Pathogenesis (development of disease)
Orgasmic disorder is a delayed or absent orgasm after a normal phase of arousal. Causally, various factors such as hormonal disorders or organic diseases, but also psychological influences can interact.
Etiology (causes)
Biographical causes
- Abuse in the past
- Hormonal factors
Behavioral causes
- Psycho-social situation
- Psychological conflicts
- Fear and shame
- Stress
- Sexual pressure to perform
Causes related to illness
- Depression
- Diabetes mellitus (diabetes)
- Circulatory disorders
- Nerve damage
- Tumor diseases
- Injuries
- Adhesions after operations
Medication
- Amphetamines (orgasmic disorder)
- Anticholinergics (arousal disorder).
- Antidepressants
- Selective serotonin update inhibitors (libido, arousal, and orgasmic dysfunction).
- Tricyclic antidepressants (libido, arousal, and orgasmic dysfunction).
- MAO inhibitors (orgasmic disorder).
- Trazodone (libido disorder)
- Venlafaxine (libido disorder)
- Antipsychotics (neuroleptics) (libido and orgasmic disorder).
- Babiturate (libido, arousal, and orgasmic disorder).
- Benzodiazepines (libido and arousal disorder).
- Chemotherapeutic agents (libido and arousal disorder).
- Histamine receptor blockers
- Hormones
- Anti-androgen-acting drugs – e.g. cyproterone (libido, arousal, and orgasmic disturbance).
- Antiestrogens – tamoxifen (libido and arousal disorder).
- Aromatase inhibitors (libido and arousal disorder).
- GnRH agonists (GnRH analogues) – e.g. goserelin (libido and arousal disorder.
- Hormonal contraceptives (estrogens + progestin) → concentration of SHGB (sex hormone-binding globulin) increases and freely available testosterone decreases, which may be associated with decreasing libido.
- Testosterone derivatives – e.g. Danazol.
- Indometacin (analgesic) (libido disorder).
- Cardiovascular/antihypertensive drugs that may be associated with libido disturbance: Beta-blockers, clonidine (+ arousal disorder), digoxin (+ orgasm disorder), lipid-lowering drugs, methyldopa, spironolactone.
- Ketoconazole (antifungal) (libido disorder).
- Lithium (libido, arousal, and orgasm disorder).
- Phenytoin (anticonvulsant) (libido disorder).
- Proton pump inhibitors (proton pump inhibitors, PPI).
- Sedatives (orgasm disturbance).
