Primary orgasmic dysfunction: diagnostic considerations and review of treatment.

The diagnostic category primary orgasmic dysfunction has been used to describe women who, report never having experienced orgasm under any circumstance (Kaplan, 1974a; Masters & Johnson, 1970). Despite the sexual information and treatment advances of recent years, the incidence of this sexual difficulty appears unchanged. As early as 1929, Hamilton reported that 20% of the 100 women surveyed had never experienced orgasm and an additional 11% were doubtful (Hamilton, 1929). Terman’s (1938) initial study and subsequent replication (1951) were the first large-scale correlational studies of personality variables and sexual response in women. From his sample of 760 married women, 8.3% reported never reaching orgasm. The Kinsey group (Kinsey, Pomeroy, Martin, & Gebhard, 1953), interviewing 2,480 women who had been previously or were currently married, estimated that at least 10% of the female population would never experience orgasm during their life. Surveys of more recent origin identified 7% (Hunt, 1974) and 10% (Hite, 1976) of the female population as nonorgasmic. Although there are interpretive difficulties with such survey data, convergent evidence appears to indicate that primary orgasmic dysfunction remains a clinical problem of considerable magnitude. In the absence of organic or anatomical problems, most orgasmic difficulties are regarded as psychogenic. Yet for many years traditional psychotherapy (i.e., psychoanalytically oriented treatment) was unsuccessful in treating this condition (Bergler, 1951). More recently, other therapy models have improved clients’ general sexual functioning and produced changes in orgasmic status. The present article reviews the treatments for primary orgasmic dysfunction for which significant clinical support and empirical documentation exist, which include systematic desensitization, sensate focus, directed masturbation, and hypnosis. Each technique is briefly described so that the reader can discern differences between them as well as variations in their application. During the last 20 years the sex therapy literature has progressed from case studies and individual analyses, through single group designs and own-control group designs, to treatment comparisons with untreated controls. The reviews for each treatment will follow this framework rather than a chronological progression per se. Controlled treatment comparisons are presented in a final section. In surveying research of primary orgasmic dysfunction it will become obvious to the reader that the women included in the investigations represent a continuum of psychological, physiological, and behavioral sexual responsivity despite their sharing the failure to have experienced orgasm. Therefore, to structure the presentation, discussion of the diagnosis of female sexual dysfunction with particular emphasis on inorgasmia is included. An effort will be made in the review to provide sufficient detail so that the reader may begin to discern not only which treatments have the greatest utility but also which treatments might be best suited for particular subgroups of nonorgasmic women.