(100) Beyond Biomechanics: A Systematic Review of Psychosocial and Relational Determinants in Female Orgasmic Disorder

Introduction Female Orgasmic Disorder (FOD) is a prevalent sexual health concern characterized by marked difficulty or inability to attain orgasm. While biomedical factors are often investigated, an overemphasis on physiological aspects can overshadow the profound influence of psychosocial and relational contexts. A comprehensive understanding of FOD necessitates integrating evidence from mental health, sex therapy, and relational dynamics to inform effective, person-centered interventions. Objective This systematic review aimed to synthesize and critically appraise the existing evidence on the psychosocial, relational, and cultural determinants associated with FOD, moving beyond a purely biomedical model. Methods A systematic search was conducted in PubMed, Web of Science, and Scopus for articles published from January 2015 to September 2025. Search terms included "female orgasmic disorder," "anorgasmia," "psychological factors," "relationship satisfaction," "intimacy," "sex therapy," and "systematic review." Eligible studies were peer-reviewed articles, including observational studies, clinical trials, and qualitative research, that focused on psychosocial or relational aspects of acquired, generalized FOD in adult women. Studies focusing solely on pharmacological or biological treatments were excluded. Data extraction and thematic synthesis were performed by two independent reviewers. Results Out of 1,723 identified records, 42 studies met the inclusion criteria. The synthesis revealed several key non-biomedical determinants: 1.Psychological Factors: Anxiety (particularly performance anxiety and generalized anxiety), depression, and a history of sexual abuse were strongly correlated with FOD. Body image concerns consistently emerged as a major barrier. 2.Relational Dynamics: Relationship satisfaction, emotional intimacy, and non-sexual communication were significantly predictive of orgasmic function. Partner's sexual technique and emotional responsiveness were frequently cited as critical factors. 3.Cognitive and Behavioral Aspects: The inability to become mentally absorbed in sexual stimuli ("spectatoring") and avoidant coping strategies were prevalent cognitive-maintaining factors. 4.Cultural Influences: Cultural norms surrounding female sexuality, including permissiveness and beliefs about female pleasure, significantly impacted the prevalence and reporting of distress related to FOD. Conclusions The etiology and maintenance of Female Orgasmic Disorder are multifactorial, with psychosocial and relational factors playing a central role. Effective assessment and treatment must adopt a biopsychosocial model. Sex therapy interventions should prioritize addressing performance anxiety, enhancing body image, improving couple communication and intimacy, and dismantling restrictive cultural beliefs. Clinicians are encouraged to routinely evaluate these dimensions to develop holistic and effective treatment plans for women presenting with FOD. Disclosure No