<br />Thank you for your question. It is an honor to be of some assistance to you.
<br />There are many reasons a woman can have difficulty with orgasm - and can stem from physicological to psychological (the most common by far).
<br />Physical causes
<br />A wide range of illnesses, physical changes and medications can interfere with orgasm:
<br />Medical diseases.
Any illness can affect this part of your sexuality, including diabetes and neurological diseases like multiple sclerosis. Orgasm may also be affected by gynecological surgeries, such as hysterectomy or cancer surgeries. In addition, lack of orgasm often goes hand in hand with other sexual problems, such as painful intercourse.
Many prescription and over-the-counter medications can interfere with orgasm. This includes blood pressure medications, antihistamines and antidepressants — particularly selective serotonin reuptake inhibitors (SSRIs). In men, SSRIs can actually result in both anorgasmia and inability to obtain an adequate erection for satisfactory sexual activity (erectile dysfunction).
Alcohol and drugs.
A glass of wine may make you feel amorous, but too much alcohol can cramp your ability to climax; the same is true of street drugs.
The aging process.
As you age, normal changes in your anatomy, hormones, neurological system and circulatory system can affect your sexuality. The drop in estrogen
that occurs during the transition to menopause can be a particularly notable foe of orgasm. Lower levels of this female hormone can decrease sensations in the clitoris, nipples and skin and impede blood flow to the vagina and clitoris, which can delay or stop orgasm entirely. Still, anorgasmia isn't limited to older women. And many women say sex becomes more satisfying with age.
<br />Psychological causes
<br />Many psychological factors play a role in your ability to orgasm, including:
<br />Mental health problems, such as anxiety or depression
<br />Performance anxiety
<br />Stress and financial pressures
<br />Cultural and religious beliefs
<br />Fear of pregnancy or sexually transmitted diseases
<br />Guilt about enjoying sexual experiences
<br />Relationship issues
<br />Many couples who are experiencing problems outside of the bedroom will also experience problems in the bedroom. These overarching issues may include:
<br />Lack of connection with your partner
<br />Unresolved conflicts or fights
<br />Poor communication of sexual needs and preferences
<br />Infidelity or breach of trust
<br />It is time to discuss this with your doctor. Primary care doctors and gynecologists often ask about sex and intimacy as part of a routine medical visit, and you can take this opportunity to discuss your concerns. Or you can make an appointment just to address this issue. You may feel embarrassed to talk about sex with your doctor, but this topic is perfectly appropriate. Your regular doctor may diagnose and treat the problem or refer you to a specialist who can.
<br />A medical evaluation for anorgasmia usually consists of:
<br />A thorough medical history. Your doctor may ask exactly what you feel during sexual stimulation and under what circumstances you have achieved orgasm, if ever. Your doctor may also inquire about your sexual history, surgical history and current relationship. Don't let embarrassment stop you from giving candid answers. These questions provide clues to the cause of your problem.
<br />Physical examination. Your doctor will probably conduct a general physical exam to look for physical causes of anorgasmia, such as an underlying medical condition. Your doctor may also examine your genital area to see if there is some obvious physical or anatomical reason for lack of orgasm.
<br />It can be difficult to treat anorgasmia. Your treatment plan will depend on the underlying cause of your symptoms, but your doctor may recommend a combination of these tactics:
<br />Lifestyle changes and therapy
<br />For most women, treatment means more than medications. It's important to address relationship issues and everyday stressors. Understanding your body and trying different types of sexual stimulation also can help.
<br />Understand your body better. Understanding your own anatomy and how you like to be touched can lead to better sexual satisfaction. If you need a refresher course on your genital anatomy, ask your doctor for a diagram or get out a mirror and look. Then take some time to explore your own body. Masturbating or using a vibrator can help you discover what type of touching feels best to you, and then you can share that information with your partner. If you're uncomfortable with self-exploration, try exploring your body with your partner.
<br />Increase sexual stimulation. Many women who've never had an orgasm aren't getting enough effective sexual stimulation. Most women need direct or indirect stimulation of the clitoris in order to orgasm, but not all women realize this. Switching sexual positions can produce more clitoral stimulation during intercourse; some positions also allow for you or your partner to gently touch your clitoris during sex. Using a vibrator during sex can also help trigger an orgasm.
<br />Seek couples counseling. Conflicts and disagreements in your relationship can zap your ability to orgasm. A counselor can help you work through disagreements and tensions and get your sex life back on track.
<br />Try sex therapy. Sex therapists are therapists who specialize in treating sexual problems. You may be embarrassed or nervous about seeing a sex therapist, but sex therapists can be very helpful in treating anorgasmia. Therapy often includes sex education, help with communication skills, and behavioral exercises that you and your partner try at home.
<br />For example, you and your partner may be asked to practice "sensate focus" exercises, a specific set of body-touching exercises that teach you how to touch and pleasure your partner without worrying about orgasm. Or you and your partner may learn how to combine a situation that allows you to achieve orgasm — such as clitoral stimulation — with a situation in which you want to achieve orgasm, such as intercourse. By using these techniques and others, you may learn to view orgasm as one pleasurable part of sexual intimacy, not the whole goal of every sexual encounter.
<br />Medical treatments
<br />Hormone therapies aren't a guaranteed fix for anorgasmia. But they can help. So can treating underlying medical conditions.
<br />Treating underlying conditions. If a medical condition is hindering your ability to orgasm, treating the underlying cause may resolve your problem. Changing or modifying medications known to inhibit orgasm may also eliminate your symptoms.
Estrogen therapy. Systemic estrogen therapy — by pill, patch
or gel — can have a positive effect on brain function and mood factors that affect sexual response. Local estrogen therapy — in the form of a vaginal cream or a slow-releasing suppository or ring that you place in your vagina — can increase blood flow to the vagina and help improve desire. In some cases, your doctor may prescribe a combination of estrogen and progesterone.
Testosterone therapy. Male hormones, such as testosterone, play an important role in female sexual function, even though testosterone occurs in much lower amounts in a woman. As a result, testosterone may help increase orgasm, especially if estrogen and progesterone aren't helping. However, replacing testosterone in women is controversial and it's not approved by the Food and Drug Administration (FDA) for sexual dysfunction in women. Plus, it can cause negative side effects, including acne, excess body hair (hirsutism), and mood or personality changes. Testosterone seems most effective for women with low testosterone levels as a result of surgical removal of the ovaries (oophorectomy). If you choose to use this therapy, your doctor will closely monitor your symptoms and blood levels to make sure you're not experiencing negative side effects.
<br />Herbal supplements. Herbal lubricants, such as Zestra, may help some women. These products help warm the clitoris and may increase sexual arousal and orgasm.
<br />I know this is a lot of information to digest - and there is help for you out there.
<br />Please remember to press ACCEPT so I may get credit for the time I spent assisting you. As always POSITIVE FEEDBACK and BONUS are always appreciated. Please, do not hesitate to ask me any questions in the future or to request me.
<br />Remember, this communication does not replace a visit to the doctor.
<br />Good Luck and Well Wishes,
<br />Dr. Haver
Edited by Mary Claire Haver, M. D. on 9/18/2009 at 11:28 AM EST