Sexual dysfunction in men and women are relatively common, with research indicating that 40-45 percent of adult women and 20-30 percent of adult men have at least one sexual dysfunction (e.g. erectile dysfunction, hypogonadism/low T, low estradiol and sexual dissatisfaction), the prevalence of which increases with age.1 Other research2 shows that sexual dysfunction is also more likely among men and women with poor physical and emotional health, and is associated with negative experiences in sexual relationships and overall well-being. Furthermore, studies3 have found a high prevalence of low sexual desire (43 percent) among women. This article addresses the sexual health of women, and nutraceuticals that may be beneficial for this purpose (I will address the sexual health of men in the March 2015 issue of Vitamin Retailer).
Libifem
Libifem is a fenugreek seed extract standardized to 50 percent Fenuside, a proprietary term used to describe phytochemical constituents, which include furostanol saponins and steroidal saponins. In a double-blind, randomized, placebo-controlled study,4 80 healthy women (aged 21 to 49) in stable relationships received 300 mg Libifem twice daily over two menstrual cycles (starting in follicular phase). The results of validated questionnaires showed a significant increase in scores for sexual functioning in those participants in the Libifem group, including increases in sexual cognition/fantasy, sexual arousal, sexual experience, orgasm and sexual drive/relationship. The placebo group showed no difference except for a significant increase in sexual drive/relationship at week 8 of treatment.
After eight weeks, the Libifem group also experienced a significant increase in estradiol (an estrogen) compared to the placebo group (p<0.05).
DHEA
Produced in the adrenal glands and testes, dehydroepiandrosterone or dehydroepiandrostenedione (DHEA) is a prohormone, which is transformed into testosterone and/or estrogens.5 In females, adrenal-derived testosterone is important in maintaining normal pubic and axillary hair, and after the menopause DHEA may also be an important source of estradiol once converted peripherally. However, plasma DHEA decreases about 80 percent between ages 25 to 75,6 and DHEA secretion has already decreased by a mean of 60 percent at time of menopause.7 DHEA-S is the blood marker for measuring DHEA.
In a double-blind, placebo-controlled study,8 280 healthy women and men (60-79 years old) were given 50 mg DHEA or placebo daily for a year. Besides the reestablishment of a "young" concentration of DHEA-S, women also experienced a small increase in testosterone and estradiol. Furthermore, there was a significant increase in most libido parameters was in women >70 years old. In a randomized, double-blind, placebo-controlled study,9 24 women with adrenal insufficiency received 50 mg DHEA or placebo daily for four months. Treatment with DHEA corrected the initially low serum concentrations of DHEA, DHEA-S, androstenedione and testosterone. Furthermore, DHEA significantly increased the frequency of sexual thoughts (P=0.006), sexual interest (P=0.002) and satisfaction with both mental and physical aspects of sexuality (P=0.009 and P=0.02, respectively). DHEA also significantly improved overall well-being, as well as scores for depression and anxiety.
L-arginine + Yohimbine
L-arginine is a semi-essential amino acid,10 which is converted into nitric oxide (NO) in the body. NO, causes blood vessel vasodilation,11 which promotes circulation. Consequently, through its role as an NO precursor, L-arginine offers many benefits for cardiovascular health, as well as for sexual function due to increased circulation to the genital region.12
The bark of the yohimbe tree (Pausinystalia johimbe, syn. Pausinystalia yohimbe) has a history of use as an aphrodisiac in West Africa.13 It is the alkaloid yohimbine, typically derived from yohimbe bark, which provides the predominant pharmacological activity, and has been used for about 90 years as a treatment for male and female sexual difficulties.14
In a randomized, double-blind, placebo-controlled, three-way cross-over study,15 24 postmenopausal women with Female Sexual Arousal Disorder received treatment with either L-arginine glutamate (6 g) plus yohimbine HCl (6 mg), yohimbine alone (6 mg) or placebo. Sexual responses to erotic stimuli were measured approximately 30, 60 and 90 minutes following treatment, and resulted in substantially increased vaginal-pulse amplitude responses to the erotic film at 60 minutes post administration compared with placebo.
Vitex Agnus Castus
Menstrual irregularities and imbalances in certain hormones can also have a negative effect on sexual health in women. That’s where the herb Vitex agnus castus (aka, chaste berry, chaste tree) can help.
