Of Age and Pleasure

I used to be able to orgasm easily, but now it is very difficult. I have to hit the exact spot in exactly the right way. Is there anything I can do to improve this? I can orgasm when I masturbate, but not usually with my partner. I’m 60+. Help!

— Anonymous, Dallas

[Have a question about women’s health? Ask Dr. Gunter yourself.]

Short take

As women age, some report a decrease in orgasm intensity as well as difficulty achieving orgasm. This phenomenon can be age-related, though low estrogen may also play a role. Other factors may include medical conditions or their treatments. The good news is there is often help.

Tell me more

There could be many reasons a woman’s ability to orgasm changes with age. Before determining the cause of age-related sexual problems, a doctor should first rule out that there are no libido issues or previous difficulties achieving orgasm, and establish that everything is solid relationship-wise.

After that, a woman could consider that she may simply need a little “help” achieving orgasm. Age-related changes happen in many organ systems, and the clitoris is no exception; after all, many people need reading glasses or a hearing aid as they age. For women who do not experience pain with sex and simply find it takes more effort to achieve orgasm, incorporating a vibrator for clitoral stimulation into sexual play — while masturbating or with a partner — may be all that is needed. There are many vibrator options with different levels of intensity and construction types to hit different “spots.” Some also provide more of a suction sensation versus traditional vibration.

Another factor in orgasm may be a decrease in strength in the levator ani muscles. These are the muscles that support the vagina, bladder and rectum, and they also produce the physical contractions of orgasm. Your orgasms may be affected if these muscles are weak because of age or childbirth. A doctor — typically a gynecologist or urogynecologist — can examine these muscles to determine if you have a pelvic floor disorder. If they are weak, you may be offered Kegel exercises to strengthen them. You may even be referred to a physical therapist who specializes in treating the pelvic floor muscles.

For women in menopause, low estrogen levels can have sexual consequences because of a decrease in blood flow, tissue elasticity and lubrication. Low estrogen can also lead to pain with sex, which can definitely affect orgasm. The changes caused by low estrogen can sometimes be managed with over-the-counter lubricants and vaginal moisturizers, but often a prescription product, most commonly topical estrogen, is needed.

Medical conditions, such as depression and diabetes, can also affect sexual response as can some medications, such as antidepressants and opioids. Antidepressants and anti-seizure medications that are often prescribed for hot flashes during menopause can negatively affect orgasm, so consider the potential sexual side effects when deciding to start or stay on these medications. Sorting out how medical conditions and medications may affect a woman’s sexual response can be challenging, so working with an experienced practitioner is essential.

Another factor to consider

Women whose male partners have erectile dysfunction sometimes tell me this condition can have an impact on their own sexual response. This phenomenon is not well-studied, but I hear it often enough that I can’t dismiss it. Not knowing if a partner will be able to achieve a full erection can be stressful. And if sex has to move quickly to catch the moment for penetration, it may bypass what some women need emotionally and physically to reach orgasm. If a woman’s orgasm is normal when she masturbates, but not with her male partner, erectile dysfunction may be a factor to consider. There are a variety of treatments for erectile dysfunction that a male partner can discuss with his own health care provider.

Dr. Jen Gunter, often called Twitter’s resident gynecologist, is teaming up with our editors to answer your questions about all things women’s health. From what’s normal for your anatomy to healthy sex and clearing up the truth behind strange wellness claims, Dr. Gunter, who also writes a column called The Cycle, promises to handle your questions with respect, forthrightness and honesty.

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