The diagnosis of orgasmic disorder: the role of gynecologist

Orgasm has important individual and relational meanings. The orgasmic disorder can be either lifelong or acquired, generalized or situational, limited to one or every partner and/or with one or all types of sexual expressions. The diagnosis should evaluate predisposing, precipitating and maintaining factors that concur to the orgasmic disorders. Biological factors include: antidepressants, hypotonic or hypertonic conditions of the pelvic floor, urge incontinence, inadequate outcome of episiotomy or perineal surgery, vulvar dystrophy and inadequate androgen and estrogens tissue level. Psychosexual factors include comorbidity with desire and arousal disorders, depression, quality of erotic self-confidence the women feels, previous sexual abuses. Relational factors include the quality of couple relationship, and/or male sexual problems, such as premature ejaculation or erectile deficits. The paper analyzes the clinical approach - history and physical examination - the gynecologist can use in his/her practice to define the diagnosis of orgasmic disorder and to tailor treatment accordingly.