If you are having trouble having good orgasms, one possible reason might be that your pelvic floor is weak. In fact, this is a common problem. In 2008, a study by Kaiser Permanente found that one-third of women suffer from one or more pelvic floor disorders.

The pelvic floor begins around the pubic bone, comes to the urethra, vagina and anus, and then goes out to the sitz bones — the bones in your lower bottom that you'll feel touching a chair when you're sitting. A weakened pelvic floor can cause a loss of sensation in your genitals.

There are many reasons you might have a weakened pelvic floor. The most common is pregnancy and childbirth. Anyone who has given birth is at risk, and the more children you have, the greater the risk.

Other causes include menopause, obesity, and the associated straining of chronic constipation.

The muscles of the pelvic floor can be strengthened, leading to more sexual pleasure. Pelvic physical therapy is a nonsurgical solution that can include pelvic floor muscle stretching or strengthening exercises. Many of these exercises can be done at home. In the actual office of a pelvic floor physical therapist, modalities like electrical stimulation and biofeedback can also be used.

I have noticed that this possible cause for weak orgasms is not mentioned much in women’s magazines. That is a pity. Sometimes self-help articles are not helpful. It’s always a good idea to see a medical professional when you are having physical problems.

Even if you are a bit embarrassed to talk to your gynecologist about this problem, try to overcome your shyness. You should get yourself evaluated. Your physician will know the names of the good pelvic floor physical therapists. Or, you can look up a pelvic therapist yourself online, at the website of the Academy of Physical Therapists Association.

One of my patients actually became very distressed about her difficulty having good orgasms. She came to me for help, and described her plight. 

This woman had taken antidepressants, and she became convinced that her orgasmic difficulties were a direct result of her medication, having read a lot of information on the internet. (In fact, sometimes antidepressants can cause female sexual dysfunction. )

She became depressed and angry at herself for taking these medications. She began to avoid sex altogether, because she found it so distressing to feel so little pleasure during intercourse.

Furious, she stopped taking the antidepressants, hoping that would help. But she became more and more depressed, and even off the medications her ability to have a good orgasm did not come back.

Eventually, as COVID got more under control where she lived, she was able to get into see a highly trained pelvic floor physical therapist, who discovered that the woman’s pelvic floor was extremely weak.

Doing the exercises was a challenge, because she was busy all the time with a job, a husband, and a child. It wasn’t easy to fit in ten minutes twice a day to do her pelvic therapy

But she worked diligently on her at home strengthening exercises, and was delighted to feel her pleasurable sensations increase.

The moral of this story is to ask a professional for help when you feel like your body is betraying you.Don’t diagnose yourself from a magazine or from your reading on the internet.