Dear Sh!

I wanted to ask about orgasms, please. I have multiple sclerosis – I’ve had it for 30 years and have been fine until maybe 2 years ago when I started having problems with fatigue. It’s then I started having problems with (no) orgasms. I’m not asking for medical advice! I tried to get NHS advice (they don't want to talk/don't have any useful ideas if they will talk). And I think your specialist knowledge might help me with orgasms. Hopefully!

Myself, I think the biggest problem is that I lost confidence. I was very tired (MS-related fatigue), lost a lot of weight (so muscle), and had MS-related problems with urinary and gastrointestinal symptoms. And I was having my menopause!

I’ve sorted lots of this out myself: with breathing exercises for hot flushes; increased weight and aerobic exercise (so I’m not just bones now), and some – but I think probably not enough – pelvic floor exercises. That leaves me with a lack of confidence. And no orgasms! My (male) partner is keen for me to have orgasms. I feel under pressure from him, as well as me. Of course, I’ve bought lots of your lovely vibrators (and lube). And your staff are lovely. But… I’m stuck. Having no orgasms. Can you help?

I don't take any special MS medicines (or anything else except some vitamins)
Yours hopefully, A. 

Dear A,

From your letter, it does sound like you have a good idea of what’s happened to your orgasm.

Body changes, such as MS fatigue & menopause, effect pleasure & orgasm 

Any body changes can interrupt the way we orgasm, meaning we need to relearn what once may have felt natural.

Fatigue, loss of confidence and pressure to orgasm (both from yourself and your partner) will all impact your ability to climax.

You don’t say in your letter where you are with enjoying intimacy, sex or masturbation, aside from not being able to orgasm.

• Do you feel a connection with your partner?
• Do you have fun, flirting and affection outside the bedroom?
• Do you feel desire for him?
• During sex do you feel arousal?
• Do you experience an increase of pleasure that maybe reaches a plateau?

Thinking about these questions can help you identify blocks.

Regarding menopause, a fall in oestrogen and testosterone can mean your vagina loses some of its elasticity and ability to lubricate plus your sex drive can lower. You could talk to your GP about pills and cream that could help with this. And as you’ve already said you’re using lube.

You recognise in your email, mood and wellbeing can play a big part in your enjoyment of sex. If you are feeling low, exhausted, despondent or disconnected from your body this will affect you.

Orgasms are often about being able to 'let go'

• Are you able to enjoy time alone and with your boyfriend?
• Do you do activities where you’re able to laugh?
• Express yourself?

All these can help.

When people get stuck at the plateau phase of arousal, where they feel a rise of pleasure that evens out and doesn’t end in aclimax, they try to push on to towards orgasm.

They stop when they feel too sensitive, lose arousal or feel frustrated because it’s taking too long.

Not being able to climax can feel frustrating.

Yet expecting it every time you are intimate with someone or masturbate can add pressure and chase it away. It’s important to not keep doing the same masturbation or sex routine because it can leave you feeling more helpless and disconnected from your body.

As can throwing a random medley of toys at potions at the matter in the hope it will right itself.

When masturbating, taking time to explore and enjoy your body, thinking of fantasies – maybe reading erotica or watching something sexy, listing to music or mindfully concentrating on the sensations can help you reconnect with it.

Try not to be goal-oriented.

Try and stay in the moment enjoying the sensations and experimenting with different strokes. You may like to experiment with toys but these should be bought in the spirit of fun and hope rather than feelings of sadness or desperation.

In time, if you feel a bit more connected, or if you find this exercise unhelpful, try and role-play an orgasm. Bite the pillow, thrash about, moan loudly and do your kegel exercises (our Kegels spasm during orgasm). This will train your body and mind to know it’s OK to let go.

Communicate with your partner

I wonder why your partner is keen for you to have orgasms.

• Is it because he feels that your orgasm is proof he can perform?
• Is he concerned about your enjoyment?
• Does he feel sex isn’t sex without an orgasm?

Whatever the reason, discussing together how you both feel about sex, empathising with what is said and coming up with ways to enjoy each other can help you to both feel closer. When you are being intimate with each other, try both communicating about what feels good – maybe with compliments or moans. Rather than carrying on until you have the punctuation of orgasm, indicate when stopping is ok.

A helpful online course might be Becoming Orgasmic which will teach you all the different ways to explore pleasure and connect mind and body. 

Do let us know how you get on.

Best of luck,

Sarah