I am a 68-year-old man. In the last few years my orgasms have decreased in intensity. They now vary from “That was OK, I guess” to “Oh, I think I felt it.” I still feel desire and excitement during sex, but the climax is often very disappointing. At times the only evidence I have of orgasm is the fact that I have ejaculated. This is gradually tempering my libido and I often only initiate sex to please my partner; I no longer expect any pleasure for myself. What is wrong with me?

It would be wise to seek an evaluation from a physician. Ageing does not cause decreased orgasmic intensity in itself, but dwindling hormones and a number of other conditions or diseases might cause it. Certain medications or supplements – prescribed or otherwise – can lead to all kinds of sexual side-effects, so be sure to seek detailed information about anything you are taking and request a change if necessary. Also consider that psychological issues such as depression can affect a person’s sexual response, as can stress and anxiety … do any of those apply to you? While investigating the cause of your disappointing orgasms, don’t be afraid to advocate strongly for your sexual health and pleasure.

• Pamela Stephenson Connolly is a US-based psychotherapist who specialises in treating sexual disorders.

• If you would like advice from Pamela 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. She regrets that she cannot enter into personal correspondence. Submissions are subject to our terms and conditions.

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