x.3.2.4.2.4 Orgasm dys.
The physiology of the male and female orgasm remains unclear. Definitions vary from ‘a psychic phenomenon, a sensation (cerebral, neuronal discharge) elicited by the accumulative effect on certain brain structures of appropriate stimuli originated in the peripheral erogenous zones’ to ‘the acme of sexual pleasure of rhythmic contraction of perineal reproductive organs, cardiovascular, and respiratory changes, a release of sexual tension.’ Given that both male and female patients with lower-limb paraplegia (below the thoracolumbar fascia) can achieve orgasm, it is generally assumed that the orgasm is largely cerebral in nature. Stimulation of the cervix in paraplegic patients can trigger an orgasm, probably via the nervus vagus. There are however many neurological conditions which can interfere with the patient’s ability to achieve orgasm, the most notable being multiple sclerosis. Delayed orgasm is sometimes observed in patients taking SSRIs. Lifelong and generalized anorgasmia may be due to the patient never having learned to sexually stimulate himself or herself adequately. Similarly, situational anorgasmia (in coitus) may be due to inadequate sexual technique or an overly altruistic or passive attitude on the part of the female partner (e.g. failing to move the hips and pelvis). For many women, the inability to achieve orgasm during intercourse, while indeed able to do so by masturbating, is not a cause of great concern. Cultural attitudes play a major part.