Background: Despite of access data on influence of gynecological pathologies on development of sexual dysfunctions, there is no clear scientifically proved evidence on influence of sexual disorders, such as anorgasmia, on development of gynecological pathologies.

Objective: Objective of study was detection of relationship between women’s sexual functions (orgasm and libido) and gynecological pathologies.

Materials and methods: 676 sexually active women (aged 18-55yy, mean age 31, 7+3) have been investigated on the basis of Center for Reproductive Medicine “Universe” and outpatient clinics of Medical Corporation Evex. They were divided in 3 groups:I gr. – 148 women with ovarico-varicocele (OVVC), II gr. – 125 women with dilatation of myometrium veins (DMV) and III gr. - 403 women with other gynecological pathologies (myoma, inflammatory diseases, gynecological-endocrine disorders, etc.). In all groups frequency of orgasms (never, rare, often, always) and grade of libido (low, medium, high) have been assessed by interviewing.

Results: In I group rate of women with anorgasmia (70,9%) and rare orgasms (20,9%) was significantly higher (P<0.01) than rate women, who had orgasms often (6,1%) or always (2,0%). In II group rate of women with anorgasmia (39,2%) and rare orgasms (44,0%) was significantly higher (P<0.01) than women, who had orgasms often (12,8%) or always (4,0%). In III group generally was observed prevalence of women without absolute absence or presence of orgasms -rate of women, who had orgasms often (36,7%) or rarely (44,4%) was significantly higher (P<0.01) than women, who had orgasm always (5,2%) or never (13,6%). As of relationship between intensity of sexual drive (libido) and frequency of orgasms – in all groups there was inverse dependence - women with anorgasmia and rare frequency of orgasms mainly had low or medium libido and in women, who had orgasms often or always libido was mainly medium or high.

Conclusion: Orgasmic dysfunctions (anorgasmy) can promote congestive process in pelvis, development of varicosis of ovarian and pelvic veins (with corresponding other gynecological complications), which themselves can determine chronic pelvic pain that deepens the anorgasmic process.

In younger ages and early stages of beginning of sexual life, timely management of anorgasmy might be good prevention for further development of gynecological pathologies. The issue needs further investigation for revealing of cause-result relationship.

• Anorgasmy; Libido; Ovarico-varicocele; Dilatation of myometrium veins

Kobaladze L, Kristesashvili J, Andguladze S (2021) Female Orgasmic Dysfunction and Gynecological Pathologies. JSM Sexual Med 5(3): 1074.

Good sexual and reproductive health is a state of complete physical, mental and social well-being in all matters relating to the reproductive system [1]. Orgasmic dysfunction in women is one of the most important sexual disorders that determine decrease of quality of life in women as well as couples.

Frequency of female anorgasmia according to country data is very different [2-5]: USA – 26%, Australia - 29%, Turkey – 43%,Iran – 37%, Nigeria – 55%, Brazil - 21%, China - 31%.Dr. Elisabeth A. Lloyd summarized 32 studies conducted over 70+ years, on the frequency of women’s orgasms with intercourse- intercourse alone, not orgasm with additional direct clitoral stimulation – anorgasmy - 5-10% [6].

There is a huge data base on causes of sexual dysfunctions in women, indicating on most frequent factors such as anatomic, hormonal, vascular, neurological, psycho-emotional, situational, data, it’s possible to conclude that the endometriosis leads to a significant disruption of sexual health of women and marital relations and correspondingly reduced quality of life for both partners [8-10].

Despite of access data on influence of gynecological pathologies on development of sexual dysfunctions, we couldn’t find scientifically proved evidence on influence of sexual disorders, such as anorgasmia, on development of gynecological pathologies. Only in few articles, dedicated to varicose extension of pelvic veins (VEPV), dyspareunia and anorgasmia are indicated as risk factors for development of VEPV [11,12].

For us logical chain was under question-mark:in sexual response cycle during excitement and plateau phases blood supply of pelvic organs increases and orgasm is the retraction mechanism for shedding blood back from these organs during resolution phase. In case of anorgasmic coitus, blood stays in pelvic organs for longer time, causing venous stasis and correspondingly pelvic congestion syndrome, that itself can determine development of ovaricovaricocele and dilatation of myometrium veins Figures 1 and 2.

Figure 1: Blood supply of pelvic organs during anorgasmia in women.

Figure 2: Anorgasmia in women – possible results.

Based on above-mentioned, objective of our study was detection of relationship between women’s sexual functions (orgasm and libido) and gynecological pathologies. relationship problems, chronicle diseases, pharmaceuticals, aging, etc [6].

Well investigated is also the role of gynecological pathologies and pain related to them in development of sexual disorders.

According to Fugl-Meyer KS & Fugl-Meyer AR [7] a lot of women, who report manifested sexual genital pain, also report: low level of sexual interest (67%), insufficient vaginal lubrication (61%), manifested orgasmic dysfunction (48%), vaginismus (9%).

Several studies indicate on direct influence of endometriosis on development of sexual dysfunctions in women [8-10]. Stenyaeva N and co-authors in their study of women with endometriosis revealed that in the structure of sexual dysfunctions prevailed deep dyspareunia (87.1%), decreased libido (83.3%), coital anorgasmia (80.6%), accompanied by disruption in sexual adaptation in pair (93.5%). All patients demonstrated depression and anxiety. On the bases of literature 

676 sexually active women (aged 18-55yy, mean age 31,7+3) have been investigated on the basis of Center for Reproductive Medicine “Universe” and outpatient clinics of Medical Corporation Evex. They were divided in 3 groups:I gr. – 148 women with ovarico-varicocele (OVVC), II gr. – 125 women with dilatation of myometrium veins (DMV) and III gr. - 403 women with other gynecological pathologies (myoma, inflammatory diseases, gynecological-endocrine disorders, etc.).

