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“Chasing the Big O.” That is how one of my patients described her orgasm dysfunction and her quest to find a solution. The incredulous fact is that despite the fact that millions of women suffer from orgasm dysfunction, there exists no FDA approved treatment option.
Yes, you read that correctly, there is no FDA approved treatment option for orgasm dysfunction. As healthcare professionals, we can carefully measure the amount of dysfunction a patient has as part of the FSFI (female sexual dysfunction index). Orgasm is one of the sexual domains measured in the questionnaire. So we can diagnose, but we cannot offer an FDA approved treatment option? This is truly maddening.
So, what is a woman to do? A Google search may lead to promises of the best orgasm ever or fixes that have no data, no evidence to support safety or efficacy. The type of treatment a woman needs depends on why the orgasm dysfunction is occuring. You see, an orgasm involves much more anatomy than our clitoris. It is true that the clitoris is the only organ that exists solely for pleasure. But, the clitoris, as mighty as it is, cannot function alone. During orgasm, our brain fires signals, our spinal cord sends and receives messages, our uterus, cervix, vagina and vulva contract. If there is a problem with neurochemistry, hormones, our endocrine system, our neurologic system, our skin or even with our partners technique we may have trouble achieving the Big O.
How do we figure out the cause of a woman’s orgasm dysfunction? If you are struggling with orgasm, if it takes too long, never happens, feels weak, or is not associated with any pleasure - what is your next step? A visit to a sexual health provider that involves an exam, discussing your medical history, labs and potentially imaging may be in order. That way the origin of the orgasm dysfunction can be discovered.
Finally, what are some treatment options that are non-FDA approved? There is evidence that there are some treatment options that are effective and safe.
There are a few buckets of treatment options that include:
- Off-label prescription medications
- Over the counter options
- Procedural options
Off-label prescription medications
There are medications that are indicated or approved for other medical reasons that may have the added benefit of treating orgasm dysfunction, like a beneficial side effect. Some of these medications may work by altering neurochemistry in favor of an orgasm. Sometimes a provider may prescribe a medicine that helps a woman to focus on pleasure. If a patient has an underlying endocrine problem, neurologic problem, dermatologic problem, oftentimes treating this will also treat the resulting orgasm problem.
Over the counter options
Hormonal options include testosterone therapy. Testosterone is a hormone that has been proven to be beneficial in some patients to treat orgasm dysfunction.
There are also procedures that may be beneficial including, lasers, radiofrequency, sound wave therapy, and the O shot. These treatment options suggest that they work by increasing blood flow to the clitoris. Many of these options have very limited data for efficacy and should be discussed with a healthcare provider. Finally, if a problem is discovered in the neurologic system, surgery may be required to repair the anatomy.
Counseling and pelvic floor physical therapy are two other options that can help treat orgasm dysfunction. Past trauma, partner skill, or even anxiety and depression can lead to problems with orgasm.
Orgasm dysfunction affects millions of women, is complicated and may have many causes. However, treatment options do exist, albeit not FDA approved. Maybe just maybe, we can keep our fingers crossed that the FDA will approve a medication for orgasm dysfunction sometime soon.
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