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Dear Drs. Lewis and Gail Wyatt:

I’m 34 years old and I’ve never had an orgasm. I’m a healthy woman. I enjoy intimate relations. What’s wrong with me? —Diane W.

There is probably nothing wrong with you! Having an orgasm is not as easy as one might think. One in 10 women have never had an orgasm through sexual intercourse, manual stimulation (using your hand) or the use of sex toys, so let’s eliminate three common reasons that can get in the way. You will have to tackle these issues before following the steps below.

1. Your health: You have medical issues such as diabetes or dyspareunia (painful sex), take medications such as antidepressants or birth control pills, smoke heavily, drink alcohol or use recreational drugs excessively.

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2. Your relationship with your partner: You can’t trust your partner, you’re afraid of being physically hurt, you fear becoming pregnant or infected with a sexually transmitted infection or HIV, or you have been sexually abused.  

3. Your pacing: You have no privacy, you’re a very nervous person, you don’t have enough time to get sexually excited during sex or your partner has trouble sustaining an erection.

If you have any of the problems listed in Nos. 1 or 2, you should consult your doctor for help and negotiate with your partner to protect you from what you don’t want to happen before, during or after sex.

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If the possible reasons you’re not having an orgasm are mentioned above, remember that no one can give you sexual pleasure. It begins with what your mind and your body need for you to get yourself ready for an orgasm. Here is how you start:

Relax: Set aside a half-hour in a room with a locked door where you can be alone each day. This is the time for you to relax, meditate, pray, bathe or shower, listen to your favorite music and just do nothing. Concentrate on your deep breathing.

Give yourself permission: Allow yourself to experience an orgasm. You are going to learn how to excite yourself sexually. If your mind is ready for an orgasm, your body will follow.

Watch how it’s done: Many women don’t know how an orgasm looks or feels. Find an instructional video (not porn) or a book with pictures describing what happens and how an orgasm might feel. What you feel, however, might not be how anyone else feels. You are just getting ideas from videos and books.

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Touch yourself: Bathe or shower, dry yourself and slowly rub lotion all over your body. Notice where you have good feelings and where the feelings are more intense. Include your breasts; the lips, or labia, of the vagina; the clitoris; and the openings between your legs and around your bottom. Notice the kind of touch that you like (gentle or more firm) and where you like to be touched so that you can tell your partner. Continue rubbing the areas where the feelings are more intense. You are discovering whether you prefer direct touch to the clitoris, the labia or both at the same time. Increase the pace of touching yourself.

Practice these first four tips every day until your breathing gets deeper and you feel sexual excitement.

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Add something or someone: Some women add a vibrator to intensify the stimulation of their clitoris and lips until they reach a mildly pleasant sensation that may be an orgasm. Others get ready for intercourse by following these steps. Feeling excited when you show your partner how to arouse you even more can add pleasure to the experience and make it easier. There is no right or wrong way, and you won’t have an orgasm each time you try. You have to experiment and find what works for you. Three out of four women never experience orgasm with intercourse alone, so you may discover that you enjoy more than one method.

Be patient: Take your time, practice as often as you can and show your partner your progress when you are ready. When you experience sexual pleasure, you may motivate your partner to learn to maintain an erection longer so that you can enjoy each other more. Enjoy!

For answers to your questions about sexual health, write to us at justsex@theroot.com. Be sure to include your age, gender, any medications you’re taking and the nature of your sexual problem.

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Gail Wyatt, Ph.D., is a licensed clinical psychologist and sex therapist. She is also a professor at UCLA and director of the university’s Sexual Health Program. Lewis Wyatt Jr., M.D., is a board-certified obstetrician-gynecologist in private practice in Beverly Hills, Calif. He specializes in sexual health and bioidentical hormone treatment.