Typologies of Women with Orgasmic Difficulty and Their Relationship to Sexual Distress

Abstract

Background About 50% of women who report orgasmic difficulty (OD) during partnered sex are distressed by their condition, yet why some women are distressed and others are not is unclear. Aim To determine whether sexual distress is related to women's perceived causes of their OD during partnered sex. Methods We established homogenous subgroups of women based on their attributions for OD during partnered sex, and these groups were validated by comparing them on variables relevant to sexual response. We then predicted OD-related distress from subgroup memberships as well as from a number of sociodemographic, control, and empirically supported sexual response variables. Results 3 distinct OD subgroups emerged: type 1—high psychological–high somatic reasons; type 2—partner-related reasons; and type 3—moderate psychological–low somatic reasons. These groups also differed on independent parameters related to sexual frequency and arousal. Subgroup membership, along with age, sexual relationship satisfaction, and frequency of partnered sex predicted sexual distress related to OD. Clinical Implication Particular perceptions regarding the causes for OD help predict women's sexual distress, and such factors might be considered in identifying sexual issues and managing them within the context of a sexual relationship. Strengths & Limitations A large sample size drawn from a multinational population powered the study, while the cross-sectional nature of the sample could not rule out bidirectional associations between predictor covariates (including OD subgroup) and the outcome measure (sexual distress). Conclusion Type 1 membership (high levels of psychological and somatic attributions) predicted greater levels of OD-related distress than type 2 (partner-related attributions) or type 3 (moderate psychological and low somatic attributions) membership, with type 1 women having a greater likelihood of internalizing (accepting responsibility/blame for) OD attributions.

Body Image, Orgasmic Response, and Sexual Relationship Satisfaction: Understanding Relationships and Establishing Typologies Based on Body Image Satisfaction

“…7,43 Body dissatisfaction, related to increased psychological distress, has been related to less frequent, pleasurable and consistent orgasm among women. 7,8,69 Our results, using a standard measure for body image satisfaction, 59 confirmed this pattern, indicating that lower body image satisfaction is associated with higher levels of "problems with orgasm," a composite measure comprised of orgasmic difficulty, percent of time reaching orgasm, and diminished orgasmic pleasure. Other variables included in the SEM-age, frequency of partnered sex, and overall interest in sex-were also significant predictors of "problems with orgasm."…”

“…From a psychological perspective, women who struggle to reach orgasm under any circumstances may tend to internalize the problem, feel greater distress, and experience diminished feelings of overall sexual self-efficacy. 7,8,13 During masturbation (even with no "evaluating observer" physically present), as women focus on their own bodies more intensely, some may be reminded of their shame and dissatisfaction, viewing themselves from an outside objectifying position (spectatoring). Furthermore, given that body image dissatisfaction is often associated with negative genital selfimage, as women physically touch their own bodies, they may trigger negative thoughts concerning their appearance.…”

“…45,51,52 Higher body image satisfaction likely leads to more comfortable (less distressful) sexual interactions with the partner, greater pleasure, and hence a more satisfying sexual relationship. 7,8,49 At the same time, better relationship satisfaction may offer greater balance to the physical and emotional components of sexual intimacy, affording women some protection against negative self-evaluation/dissatisfaction regarding their body appearance. 23,43,45,51e53 Other predictors of sexual relationship satisfaction included a higher frequency of partnered sex (a proxy often linked to this outcome) and lower frequency of masturbation.…”

“…Rather, distress is more strongly linked to women's perceived causes for their OD: those women attributing their OD to psychological factors such as general anxiety or stress, sex-specific/performance anxiety, and cognitive distractibility report higher OD-related distress. 8 Thus, compared with non-distressed OD counterparts, distressed women see their OD problem as emanating primarily from themselves. In doing so, they internalize the OD problem, take blame for it, and feel guilt, shame, self-anger, and distress about it.…”

“…* Clarifying wording changes were made for most questions based on consensus input during the survey development process from 3 focus groups of women [see7,8,11 ]. Such changes were often necessary as FSFI items do not specifically query about situations involving masturbation.…”