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The Existing Therapeutic Interventions for Orgasmic Disorders: Recommendations for Culturally Competent Services, Narrative Review

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The Existing Therapeutic Interventions for Orgasmic Disorders: Recommendations for Culturally Competent Services, Narrative Review Iran J Reprod Med Vol.13. No. 7. pp: 403-412, July 2015 Original article The existing therapeutic interventions for orgasmic disorders: recommendations for culturally competent services, narrative review Zahra Salmani1 Ph.D. Student, Ali Zargham-Boroujeni2 Ph.D., Mehrdad Salehi3 M.D., Therese K.Killeen4 Ph.D., Effat Merghati-Khoei5 Ph.D. 1. Student Research Center, School Abstract Mursing and Midwifery, Isfahan University of Medical Science, Background: In recent years, a growing number of interventions for treatment of Isfahan Iran. female orgasmic problems (FODs) have emerged. Whereas orgasm is a extra 2. Nursing and Midwifery Care biologically and learnable experience, there is a need for practitioners that to be able Research Center, Faculty of to select which therapy is the most appropriate to their context. Nursing and Midwifery, Isfahan University of Medical Sciences, Objective: In this critical literature review, we aimed to assess areas of controversy Isfahan Iran. in the existing therapeutic interventions in FOD with taking into accounted the 3. Psychosomatic research center, Iranian cultural models. Isfahan University of Medical Materials and Methods: For the present study, we conducted an extensive search Sciences, Isfahan Iran. 4. Addiction Science Division, of electronic databases using a comprehensive search strategy from 1970 till 2014. Medical University of South This strategy was using Google Scholar search, “pearl-growing” techniques and by Carolina, Charleston, South hand-searching key guidelines, to identify distinct interventions to women's Carolina, USA. orgasmic problem therapy. We utilized various key combinations of words such as:" 5. Sexual and Family Health Division in Brain and Spinal orgasm" OR "orgasmic "," female orgasmic dysfunction" OR Female anorgasmia Injury Research Center (BASIR), OR Female Orgasmic Disorder ", orgasmic dysfunction AND treatment, “orgasm Tehran University of Medical AND intervention”. Selection criteria in order to be included in this review, studies Sciences, Tehran, Iran. were required to: 1 employ clinical-based interventions, 2 focus on FOD. Results: The majority of interventions (90%) related to non-pharmacological and other were about pharmacological interventions. Self-direct masturbation is suggested as the most privilege treatment in FOD. Reviewing all therapies indicates couple therapy, sexual skill training and sex therapy seem to be more appropriate to be applied in Iranian clinical settings. Conclusion: Since many therapeutic interventions are introduced to inform sexually-related practices, it is important to select an intervention that will be Corresponding Author: culturally appropriate and sensitive to norms and values. Professionals working in Effat Merghati-Khoei, Keshavarz Blv; Imam Khomeini Hospital, the fields of health and sexuality need to be sensitive and apply culturally Reyhaneh Bld, Level 3; Tehran, appropriate therapies for Iranian population. We further suggest community well Iran. defined protocols to screen, assessment and management of women’ sexual Email: [email protected] problems such as FOD in the Iranian settings. Tel: (+98) 21 66581560-1 Key words: Iranian women, Orgasm, Reproductive health, Sexual dysfunction. Received: 8 September 2014 Revised: 19 January 2015 This review extracted from Ph.D. thesis. (Zahra Salmani) Accepted: 18 March 2015 In management of sexual problems, Introduction considerable variation exists in the therapeutic interventions. The range of different he notion that culturally competent therapeutic interventions for women's services should be available to people orgasmic problems has been growing over the who are seeking help in sensitive topics recent years, alongside an increasing interest T in orgasm related therapies to inform sexual such as sexuality has been debated for many and reproductive health related practices (4- decades. Cultural safety and cultural 6). While the term "sex therapy" is frequently competency are currently important topics for used to describe how women's orgasmic sexual health professionals (1, 2). Culturally problems are treated, far more terms are used competent services will be warranted if to describe the therapy of orgasmic problems. therapeutic interventions adapted to the given The profusion of interventions can mask some culture (3). of the basic decisive factors in therapy that the Salmani et al different therapeutic interventions share, and sexual encounters mostly is contextual and also lead to some confusion regarding which affected by their sexual scripts (23-25). It is therapy is most appropriate in