An orgasm in the human female is a variable, transient peak sensation of intense pleasure, creating an altered state of consciousness, usually with an initiation accompanied by involuntary, rhythmic contractions of the pelvic striated circumvaginal musculature, often with concomitant uterine and anal contractions, and myotonia (muscle relaxation) that resolves the sexually induced vasocongestion and myotonia, generally with an induction of well-being and contentment.
Anorgasmia (inability to experience orgasm) is more common among younger women, demonstrating that sexual response is a learned response. The problem of anorgasmia may be constant, or may occur only with a partner or with penetration.
Women's orgasms can be induced by erotic stimulation of a variety of genital and nongenital sites. As of yet, no definitive explanations for what triggers orgasm have emerged. Studies of brain imaging indicate increased activation at orgasm, compared to pre-orgasm, in the paraventricular nucleus of the hypothalamus, periaqueductal gray of the midbrain, hippocampus, and the cerebellum. Psychosocial factors commonly discussed in relation to female orgasmic ability include age, education, social class, religion, personality, and relationship issues. Findings from surveys and clinical reports suggest that orgasm problems are the second most frequently reported sexual problems in women. Cognitive-behavioral therapy for anorgasmia focuses on promoting changes in attitudes and sexually relevant thoughts, decreasing anxiety, and increasing orgasmic ability and satisfaction. To date there are no pharmacological agents proven to be beneficial beyond placebo in enhancing orgasmic function in women.
Sex education, communication skills training and Kegel exercises are often included in cognitive behavioural treatment programmes for anorgasmia. To date there are no trials showing that any pharmacological agent is more efficacious than placebo in enhancing orgasmic function among these women.
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