Dyspareunia “Sexual coldness”, “frigidity”, “sexual anesthesia” – obsolete terms, indicating a decrease in sexuality in women. Their boundaries are fuzzy, the terms imply the weakening or absence of orgasm during sexual acts.

determined by the age of the woman and the regularity of sexual activity: approximately 30% of women orgasm occurs only after childbirth, after 10-15 years of regular sex life orgasm is experienced by 80-90% of women. Distinguish primary (from the beginning of sexual life) and secondary (loss of orgasmic sensations) anorgasmia. Thus, in most women, anorgasmia occurs when the partner is changed and after prolonged sexual abstinence.

Manifestations of anorgasmia depend on the duration of the disorder, as well as the safety or loss of other components of sexual intercourse: libido, sexual excitability. For example, anorgasmia can be accompanied by a complete lack of sexual attraction with the preservation of platonic and erotic, a violation of the orientation of attraction (perversion, paraphilia). With prolonged absence of orgasm, sexual attraction usually fades. In some cases, anorgasmia causes a painful feeling of unreacted sexual arousal, a feeling of increased blood filling of the genital organs, pain, emotional disturbances, sleep disorders, in others – is not accompanied by either physical or mental discomfort.

Anorgasmia can be complete (absolute, total), when orgasm does not occur under any circumstances, partial (partial), when orgasm occurs in erotic dreams or masturbation, but does not develop under any forms of stimulation of erogenous zones by the partner, and relative. With relative anorgasmia, orgasm occurs only with a certain stereotype of sexual actions (with tension of the muscles of the legs and the perineum, with special stimulation of the extragenital and genital erogenous zones, with a certain position of the partners), is absent when communicating only with a certain partner, after the partner develops sexual disorders or only in the implementation of paraphilic tendencies (sadomasochism, fetishism, transvestism, visionism). Relative anorgasmia is also attributed to a low percentage of orgasmicity, including the onset of orgasm only on certain days of the menstrual cycle.

Diagnosis of dyspareunia.

usually does not cause difficulties and is based on characteristic complaints and anamnesis, as well as on objective research data. It is more difficult to identify the cause of anorgasmia. When combined anorgasmia with pronounced infantilism, changes in sexual hair and pigmentation, violations of fat metabolism, menstrual cycle, infertility, acromegaly, vascular crises, an additional endocrine examination is necessary. When combined anorgasmia with sleep disorders, depression, a supervalue to orgasm, unusual sensations in the genital area (in the absence of objective data), psychogenic disease should be excluded.

Anorgasmia must be differentiated from pseudo-anorgasmia, in which the woman “does not notice” a dim, fast-onset orgasm during the period of caresses or first frictions, and from multiorganism, undulating orgasm, in which after sexual intercourse there remains a feeling of unreacted excitement.

Treatment of dyspareunia.

should be strictly individual and aimed at creating optimal conditions for the manifestation of the sexuality of women, as well as the adequacy of stimulation of its erogenous zones. The leading role belongs to rational psychotherapy, sex therapy, sometimes suggestive therapy and auto-training can be effective. Drug therapy, physiotherapy, reflexology depend on the nature of the disorders. With anatomical defects of the genital organs, surgical treatment is performed. The prognosis improves with the interest of both partners in achieving a woman’s orgasm, willingness to change the stereotypes of sexual behavior.

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