Orgasm and Ejaculation in Women

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It’s true that women have a great capacity for sexual pleasure. We have a greater capacity than men for orgasm and ejaculation when we are in the right relationship, and are in possession of normal youthful female hormones, estradiol and testosterone. These hormones decrease with age over 40 and with them go our amazing sexual drive, climax and pleasure. The presence of excellent sexual response reflects a youthful level of both hormones.

The patients I see are aging and have seen the signs of low testosterone and estradiol on their sexuality. The problem is that in the US doctors are told that’s normal and there is nothing they can do about it, but there is! Replacing Testosterone and estradiol brings us back to our 30s no matter what our age is! Often I hear that my patients’ sex drives are better than when they were in their 30s because the use of birth control pills and the stress of children suppressed their testosterone levels. So there is hope! Read on….

Women’s sexuality requires several basic hormones that women have plenty of after age twelve. The most important hormone is testosterone produced in the ovary. It provides increased skin sensitivity around the vagina, it releases the necessary neurotransmitters for orgasm—dopamine, serotonin, and norepinephrine. We are awash in fluid communication meant to give us the ability to enjoy the activity that gives us the next generation of children.

You may have heard of these neurotransmitters that are necessary for us to feel sexually attractive and have desire, but there are other hormones that are stimulated by the primary ovarian hormones, that may be more unfamiliar. Oxytocin is a hormone from the hypothalamus in the brain that causes dilation of blood vessels in the pelvis, endorphins in our brain that make us feel joy, and oxytocin increases the feeling of orgasm among other things. We even have an increase of intestinal peptides that stimulate the ejaculation of fluid from the vagina.

Most adult women have experienced the bliss of orgasm, but not all have the experience of ejaculation. Just like in men, female ejaculation is a complex process involving all of the hormones listed above, and it involves fluid coming from a variety of areas in and around the vagina. It can be associated with orgasm or it can happen anytime in the sexual process. It is documented that the stimulation of various areas of the vagina can cause fluid from different areas.

Stimulation of several areas can cause orgasm and ejaculation. For example, cervical stimulation from deep trust or manually can cause the vagina to recruit fluid from the pelvic cavity and it transudates through the vagina causing gushes of clear or white fluid. This fluid is generally sweet, and contains lipids. It does not generally have force behind it so it just fills the vagina with fluid.

Stimulation of the G-spot, in the anterior vagina, causes a release of clear slippery fluid from the urethra, but it is not urine. Many women are worried about this and think they have released urine, but it is ejaculatory fluid and has none of the properties of urine.

The clitoral stimulation causes spurts of fluid from the peri-urethral glands which are beside the urethra. This type of ejaculation can have the “spurting” characteristic that is familiar to most men, as that is how they describe ejaculation.

Vaginal wetness is common to all women and is not ejaculatory fluid, but consists of a combination of blood sugar in it to support sperm motility, amino acids and fats for, lubrication. This type of vaginal fluid transudates (passes through the vaginal wall) from the pelvis through the vaginal wall. There is some question as to where this comes from but there is always some fluid in the pelvis and it is thought to come from the lining of the pelvic cavity and the intestinal walls.

To reclaim orgasms and possible ejaculatory function the primary hormones to replace include testosterone and estradiol. Most women recover with just these two hormones. In the case of women on multiple psychiatric drugs many of the neurotransmitters are decreased and they can be functional but it may not be like it was when they were younger.

Medications that decrease orgasm/ejaculation include anti-depressants, beta blockers for blood pressure, antipsychotic drugs, diuretics. There are more categories but these are the most common.

The patients who are resistant to recovering their orgasmic function are usually helped by using oxytocin sublingual tablets from a compounding pharmacy, the supplement L-arginine, and or increasing testosterone levels. I have been very successful with recovering the best part of sex for most of my patients who have a healthy sexual relationship at home.