unPAUSED with Dr. Mary Claire Haver Where Did My Orgasm Go? Menopause, SSRIs, and the Science of Pleasure with Dr. Lauren Streicher
Dec 16, 2025
Dr. Lauren Streicher, a leading expert in sexual medicine and menopause, joins to tackle the mysteries of orgasms in midlife. They dive into why many women experience changes post-menopause and explore the complexities of orgasm anatomy, debunking myths around penetration. With insights on vaginal and cervical orgasms, the impact of SSRIs, and the benefits of vaginal estrogen, Dr. Streicher offers practical advice. She emphasizes the need for better sexual education and encourages self-exploration as a key to reclaiming pleasure.
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What An Orgasm Physically Is
- An orgasm is a physical sequence of pelvic blood flow, nerve signaling to the brain, and pelvic floor muscle release.
- Clitoral stimulation is usually required because those nerves send direct pleasure signals to the brain.
Why PIV Alone Rarely Works
- Most women cannot orgasm from penis‑in‑vagina sex alone because the clitoris is usually the primary organ driving orgasm.
- Vaginal orgasms can come from arousal, cervical stimulation, or a G‑spot plexus, but are uncommon without clitoral input.
Princess Marie Bonaparte's Search
- Princess Marie Bonaparte measured clitoris‑to‑vaginal distance to study why she couldn't orgasm during intercourse.
- She found a ~1 inch distance correlated with ability to orgasm from penetration but her surgeries failed to fix it.
