Why can’t I orgasm? Sexual change and ageing in women

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The female body goes through several stages in a lifetime. With each stage, you tend to get to know the rhythm like clockwork, for example your menstrual cycle. With most women, the same goes for orgasms: given the right conditions during a sexual encounter, in a couple or alone, an orgasm is expected as an end result, if that is your aim.

For various reasons, however, this expected end result can cease to be the case, and there are many reasons for this to happen to you. Anorgasmia, an inability to orgasm, can affect up to a third of women.1 Having had orgasms in the past and then finding you are unable to can affect around 50% of women, and becomes more common with age.2

But why is this? And what even is an orgasm?

What is an orgasm?

Defined broadly as an intense sexual experience, an orgasm occurs following sexual stimulation and involves muscle contractions in the genital area due to the release of certain chemicals (endorphins) in the brain.

From an evolutionary point of view, orgasm is thought to occur as a means of choosing an optimal partner, as the rhythmic stimulation required for it to occur can be a sign of physical fitness.3

Furthermore, the optimal time for a woman to orgasm is mid-cycle, when she is ovulating. In fact, the clitoris size has been noted to increase by 20% during this time.4 The mechanism of how or why this occurs isn’t fully understood, and there are various factors which can affect the chances of an orgasm occurring. But what are these, and how do physical and mental changes that come with age affect them?

Hormonal and physical genital changes

At certain times in a woman’s life, including pregnancy, breastfeeding, perimenopause, and menopause, hormonal fluctuations occur. This affects not only sexual desire and libido, but also the physical environment around the genitals.

While it may take an 18-year-old a few seconds to feel aroused, it takes a 40-year-old much longer, hence the time it takes to achieve orgasm can also be prolonged. Testosterone, which can decrease with age in women as well as men, is also an important hormone in sexual arousal.

Oestrogen levels start declining as you age, which means your vagina can become dry, making intercourse or stimulation uncomfortable. This is because the tissues in the vagina contain oestrogen receptors and oestrogen is required to maintain the character of these tissues, which includes moisture and a pink colour.5

From an evolutionary point of view, orgasm is thought to occur as a means of choosing an optimal partner, as the rhythmic stimulation required for it to occur can be a sign of physical fitness.

Physical changes with pregnancy, childbirth, and menopause can impact the distance between the clitoris and the vagina. This can affect the ease at which orgasms occur, as a shorter distance (2.5cm) is associated with better orgasms, which may be interpreted as easier orgasms, as stimulation is easier.6 As each change ‘milestone’ ceases, however, you may find sex drive and ability to orgasm increases again.

However, some changes, such as a prolapse following childbirth, or vaginal dryness occurring with menopause may remain unless you seek medical help. It is worth having a discussion with a healthcare professional if you are experiencing problems with your sex drive or ability to orgasm, as they can signpost you to good lubricants for dryness, any medical interventions that may help such as HRT, or even seeing a women’s health physiotherapist, or having counselling.

Other conditions that can affect your ability to orgasm

In order for any muscle to work effectively it requires a good blood flow. Blood flow is increased to the genital area during sexual arousal, which is required to provide nutrients and substances for a part of the body to function optimally. Just as the heart may not work properly if its arteries are blocked, the muscles that control orgasm may also be affected.

For this reason, there is an association between sexual dysfunction and medical conditions such as hypertension, diabetes, and heart disease, and these are all conditions that become more common with age.

Lifestyle changes can prevent these conditions from affecting you, or improve your symptoms if you have already received a diagnosis. The same lifestyle changes can also improve your pelvic blood flow and thus improve your ability to attain orgasms. Changes worth making include not smoking, exercising regularly, and eating a good, plant-focused, mediterranean style diet. If you do have a condition such as one of the above, or have other symptoms, it is important to speak to your doctor to ensure you are receiving appropriate treatment.

Psychological changes that can affect your ability to orgasm

These changes can include mood disorders such as depression or anxiety, worrying about performance in bed, relationship problems, and previous traumatic sexual experiences, to name but some.

Effects on sexual desire can also lead to problems with orgasm, and these effects include lack of sleep, the impact of excess alcohol and drug use, and certain medications.

Mood changes tend to occur with age as the hormonal fluctuations, such as the drop in oestrogen around menopause, have an an impact on regulating the neurotransmitters that affect our mood.7

Feeling anxious or depressed can lead to a lack of interest in activities, which can subsequently affect the outcome of a sexual encounter. This can also lead to a vicious circle of worrying about sex, which can impact on performance, orgasm, and even your sexual relationships with others.

