I’m 73 and I can’t bring myself to orgasm any more

I am a 73-year-old woman. I have had no trouble having orgasms with a vibrator until recently. But now, though I get close, it just doesn’t happen. What do you think is wrong?

The suddenness with which your anorgasmia appeared might suggest there is something going on of a physiological nature, and it would be wise to have a checkup with your doctor. Some medications – even over-the-counter preparations – might have sexual side-effects, and do ask your doctor about your hormone levels, as there is a relationship between hormonal activity and orgasm. To be proactive, step up your exercise programme if your doctor allows it, and maintain general healthy habits.

Has something changed in your life recently that might be sexually significant, such as a downturn in your self-esteem, body image or mood? Are you feeling sad or worried about something? Depression can negatively influence sexuality, and so can anxiety, stress and bereavement.

The use of fantasies or erotic materials during self-pleasuring sessions is recommended, but with overuse they can become boring, so consider revamping your repertoire. You could also consider experimenting with different kinds of lubrication, to explore the new sensations these might generate. If you engage in lovemaking with a partner, be brave enough to discuss the problem and ask for help. And there are many kinds of vibrators out there; cheating on your old one might just do the trick.

• Pamela Stephenson Connolly is a US-based psychotherapist specialising in sexual disorders.

• If you would like advice from Pamela Stephenson Connolly on sexual matters, send us a brief description of your concerns to private.lives@theguardian.com(please don’t send attachments). Each week, Pamela chooses one problem to answer, which will be published online and in print. She regrets that she cannot enter into personal correspondence.