Female sexual climax disorder

　　I. Social, psychological, and spiritual factors

　　1. Social and environmental factors The education of women's sexual knowledge is often one-sided and lacks scientific basis, giving women a negative cultural influence on sexual life in their youth, which makes many women ignorant of or misunderstand sexual knowledge. Especially in China, women have been influenced by feudal patriarchal thought for a long time, with a lack of sexual knowledge education. Women receive education to suppress sexual behavior throughout their childhood, adolescence, and adulthood, and are required to suppress sexual feelings and behavior. Over time, many women still intentionally suppress themselves in marital sex, showing shyness and passivity in sexual activities, thus affecting the occurrence of orgasm. External interference such as crowded housing, uncomfortable beds, bright light, noise, unsecure living quarters, fear of being seen by children or outsiders, a tense and stressful work environment such as long working hours, work not going well, tense interpersonal relationships, lack of privacy in the family environment, busy household chores, economic difficulties, and other factors may cause women to be unable to fully engage in sexual activities, leading to the inability to achieve orgasm.

　　2. Psychological and spiritual factors Psychological factors can lead to the suppression of female orgasm, such as female trauma in sexual experience often causing fear of sex, some women worry about sexual intercourse pain, fear of pregnancy and abortion, or fear of emotional control during sexual pleasure or orgasm. Or due to emotional factors and mental diseases (such as depression, anxiety, and obsessive-compulsive disorder, etc.), which can also cause sexual climax disorders, the former such as excessive nervousness, work and life pressure, intense job competition, being frightened, worried, sad, or feeling inferior due to self-perceived plain appearance, poor image, and lack of talent and knowledge, and intentionally avoiding sexual contact. Some women are physically weak or have other diseases, worrying that they cannot meet their husband's sexual needs and have anxiety. Some patients with mental diseases, such as depression, anxiety, and schizophrenia, can also cause sexual climax disorders.

　　II. Organic factors

　　Clinical cases are not common, mainly seen in diseases of the reproductive and urinary systems, such as diseases of the vulva, vagina, uterus and its appendages, bladder, urethra, pelvic inflammatory disease, tumors, etc. Sexual intercourse can cause pain and discomfort, thus inhibiting the occurrence of orgasm. Diseases in other systems of the body will suppress and interfere with sexual response to varying degrees, destroying the acquisition of orgasm. Women with underdeveloped reproductive organs, incomplete ovarian endocrine function, severe neurasthenia, tuberculosis, liver and kidney insufficiency, diseases affecting the spinal cord or peripheral pelvic organ innervation (spinal cord injury or tumor, multiple sclerosis, diabetic peripheral neuropathy, amyotrophic lateral sclerosis, severe malnutrition and vitamin deficiency, poliomyelitis, etc.), vaginal blood circulation disorders (thrombotic obstruction, severe atherosclerosis), or endocrine diseases such as diabetes, hypothyroidism or hyperthyroidism, or hypothalamic-pituitary-gonadal dysfunction can all cause sexual climax disorders.

　　3. Drug factors

　　Some women suffer from mental illnesses and have been taking antidepressant drugs for a long time, which can lead to female sexual climax disorders.

　　Female sexual climax disorders are different from other types of sexual dysfunction, but they may also be accompanied by low libido or sexual arousal disorders.

　　Low libido refers to a persistent or recurrent lack of desire or complete lack of desire for sexual life. It can be divided into complete and situational low libido. Most completely low libido individuals have sexual life only once a month or less, but they can be passively compliant when their spouse requests sexual life; situational low libido occurs only in a specific environment or with a specific sexual partner. Low libido does not exclude the possibility that women can reach sexual arousal and obtain sexual pleasure when passively accepting sexual life.

　　Female sexual climax disorders refer to the situation where, after receiving sufficient sexual stimulation, women do not show a persistent increase in sexual excitement, pelvic organ congestion, increased vaginal secretions, increased overall muscle tension, and involuntary rhythmic, spasmodic contractions of the vagina, and the process of completely releasing sexual tension is not achieved.

