432 Sexual Dysfunctions
psychological, sociocultural, and physiological factors likely interact in complex ways to
influence women’s experience of orgasm and of orgasm difficulties. 
Culture-Related Diagnostic Issues 
The degree to which lack of orgasm in women is regarded as a problem that requires treat-
ment may vary depending on cultural context. In addition, women differ in how important
orgasm is to their sexual satisfaction. Ther e may be marked sociocultural and generational
differences in women’s orgasmic ability. For example, the prevalence of inability to reach or-
gasm has ranged from 17.7% (in Northern  Europe) to 42.2% (i n Southeast Asia). 
Diagnostic Markers 
Although measurable physiological change s occur during female  orgasm, including
changes in hormones, pelvic floor musculature,  and brain activation, there is significant
variability in these indicators of orgasm across  women. In clinical situations, the diagnosis
of female orgasmic disorder is based on a woman’s self-report.
Functional Consequences of  Female Orgasmic Disorder 
The functional consequences of female orgasmic  disorder are unclear.  Although there is a
strong association between relationship proble ms and orgasmic difficulties in women, it is
unclear whether relationship factors are risk fa ctors for orgasmic difficulties or are conse-
quences of those difficulties.
Differential Diagnosis
Nonsexual mental disorders. Nonsexual mental disorders,  such as major depressive
disorder, which is characterized by markedly dimi nished interest or pleasure in all, or al-
most all, activities, may explain female orgasm ic disorder. If the orgasmic difficulties are
better explained by another me ntal disorder, then a diagnosis  of female orgasmic disorder
would not be made. 
Substance/medication-induced sexual dysfunction. Substance/medication use may
explain the orgasmic difficulties.