Diagnosis of patients was based on analysis of patient records. Diagnosis of OVVC and DMV were based on results of iinvestigation by transvaginal US of the pelvic venous system with Doppler examination of blood flow in the uterine veins.

In all groups frequency of orgasms (never, rare, often, always) and grade of libido (low, medium, high) have been assessed by interviewing.

Statistical analysis was conducted by SPSS.21. The independent t-test was used for variables, e.g. age, duration of sexually active years and frequency of intercourse per month. Pearson Chi-square test was performed for comparing categorial data. Conclusions of study results were based on statistically reliable results in 95% confidence interval – P<0,05).

There were no statistically significant differences (P>0.05) in women with different frequency of orgasms in age, sexually active years, number of intercourses per month (Tables 1-3).

Assessment of orgasms in different groups revealed significant prevalence of anorgasmia in I and II groups, comparing to III group.

There were no statistically significant differences (P>0.05) in any group between frequencies of grades of libido

Sexological evaluation of women according to groups

In I group (women with ovarico-varicocele) rate of women with anorgasmia (70,9%) and rare orgasms (20,9%) was significantly higher (P<0.01) than rate women, who had orgasms often (6,1%) or always (2,0%).

As of relationship between intensity of sexual drive (libido) and frequency of orgasms – there was inverse dependence - women with anorgasmia (70,9%) and rare frequency of orgasms (20,9%) mainly had low (38,7-41,9%) or medium (35,2-43,8%) libido and in women, who had orgasms often (6,1%) or always (2,0%) libido was mainly medium (44,4-55,6%) or high (100%) (Table 4).

In II group (women with dilatation of myometrium veins) rate of women with anorgasmia (39,2%) and rare orgasms (44,0%) was significantly higher (P<0.01) than women, who had orgasms often (12,8%) or always (4,0%).

As of relationship between intensity of sexual drive (libido) and frequency of orgasms – in this group also there was inverse dependence - women with anorgasmia (39,2 %) and rare frequency of orgasms (44,0 %) mainly had low (20,0-59,2%) or medium (40,8-52,7%) libido and in women, who had orgasms often (12,8%) or always (4,0%) libido was mainly medium (20,0- 43,8%) or high (20,0-80,0%) (Table 5).

In III group generally we observed prevalence of women without absolute absence or presence of orgasms - rate of women, who had orgasms often (36,7%) or rarely (44,4%) was significantly higher (P<0.01) than women, who had orgasm always (5,2%) or never (13,6%);

As of relationship between intensity of sexual drive (libido) and frequency of orgasms – in this group also there was inverse dependence, but not so expressed as in I and II groups - women with anorgasmia (13,6 %) and rare frequency of orgasms (44,4%) mainly had low (41,9-49,1%) or medium (23,6-45,3%) libido and in women, who had orgasms often (36,7%) or always (5,2%) libido was mainly medium (14,3-48,0%) or high (26,4-85,7%) (Table 6).

Study results provide fruitful field for analysis and discussion. Prevalence of anorgasmia and rare frequency of orgasms in women with OVVC and DMV might be considered as an evidence of causal influence of anorgasmic coitus on development of congestive processes in small pelvis with further development of varicose changes of ovarian veins and dilatation of myometrium veins. Itself OVVC and DMV might be good bases for amplification of other gynecological pathologies and conditions.

Ovarian varicose veins characterize themselves in the form of dilated, tortuous and congested veins next to the ovarian gland, often causing chronic pelvic pain and a feeling of heaviness in the pelvis in women [13,14].

Several studies have demonstrated that over 50% of patients with ovarian varicose veins have polycystic ovaries [15-30] and that the morphologic and functional change in the polycystic ovary syndrome increases the risk of cancer [16,18], venous thrombosis [17,18], infertility and cardiovascular problems [19], as well as decreasing the ovarian reserve16.

Increased oxidative stress (OS) in varicose dilations provokes histological damage in the ovaries and suggests a negative effect related to fertility [20]. Moreover, researchers have also evidenced that female infertility may increase the risk of cancer and other pathologies [21,22].

Some authors have demonstrated the frequency of ovarian varicose veins in women by pathology: in women who suffered from chronic pelvic pain, the prevalence was of 50% [23,24], in women with endometriosis, the prevalence was of 80% [25], in women who had endometriomas in the left ovary, the prevalence was of 100% [26].

The therapeutic test suggests that varicose veins cause destruction of tissue and organs, OS in endothelial cells and, as a result of these damages, the alteration of the expression of several genes [27-29].

Congestive processes in pelvis can influence on varicose dilatation of pelvic veins including myometrium veins [30,31] that might be complicated with thrombosis, development of cystic and malignant formations [32,33].

Congestive processes and varicose of ovarian or pelvic veins often are causes of chronic pelvic pain [34,35], that in turn can influence on orgasmic functions and determine anorgasmy.

Summarizing all above-mentioned, we can conclude that orgasmic dysfunctions (anorgasmy) can promote congestive process in pelvis, development of varicosis of ovarian and pelvic veins (with corresponding other gynecological complications), which themselves can determine chronic pelvic pain that deepens the anorgasmic process. So, locked, vicious circle is forming and only strategy to manage this situation is complex approach for treating all components and conditions. Also in younger ages and early stages of beginning of sexual life, timely management of anorgasmy might be good prevention for further development of gynecological pathologies.

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