It has been clinically established that vitex increases luteinizing hormone (LH) and progesterone production through its activity on the neurotransmitter dopamine.16 Vitex also decreases elevated prolactin levels.17 The net result is helping re-establish normal balance of estrogen and progesterone during the menstrual cycle.
Hormone balance is important because some women suffer from PMS and other menstrual irregularities due to underproduction of the hormone progesterone during the second half of their cycle. Studies have shown that using vitex once in the morning over a period of several months helps normalize hormone balance and alleviate the symptoms of PMS.18 In another placebo-controlled clinical study, women with PMS were given vitex or a placebo.19 By the end of the study, women taking the vitex had a significantly greater reduction in overall PMS symptoms (including irritability, headache, breast tenderness, etc.) than the placebo group.
Vitex has other benefits for the female reproductive system. Research has shown that women with menorrhagia (i.e., heavy menstrual flow) have elevated levels of the hormone prolactin.20 Vitex may therefore be valuable in cases of menorrhagia, as it has been shown decreasing elevated prolactin levels.21 It has certainly been shown to be helpful in other menstrual-related situations, such as breast pain and amenorrhoea or scanty/irregular periods.22 Vitex, however, is not a fast-acting herb. Consequently, it may need to be used continuously for three to six menstrual cycles before results are forthcoming.
Other current and evidence based uses for vitex include, but are not limited to: insufficient lactation, infertility (due to decreased progesterone levels or hyperprolactinemia) and teenage acne.24, 25 A good daily dose of vitex is 40 mg, standardized 0.5 percent agnuside.
Conclusion
There is no single nutraceutical that will work well for every woman with a sexual dysfunction. Nevertheless, the nutraceuticals presented in this article are likely to offer some level of benefit to many women with sexual dysfunctions. VR
References:
1 Lewis RW, Fugl-Meyer KS, Bosch R, Fugl-Meyer AR, Laumann EO, Lizza E, Martin-Morales A. Epidemiology/Risk Factors of Sexual Dysfunction. J Sex Med. 2004;1(1):34-9.
2 Laumann EO, Paik A, Rosen RC. Sexual Dysfunction in the United States: Prevalence and Predictors. JAMA. 1999;281:537-544.
3 Kingsberg SA, Rezaee RL. Hypoactive sexual desire in women. Menopause. 2013 Dec;20(12):1284-300.
4 Rao A, Steels E, Beccaria G, Vitetta L. Influence of Libifem, a specialized extract of Trigonella foenum-graecum (Fenugreek) on sexual function, hormones and metabolism is healthy menstruating women, in a randomized placebo controlled study. Gencor Pacific Pty. Ltd. Unpublished. 2013:18 pgs.
5 Labrie, F., Luu-The, V., Bélanger, A., Lin, SX., Simard, J., Pelletier, G. and Labrie, C. Is dehydroepiandrosterone a hormone? J Endocrinol 2005;187:169-96.
6 Weiss, E.P., Villareal, D.T., Fontana, L., Han, D-H. and Holloszy, J.O. Dehydroepiandrosterone (DHEA) replacement decreases insulin resistance and lowers inflammatory cytokines in aging humans. Aging 2011;3:533-542.
7 Labrie, F. DHEA, important source of sex steroids in men and even more in women. Prog Brain Res 2010;182:97-148.
8 Baulieu, E.E., Thomas, G., Legrain, S., Lahlou, N., Roger, M., Debuire, B., Faucounau, V., Girard, L., Hervy, M.P., Latour, F., Leaud, M.C., Mokrane, A., Pitti-Ferrandi, H., Trivalle, C., de Lacharrière, O., Nouveau, S., Rakoto-Arison, B., Souberbielle, J.C., Raison, J., Le Bouc, Y., Raynaud, A., Girerd, X., Forette, F. Dehydroepiandrosterone (DHEA), DHEA sulfate, and aging: contribution of the DHEAge Study to a sociobiomedical issue. Proc Natl Acad Sci USA 2000;97:4279-84.
9 Arlt, W., Callies, F., van Vlijmen, J.C., Koehler, I., Reincke, M., Bidlingmaier, M., Huebler, D., Oettel ,M., Ernst, M., Schulte, H.M. and Allolio, B. Dehydroepiandrosterone replacement in women with adrenal insufficiency. N Eng J Med 1999;341:1013–1020.
