Inclusion Criteria:
1. Age 25 to 60.
2. In a sexual relationship and sexually active within the past month
3. Diagnosis of ICD-10 2023 Orgasmic Dysfunction, secondary or primary. See Investigator's Brochure, section 2, "Medical Need and Diagnosis" for rationale.
4. Orgasmic Dysfunction is the predominant form of sexual dysfunction, is acquired rather than lifelong, and is generalized rather than situational.
5. At screen and baseline visit, scores \<8 on the raw score of the FSFI orgasm domain (at least moderate severity)
6. May have depression and/or anxiety if condition is no worse than mild with treatment and if patient will continue the same treatment for the duration of this trial
7. Side effects from any continuing concomitant medications must be stable.
8. Not pregnant or lactating for six months; using contraception that is medically reliable in the investigator's judgment, or (if the investigator finds the patient credibly monogamous) vasectomy of male partner. If hormonal contraception is used, the same medication must have been used for at least 3 months.
9. Gives informed consent for and is willing to undergo all of the scheduled evaluations
10. Prompt for screening and baseline visits, is cooperative, and takes reasonable directions without excessive explanations
11. Her sexual partner is sexually unimpaired (erectile dysfunction allowed only if adequately treated), and available to the subject at least half of the time (in days per week).
12. Agrees to have sexual activity with her partner at least once a week for the duration of her participation in this study.
Exclusion Criteria:
1. Masturbates to orgasm more than once a week.
2. Sexual aversion or sexual pain disorder
3. Chronic conditions that, in the investigator's judgment, are likely to deteriorate within 3 months of screening are not allowed (e.g., gastrointestinal bleeding, uncontrolled diabetes, frequent asthma attacks, uncontrolled Major Depressive disorder, history within the prior 6 months of suicidality or drug abuse; recurrence within the prior year of breast, cervical, uterine, ovarian or other systemic cancer). However, chronic conditions with a relatively stable course are allowed; see Investigator's Brochure, section 2, "Medical Need and Diagnosis" for rationale.
4. Requires CYP3A4, CYP 2B6, or CYP 2D6 strong inhibitor or inducer drugs
5. History of bipolar and/or psychotic disorders and/or takes an antiepileptic/mood stabilizer, antipsychotic, or opioid drug
6. History of severe, serious, or allergic adverse reaction(s) to stimulants or sedatives
7. Drinks \>2 alcoholic drinks per day (12-oz beer, 4-oz wine, 1 ½ oz liquor, etc.)
8. History of seizures or use of antiepileptic medication
9. Long QT syndrome (QTc \>480 msec), other significant cardiovascular disease
10. moderate or severe dysfunction of the liver (any LFT \>3x ULN) or renal dysfunction (BUN \> 30 or Cr \>2.0)
11. History of blood clots or abnormal bleeding tendencies, including daily use of medications adversely affecting coagulation, e.g., NSAIDs, systemic corticosteroids, or \>81 mg aspirin daily.
