Diagnostic concerns

DSM-IV cautions that 'the diagnosis of female orgasmic disorder be based on the clinician's judgement that the woman's orgasmic capacity is less than would be reasonable for her age, sexual experience, and the adequacy of sexual stimulation she receives'. These variables lead to diagnostic confusion and little agreement as to what constitutes an orgasmic disorder. Anorgasmia is clearly the diagnosis for a woman who has never achieved orgasm under any circumstances; 10 to 15 per cent of women fall into this category. However, as orgasm achieved solely with intercourse is elusive and masturbation is not widely accepted in women, diagnosing orgasmic conditions becomes more problematic. Kaplan estimated that only one-third of women are able to regularly achieve orgasm through intercourse alone; therefore, two-thirds of adult women cannot be labelled anorgasmic. For some women, manual and/or oral stimulation is often the only means of reaching orgasm, while for others self-stimulation with a vibrator is their sole method of climaxing. Whether or not reliance on only one means of achieving orgasm constitutes a dysfunction is not clear. Adding to the confusion is the media's constant reinforcement of unrealistically high expectations for achieving orgasms from sexual encounters. Both men and women are led to believe that women can easily and regularly achieve multiple orgasms from penile thrusting alone, and all sexual activity should lead to orgasm for the woman as well as the man. The clinician's dilemma is to distinguish between normal variation and dysfunction.

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