OpenHealth Q&A

Seeking Guidance on Acquired Anorgasmia

Hello, I’m a 41-year-old woman, weighing 210 pounds and standing at 5’4”, residing in the United States. My daily routine includes taking 18mg of Methylphenidate for ADHD, alongside a daily multivitamin and vitamin D. I also apply estrogen cream every three days. I don’t smoke and drink alcohol infrequently. Initially, I was on Trintellix for depression but transitioned off it, opting for Methylphenidate instead. Although I occasionally smoke cannabis, it’s not a frequent habit—once every few weeks or so. I had been taking Zyrtec daily as well, but I discontinued that once I began experiencing my current symptoms. Up until July 2025, I was able to reach orgasm consistently through clitoral stimulation, achieving climax every time, whether it was initiated by me or my partner. However, around that time, I suddenly found myself unable to orgasm at all. Concerned about this drastic change, I consulted with my doctor, who prescribed estrogen cream. The result was a slight improvement: I experienced orgasms approximately 10% of the time, but they were far less satisfying than before. During a follow-up, my doctor speculated that I might have lichen sclerosis. This was perplexing since I had not experienced any prior symptoms. Nevertheless, she referred me to a gynecologist, who shared the same suspicion. After a biopsy, the diagnosis of lichen sclerosis was ruled out, but I was found to have lichen simplex chronicus instead. Interestingly, I don't experience significant itching, which leaves me uncertain about its relevance. Because my orgasmic difficulties persisted, my gynecologist suggested discontinuing the antidepressant, Trintellix, which I did, but unfortunately, this change did not yield any improvement. In my follow-up with the gynecologist, I inquired about the potential benefits of topical testosterone as suggested by discussions on a perimenopause subreddit. She expressed skepticism, mentioning that my libido remains strong and cautioned about the risk of clitoral changes, yet she proceeded to write a prescription. I have not begun using it due to her reservations. Currently, I am attempting to find a sex therapist, but many are either full or have lengthy waiting lists. Additionally, I came across information indicating that Zyrtec could interfere with orgasm, prompting me to stop taking it. Consequently, I am now dealing with constant watery eyes from allergies, though I wonder if these symptoms might be due to perimenopause instead. I have found that light cannabis use does provide some relief, and the estrogen cream has helped moderately, yet I still only experience disappointing orgasms about 10% of the time. My libido is quite healthy, and while I often feel aroused and even come close to climax, achieving it still eludes me most of the time. I’ve also noticed that while I may feel aroused, my clitoris does not always exhibit the expected engorgement. I have an upcoming appointment with my primary care physician next week, where I plan to revisit this issue. I would greatly appreciate any suggestions or considerations for additional options I might discuss with her. It often feels like both my PCP and gynecologist respond with sympathy but lack proactive solutions, only venturing into further investigations like the lichen sclerosis situation.

Answers (1)

2/11/2026, 9:01:16 PM

OpenHealth AI

I understand that you're dealing with a challenging situation regarding acquired anorgasmia, which can be frustrating and distressing. It sounds like you've already taken steps to address this, but you're still experiencing difficulties even after considering treatments. Here’s a structured response to guide you:

Key Points:

1. Possible Contributing Factors: Your symptoms may relate to hormonal changes, medications, or even psychological factors.
2. Sexual Health Approach: Consider discussing additional treatment options like topical testosterone.
3. Finding Support: While waiting for a sex therapist, explore self-help strategies and resources.

Explanation:

Acquired anorgasmia can result from various factors, including hormonal imbalances (like those that might occur during perimenopause) and medications. The combination of your medical history—including the use of Methylphenidate, cessation of Trintellix, and the recent discontinuation of Zyrtec—might also play a role. Even if your libido remains strong, physical aspects of arousal and climax can be affected.

Next Steps:

1. Discuss Topical Testosterone: Since your gynecologist expressed skepticism but still prescribed it, ask specific questions about its benefits and risks in your case. You can inquire about starting at a low dose and monitoring your response closely.

2. Consider Hormonal Evaluation: Request a comprehensive hormonal panel from your primary care physician to check levels related to estrogen, testosterone, and others that may influence sexual function.

3. Self-Care Strategies:

   • Keep a Journal: Track your experiences, noting any patterns with orgasm satisfaction, arousal, and hormonal fluctuations related to your cycle or stress levels. This can help your doctor understand your situation more thoroughly.
   • Explore Foreplay and New Techniques: Experimenting with different types of stimulation (variety in techniques or settings) could help. Communication with your partner about what feels good can also be beneficial.
   • Mindfulness Practices: Consider integrating relaxation or mindfulness exercises into your routine. Techniques such as deep breathing before intimacy may enhance your bodily awareness and arousal.

4. Seek Support Groups or Online Resources: While waiting for a sex therapist, look for online communities or workshops focusing on sexual health and well-being. They can provide a platform for sharing experiences and learning from others who have similar concerns.

I hope this guidance helps you feel more empowered and supported as you explore potential solutions. Please feel free to update me on your progress or if you need further assistance.