Ask Dr. Berman: 52 Years Old and I've Never Had an Orgasm

Q: I'm 52 and have been married for almost 30 years. I don't seem to have any sex drive, nothing feels good, and I've never had an orgasm. Years ago I spoke with my gynecologist about this, and he referred me to a psychologist and group therapy — but still nothing has worked. My husband is encouraging and eager to help, but lately I've started to wonder if it could be a hormonal problem. I'm ready to see a sex therapist if you think it's possible things could change, but I don't know how to find the right professional. Any suggestions?

A: It's important that you get tested for any physical factors that may be diminishing your sexual function. Since you are at or past the age of menopause, I'm almost certain some hormonal imbalances are at work. Decreased estrogen can cause the vagina to lose its suppleness and lubrication, and decreased testosterone can affect both your sex drive and your lack of "feeling good" when touched. Visit your doctor and get a full hormone profile done. Then explore whether hormone replacement is right for you based on your health history.

However, hormones are not the only problem here. Since you've never had an orgasm, you have what's known as primary orgasmic disorder. The causes can be physical, emotional, or both. You might want to get evaluated for any nerve damage, which can impair your ability to orgasm. A fall that may have injured the pelvis or any type of pelvic surgery can do it.

Aside from nerve damage, your inability to reach orgasm likely has a deep-seated emotional source. Even if you find there are some physical factors at work here, visiting a sex therapist is an excellent idea. A licensed therapist will help you explore what is getting in the way of your orgasm ability. (The best resource for finding a certified sex therapist is the American Association of Sexuality Educators, Counselors, and Therapists.)

Often, powerful childhood messages and experiences are the culprit. Many women experienced a negative environment around sexuality growing up. They were told sex was dirty or shameful. Those who can't reach orgasm often have difficulty letting go and being vulnerable to their partner during sex, which is essential. Fortunately, it sounds as if you have a supportive partner who will help you work through any issues.

Finally, be sure you are using a lubricant during sexual activity, and you might also want to try a vibrator if you haven't already. The powerful stimulation delivers many women to their first orgasm. Aphrodite is a good model to experiment with, since it virtually guarantees climax. Try it out on your own and explore the feelings it stirs up with your partner. Write about your experiences in a journal. Make sure to implement plenty of fantasy, whether it involves your husband, or even the cute stranger in your office building or a sexy celebrity. Fantasizing about other men does not signify cheating, so remember: When it comes to fantasy, anything goes…leave judgment and shame at the door, and just enjoy yourself!

 — Dr. Laura Berman