Pharmacological Approaches

Of the few placebo-controlled studies examining the effectiveness of pharmacological agents for treating female orgasmic disorder, most examine the efficacy of agents for treating antidepressant-induced anorgasmia. Whether pharmacological agents would have the same treatment outcome effect on non-drug- vs. druginduced anorgasmia is not known.

Modell reported no significant effect beyond placebo of either 150 or 300 mg/day bupropion-SR on orgasm in 20 women with delayed or inhibited orgasm. Ito conducted a double-blind, placebo-controlled study of ArginMax, a nutritional supplement comprising ginseng, Ginkgo biloba, Damiana leaf, and various vitamins, on sexual function in 77 women with unspecified sexual function. Approximately 47% of women treated with ArginMax reported an increase in the frequency of orgasm compared with about 30% of women treated with placebo—a marginally significant group difference. It cannot be determined from the report how many women would meet a clinical diagnosis for anorgasmia. To date, there have been no published placebocontrolled studies on sildenafil for female anorgasmia and findings from uncontrolled studies are equivocal. In an open-label trial, Kaplan reported a very modest 7.4% improvement in orgasm at 12 weeks with 50 mg sildenafil. Participants were 30 post-menopausal women with self-reported mixed sexual dysfunction.

As noted earlier, there is a high incidence of adverse sexual side effects noted with antidepressant treatment. A number of pharmacological agents have been prescribed along with the antidepressant medication in an effort to help counter these effects. Some such drugs include antiserotonergic agents such as cyproheptadine, buspirone, mirtazapine, and granisetron; dopaminergic agents such as amantadine, dextroamphetamine, bupropion, methylphenidate, and pemoline; adrenergic agents such as yohimbine and ephedrine; cholinergic agents such as bethanechol; and the selective cyclic-GMP catabolism inhibitor sildenafil. A number of case reports and open-label studies report success in alleviating SSRI-induced anorgasmia with some of these agents. Findings from the few placebo-controlled studies published are less optimistic. Michelson examined the comparative effects of 8 weeks of treatment with buspirone (n = 19), amantadine (n = 18), or placebo (n = 20) on fluoxetine-induced sexual dysfunction in premenopausal women reporting either impaired orgasm or sexual arousal. The authors reported all groups experienced an improvement in orgasm during treatment, but neither buspirone nor amantadine was more effective than placebo in restoring orgasmic function. It should be noted, however, that the doses of buspirone (20 mg/day) and amantadine (50 mg/day) administered were very low. At a higher dose level (mean daily dose = 47 mg), buspirone showed a marginally significant alleviation of sexual side effects in women taking either citalopram or paroxetine compared with placebo. The authors did not distinguish between orgasm and desire disorders in either the classification of patients or treatment outcome. In a randomized, double-blind, parallel, placebocontrolled study of mirtazapine (15 mg/day), yohimbine (5.4 mg/day), olanzapine (0.25 mg/day), or placebo for fluoxetine-induced sexual dysfunction, Michelson found no significant improvement in orgasmic ability beyond placebo in 107 women with either impaired orgasm or vaginal lubrication. Kang reported no significant effect of Gingko biloba beyond placebo in a small group of women with SSRI-induced sexual dysfunction. Meston reported no significant effect of ephedrine (50 mg, 1 h prior to intercourse) beyond placebo on orgasmic function in 19 women with sexual side effects secondary to fluoxetine, sertraline, or paroxetine treatment. The study was conducted using a randomized, double-blind, placebo-controlled, cross-over design. In summary, to date there are no pharmacological agents proven to be beneficial beyond placebo in enhancing orgasmic function in women.

Conclusions

We conclude that DM is an empirically valid and efficacious treatment for lifelong female orgasmic disorder. To date, there are no empirically validated treatments for acquired female orgasmic disorder. Anxiety reduction techniques such as sensate focus and systematic desensitization have not been shown to be efficacious for treating either lifelong or acquired female orgasmic disorder. Anxiety reduction techniques may serve as beneficial adjuncts to therapy if the woman is experiencing a high level of anxiety. There is no direct empirical evidence to suggest that sex education, communication skills training, or Kegel exercises alone are effective for treating either lifelong or acquired female orgasmic disorder. Of the few studies examining the effects of pharmacological agents for female orgasmic disorder, none have been shown to be more effective 208 Meston and Levin than placebo. Placebo-controlled research is essential to examine the effectiveness of agents with demonstrated success in case series or open-label trials (i.e., sildenafil, testosterone) on orgasmic function in women.