‘Antidepressants stole my orgasm. Can a four-week sex therapy course bring it back?’

I’m lying down in bed, fan on, vibrator to the left of me, and phone in hand, ready to attempt an orgasm while my husband is out at a gig.

Then I bolt upright and squint at the screen. Dr Laurie Mintz is holding up a plush vulva, making sweeping motions with one hand to indicate where exactly I should touch myself. I need to watch this closely.

I’m midway through a five-module course that’s teaching me how to orgasm again. While I’m raring to go and tick off the practical homework (practices include instructing my partner, listening to erotic stories, and experimenting with different vibrators), it turns out I need to get to grips with the basics first.

Going years without an orgasm can make you feel like a total beginner. When I first started taking fluoxetine for my depression in 2017, I noticed early on that my experience of sexual pleasure took a hit. Any desire for sex disappeared. Clitoral stimulation felt akin to having my elbow rubbed. Orgasms were simply not a thing.

But when I scoured the pamphlet in my medication box, sex wasn’t mentioned once in the lengthy list of potential side effects. I searched online but found the majority of advice was focused on men’s experiences. When I developed the courage to discuss it with my GP, they were dismissive, suggesting that perhaps I was just experiencing a sexual lull in a long-term relationship. I took that view as gospel and settled into an assumption that enjoyable sex just wasn’t for me.

It took a toll on my relationship — I had no sex drive, and when I did have sex, I didn’t get anything from it, which in turn didn’t make me want to have sex, and on and on the cycle went. I considered options but ultimately decided to put up with it, accepting the loss of sexual pleasure and desire as a worthwhile sacrifice for respite from near-constant suicidal ideation.

Then I spoke to sex therapist Laurie Mintz, who told me that she and her friend, Suzette Johnson, an obstetrician and gynaecologist, had launched a new course with Mojo (a platform offering in-app courses to resolve common sex and relationship issues) and wondered if I might be interested in trying it. That course was ‘Rebuild Your Orgasm’, a month-long series of educational videos, practical exercises, and conversations with an AI therapist, through the Mojo app. The course is not solely for women for whom SSRIs have stolen orgasms, but for women struggling with the common reasons for a decline in the ability to climax: “menopause and extreme stress”, as Mintz explains.

Hence how I ended up back in bed with a vibrator, this time listening to a fictional Scottish man named Lochlan telling me to take my clothes off.

It’s long been known that SSRIs can have an impact on women’s sexual pleasure, but it’s an issue that’s rarely discussed. “While antidepressants can be life-changing for many people, some, particularly SSRIs, can interfere with sexual function,” explains Johnson. “Increased serotonin can dampen the excitatory systems in the brain — dopamine, norepinephrine, and oxytocin (neurotransmitters) involved in desire, arousal, and orgasm. Women commonly report reduced libido, difficulty becoming aroused, delayed orgasm, or the inability to reach orgasm altogether.”

Beyond this, there’s a significant orgasm gap between men and women, with straight women the least likely to experience orgasm. There are complex reasons for this — the emphasis on penetration rather than clitoral stimulation, for example, challenges with self-esteem, the difficulty of pleasure in lives that are packed with stress, overthinking, and constant distraction — and it’s worth noting that sexual pleasure isn’t wholly reliant on orgasm.

We can’t place the blame for a lack of sexual pleasure entirely on antidepressants’ door… but when we know that there’s an extremely common contributor to this problem (antidepressant prescriptions in the UK are at a record high, and women are far more likely to be prescribed SSRIs than men), it feels essential that we discuss it, interrogate it, and arm women with solutions.

Mintz herself has experience with SSRI-induced orgasm loss — something, as a sex therapist and orgasm expert, she found particularly devastating. “I’ve always been orgasmic,” Mintz tells me. “Orgasms are such a part of my whole life and who I am. It’s part of my identity.” For decades, Mintz has been guiding other women on how to have pleasurable sex; the female orgasm is kinda her thing. She even published a book on the topic, Becoming Cliterate, and is known as one of the world’s leading experts on women’s sexual pleasure. So, when she went even just a few weeks without having an orgasm, it felt like the wheels had come off of her life.

And so, Mintz decided to take action. She immediately dived into research to work out what would help and realised that while she had the psychological component of a treatment plan covered, she’d need some assistance on how to fix the physical side of what was going on. So she called up Johnson, who had also been through something similar — and knew exactly what to do.

She prescribed Mintz a cream made up medical compounds that function to increase blood flow and sensitivity; sildenafil (better known as Viagra, which works by increasing blood flow), theophylline (a lung medication that has a side use relaxing muscles and increasing circulation), l-arginine (an amino acid that’s used to support heart health, athletic performance, and to treat erectile dysfunction), pentoxifylline (typically used to treat vascular disease, but again with a side benefit of increasing circulation), and ergoloid mesylates (thought to trigger dopamine and serotonin and boost blood flow specifically in the brain, although the evidence base for this is shaky). For Mintz, the cream in combination with the psychological techniques she’d spent years honing ended up being transformative.