a given culture necessary to pay attention to those factors at or context. the time of assessment or implementing an No question, there are number of intervention (26). This paper does not argue interventions introduced worldwide to treat that the various orgasm-related therapies are women's orgasmic problems (7). The unnecessary, but rather seeks to draw psychological and cultural valuation and together and review the full range of 'meaning' of orgasm are complex and therapeutic interventions available to assist considerably different in various societies (8). future professionals in selecting therapeutic Sometimes the interventions are not efficient intervention and adopt them into their cultures. because they are not culturally sensitive or Since the existing evidence-based therapies appropriate (9, 10). There is a need for are fused with Western norms, scholars and researchers and practitioners to be able to investigators need to determine whether such identify areas of controversy in the existing treatments are equally effective for other therapeutic interventions. cultures or whether new culturally sensitive Orgasmic problem is the second most therapies are necessary (27). common sexual complaint reported by The primary purpose of this paper is to women. The high prevalence of orgasmic critically review the existing literature problems and its consequences in one's life regarding domains of therapies such as lead researchers and professionals to study pharmacological and non-pharmacological for about etiology and find effective therapies for FODs and to explore areas of cultural these problems (11-13). According to the controversy in the contexts such as Iran. The Diagnostic and Statistical Manual of Mental secondary purpose of this paper is to suggest Disorders4th ed. (DSM-IV), Female orgasmic implications for clinical practice to be culturally disorder (FOD) is „„Persistent or recurrent sensitive and competent in Iranian settings. In delay in, or absence of, orgasm following a order to reach out the benefit of this review, normal excitement phase”. The DSM-V adds we need to answer the following important some explanations to the nature of FOD: questions: “reduced intensity, delay, infrequency or 1. What make a therapeutic intervention for absence of orgasm. The symptoms must last FOD culturally sensitive in Iranian-Islamic for at least six months and not be related to context? other physical, mental or relational problem” 2. Are the existing interventions for FOD (14). Epidemiologic research estimated adapted and/or tested in the Iranian or prevalence of orgasmic dysfunction from similar culture? approximately 20-40% (15, 16). Prevalence of 3. What possible recommendations for orgasm problem in US and Australia have culturally competent services can be made estimated between 21 to 29 percent (17, 18). for Iran or other similar contexts? Data from a study of 40-80-year-old adults in 29 countries found even higher prevalence of Materials and methods problems with orgasm among women in Asian countries (19). Iranian sexual studies have This is a narrative review of literature been restricted to prevalence and related related to interventions for FODs. This review factors of orgasmic disorders. A study with was approved by the ethic committee of 2526 Iranian women estimated the prevalence Isfahan University of Medical Sciences in of orgasmic disorder about 37% (20). Another 2014. descriptive study reported a rate of 21% orgasm disorder among a sample of 1456 Search Strategy Iranian women (21). Papers which used or discussed relevant FOD a multidimensional problem that interventions were identified by undertaking a influenced by affected personal, sociocultural, high sensitive search using Google scholar, religious and political contexts factors (22). PubMed(including Medline and CINAHL), Although genetic bases of women‟s orgasmic Embase, Psyc INFO, Cochrane, and hand- dysfunction are suggested, however, overall searching key journals and guidelines of pleasure experienced by women through their intervention from 1970-2014. We utilized 404 Iranian Journal of Reproductive Medicine Vol. 13. No. 7. pp: 403-412, July 2015 Therapeutic Interventions and orgasmic problem in women various key combinations of words such as: conducted in a couple setting sex therapy and "orgasm" OR "orgasmic", "female orgasmic sexual skills training were the most frequently dysfunction" OR “Female anorgasmia” OR studied interventions over the years. “Female Orgasmic Disorder", “orgasmic Compared to results of this review are not dysfunction AND treatment”, “orgasm AND completely consistent, and this discrepancy intervention” selection criteria in order to be may be linked to several factors that differed included in this review, studies was required between studies, such as the meanings were (to: 1 employs clinical-based interventions, 2) used to define and operationalize the term focus on
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