Dear Yenta,

I still have not had an orgasm. I feel pressure mounting in my genitals, and then it always subsides. I have tried masturbating and have had sex with many men. I haven’t been in a serious relationship in a very long time, though. I am pretty sure there is something medically wrong with my hormones and want to get tested. What do you think?

-Without

Dear Without,

In my personal opinion an orgasm is always possible, it just might take some personal work to achieve. Doctors would be my very last resort. When obstruction occurs, it can be due to a number of physical and emotional factors. More women than you realize are sexually stunted in this very same way.

Here is a step by step plan:

1) Do an inventory of your mental self. Are you stressed? Were you raised to think sex was sinful? Do you have control issues? Were you sexually abused in your life? Were you in a traumatic situation where you lost physical control? Any number of these things could be distracting you from release. Sometimes our bodies tell us no as a signal that we need help or healing. Talk therapy or meditation could help, exploring the topic of letting go and what is so often terrifying about doing so.

2) How do you feel about your body? Do you feel fat? Hairy? Stalky? Ugly? Too much? Too little? Are you too loud? Too sweaty? One time at a bar in Panama a Canadian woman took my aside and asked if I had ever made love to myself, “like really made love to yourself?” This connection to self and body is the key to enjoying sex with another, and if you can’t let go alone, can’t love your thighs or breasts or vagina without a partner, then chances are you won’t be able to with them either. Make love to yourself. Kiss your arm. Stare at your genitals, tell all those things that you think are “too” something that they are just right. Cultivating a healthy sex life is something that for many needs to be built, like a yoga practice, over years of observation and commitment.

3) Trust. Do you trust yourself? Do you trust your partner? If you aren’t in serious relationships, who is making love to your body? Do you feel safe with them? Sexy with them? Respected by them? This deeper emotional comfort may be key to orgasms for many women. Others need things like a moving train or a public restroom and a stranger. But in your case, it sounds like you need love, trust, and safety: key ingredients to a wild sex life full of orgasmic release.

4) Keep at it. Leave the bedroom locked and make self-love a priority for a few months. Forget the orgasm, explore the folds of your labia, the underside of your clitoris, the edges of your aeriola. You need to become calm in your own body, enter your own form, learn to love pleasure without release. Find your G-spot, play with your rear, check in with armpits and elbows. Make love to your body as if a spiritual practice and see where this leads you. If, over time, you start to feel safer in your skin, you might allow it to erupt and take charge in its own explosive orgasmic way.