The physical changes which occur to your body and impact your sex life can also affect your mental health, and create another vicious cycle. For example, if sex is uncomfortable due to dryness, this can lead to unpleasant sex, even resulting in trauma, which can, in turn, increase anxiety about subsequent sexual encounters. In this instance it is important to seek help from your GP who may refer you to a psychosexual therapist, and recommend you treatment for the physical changes that also affect mental health.

The physical changes which occur to your body and impact your sex life can also affect your mental health, and create another vicious cycle. For example, if sex is uncomfortable due to dryness, this can lead to unpleasant sex, even resulting in trauma, which can, in turn, increase anxiety about subsequent sexual encounters.

One study has shown that chronic alcohol and drug use has a clear deleterious effect on sexual functioning for many individuals.8 Small amounts of alcohol can make your blood vessels expand and improve circulation, but chronic misuse of alcohol damages organs, including the nervous system. The changes that happen as women age combined with alcohol can, therefore, be detrimental to both menopausal symptoms and also mood disorders such as depression. With an increase in alcohol consumption among women and the elderly, this is worth addressing to improve not only sexual health but also health and longevity.

Sleep is also extremely important for the daily rhythm of the body, the circadian rhythm. Lack of sleep can impact hormone levels, and it has been shown that getting enough sleep is important for the promotion of healthy sexual desire, genital response, and engaging in sexual activity.9

With hormonal and social issues affecting sleep, especially as women get older, it is important these factors are addressed. Progesterone is a sleep-inducing hormone which appears to have a role in the production of other hormones implicated in sleep,10 and its neurometabolic effects are also seen to be sedative.11 However, progesterone starts to decrease with age, and a discussion regarding hormone replacement may be warranted if lack of sleep is contributing to your sexual health.

If your sex drive is bothering you at any age, or you have lost the ability to orgasm, it is worth going to seek help from your GP to explore your options. It is a common problem, particularly in older women, so there is no need to feel embarrassed, and there are plenty of treatment options available.

Featured image shows a woman with grey hair in a bun looking down. The image is cropped so you can only see her eyes, forehead, and some of her hair.

References

  1. NHS Choices Health A-Z, ‘What can cause orgasm problems in women?’, [website], 2016, https://www.nhs.uk/chq/Pages/causes-of-orgasm-problems-in-women.asp, (accessed 25 May 2018).
  2. Ibid.
  3. A. Safron, ‘What is orgasm? A model of sexual trance and climax via rhythmic entrainment’, Socioaffective Neuroscience and Psychology, vol. 6, no. 1, 2016.
  4. C. Battaglia et al., ‘Menstrual cycle-related morphometric and vascular modifications of the clitoris’, Journal of Sexual Medicine, vol. 5, no. 12, 2008, pp. 2853-61.
  5. D.W. Sturdee et al on behalf of the International Menopause Society Writing Group, ‘Recommendations for the management of postmenopausal vaginal atrophy’, Climacteric, vol. 13, no. 6, 2010, pp. 509-522.
  6. D. Mazloomdoost and R. N. Pauls, ’A Comprehensive Review of the Clitoris and Its Role in Female Sexual Function’, Sexual Medicine Reviews, vol. 3, no. 4, 2015, pp. 245-263.
  7. W. Wharton et al., ‘Neurobiological underpinnings of the estrogen-mood relationship’, Curr Psychiatry Rev, vol. 8, no. 3, 2012, pp. 247-256.
  8. J. Peugh and S. Belenko, ‘Alcohol, drugs and sexual function: a review’, Journal of Psychoactive Drugs, vol. 33, no. 3, 2001, pp. 223-232.
  9. D. A. Kalmbach et al., ‘The impact of sleep on female sexual response and behaviour: a pilot study’, Journal of Sexual Medicine, vol. 12, no. 5, 2015, pp. 1221-1232.
  10. A. Caufriez et al, ‘A potential role of endogenous progesterone in modulation of GH, prolactin and thyrotrophin secretion during normal menstrual cycle’, Clin Endocrinol (Oxf), vol. 71, no. 4, 2009, pp. 535-542.
  11. A. H. Soderpalm et al., ‘Administration of progesterone produces mild sedative-like effects in men and women’, Psychoneuroendocrinology, vol. 29, no. 32004, pp. 339-354.

Dr. Deyo Famuboni

Dr. Deyo Famuboni is a UK trained GP with over 10 years of medical experience. After graduating from the University of Edinburgh, she went on to do further training within a wide range of medical specialities including obstetrics and gynaecology. She has spent time working abroad as well as within the NHS and private sectors in the UK. She is a member and clinical advisor of the Royal College of General Practitioners and a diplomate of the Royal College of Obstetrics and Gynaecology, Royal College of Paediatricians and the Faculty of Sexual and Reproductive Health. She also has a strong interest in nutrition and health and blogs at https://doctordeyo.com/.

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