This post is part of a series of guest posts on GPS by the graduate students in my Psychopathology course during Spring 2014. As part of their work for the course, each student had to demonstrate mastery of the skill of “Educating the Public about Mental Health.” To that end, each student has to prepare two 1,000ish word posts on a particular class of mental disorders, with one of those focusing on evidence-based treatments for those disorders and the other focused on a particular myth or misunderstanding about mental illness.
Treatments for Female Orgasmic Disorder by Lauren Reed
Female Orgasmic Disorder (FOD) is defined in the DSM-5 as marked delay in, marked infrequency of, or absence of orgasm and/or markedly reduced intensity of orgasmic sensations. Reported prevalence rates for this disorder vary widely in women, ranging from 10% to 42% depending upon multiple factors such as age, culture, duration, and severity of symptoms. Variation in how symptoms are assessed also vary widely and are mostly dependent upon clinical judgment. The inability to obtain orgasms does not always lead to distress or dissatisfaction in a woman, and as such this diagnosis should only be given if criteria is met and the women feels clinically significant distress because of it.
In examining the empirically supported treatments for Female Orgasmic Disorder, it became apparent that there are only a few efficacious treatments available and a vast amount of other treatments that haven’t been properly tested, have mixed results, or have been shown to be completely ineffective. Efficacious treatment approaches attempt to take into account many common ingredients in Female Sexual Dysfunctions. This includes 1) a detailed history that assesses physical, psychosocial, and interpersonal factors, 2) 5-20 sessions of solution-focused treatment, 3) a theoretical basis of Cognitive Behavioral Therapy, 4) home prescriptions, and 5) the perspective that sex is a legitimate symptom rather than only a sign of other issues or psychopathology.
Substantial empirical outcome research is only available for cognitive-behavioral therapy (CBT) approaches in association with FOD. Regardless of the treatment used, clinicians need to keep in mind a variety of relational factors that can affect a woman’s ability to orgasm. These factors include marital or partner satisfaction, happiness, and stability which each play a role in overall relational satisfaction. Childhood sexual abuse, domestic abuse, and other forms of trauma have also been correlated with various sexual difficulties and need to be taken into account. Treatment approaches need to be individualized and the factors just mentioned must be considered in order to provide the best treatment.
Using CBT for treatment of FOD focuses on promoting changes in attitudes and sexually relevant thoughts, decreasing anxiety, establishing a connection between positive emotions and sexual and sexual activity, and increasing ability and satisfaction of the female orgasm. These treatments are not, however, what you would commonly think of in reference to CBT. The treatments of FOD are centralized around sex therapy while also incorporating aspects of sexual behavioral change. The efficacious treatments most commonly used in the treatment of FOD include directed masturbation (DM), sensate focus, and systematic desensitization. Although these treatments are considered efficacious, it is important to point out an important limitation: because these treatments are often combined in therapy studies, it is difficult to determine if the treatments would still be efficacious on their own rather than combined.
Directed Masturbation is the most frequently utilized treatment for women with FOD. This treatment begins by assigning a woman the task of exploring her body, typically using a mirror and educational material depicting the female genital area. This step is engineered to aid the woman in first becoming visually familiar enough with her genital area that she can identify the sensitive areas that elicit pleasure. After visual identification has occurred, the next assignment is given to the woman to apply targeted manual stimulation to these regions. The purpose of this self-stimulation is directed toward the woman achieving orgasm alone. Once this has been accomplished, her partner is then incorporated into the DM sessions. This presence of the partner serves a couple of points. First, the woman is learning to openly experience sexual arousal and orgasm with her partner present. This serves to desensitize the woman to the initial sexual anxieties she may feel in the presence of her partner. Secondly, the partner observes how to stimulate the woman effectively. Women diagnosed with FOD have successfully been treated using DM in several therapy settings, including group, individual, and couples’ therapy. Success rates have been estimated as high as 92% in some case reports and a number of outcome studies.
Sensate Focusing is another approach often used by sex therapists that is aimed at increasing personal and interpersonal awareness of one’s own needs as well as the needs of their partner. This approach is also set up in stages, similar to that of directed masturbation. In the first stage, the couple is encouraged to touch each other’s bodies, excluding breasts and genitals. This stage is meant for the individuals to explore the skin and focus on what they find interesting, not on what they think the other may enjoy. The second stage increases the initial touching to include breasts. In the first and second stage, touching of genital areas and intercourse are not allowed. Further stages of sensate focusing include the gradual introduction of genital areas and increased foreplay. The final stage is full intercourse. Although orgasm is never the focus, this technique is still used as treatment of FOD and primarily aids in the reduction of anxiety for the woman.
Another anxiety reducing treatment for FOD, is that of systematic desensitization. In this method, the woman and therapist develop a fear hierarchy. This includes a succession of anxiety-provoking stimuli that represent increasingly threatening sexual situations. The gradual exposure to increasing levels of anxiety actually decreases overall anxiety in the long run. After the woman has decreased anxiety in the thoughts about the anxiety provoking situations, she then engages in a hierarchy of actual activities. This usually brings in the technique of sensate focusing, with the highest-anxiety situation being full intercourse.
It is important to note that many pharmacological treatments have been developed across the decades, yet none have proven effective at treating Female Orgasmic Disorder. The search still continues for the pink version of Viagra, with all drug companies failing to find this “magical drug” thus far. Until then, the combination of CBT approaches in sex therapy and sexual education appear to be the most advantageous in treatment of women diagnosed with Female Orgasmic Disorder.