Content written by Irwin Goldstein MD

Women may experience inability to achieve an orgasm, or have great difficulty achieving a rather muted form of sexual orgasm. Such cases of orgasmic dysfunction may be primary and lifelong; or secondary and acquired. Some women experience distress from their orgasmic dysfunction and may seek treatment to improve sexual function.

There appears to be a balance between psychologic and physiologic factors involved in the facilitation and inhibition of brain centers involved in the regulation of orgasm within the central nervous system. Neurochemicals recognized in the facilitation of the orgasmic response include dopamine, oxytocin, noradrenalin, and melanocortins. Neurochemicals recognized in the inhibition of the orgasmic response include serotonin, prolactin, opioids and endocannabinoids.

In women with early or premature orgasmic concerns, the balance may be towards facilitation with a lack of inhibition of the orgasmic reflex. For example, a woman with persistent genital arousal disorder responsive to varenicline tartrate may have had a hyperdopaminergic release from certain brain centers. In that woman, the drug varenicline tartrate may have acted to re-establish more normative orgasmic function by reducing the hypothesized excess dopamine facilitation.

In women with primary and lifelong, or secondary and acquired inability to achieve an orgasm, or who have great difficulty achieving a rather muted form of sexual orgasm,the balance may be towards inhibition with a lack of facilitation of the orgasmic reflex. Such cases of orgasmic dysfunction may be due to low concentrations of central facilitation neurochemicals such as noradrenalin, or to excess inhibitory neurchemicals such as serotonin.

Yohimbine hydrochloride, currently an FDA-approved treatment for men with erectile dysfunction, is a selective competitive alpha ?2-adrenergic receptor blocker that has central activity and crosses the blood-brain barrier. Yohimbine hydrochloride may have a facilitatory action on orgasmic dysfunction by reducing the threshold for orgasm facilitation in the part of the brain called the forebrain.

In a study of men with orgasmic dysfunction, yohimbine hydrochloride treatment was successful in 55% concluding that yohimbine hydrochloride may represent a pharmacologic strategy for restoring orgasms that is relatively free from serious side effects. In this study, it was noted that yohimbine hydrochloride was not well absorbed from the stomach, so oral administration was recommended on a relatively empty stomach several hours after a meal. Yohimbine hydrochloride was also rapidly cleared, so oral administration was recommended about one half hour to one hour prior to sexual activity. Side effects included an increase in pulse rate and blood pressure, palpitations, tremor of the hands, facial flushing, anxiety, malaise and headache. More research is needed with yohimbine hydrochoride in women with orgasmic dysfunction.