Archives of Sexual Behavior

, Volume 31, Issue 4, pp 323–332 | Cite as

The Effects of Yohimbine Plus L-arginine Glutamate on Sexual Arousal in Postmenopausal Women with Sexual Arousal Disorder

  • Cindy M. Meston
  • Manuel Worcel


This study examined the effects of the nitric oxide-precursor L-arginine combined with the α2-blocker yohimbine on subjective and physiological sexual arousal in postmenopausal women with Female Sexual Arousal Disorder. Twenty-four women participated in three treatment sessions in which self-report and physiological (vaginal photoplethysmograph) sexual responses to erotic stimuli were measured following treatment with either L-arginine glutamate (6 g) plus yohimbine HCl (6 mg), yohimbine alone (6 mg), or placebo, using a randomized, double-blind, three-way cross-over design. Sexual responses were measured at approximately 30, 60, and 90 min postdrug administration. The combined oral administration of L-arginine glutamate and yohimbine substantially increased vaginal pulse amplitude responses to the erotic film at 60 min postdrug administration compared with placebo. Subjective reports of sexual arousal were significantly increased with exposure to the erotic stimuli but did not differ significantly between treatment groups.

yohimbine L-arginine female sexual arousal photoplethysmography nitric oxide adrenergic 


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  1. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text revision). Washington, DC: Author.Google Scholar
  2. Andersson, K. E., & Wagner, G. (1995). Physiology of penile erection. Physiological Reviews, 75, 191-236.Google Scholar
  3. Ashton, A. K. (1999). Sildenafil treatment of paroxetine-induced anorgasmia in woman [Letter]. American Journal of Psychiatry, 156, 800.Google Scholar
  4. Ashton, A. K., & Bennett, R. G. (1999). Sildenafil treatment of serotonin reuptake inhibitor-induced sexual dysfunction [Letter]. Journal of Clinical Psychiatry, 60, 194-195.Google Scholar
  5. Boolell, M., Allen, M. J., Ballard, S. A., Gepi-Attee, S., Muirhead, G. J., Naylor, A. M., et al. (1996). Sildenafil: An orally active type 5 cyclic GMP-specific phosphodiesterase inhibitor for the treatment of penile erectile dysfunction. International Journal of Impotence Research, 6, 47-52.Google Scholar
  6. Burnett, A. L. (1995). Role of nitric oxide in the physiology of erection. Biology of Reproduction, 5, 485-489.Google Scholar
  7. Burnett, A. L. (1997). Nitric oxide in the penis: Physiology and pathology. Journal of Urology, 157, 320-324.Google Scholar
  8. Burnett, A. L., Calvin, D. C., Silver, R. I., Peppas, D. S., & Docimo, S. G. (1997). Immunohistochemical description of nitric oxide synthase isoforms in human clitoris. Journal of Urology, 158, 75-78.Google Scholar
  9. Chen, J., Wollman, Y., Chernichovsky, T., Iaina, A., Sofer, M., & Matzkin, H. (1999). Effect of oral administration of high-dose nitric oxide donor L-arginine in men with organic erectile dysfunction: Results of a double-blind, randomized, placebo-controlled study. BJU International, 83, 269-273.Google Scholar
  10. Derry, F. A., Dinsmore, W. W., Fraser, M., Gardner, B. P., Glass, C. A., Maytom, M. C., et al. (1998). Efficacy and safety of oral Sildenafil (Viagra) in men with erectile dysfunction caused by spinal cord injury. Neurology, 51, 1629-1633.Google Scholar
  11. Dinsmore, W. W., Hodges, M., Hargreaves, C., Osterloh, I. H., Smith, M. D., & Rosen, R. C. (1999). Sildenafil citrate (Viagra) in erectile dysfunction: Near normalization in men with broad-spectrum erectile dysfunction compared with age-matched healthy control participants. Urology, 53, 800-805.Google Scholar