　　In female sexual activity, there must be enough time and intensity of sexual stimulation to reach a certain level of sexual excitement and tension before sexual climax can occur. Therefore, only when there is a continuous effective stimulation of a certain intensity and duration, and still no sexual climax, can it be diagnosed as a sexual climax disorder. In clinical practice, it is difficult to quantitatively evaluate female sexual response, and the various changes that occur are difficult to measure, observe, and understand. The methods to evaluate the physiological changes in the process of female sexual response mainly come from the measurements of vaginal congestion and dilatation by psychologists and physiologists in psychological treatment.

　　1. Overly passive and shy

　　This is related to social and cultural influences. Many women believe that in sexual life, a strong man should take the leading role, and if they are proactive and enthusiastic, they may be considered promiscuous and superficial. Therefore, they only adopt a cooperative or passive attitude. This invisible effort to please the other person can cause psychological tension within oneself, making it impossible to relax and immerse oneself, thus unable to experience the wonderful feelings of the peak moment.

　　扫清障碍：一个循序渐进的过程可以帮你克服被动羞怯的心理，先把灯关掉，在黑暗中开始性爱，几次后，当你感到可以完全放松和坦然的时候，把灯打开，调到最暗的光线，和他做爱；几次以后，当你适应了，下次再把灯调亮些。

　　2、过分在乎自己形象

　　因为担心自己在做爱或高潮的样子不够好看，或者说出失态的话，做出失态的举止，而时刻注意保持着自己的形象，虽然这种担心实在不必要，却是很多女性都有的。

　　扫除障碍：性爱应该是激情而热烈的，在对方眼里，完全投入的你就是最美丽的，而忸怩作态只能令对方感到扫兴。

　　3、总担心自己表现不够好

　　自己身体或者心情欠佳，有无法拒绝丈夫的温存要求时，只能勉为其难地进行。同时还得担心会不会由于自己表现不够好而令对方心存不满或疑虑，这种焦虑的心理会影响到你对性生活的态度，并带来身体上的疼痛等不舒适的感觉。预后

　　Further observation is needed on the effectiveness of the current individual or combined psychological and physiological treatments; there are still those who have not improved after multiple treatments (refractory sexual climax disorder).

　　相关的实验室检查如血性激素（FSH，LH，睾酮及雌二醇）和甲状腺激素水平，血糖和血脂测定等，都有助于发现引起女性性高潮障碍器质性因素，对可能出现的性激素水平低下，甲状腺功能减退或糖尿病等都可尽早发现。

　　女性生殖道血流，阴道pH，阴道顺应性及生殖道震动感应阈值等，在施行性刺激的前后分别予以测量，彩超测定阴蒂，阴唇，尿道，阴道和子宫血液流速（最大收缩期流速）和静脉池（舒张期末流速），阴道pH是阴道润滑的间接指标，可用数字式pH测量探头测量，阴道压力/流量变化可采用顺应性测量仪测定，阴蒂和阴唇震动阈值可用标准的生物震感阈值测量器记录，在性刺激前及观看15min色情录像和使用震动器后测量，诊断女性性高潮障碍，既要评价性反应异常又要诊断器质性疾病，如血管供血不足，内分泌异常和神经系统病变，阴道和阴蒂部位的温觉及震动觉阈值测定即可作为诊断神经源性女性性高潮障碍的手段。

　　一、女性性高潮障碍食疗

　　1、枸杞牛鞭：枸杞子30克，牛鞭100克，葱、姜、盐、胡椒等调料各适量。将枸杞、牛鞭洗净，切片，一起放人砂锅内放入葱、姜，加水500毫升，用武火煮沸后改用文火煮至牛鞭熟烂，拣去葱、姜，加入盐、料酒、胡椒粉等调料调味，再煮5分钟即可。食牛鞭，喝汤，2天吃完，可连吃10天。能补肾壮阳，强筋壮骨。适用于肾虚所致女性性功能低下、性高潮障碍。

