testosterone, and both FSH and LH. In less common situations, genital sensation and blood flow are determined quantitatively to see if this is a problem. Remember that diabetes is a big factor in having anorgasmia in both sexes. The treatment of anorgasmia related to physical causes includes the correction of hormonal imbalances, clitoral vacuum pumps to help engorge the clitoris, sildenafil or Viagra, and vardenafil, which is another drug related to Viagra. As mentioned, this can be used for both men and women with anorgasmia. Cabergoline, which decreases prolactin production, can be used to restore orgasms in a woman with secondary anorgasmia. Other drugs are being studied for anorgasmia from SSRI use.
VAGINISMUS Vaginismus is a sexual problem leading to involuntary muscle spasms that prevent adequate penetration. The woman often has extreme pain with any attempt at having sexual intercourse. The most common underlying factors include vaginitis, previous episiotomy, endometriosis, and sexual assault in the past. In order to qualify for the disorder, there should not be an anatomical cause of the problem. Primary vaginismus is usually discovered in young women or teens, when tampons cannot be used or a Pap smear is impossible. The woman has never been able to have vaginal penetration. The problem can be due to inflammation of the vulva and vaginal introitus, urinary tract infections, history of sexual assault, yeast infections of the vagina, fear of penetration, history of nonsexual trauma, stress, anxiety, or living in a sexually repressive environment. The problem can be idiopathic. The disorder has different degrees, with first degree vaginismus involving being able to accept penetration with reassurance and fourth degree vaginismus involving being unable to open the thighs at all. Some women will have a sympathetic fight or flight response with sweating, palpitations, trembling, and hyperventilation. The main muscle involved in vaginismus is the pubococcygeus muscle, although the bulbocavernosus or the entry muscle the levator ani muscle, and the puborectalis muscles in the mid vaginal area can be a factor. The spasm usually happens with an attempt at vaginal penetration so that intercourse cannot happen easily or at all. 94
