’ house, with positive sexual experience during the first intimate relations, with a sense of self-worth and sexual attractiveness of the girl.

2. Active partner selection. The success of a woman is mainly due to the fact that she understands her sexual activity as something she decided on herself.

3. Trustworthy partner. Moreover, the partner must also be self-confident, since the alleged insufficiency of the partner inevitably becomes its insufficiency. In most cases, even strong partnerships are important, since female sexuality is most fully revealed in the situation of a romantically tinged, stable relationship with a gentle and attentive partner.

4. The ability to react freely to the sexual need.

5. Independence from narcissistic behavior. An authentic reaction is characterized by the naturalness of sexual behavior and the joy of self-giving. A woman, along with genital satisfaction, seeks tenderness and a special kind of fusion or identification with a partner.

6. Freedom from feelings of guilt and fear. These feelings adversely affect the sexual reactivity and emotional involvement of the woman.

7. Cultural influence. “Sexual abilities and behaviors of a woman bear the stamp of a cultural orientation on sexuality and morality, the sexual code and the position of a woman as such.”

8. The vital reality of “today.” According to the daily given, they affect the emotional state of a woman. The same applies to the mood of the partner. And the connection with the sexuality of this point is quite high.

9. Satisfied desire to be recognized. In a woman capable of an authentic orgasmic reaction, personal development is such that she does not need to confirm her value anymore and she does not doubt her sexual abilities.

A woman who is actively involved in sexual relations in which she “entered or intentionally started, without being an outside observer and without intellectualizing, without obsessive thoughts about them and without inventing special conditions, without experiencing anxiety or fear, without“ producing ”herself narcissistically and without competing with a partner, he begins to feel passion and dares to react in a way that fully meets her needs, until he can no longer control himself – and then in his changed consciousness She is experiencing complete liberation, calm after a storm, accompanied by a rush of gratitude and a sense of respect for her partner. ”

The factors contributing to the achievement of an orgasm by a woman include the following: the optimal level of androgens in the body; good reactivity of the nervous system; sufficient tension of the perineal muscles during sexual intercourse; masturbation experience; sexual initiation before the age of 18; the duration of the foreplay is over 15 minutes, the duration of coitus is over 10 minutes, the extroversion of the personality; high level of sexual education and sexual imagination; successful sensual relationship with a partner; a positive standard of sensual relationships taken out of the family environment.