　　2. Chinese Wolfberry and River Shrimp: 30 grams of Chinese wolfberry, 100 grams of river shrimp, and appropriate amounts of scallion, ginger, salt, cooking wine, and sugar as spices. Wash the Chinese wolfberry and remove impurities, decoct it into a concentrated juice for later use. Remove the whiskers from the river shrimp and wash it. Heat the pot, add cooking oil and heat it to 80 degrees, add the river shrimp, ginger, scallion, cooking wine, and medicine juice, stir-fry for a while, and then simmer for 15 minutes. Season with salt and sugar, and eat as a dish. Take one dose per day, for 5 consecutive days. It can tonify the kidney and strengthen Yang. It is suitable for women with sexual climax disorders due to kidney deficiency and essence deficiency.

　　3. Chopped Scallion and River Shrimp: 250 grams of scallion, 50 grams of river shrimp, and appropriate amounts of scallion, ginger, salt, sugar, and other spices. Wash the scallion and cut it into 1-inch long pieces, and remove the whiskers from the river shrimp and wash it. Heat the pot, add cooking oil and heat it to 80 degrees, add scallion and ginger, then add the scallion, river shrimp, and stir-fry; add salt, sugar, and wine for seasoning, and stir-fry until the vegetables are cooked and the shrimp are tender. Eat as a dish, one dose per day, for 5 consecutive days. It can invigorate the spleen and kidney, enrich essence, and strengthen Yang. It is suitable for women with sexual climax disorders due to kidney Yang deficiency.

　　4. Rosaceae Dog Meat: 30 grams of hawthorn, 25 grams of caninae, 400 grams of fresh dog meat, and appropriate amounts of scallion, ginger, salt, sugar, and other spices. Select and clean the hawthorn and caninae, wash and cut them into slices; wash and cut the dog meat into pieces, and put it in a pot with the hawthorn and caninae, add scallion, ginger, and 1500 milliliters of water, boil it with high heat, then switch to low heat to cook until the dog meat is tender. Remove the scallion, ginger, and add salt, sugar, and other spices, and boil for another 5 minutes. Eat the dog meat in portions. This recipe can tonify the liver and kidney, consolidate essence, and fill kidney essence; it is suitable for women with low libido and sexual climax disorders due to kidney yang deficiency.

　　5. Codonopsis and Mutton: 20 grams of codonopsis, 20 grams of astragalus, 500 grams of mutton, and appropriate amounts of scallion, ginger, salt, sugar, and other spices. Cut codonopsis and astragalus into slices and wrap them in gauze. Wash the mutton and cut it into pieces, then place it in a steaming bowl with the medicine package, add ginger, scallion, and cooking wine; add 500 milliliters of clear soup, cover it tightly, and steam for 2 hours. Remove the scallion, ginger, and medicine package, add paste salt and other spices, and steam for another 10 minutes. Eat it over 2 days, eating the meat and drinking the soup. It can warm the middle, invigorate the spleen, and benefit the qi. It is suitable for women with sexual climax disorders due to deficiency of Qi and blood.

　　Second, what is good for women with sexual climax disorders

　　1. Appropriate intake of fat, some women, in order to lose weight, overeat and do not eat meat containing fat. Surveys show that women who have been vegetarian for a long time have delayed menarche, reduced estrogen secretion, decreased libido, and affected reproductive ability.

　　2. Supplement vitamins and trace elements, eat more fruits and vegetables. Studies have shown that vitamin E and vitamin A are vitamins related to maintaining sexual function and delaying aging. They play a decisive role in promoting ovarian development, increasing the production of sex hormones, and enhancing their vitality. Vitamin C also has a positive effect on the recovery of sexual function, and it is rich in fruits and vegetables such as hawthorn, green peppers, fresh jujube, and tomatoes.

