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
Persistent or recurrent difficulties with ≥1 of: vaginal penetration during intercourse; marked vulvovaginal or pelvic pain during intercourse or penetration attempts; marked fear/anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as a result of vaginal penetration; marked tensing or tightening of pelvic floor muscles during vaginal penetration attempts
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. Persistent or recurrent difficulties with ≥1 of: vaginal penetration during intercourse; marked vulvovaginal or pelvic pain during intercourse or penetration attempts; marked fear/anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as a result of vaginal penetration; marked tensing or tightening of pelvic floor muscles during vaginal penetration attempts 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)
BPrimary medical cause - endometriosis, vestibulodynia, pelvic inflammatory disease, lichen sclerosus (must exclude with examination); SSRI-induced vaginal dryness (medication history); Female sexual interest/arousal disorder (low arousal contributing to insufficient lubrication)