  12. Ende, N., Gertner, S. B., Hwang, S. G., & Kadi, R. S. (1989). Measurement of postcoital sympathetic activity in females by means of vanillylmandelic acid. Hormones and Behavior, 23, 150-156.Google Scholar
  13. Everaerd, W., & Laan, E. (2000). Drug treatments for women's sexual disorders. Journal of Sex Research, 37, 195-204.Google Scholar
  14. Exton, M. S., Bindert, A., Kruger, T., Scheller, F., Hartmann, U., & Schedlowski, M. (1999). Cardiovascular and endocrine alterations after masturbation-induced orgasm in women. Psychosomatic Medicine, 61, 280-289.Google Scholar
  15. Fugl-Meyer, A. R., & Sjogren Fugl-Meyer, K. (1999). Sexual disabilities, problems, and satisfaction in 18-74 year old Swedes. Scandinavian Journal of Sexology, 3, 79-105.Google Scholar
  16. Giuliano, F., Hultling, C., El Masry, W. S., Smith, M. D., Osterloh, I. H., Orr, H., et al. (1999). Randomized trial of Sildenafil for treatment of erectile dysfunction in spinal cord injury. Annals of Neurology, 46, 15-21.Google Scholar
  17. Goldstein, I., & Berman, J. (1998). Vasculogenic female sexual dysfunction: Vaginal engorgement and clitoral erectile insufficiency syndrome. International Journal of Impotence Research, 8, S84-S90.Google Scholar
  18. Goldstein, I., Lue, T. F., Padma-Nathan, H., Rosen, R. C., Steers, W. D., & Wicker, P. A. (1998). Oral Sildenafil in the treatment of erectile dysfunction. New England Journal of Medicine, 338, 1397-1404.Google Scholar
  19. Govier, F. E., McClure, R. D., Weissman, R. M., Gibbons, R. P., Prichett, T. R., & Kramer-Levien, D. (1993). Experience with triple-drug therapy in a pharmacological erection program. Journal of Urology, 150, 1822-1824.Google Scholar
  20. Hackbert, L., Heiman, J. R., & Meston, C. M. (1998, June). The effects of DHEA on sexual arousal in postmenopausal women. Poster session presented at the annual meeting of the International Academy of Sex Research, Stony Brook, NY.Google Scholar
  21. Heiman, J. R., & Rowland, D. L. (1983). Affective and physiological sexual response patterns: The effects of instructions on sexually functional and dysfunctional men. Journal of Psychosomatic Research, 27, 105-116.Google Scholar
  22. Klotz, T., Mathers, M. J., Braun, M., Bloch, W., & Engelmann. U. (1999). Effectiveness of oral L-arginine in first line treatment of erectile dysfunction in a controlled crossover study. Urologia Internationalis, 63, 220-223.Google Scholar
  23. Laan, E., Everaerd, W., & Evers, A. (1995). Assessment of female sexual arousal: Response specificity and construct validity. Psychophysiology, 32, 476-485.Google Scholar
  24. Laan, E., van Lunsen, R. H.W., Everaerd, W., Heiman, J. R., & Hackbert, L. (2000, June). The effects of Sildenafil on women's genital and subjective sexual response. Paper presented at the annual meeting of the International Academy of Sex Research, Paris, France.Google Scholar
  25. Laumann, E. O., Gagnon, J. H., Michael, R. T., & Michaels, S. (1994). The social organization of sexuality: Sexual practices in the United States. Chicago: University of Chicago Press.Google Scholar
  26. Laumann, E. O., Paik, A., & Rosen, R. C. (1999). Sexual dysfunction in the United States: Prevalence and predictors. Journal of the American Medical Association, 281, 537-544.Google Scholar