　　3、多食优质蛋白质，优质蛋白质主要是指各种动物性食物，如鸭、鱼、鸡、瘦肉、蛋类。

　　一、治疗

　　在性高潮抑制的治疗上主要采用心理分析，诱导治疗方法，达到行为治疗的效果，对于原发性性高潮障碍，主要治疗目的是让其体会到初次性高潮的兴奋，摧毁那种无意识对高潮反射的压抑，可采用分散注意力；放松高度痉挛的会阴层及阴道肌肉，让其有节奏地收缩放松；将高潮转移到异性情爱情景中，融合上升；还可应用振荡器刺激阴蒂诱导或采用手淫法体会达到高潮的舒畅而逐步转移至夫妻性高潮中。完全性性高潮障碍的治疗则比较棘手，除了心理治疗，手淫和振荡器等治疗外，还可辅以药物，理疗等。

　　1、药物治疗

　　（1）激素类：干扰下丘脑-垂体-性腺轴或继发于化疗和手术后的激素缺乏往往可影响女性性高潮障碍，这类患者对药物治疗敏感，主要针对绝经后女性（自然的或手术所致的），除了缓解发热潮红，防止骨质疏松及降低心脏病的危险性之外，雌激素替代治疗还可增加阴蒂的敏感性和性欲，减轻性交疼痛，局部应用雌激素可以缓解女性绝经后并发的阴道干涩，灼热感以及尿频，尿急感，目前有一种雌二醇的阴道栓剂，局部应用可为乳腺癌或其他原因不能使用雌激素的患者提供低剂量的雌激素，另有报道应用甲睾酮（通常与雌激素合用）可减轻绝经后妇女因性交疼痛和阴道干涩而引起性高潮障碍的患者，局部应用睾酮霜剂也可增加阴蒂的敏感性，阴道的润滑作用和性欲，增强性唤起能力，促使性高潮的出现，其副作用包括体重增加，阴蒂增大，颜面部毛发增多，血红蛋白升高和高胆固醇血症等。

　　（2）西地那非：作为高选择性的V型磷酸二酯酶的抑制剂，西地那非可以减少第二信使cGMP的降解，增强NO介导的阴蒂和阴道海绵体平滑肌的舒张作用，西地那非单用或与其他血管活性药物联合应用，治疗女性性唤起障碍疗效明显，现在正在进行西地那非治疗女性性唤起障碍的有效性和安全性评价的临床试验研究，近来有研究报道，西地那非对继发于5-羟色胺再摄取抑制剂治疗的女性性高潮障碍特别有效，西地那非治疗女性性功能障碍可部分改善患者的主观症状，对性功能指数则无显著变化，其药物不良反应主要表现在不同组织抑制磷酸二酯酶（PDE）的药理学活性，其中包括头痛（16％），颜面潮红（10％），眩晕（2％）和视觉异常（3％）等。

　　（3）精氨酸（左旋精氨酸）：精氨酸（左旋精氨酸）是NO合成的前体物质，在NOS的作用下分解为N0，该药对女性性功能障碍治疗的研究工作在进行中。

　　（4）前列地尔（前列腺素E1）：为一种尿道内使用，经尿道黏膜吸收的前列地尔（前列腺素E1）的0.01％凝胶制剂，自1995年起应用于治疗男性阴茎勃起功能障碍，疗效肯定，而阴道内使用的类似制剂正在临床研究中，其治疗女性性高潮障碍是否有效尚有待证实。

　　（5）酚妥拉明：非选择性α受体阻滞药，可引起阴蒂海绵体和阴道血管平滑肌舒张，一项对绝经后妇女研究结果显示，酚妥拉明可以增加阴道血流，改善性唤起能力。

　　（6）中医中药：中医学认为，肾为先天之本，内藏真阴真阳，是人体生长，发育，生殖的源泉，肝司谋虑，凡精神情志之调节功能，与肝密切相连，心主神明，神动则欲起，脾为后天之本，气血生化之源，故肾，肝，心，脾中任何一环节的紊乱，都可导致性高潮障碍，如禀赋不足，或久病伤肾，或房事过度等，都可能损伤命火肾精，所欲不遂，情欲不能疏泄，久生抑郁，或因病致郁，每使肝气郁结，因病伤脾，劳心过度，纵欲伤神，导致水火失济。

