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By msnbc.com contributor
msnbc.com contributor
updated 7/9/2009 8:28:16 AM ET 2009-07-09T12:28:16

What's a woman to do who can't quite attain the Big O? Also, a man fears his wife will leave him for a vibrator. Sexploration answers your queries. Got a question? E-mail us .

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Q. I am a 55-year-old woman. I am fairly attractive and have been separated from my husband for three years after a marriage of 38 years. I seem to stay in a state of arousal all the time, but when I try to bring myself to an orgasm, it builds but I can never “go.” I did this during marriage with better results.

Q. My problem isn’t desire; my boyfriend says I’m insatiable. My issue is with achieving orgasm. I get close, but sometimes I can’t climax. I was wondering if Cialis would be effective since it increases blood flow and might help me orgasm more often.

Q. I am 43 and have three grown children. I don’t think I have ever had an orgasm. I know sex feels good, but nothing like what my friends tell me it feels like. How can I tell if I am having an orgasm?

A. In surveys, about a quarter of American women report some sort of orgasm snafu, either not being able to have one at all (called anorgasmia) or often getting close without being able to take that blissful leap over the edge. Not surprisingly, the leading figures among those who are trying to solve such riddles are all women, like Dr. Marcalee Sipski Alexander (no relation) of the University of Alabama, Cindy Meston of the University of Texas at Austin, and of course, Beverly Whipple, who helped pioneer the effort.

But even they cannot say for sure what makes an orgasm. “As of yet, no definitive explanations for what triggers orgasm have emerged,” states a review of the science authored by Meston, Alexander and others. This is because orgasm is a very complicated dance between the emotions and biology.

So a 55-year-old newly single woman may be affected both by the relationship change and by the biology of menopause. Testosterone levels drop, estrogen levels drop, body systems age, medications may interfere.

Other contributors to orgasm trouble include nicotine (smoking can kill your sex life before it kills you), some anti-depressants, obesity and cardiovascular disease. So stay in shape and lose the extra pounds.

Psychology is important, too. A younger woman may have “insatiable” desire and yet, say, have a body image problem that prevents her from “letting go.” In a study led by Meston, 21 women were shown an erotic video. Some were made more aware of their own bodies through the use of a mirror while others were not. “Results showed that subjective mental sexual arousal and perceptions of physical sexual arousal increased in response to erotica in the Body Awareness condition,” the study found.

Guilt, anxiety, depression, religion, education level, socio-economic level, can all become like bricks in a dam preventing the rush of water from releasing its energy. Behavioral therapy has shown some promise in removing some bricks. Other techniques like sensate focus — practicing intense concentration on the feel of erotic stimulation while blocking other thoughts — has also worked.

Some women have found relief through hormones like topical estrogen and testosterone (though testosterone therapy remains controversial). A suction machine called the Eros Clitoral Therapy Device, available by prescription, has helped some women regain orgasmic ability. It works by engorging the clitoris with blood. An erectile dysfunction drug like Cialis might help, too, but it hasn’t been proven to do so in women.

Sometimes difficulty with orgasm can feed on itself, like insomnia. Just as after a sleepless night, you can become anxious about falling asleep the next night, after having trouble with an orgasm, your head can be full of worries about having an orgasm.

Many therapists suggest practice, practice, practice with vibrators or fingers or whatever works. Go solo at first so there is no pressure to perform. The last thing you want is for a lover to lose patience and switch on an old episode of "Green Acres."

To know if you have actually had an orgasm isn’t always easy; some are mild tremors, some are major earthquakes. Here is one definition used by experts like Meston and the World Health Organization: 10 surprising sex statistics

“Orgasm in the human female is a variable, transient peak sensation of intense pleasure, creating an altered state of consciousness, usually with an initiation accompanied by involuntary, rhythmic contractions of the pelvic striated circumvaginal musculature, often with concomitant uterine and anal contractions, and myotonia that resolves the sexually induced vasocongestion and myotonia, generally with an induction of well-being and contentment.”

Sexy, no? The “altered state of consciousness” seems a little vague, but a female pal says that in her altered state she sees God and he looks just like Johnny Depp.

Q. I am wondering if vibrators can have an unintended side effect. It seems to me that after a woman starts using a vibrator, foreplay and intercourse will not be able to stimulate the clitoris as intensely as the vibrator does. I ask because this has happened with my wife and me. I thought it was just us, but then a few other friends have brought this up. All of the wives went to the same vibrator party, so were all introduced to vibrators at the same time. [She gets] very aroused and excited as before, but then does not orgasm very often anymore.

A. So, did you talk about this while cooking bratwurst at the neighborhood Fourth of July barbecue? We here at Sexploration are just curious how the topic came up.

Your wives, newly enamored with having a lover who won’t wear out until the AA batteries do, will find they have once again become just as sensitive as ever to your touch if they simply idle the vibrators for a few days. While a vibrator can numb a clitoris for a very short time, like minutes, the probable cause of the trouble is that they create a different sensation. This is good; it expands the menu. But if a woman comes to expect that same feeling to always be the one that pushes her over the edge, she can become frustrated. So keep the toys in the sock drawer for a little while and then slowly integrate them again.

Brian Alexander is the author of the book “America Unzipped: In Search of Sex and Satisfaction," now in paperback.

© 2013 msnbc.com.  Reprints

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