  27. Lebret, T., Herve, J. M., Barre, P., Lugagne, P. M., & Botto, H. (2000). Safety and efficacy of the combination of arginine and yohimbine for the treatment of erectile dysfunction. A controlled human trial. Proceedings from the Third meeting of the European Society for Impotence Research. (ESIR), p. 23.Google Scholar
  28. Levin, R. J. (1991). VIP, vagina, clitoral and periurethral glans:Anupdate on female genital arousal. Experimental and Clinical Endocrinology, 98, 61-69.Google Scholar
  29. Levin, R. J. (1992). The mechanisms of human female sexual arousal. Annual Review of Sex Research, 3, 1-48.Google Scholar
  30. Lindal, E., & Stefansson, J. G. (1993). The lifetime prevalence of psychosexual dysfunction among 55 to 57-year-olds in Iceland. Social Psychiatry and Psychiatric Epidemiology, 28, 91-95.Google Scholar
  31. Marks, L. S., Duda, C., Dorey, F. J., Macairan, M. L., & Santos, P. B. (1999). Treatment of erectile dysfunction with Sildenafil. Urology, 53, 19-24.Google Scholar
  32. Mazer, N. A., Leiblum, S. R., & Rosen, R. C. (2000). The brief index of sexual functioning for women (BISF-W): A new scoring algorithm and comparison of normative and surgically menopausal populations. Menopause, 7, 350-363.Google Scholar
  33. Meston, C. M. (2000). The psychophysiology of female sexual arousal. Journal of Sex Education and Therapy, 25, 6-16.Google Scholar
  34. Meston, C. M., & Gorzalka, B. B. (1995). The effects of sympathetic activation on physiological and subjective sexual arousal inwomen. Behaviour Research and Therapy, 33, 651-664.Google Scholar
  35. Meston, C. M., & Gorzalka, B. B. (1996). The differential effects of sympathetic activation on sexual arousal in sexually functional and dysfunctional women. Journal of Abnormal Psychology, 105, 582-591.Google Scholar
  36. Meston, C. M., Gorzalka, B. B., & Wright, J. M. (1997). Inhibition of subjective and physiological sexual arousal in women by clonidine. Journal of Psychosomatic Medicine, 59, 399-407.Google Scholar
  37. Meston, C. M., & Heiman, J. R. (1998). Ephedrine-activated sexual arousal in women. Archives of General Psychiatry, 55, 652-656.Google Scholar
  38. Meston, C. M., & Heiman, J. R. (2002). Acute dehydroepiandrosterone effects on sexual arousal in premenopausal women. Journal of Sex and Marital Therapy, 28, 53-60.Google Scholar
  39. Meston, C. M., Moe, I. E., & Gorzalka, B. B. (1996). The effects of sympathetic inhibition on sexual behavior in the female rat. Physiology and Behavior, 59, 537-542.Google Scholar
  40. Montorsi, F., McDermott, T. E., Morgan, R., Olsson, A., Schultz, A., Kirkeby, H. J., et al. (1999). Efficacy and safety of fixed-dose oral Sildenafil in the treatment of erectile dysfunction of various etiologies. Urology, 53, 1011-1018.Google Scholar
  41. Munarriz, R., Talakoub, L., Garcia, S. P., Sarkissian, E., Gioia, L., Hoag, M., et al. (2001, October). Dehydroepiandrosterone (DHEA) treatment for female androgen insufficiency sexual dysfunction: Baseline and post-treatment sexual questionnaire outcome data in those patients with restored androgen values. Presented at the annual meeting of the Female Sexual Function Forum, Boston, MA, Poster.Google Scholar
  42. Nurnberg, H. G., Hensley, P. L., Lauriello, J., Parker, L. M., & Keith, S. J. (1999). Sildenafil for women patients with antidepressant-induced sexual dysfunction. Psychiatric Services, 50, 1076-1078.Google Scholar
  43. Padma-Nathan, H. (2000, July). Hemodynamic effects of the oral administration of a combination of arginine and yohimbine measured by color duplex ultrasonography in men with erectile dysfunction. Presented at the annual meeting of the European Society for Impotence Research, Poster.Google Scholar