　　2、中医治疗

　　女性性高潮障碍应本着疏肝，益气，活血，补肾，温补肾阳，滋补肾阴的原则，治疗女性性高潮障碍的药膳较多，现介绍几种常用的方剂：

　　（1）金樱子狗肉：金樱子30g，金毛狗脊25g，鲜狗肉400g，葱，姜，盐，糖等调料各适量，将金樱子，金毛狗脊择除杂质，洗净切片，狗肉洗净切块，和金樱子，狗脊一起放入砂锅内，投入葱，姜，加水1500ml，用武火煮沸后，改用文火炖至狗肉熟烂，拣去葱，姜，加入盐，糖等调料再煮5min即可，分次食狗肉，该方能补益肝肾，收敛固精，填补肾精，适用于肾阳亏虚的女性高潮障碍。

　　(2) Ginseng and Mutton: 20g of codonopsis, 20g of Astragalus, 500g of mutton, scallion, ginger, salt, sugar and other seasonings as needed. Cut the codonopsis and Astragalus into slices, wrap them in gauze, wash the mutton and cut into pieces, put them together with the medicine package in a steaming bowl, add ginger, scallion, cooking wine, 500ml of clear soup, cover tightly, steam for 2 hours, remove the scallion, ginger, medicine package, add soy sauce and other seasonings and steam for another 10 minutes, eat for 2 days, eat the meat and drink the soup, this can warm the middle, replenish deficiency, invigorate the spleen and benefit Qi, suitable for female sexual climax disorder due to deficiency of Qi and blood.

　　(3) Goji Cow's Penis: 30g of goji berries, 100g of cow's penis, scallion, ginger, salt, pepper and other seasonings as needed. Wash the goji berries and cow's penis, slice them, put them together in a pot, add scallion, ginger, add 500ml of water, boil with high heat and then switch to low heat to cook the cow's penis until tender, remove the scallion, ginger, add salt, cooking wine, pepper and other seasonings for seasoning, boil for another 5 minutes, eat the cow's penis and drink the soup, finish in 2 days, can eat for 10 days in a row, can tonify the kidney and Yang, strengthen the tendons and bones, suitable for female sexual climax disorder caused by kidney deficiency.

　　(4) Goji and River Shrimp: 30g of goji berries, 100g of river shrimp, scallion, ginger, salt, cooking wine, sugar and other seasonings as needed. Wash the goji berries and remove impurities, decoct into a concentrated juice for later use. Clean the river shrimp and remove the whiskers, heat the pot and add cooking oil, heat the oil to 80℃, add the river shrimp, ginger, scallion, cooking wine, medicine juice, stir-fry for a while, simmer for 15 minutes, add salt, sugar and other seasonings for seasoning, eat as a dish, 1 dose per day, eat for 5 days in a row, can tonify the kidney and Yang, suitable for female sexual climax disorder due to kidney deficiency and essence deficiency.

　　(5) Fried Chive and River Shrimp: 250g of chive, 50g of river shrimp, scallion, ginger, salt, sugar and other seasonings as needed. Wash the chive and cut into 1 inch long pieces, clean the river shrimp and remove the whiskers, heat the pot, add cooking oil to 80℃, fry the scallion and ginger, then add the chive and river shrimp, stir-fry, add salt, sugar, wine and other seasonings for seasoning, stir-fry until the vegetables are cooked, the shrimp is ready, can be eaten as a dish, 1 dose per day, take for 5 days in a row, this can invigorate the spleen and kidneys, benefit essence and strengthen Yang, suitable for female sexual climax disorder due to kidney Yang deficiency.

　　II. Prognosis

　　Further observation is needed on the effectiveness of the current individual or combined psychological and physiological treatments; there are still those who have not improved after multiple treatments (refractory sexual climax disorder).