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Sexual Health & Intimacy

Enhancing Female Orgasm
Solutions for Providers and Patients

Susan Kellogg-Spadt, CRNP, PhD; Jennifer Giordano, EdD, NCC

Recognition of female sexual dysfunction (FSD) as a valid medical concern has come of age. More than 40 million American women, or 43%, are affected by some form of FSD,¹ including sexual pain, inhibited desire, disordered arousal, or the condition on which this article focuses: inhibited orgasm.

A Source of Distress
Increasingly, women's health care providers are called upon to diagnose and manage complaints of inhibited orgasm in the course of routine gynecologic office practice. Furthermore, women now tend to initiate much more dialogue about treatment options than in previous years and demonstrate equal tenacity in finding therapies that address their needs. Provider competency in this area is often dependent upon the differential diagnoses of the dysfunction and familiarity with new modalities that can be used to enhance female orgasm. According to the American Foundation for Urologic Disease Consensus Panel Classifications and Definitions of Female Sexual Dysfunction, orgasmic disorders involve the persistent or recurrent difficulty, delay in, or absence of attaining orgasm following sufficient sexual stimulation and arousal that causes personal distress.

Although etiologies of orgasmic dysfunction vary, and can have origins that are vasculogenic, neurologic, endocrinologic, musculogenic, or psychogenic, several treatment options now abound.

Nonmedical Treatments
In women experiencing inhibited orgasm that is nonbiologic in origin, nonpharmacologic therapies are often the most advisable.

Exercise
Physical activity, particularly the type that involves the large muscles of the thighs and buttocks, increases blood flow throughout the pelvis and genital region. Researchers suggest that 20 minutes of vigorous cycling can enhance sensation, lubrication, arousal and intensity of orgasm.

Relationship Therapy
An optimal approach to the management of FSD involves both medical and psychosexual intervention. The mental and physical context within which women experience arousal and orgasm are often as or more important than the physical changes associated with arousal and orgasm. No quantity of cream, oils, or tablets can change an unsatisfactory relationship. Specific counseling with the couple, rather than with a single partner, is often highly efficacious.

Prescription Approaches
Medicinal
Previous studies report conflicting results regarding the usefulness of the popular erectile dysfunction drug, Viagra (sildenafil), in treating FSD. Current recommendations by sexual medicine practitioners suggest that sildenafil may have a role in enhancing sexual arousal when women, particularly those in the postmenopausal age group, and studies of this agent in the treatment of inhibited orgasm are forthcoming.

Mechanical
The EROS-CTD is hand-held pump device that is attached to a tiny plastic clitoral "cup" was one of the first FDA-approved treatments of FSD. It stimulates clitoral and labial blood flow via self-applied suction. Early clinical studies reported a 90% increase and sensation and a 55% increase in ability to achieve orgasm among 12 women who used the device four times per week.

Nonprescriptive Approaches
Several orgasm-enhancing topical and oral formulations have become available in the past year. Most products are marketed via Web sites or in local health food stores. Patients should be warned that controlled clinical testing of nonprescription agents may be lacking and that, although Web sites supply the consumer with information about efficacy and side effects, these products should only be used in consultation with a health care provider. Also, health care providers should become familiar with these products so they can recognize signs and symptoms of patient use and abuse. The following are prosexual products that have been recently popularized by the lay press.

• Viacreme contains the amino acid, L arginine, in a menthol cream base. L-arginine functions as a precursor to the formation of nitric oxide, which mediates the relaxation of vascular and nonvascular smooth muscle, enhancing clitoral engorgement and lubrication. The menthol base confers a cool sensation to the genitals and may irritate sensitive mucosa when applied overzealously.
• Prosensual is a topical lubricant containing natural mint, orange, and clove oils and confers a gentle tingling and warmth when applied to the male and/or female genitals.
• Zestra for Women is a vasoactive topical feminine massage oil that contains "scientifically studied botanicals" including borage seed oil. Early placebo-controlled clinical trials suggest positive effects on female arousal and orgasm, although some anecdotal reports describe the odor of the product as unpleasant
• Arginmax is an oral dietary supplement containing L-arginine, damiana, and small amounts of ginseng and ginkgo biloba. Preliminary double-blind placebo-controlled studies report 70% to 75% of female subjects note significant improvement in sexual responsiveness after 4 weeks of daily use. Patients should be informed that supplementation with L-arginine has been associated with perpetuation of oral and genital herpes outbreaks.

Conclusion
The development of new methods for treating inhibited orgasm and FSD is an exciting and long-awaited occurrence in health care. Due to time constraints or discomfort in talking about sexual issues, many women may elect to self-treat rather than consult their clinicians about sexual enhancement. This suggests a need for incorporation of inquiry about use of nonprescriptive prosexual agents into routine sexual history taking.

As clinical trials of orgasmic dysfunction continue to be conducted, patients and their health care providers will have a greater understanding of both the condition itself and its effective treatment.

References

1. Berman JR, Berman L, Goldstein I. Female sexual dysfunction: incidence, pathophysiology, evaluation and treatment options. Urology. 1999;54:385-391.
2. Shabsigh R. Prevalence and recent developments in female sexual dysfunction. Curr Psychiatry Rep. 2001; 3(3):188-94.
3. Berman JR, Berman LA, Lin H, Marley C, Goldstein I. Female sexual dysfunction: new perspectives on anatomy, physiology, evaluation and treatment. AUA Update Series. 2000;34:266-271.
4. Berman J, Berman L. For Women Only: A Revolutionary Guide to Reclaiming Your Sex Life. New York, NY: Henry Holt & Company, 2001.
5. Dattilio F, Padesky C. Sarasota, Florida:Cognitive Therapy with Couples. Professional Resource Exchange, Inc, 1990.]
6. Berman JR, Berman LA, Lin H, et al. Effect of sildenafil on subjective and physiologic parameters of the female sexual response in women with sexual arousal disorder. J Sex Marital Ther. 2001;27(5):411-420.
7. Billups K, Berman L, Berman J, Metz M, Glennon M, Goldstein I. A new nonpharmacological vacuum therapy for female sexual dysfunction. J Sex Marital Therapy. 2001;27:435-441.
8. Steidle C, Singh G, Alexander S, Weihmiller K, Ferguson D, Crosby M. Randomized placebo-controlled, double-blind, crossover design pilot trial of the efficacy and safety of Zestra for Women in women with female sexual arousal disorder. Boston, Mass: The Female Sexual Function Forum; 2001.

Jennifer L. Giordano, EdD, NCC, is a sexologist and intimacy management specialist, The Pelvic Floor Institute, Graduate Hospital, Philadelphia, Pa. Susan Kellogg-Spadt, CRNP, PhD, is an OB/GYN nurse practitioner and director of sexual medicine, and Jennifer Giordano, EdD, NCC, is a cognitive-behavioral therapist and sexologist. Both are employed at The Pelvic Floor Institute, Graduate Hospital, Philadelphia, Pa.

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