I'm nearly 21 and have been on an array of SSRI's and SNRI's since I was 13. I was prescribed them months before I was sexually active. I have never had an orgasm and I'm really upset about it. I have a fiancee, but we aren't very sexually active (like it's been over 6 months since we had any sexual interaction). She says its bc she has low sex drive, and we have both put on a significant amount of weight since we got together and she is uncomfortable with her own body (she has no issue with mine, just extremely low body image). It didn't used to bother me, but I've had an increased sex drive for about a year, after I was put on Bupropion XL. I'm also (currently) on Cymbalta, seroquel, and straterra. I recently got off of accutane after going through 6 months of treatment, and I've read about some people having similar sexual side effects from this as SSRI's.

I've kind of tried masturbating before, but I don't really know what I'm doing and I'm uncomfortable trying anything. I'm nonbinary and have a complicated relationship with how my genitals function, somehow it's easier to forget about when I'm doing things with her but I cannot get over it by myself. I have issues getting into it as well, I can't stand porn. I enjoy smut but it's hard finding one right for the moment and it's hard touching myself while trying to read. I also can't just imagine things like some people.

I haven't mentioned this to my psychiatrist, but I'm pretty fucking certain that I wouldn't do well off of my medicine. I was incredibly suicidal when I was put on them and I self harmed for years before and following starting them. I've been going through a rough patch for a few months now as well. Since I'm worried what would happen if I were to stop or even reduce my meds, and I doubt my psych would even be alright with that if I mentioned it, I'm too nervous to mention it. That would also require me saying I've NEVER had an orgasm and that I think I have decreased sensation and sex drive, but I don't have anything to compare it to. So part of me wonders if this is just my normal? I'm also reluctant to mention it due to not being very sexually active and not being very comfortable masturbating, so for any changes made I wouldn't easily be able to notice a difference.

It is pretty upsetting and I don't really see a way to change anything. Do yall have any advice about getting more comfortable being by myself, or how I can try to make my fiancee more confident (not just for sex, I really want her to love herself and its upsetting how shitty of a self image she has. I just have no idea how to change it.), or how to bring this up with my psychiatrist?