What are natural treatments for sexual dysfunction in women?

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Treatment of sexual disorders in women.
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Introduction

Although male sexual disorders have long been the subject of intensive medical research, sexual disorders in women have received relatively little attention until recently. The tremendous commercial success of the erectile dysfunction drug Viagra has prompted pharmaceutical companies to focus on finding a comparable treatment for women.

Many women experience loss of libido, painful intercourse, or difficulty achieving orgasm. In most cases, the causes are unknown. Possible identifiable causes include side effects from drugs such as antidepressants or sedatives, hormonal insufficiency, or adrenal insufficiency. Conventional treatments for sexual dysfunction in women are limited, except when a simple treatable cause is present (such as the use of an antidepressant in the selective serotonin reuptake inhibitor, or SSRI, category).

Proposed Natural Treatments

Although there is no good evidence for natural treatments for sexual dysfunction, several substances have shown promising results in preliminary trials. These substances include dehydroepiandrosterone, yohimbine, and arginine.

Dehydroepiandrosterone. Some evidence suggests that the hormone dehydroepiandrosterone (DHEA) may be helpful for improving sexual function in older women. DHEA, however, may not be helpful for younger women.

DHEA is produced by the adrenal glands. Levels of DHEA decline naturally with age and fall precipitately in cases of adrenal failure. Because both elderly people and those with adrenal insufficiency report a drop in libido, several studies have examined whether supplemental DHEA can increase libido in these groups.

A twelve-month, double-blind, placebo-controlled trial evaluated the effects of DHEA (50 milligrams [mg] daily) in 280 persons between the ages of sixty and seventy-nine. The results showed that women older than age seventy years experienced an improvement in libido and sexual satisfaction. No benefits were seen in younger women. Two other trials did not find benefit, but they enrolled much fewer people and ran for a shorter time.

Two small, double-blind, placebo-controlled studies tested whether a one-time dose of DHEA at 300 mg could increase ease of sexual arousal in pre- or postmenopausal women, respectively. The results again indicate that DHEA is effective for older women but not for younger women.

One four-month, double-blind, placebo-controlled study of twenty-four women with adrenal failure found that 50 mg per day of DHEA (with standard treatment for adrenal failure) improved libido and sexual satisfaction. DHEA is not usually prescribed to persons with adrenal failure, but this study suggests that it should be.

Combination products. A double-blind, placebo-controlled trial evaluated a combination therapy containing the amino acid arginine; the herbs ginseng, ginkgo, and damiana; and multivitamins-multiminerals. Researchers enrolled seventy-seven women between the age of twenty-two and seventy-one years and followed them for four weeks. All participants complained of poor sexual function. The results showed superior sexual satisfaction scores in the treatment group compared with the placebo group. Some of the specific benefits seen included enhanced libido, increased frequency of intercourse and orgasm, greater vaginal lubrication, and augmented clitoral sensation. A larger follow-up study performed by the same research group also reported benefits. However, confirmation by an independent research group will be necessary before these results can be taken as reliable.

Yohimbine is a drug derived from the bark of the yohimbe tree. Studies have used only the standardized drug, not the actual herb. One small, double-blind, crossover study of yohimbine combined with arginine found an increase in measured physical arousal among twenty-three women with sexual arousal disorder, compared with placebo. However, the women themselves did not report any noticeable effects. Only the combination of yohimbine and arginine produced results; neither substance was effective when taken on its own.

An open trial of yohimbine alone to treat sexual dysfunction induced by the antidepressant fluoxetine (Prozac) found improvement in eight of nine people, two of whom were women. However, in the absence of a placebo group, these results cannot be taken as reliable; in addition, concerns exist about the safety of combining yohimbe with antidepressants.

Yohimbine and the herb yohimbe are relatively dangerous substances in general. One should use them only with physician supervision. The other constituents used in these combination therapies may also present some risks.

Other treatments. One double-blind, placebo-controlled study found evidence that the use of vitamin C led to an increase in intercourse frequency in healthy women, presumably because it increased libido. A small double-blind trial reported that a proprietary topical treatment containing gamma-linolenic acid and a variety of additional supplements and herbs improved sexual function in women with sexual arousal disorder.

A preliminary study has been used to claim that the herb ephedra is helpful for women with sexual dysfunction. However, this trial was small, enrolled women without sexual disorders, and examined only sexual responsiveness to visual stimuli. In another study, ephedrine improved sexual dysfunction caused by SSRIs, but so did placebo, and there was no significant difference between the benefits seen with the two treatments. There are serious health risks associated with ephedra. For this reason, ephedra is not recommended for use by women with sexual dysfunction.

Numerous case reports and uncontrolled studies raised hopes that the herb Ginkgo biloba might be an effective treatment for sexual dysfunction, particularly as a result of antidepressant medication. However, the results of a number of double-blind studies indicate that ginkgo is no more effective than placebo, whether or not subjects are taking antidepressants. Other treatments that are often proposed for treating female sexual dysfunction, but that lack any meaningful supporting evidence, include horny goat weed, maca, molybdenum, diindolylmethane, and Rhodiola rosea.

Bibliography

Brody, S. “High-Dose Ascorbic Acid Increases Intercourse Frequency and Improves Mood.” Biological Psychiatry 52 (2002): 371.

Ferguson, D. M., et al. “Randomized, Placebo-Controlled, Double Blind, Crossover Design Trial of the Efficacy and Safety of Zestra in Women with and Without Female Sexual Arousal Disorder.” Journal of Sex and Marital Therapy 29, suppl. 1 (2003): 33-44.

Hackbert, L., and J. R. Heiman. “Acute Dehydroepiandrosterone (DHEA) Effects on Sexual Arousal in Postmenopausal Women.” Journal of Women’s Health and Gender-Based Medicine 11 (2002): 155-162.

Ito, T. Y., et al. “The Enhancement of Female Sexual Function with ArginMax, a Nutritional Supplement, Among Women Differing in Menopausal Status.” Journal of Sex and Marital Therapy 32 (2006): 369-378.

Kang, B. H., et al. “A Placebo-Controlled, Double-Blind Trial of Ginkgo biloba for Antidepressant-Induced Sexual Dysfunction.” Human Psychopharmacology 17 (2002): 279-284.

Meston, C. M. “A Randomized, Placebo-Controlled, Crossover Study of Ephedrine for SSRI-Induced Female Sexual Dysfunction.” Journal of Sex and Marital Therapy 30 (2004): 57-68.

_______, and J. R. Heiman. “Acute Dehydroepiandrosterone Effects on Sexual Arousal in Premenopausal Women.” Journal of Sex and Marital Therapy 28 (2002): 53-60.

_______, and M. Worcel. “The Effects of Yohimbine plus L-Arginine Glutamate on Sexual Arousal in Postmenopausal Women with Sexual Arousal Disorder.” Archives of Sexual Behavior 31 (2002): 323-332.

_______, A. H. Rellini, and M. J. Telch. “Short- and Long-Term Effects of Ginkgo biloba Extract on Sexual Dysfunction in Women.” Archives of Sexual Behavior 37 (2008): 530-547.

Wheatley, D. “Triple-Blind, Placebo-Controlled Trial of Ginkgo biloba in Sexual Dysfunction Due to Antidepressant Drugs.” Human Psychopharmacology 19 (2004): 545-548.

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