“My husband and I had sex and I had an orgasm like I was 20 again,” Mintz shares. “It was better than ever.”

Mintz was amazed. She and Johnson realised they wanted to spread the word. Both had encountered numerous clients struggling with orgasm loss as a result of SSRIs, and had a eureka! moment: what if they could work together to connect the psychological and physical triggers of orgasm loss and create a treatment plan that really worked? Could they help all the women out there struggling?

“We knew we wanted women to know there were options, instead of being told either be depressed or don’t have an orgasm,” Mintz says.

US residents can purchase the course along with Mintz and Johnson’s formulation of the cream they found so incredible, called OH! Cream. Unfortunately, those outside of the US (like me!) can’t get the exact cream the experts recommend, but there are products with similar chemical make-ups that can do the same job. These work to increase blood flow, which Mintz explains to me in our chat and through the course’s videos, is an essential part of the female orgasm. The good news is that if, like me, you’re not able to access the cream, there are other methods you can use, such as vibrators or — as silly as it might sound — doing a few star jumps before you get down to foreplay.

In case you’re confused (I was, too), the star jumps increase your heart rate and thus get blood moving around the body. As Mintz explained to me, the physical process of orgasm is simply muscles contracting and then releasing, to flood the brain with feel-good hormones. This requires blood to be pumping through the arteries and making its way to the clitoris, labia, and the walls of the vagina, upping sensitivity as well as causing contractions of the muscles.

Despite not having access to the cream, I found that with these other methods and the psychological treatment offered in the course, I still experienced results. Over a few quick sessions in an app, I learned about the physical mechanics of orgasm, unlearned the shame I was holding on to for being unable to orgasm, had conversations with my husband I would never have had prior (about the positions I’d like to try, the sensations that worked best for me, and the fantasies I’d like to experiment with, but also about the truth of what my SSRIs had done to my sexual pleasure), understood the power of vibrators, employed mindfulness techniques, and got in touch with fantasies through audio erotica.

Meanwhile, the guided mindfulness sessions and instructions to dedicate time to solo play functioned as the push I needed to actually do what I knew on a subconscious level would be worth my time. I’m nothing if not a teacher’s pet, so having someone else tell me masturbation was a compulsory component of a course allowed me to forget any productivity guilt and commit with full vim. I listened to all the audio erotica like any overachiever would, and figured out that grinding sensations combined with fantasies around light domination do the trick for me — which I was then able to communicate to my partner (we swapped to a me on top position).

I know what the big question will be: did you climax? The answer is: not yet… but it feels closer than ever. And in the meantime, I’m enjoying sex again. I’ve stunned my partner by actually initiating sex — now that I’ve learned it can be pleasurable again, my desire has gone way up. The biggest change, as dramatic as it might sound, is that I have hope again. It turns out I’m not broken or forever changed by SSRIs. I can have enjoyable sex and take medication that benefits my mental health.

I asked Mintz and Johnson what they would recommend to other women who are struggling with sex due to SSRI use. They obviously suggested their course, noting that it’s rare in that it addresses all components of the biopsychosocial nature of sexual function. But they also offer up five essential steps — read on to find out.

“Vibrators get blood flowing, and the orgasm is all about blood flow,” explains Mintz. “It’s the blood flowing to the erectile tissue of your clitoris and then being released with rhythmic contractions of the pelvic floor. We know vibrators work for a biological reason. We have special receptors on our vulva that respond specifically to vibration.”

Orgasm loss can happen for multiple different reasons. There might be physical issues, mental blockers, emotional blockers. And so regaining orgasm will need to cover all these factors, too. It’s vital you understand that.

Johnson says: “Sexual function is biopsychosocial. It’s rarely just about hormones, blood flow, or the brain alone.”

Mintz explains that wetness and arousal are super connected in our minds, so when we kickstart wetness with a lube it can give our brains a nudge. It’s almost like tricking ourselves into thinking we’re already aroused.

“Adding a good lubricant can also make stimulation more comfortable and pleasurable, especially if dryness is contributing to the problem,” Johnson notes.

Give yourself proper time and space to explore pleasure on your own. What works for you might have changed — that’s okay! Getting to know what turns you on is well worth doing… and it’s fun, too.

“Women should not assume they simply have to live with orgasm difficulties,” Johnson says. “Whether the cause is antidepressants, hormonal changes, stress, relationship

factors, or a combination of these factors, there are solutions available.”

The Rebuild Your Orgasm course is available through Mojo now.

Ellen Scott is a freelance writer and editor covering all things lifestyle, royals, celebrities, and entertainment for Good Housekeeping. As the author of Working On Purpose, she’s an expert in the world of careers, and previously covered features on everything from relationships to mental health for Stylist and Metro.  

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