Which diagnosis best fits duration, episodicity, and exclusions?
A
Female orgasmic disorder
≥1 of: marked delay in, marked infrequency of, or absence of orgasm; markedly reduced intensity of orgasmic sensations — on almost all occasions (≥75–100%) of sexual activity
Absent/reduced sexual interest/arousal; ≥3 of: absent/reduced interest in sexual activity; absent/reduced sexual/erotic thoughts or fantasies; no/reduced initiation of sexual activity and unreceptive to partner's attempts; absent/reduced sexual excitement/pleasure during sexual activity in ≥75–100% encounters; absent/reduced sexual interest/arousal in response to any internal/external erotic cues; absent/reduced genital or non-genital sensations during sexual activity in ≥75–100% encounters
AA. ≥1 of: marked delay in, marked infrequency of, or absence of orgasm; markedly reduced intensity of orgasmic sensations — on almost all occasions (≥75–100%) of sexual activity B. Symptoms persist ≥6 months C. Causes marked distress
BA. Absent/reduced sexual interest/arousal; ≥3 of: absent/reduced interest in sexual activity; absent/reduced sexual/erotic thoughts or fantasies; no/reduced initiation of sexual activity and unreceptive to partner's attempts; absent/reduced sexual excitement/pleasure during sexual activity in ≥75–100% encounters; absent/reduced sexual interest/arousal in response to any internal/external erotic cues; absent/reduced genital or non-genital sensations during sexual activity in ≥75–100% encounters B. Symptoms persist ≥6 months C. Causes marked distress
Common specifiers
ALifelong; Acquired; Generalised; Situational
BLifelong; Acquired; Generalised; Situational
Differential flags
ASSRI/medication-induced (temporal relationship to medication initiation); Female sexual interest/arousal disorder (insufficient arousal preceding orgasmic difficulty); Genito-pelvic pain (pain interfering with sexual response)
BFemale orgasmic disorder (arousal intact but orgasm impaired); Genito-pelvic pain disorder (pain limiting engagement rather than absent desire); Major depressive disorder (generalised anhedonia vs specific sexual domain)