Sex File: I'm in my 30s and can't reach climax, what can I do?

I can still get aroused if my partner initiates sex, but I can't reach climax. Picture: iStock

I seem to have lost all trace of desire, and although I can still get aroused if my partner initiates sex, I can't reach climax - even if I take things into my own hands. I'm only in my thirties, so I can't be menopausal. What can I do?

The first thing you need to do is make an appointment with your GP. There are three things that need to be explored here: your relationship and your life circumstances; your sexual history; and any potential medical explanations. Age tends to be the most important clue as to which of these will be the most revealing. For example, a woman who is in her late forties or early fifties might be experiencing hormonal changes associated with the menopause, whereas this is not typically the first line of inquiry with a younger woman, like you.

Although you frame what is happening as a loss of spontaneous desire, the real red flag is the fact that you can't climax on your own. The clinical term used to describe this is anorgasmia, and there are several types. A woman like you, who has previously been able to orgasm and now can't, is described as having "acquired" anorgasmia, whereas women who have never had an orgasm are described as having "lifelong" anorgasmia. Women who have "generalised" anorgasmia experience difficulties with orgasm regardless of the type of stimulation, the situation, or the partner, whereas women who have "situational" anorgasmia only experience difficulties with certain types of stimulation, in specific situations.

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Anorgasmia can be caused by a number of factors. There is the big scary stuff: diabetes, neurological problems, multiple sclerosis, surgery, or past trauma. There can be lifestyle factors such as alcohol use, smoking and recreational drugs. It can also be a side-effect of medication, such as steroids or opioids. Even medicines such as antihistamines that you can get over the counter have been found to affect arousal and orgasm in men and women.

You can help the diagnostic process by making some notes before seeing a doctor. Write down when you first noticed that your orgasm was becoming difficult to achieve and what the circumstances were. You should also document any medical or mental health conditions that you have, or think you might have, as well as any medication that you take. This information will help your GP to decide whether you need a referral to a specialist or whether there might be a much simpler solution.

I know you don't mention your mental health, but depression is associated with low libido and anorgasmia. And, somewhat ironically, SSRI antidepressants have also been found to impair desire, arousal and orgasm in some women. If you are on antidepressants and your doctor thinks that might be what is causing the problem, he or she may be able to change your dose or swap you onto an alternative that has different active ingredients.

In younger women, hormonal birth control is a very common cause of acquired anorgasmia. If the issue is your contraception, using condoms, a diaphragm, or getting a non-hormonal IUD (coil) is worth considering. The good news is that reversing the impact of hormonal contraception on orgasm can happen very quickly.

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