  44. Padma-Nathan, H., Steers, W. D., & Wicker, P. A. (1998). Efficacy and safety of oral Sildenafil in the treatment of erectile dysfunction: A double-blind, placebo-controlled study of 329 patients. International Journal of Clinical Practice, 52, 375-379.Google Scholar
  45. Park, K., Moreland, R. B., Goldstein, I., Anthony, A., & Traish, A. (1998). Sildenafil inhibits phosphodiesterase type 5 in human clitoral corpus cavernosum smooth muscle. Biochemical and Biophysical Research Communications, 249, 612-617.Google Scholar
  46. Rosen, R. C., Taylor, J. F., Leiblum, S. R., & Bachmann, G. A. (1993). Prevalence of sexual dysfunction in women: Results of a survey of 329 women in an outpatient gynecological clinic. Journal of Sex and Marital Therapy, 19, 171-188.Google Scholar
  47. Saenz de Tejada, I., Garvey, D. S., Schroeder, J. D., Shelekhin, R., Lettss, L. G., Fernandez, A., et al. (1999). Design and evaluation of nitrosylated alpha-adrenergic receptor antagonists as potential agents for the treatment of impotence. Journal of Pharmacology and Experimental Therapeutics, 290, 121-128.Google Scholar
  48. Schiavi, R. C., & Segraves, R. T. (1995). The biology of sexual function. Psychiatric Clinics of North America, 18, 7-23.Google Scholar
  49. Sherwin, B. B., Gelfand, M. M., & Brender, W. (1985). Androgen enhances sexual motivation in females:Aprospective, crossover study of sex steroid administration in the surgical menopause. Psychosomatic Medicine, 47, 339-351.Google Scholar
  50. Shifren, J. L., Braunstein, G. D., Simon, J. A., Casson, P. R., Buster, J. E., Redmond, G. P., et al. (2000). Transdermal testosterone treatment in women with impaired sexual function after oophorectomy. New England Journal of Medicine, 343, 682-688.Google Scholar
  51. Simonsen, U., Prieto, D., Hernandez, M., de Tejada, I., & Garcia-Sacristan, A. (1997). Prejunctional alpha sub 2-adrenoceptors inhibit nitrergic neurotransmission in horse penile resistance arteries. Journal of Urology, 157, 2356-2360.Google Scholar
  52. Sintchak, G., & Geer, J. H. (1975). A vaginal plethysmograph system. Psychophysiology, 5, 113-115.Google Scholar
  53. Tam, S. W., Worcel, M., & Wyllie, M. (2001). Yohimbine: A clinical review. Pharmacology and Therapeutics, 91, 1-29.Google Scholar
  54. Taylor, J. F., Rosen, R. C., & Leiblum, S. R. (1994). Self-report assessment of female sexual function: Psychometric evaluation of the Brief Index of Sexual Functioning for Women. Archives of Sexual Behavior, 23,627-643.Google Scholar
  55. Toesca, A., Stolfi, V. M., & Cocchia, D. (1996). Immunohistochemical study of the corpora cavernosa of the human clitoris. Journal of Anatomy, 3, 513-520.Google Scholar
  56. Wiedeking, C., Ziegler, M. G., & Lake, C. R. (1979). Plasma noradrenaline and dopamine-beta-hydroxylase during human sexual activity. Journal of Psychiatric Research, 15, 139-145.Google Scholar
  57. Worcel, M. (2000). [The pharmacokinetic profile of L-arginine glutamate plus yohimbine]. Unpublished raw data.Google Scholar
  58. Zorgniotti, A., & Lizza, E. (1994). Effect of large doses of the nitric oxide precursor, L-arginine, on erectile dysfunction. International Journal of Impotence Research, 6, 33-36.Google Scholar

Copyright information

© Plenum Publishing Corporation 2002

Authors and Affiliations

  • Cindy M. Meston
    • 1
  • Manuel Worcel
    • 1
  1. 1.Department of PsychologyUniversity of Texas at AustinAustin

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