I've never had an orgasm. Is there something wrong with me?

Q: I'm a woman in my 40s and have never had an orgasm. What advice can you give me?

A: Women with orgasmic dysfunction may have difficulty achieving orgasm during sexual intercourse or masturbation. Some people are satisfied with not having an orgasm every time they have sex and some may have more intense orgasms when masturbating.

The condition of never having had an orgasm is known as primary anorgasmia. If you have difficulty reaching orgasm, even though you've done so before, you may have secondary anorgasmia.

The most common type of orgasmic dysfunction occurs when one can only orgasm during specific situations, such as during oral sex or masturbation. This is called situational anorgasmia. The inability to achieve orgasm under any circumstances, even when you're highly aroused and sexual stimulation is sufficient, is called general anorgasmia.

THERAPY

The main symptom of orgasmic dysfunction is the inability to achieve sexual climax. It is usually over a period of time that a person notices this. Some people may have an orgasm, but find them unsatisfying. Others may take longer than normal to reach climax and this may result in a lot of frustration.

A therapist can help you and your partner learn more about one another's sexual needs, evolving issues and desires. Addressing any relationship stressors that may be contributing to your inability to orgasm is also important. Some people have strong religious and cultural beliefs or have entered into virginity pacts, which can affect their ability to fully immerse themselves in sexual acts. Resolving these underlying causes can help you reach orgasm.

You may want to explore ways to increase clitoral stimulation during masturbation and sexual intercourse. Remember, it is normal to not have an orgasm every single time you have sex, and, depending on your desires, you may be satisfied with not having them at all.

For some people, a medical condition or the side-effects of medication may be causing the problem. It is important to consult your doctor. Depending on the assessment, hormonal therapy, cognitive behavioural therapy, antidepressant therapy or couple and individual counselling may be required.

Clitoral enhancers and stimulators such as lubricants and sex toys may offer increased pleasure.

• Dr Tlaleng Mofokeng (MBChB), sexual and reproductive health practice, Disa Clinic, safersex.co.za

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