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Dear Dr. Betty,

I am a 20 year old engineering student. For the last two years I have been unable to orgasm when having sex or mutually masturbating with my lover. I can only orgasm alone. This has taken a negative toll on my lover's self-esteem. Lately I have wanted sex less despite having just acquired our own space to play, and he told me that he is now feeling unloved. I think I am turning myself off, before and during sex, with my body image and an unhealthy sexual/romantic upbringing. I just do not know where to start tackling these issues.

As far as my body goes, I have a laundry list of small insecurities, but my biggest insecurity is toenail fungus. I caught fungus from my parents at such a young age that I do not remember having uninfected toenails. I have an aversion to being barefoot or getting my feet near anyone (e.g. 69ing with my lover or resting my ankles on his shoulders), and the feeling of disgust now consumes me when I have sex, barefoot or not. My only sexual insecurity has to do with oral sex and the cleanliness of my vulva due to germs transferring from my anus to my vulvar region.

As for my childhood, my parents shamed my romantic feelings, and, well, feelings in general. While I was in elementary school they would tease me about my crushes, so I learned to keep quiet about romantic interests. My father would brag that I was so successful in school because I had no boyfriends. My mom would interrogate me about boys so she could ultimately trivialize my feelings. Love was something to be ashamed of, a worthless distraction from pursuing career goals and independence.

This shameful feeling carried over to sex. In early high school I thought I was asexual, when in hindsight I was repressing sexual feelings. When I asked a boy out for what would be my first date, I cried for days trying to figure out how I would ask my dad to drive me. My mom has daddy issues, my father is the greatest control freak I have ever met, and both of my parents are alcoholics, so my dysfunctional upbringing goes on, but you get the idea.

Knowing my physical insecurities are trivial in the long run is not enough for me to believe they are trivial in the present. And something in me perceives sex as a waste of time and energy even though I want to connect with my lover. I even find myself shrugging him off when he tries to hug me throughout the day. I know that ultimately I am the one who makes the decisions, changes my actions, and does the work to accept my body, but I have not the faintest clue of where to start. I can hardly think about these things without tearing up and feeling powerless.

Dear J,

Really Darling, toenail fungus is so easy to cure (WebMD) and your concern about having a clean pussy is simply using soap and water in the shower. As for lousy parents, welcome to sexually repressed America because you can't corner the market on that one. America either drinks or prays to compensate for sexual repression.

Not to make light of your struggle but do I detect some self-pity undercurrents? If so, time to count your blessings. Another possibility: perhaps you could use a vacation from your BF to stop worrying about him. That would allow you to focus more on healing your negative body image instead of worrying about him feeling unloved.

It's not fair to punish him for your lousy parenting with a controlling dad. And more self-induced orgasms will shift some of your negative attitudes toward yourself while you have the privilege of studying to be a successful engineer. Let me repeat: Remember to count your blessings. I mean to actually write them down like you did your problems. I suspect they will outweigh all of your past and current complaints. More happy orgasms, please!

Dr. Betty