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

Over a lifetime, it is normal for sexual desires and behaviours to change. Sexual activity may ebb and flow as you move through different stages of life, and the sex you are having now may be different to the sex you had last year, or five years ago, or twenty years ago. Many people find that their experience of sex and sexuality change as they age. Whilst some of these changes may be positive, you also may encounter new sexual problems later in life.

According to the NHS, about a third of middle-aged women and half of older women are affected by sexual problems such as being unable to orgasm.¹ This article will discuss some of the hormonal, physical, and emotional changes that can occur in ageing and how they can affect sexual pleasure and enjoyment.

Hormonal and physical genital changes

As people with ovaries age and approach the menopause, hormonal fluctuations occur. The most important hormonal change is the reduction in oestrogen levels, which affects not only sexual desire and libido but also the physical environment around the genitals.

Vaginal dryness is one of the most common genital changes experienced by women as they age. Oestrogen binds to receptors in the vaginal and vulval tissues, helping to maintain vaginal moisture and thickness.² When oestrogen levels are low, the vagina and vulva become drier and more fragile. A GP or sexual health specialist can signpost you to good lubricants for dryness and may be able to prescribe oestrogen gels or creams to increase vaginal moisture.

Pelvic organ prolapse can also cause discomfort during sex, as well as urinary problems. If you think you have any of these symptoms, see your GP

Other changes in the genitals which can occur during and after menopause include narrowing of the vaginal opening and reduced clitoral stimulation, both of which lead to discomfort during sex or reduced sexual pleasure. However, these effects of these physical changes can be lessened with treatments such as vaginal moisturisers as well as hormonal therapies like HRT or vaginal oestrogen.³

Some people experience pelvic organ prolapse following childbirth or after the menopause. This is where one or more of the organs in the pelvis (such as the uterus, bladder or bowel) move from their usual position to bulge into the vagina. Symptoms of pelvic organ prolapse include a “dragging” sensation in the vagina; a heavy sensation in the lower abdomen or genitals; and feeling a lump or bulge within or coming out of the vagina.⁴

Pelvic organ prolapse can also cause discomfort during sex, as well as urinary problems. If you think you have any of these symptoms, see your GP: they will be able to do an internal pelvic examination to assess for pelvic organ prolapse, and can prescribe or refer you for treatment as necessary. Such treatments might include pelvic physiotherapy, vaginal oestrogens, or pessaries (devices inserted into the vagina to support the pelvic organs).

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.

Psychological factors that can affect your ability to orgasm include mood disorders such as depression or anxiety

For this reason, there is an association between sexual dysfunction and medical conditions such as hypertension, diabetes, and heart disease.⁵ These are all conditions that become more common with age.

Lifestyle changes can reduce the risk of developing these conditions, 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 hypertension, diabetes, or heart disease, or have other symptoms, it is important to speak to your doctor to ensure you are receiving appropriate treatment.

Psychological factors that can affect orgasm

Psychological factors that can affect your ability to orgasm include mood disorders such as depression or anxiety, worrying about performance in bed, relationship problems, and previous traumatic sexual experiences, to name but a few.

Mood changes are common around the menopause. Hormonal fluctuations during this period (such as reduced oestrogen and testosterone levels) can worsen mood and reduce libido.⁶

The physical changes which occur to your body and impact your sex life can also affect your mental health, leading to more sexual problems

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, leading to more sexual problems. 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.

Other lifestyle factors can affect sexual desire and lead to difficulty reaching orgasm. These include lack of sleep, the impact of excess alcohol and drug use, and certain medications.

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.⁷ Many people experience poor sleep during the menopause, often associated with hot flushes at nighttime.

One study has shown that chronic alcohol and drug use has a negative 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. Drinking alcohol can therefore worsen both menopausal symptoms and also mood disorders such as depression.

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 in women and people with vulvas of any age, and especially as we age, so there is no need to feel embarrassed. There are plenty of treatment options available, and your GP can discuss these with you.

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

Last updated June 2023
Next update due 2026