10 Castillo, L., Chapman, T.E., Sanchez, M., Yu, Y.M., Burke, J.F., Ajami, A.M., Vogt, J., Young, V.R. Plasma arginine and citrulline kinetics in adults given adequate and arginine-free diets. Proc Natl Acad Sci USA 1993;90:7749-7753.
11 Appleton, J. Arginine: Clinical potential of a semi-essential amino. Altern Med Rev 2002;7(6):512-22.
12 Wang, R., Ghahary, A., Shen, Y.J., Scott, P.G., Tredget, E.E. Human dermal fibroblasts produce nitric oxide and express both constitutive and inducible nitric oxide synthase isoforms. J Invest Dermatol 1996;106:419-27.
13 Betz, J.M., White, K.D., and der Marderosian, A.H. Gas chromatographic determination of yohimbine in commercial yohimbe products. J AOAC Int 1995;78:1189-94.
14 Riley, A.J. Yohimbine in the treatment of erectile disorder. Br J Clin Pract 1994;48:133-6.
15 Meston CM, Worcel M. The effects of yohimbine plus L-arginine glutamate on sexual arousal in postmenopausal women with sexual arousal disorder. Arch Sex Behav 2002;31:323-32.
16 Wutke W, et al in Loew, Dand Rietbrock N, eds: Phytopharmaka in Forschung und Klinischer Anwendung; 1995. Steinkopff, Darmstadt.
17 Milewicz A, Gejdel E, Sworen H, Sienkiewicz K, et al. [Vitex agnus castus extract in the treatment of luteal phase defects due to latent hyperprolactinemia. Results of a randomized placebo-controlled double-blind study]. Arzneimittelforschung 1993; 43(7):752-6.
18 Dittmar FW, Böhnert KJ, et al. Premenstrual syndrome: Treatment with a phytopharmaceutical. Therapiwoche Gynäkol 1992; 5:60-68.
19 Schellenberg R. Treatment of the premenstrual syndrome with agnus castus fruit extract: prospective, randomized, placebo controlled study. BMJ 2001; 332:134-7.
20 Ballinger CB, Browning MCK, Smith AHW. Hormone profiles and psychological symptoms in peri-menopausal women. Maturitas 1987; 9(3):235-51.
21 Milewicz A, Gejdel E, Sworen H, Sienkiewicz K, et al. [Vitex agnus castus extract in the treatment of luteal phase defects due to latent hyperprolactinemia. Results of a randomized placebo-controlled double-blind study]. Arzneimittelforschung 1993; 43(7):752-6.
22 Halaska M, Beles P, Gorkow C, Sieder C. Treatment of cyclical mastalgia with a solution containing Vitex agnus extract: results of a placebo-controlled double-blind study. The Breast 1999; 8:175-81.
23 Veal L. Complementary therapy and infertility: an Icelandic perspective. Complement Ther Nurs Midwifery 1998; 4(1):3-6.
24 Kuhn MA, Winston D. Herbal Therapy & Supplements: A Scientific & Traditional Approach. Philadelphia:Lippincott; 2000.
25 Presser A. Pharmacist’s Guide to Medicinal Herbs. Petaluma, California: Smart Publications; 2000
Gene Bruno, MS, MHS, the dean of academics for Huntington College of Health Sciences, is a nutritionist, herbalist, writer and educator. For more than 30 years he has educated and trained natural product retailers and health care professionals, has researched and formulated natural products for dozens of dietary supplement companies, and has written articles on nutrition, herbal medicine, nutraceuticals and integrative health issues for trade, consumer magazines and peer-reviewed publications.
Sexual dysfunction in men and women are relatively common, with research indicating that 40-45 percent of adult women and 20-30 percent of adult men have at least one sexual dysfunction (e.g. erectile dysfunction, hypogonadism/low T, low estradiol and sexual dissatisfaction), the prevalence of which increases with age.1 Other research2 shows that sexual dysfunction is also more likely among men and women with poor physical and emotional health, and is associated with negative experiences in sexual relationships and overall well-being. Furthermore, studies3 have found a high prevalence of low sexual desire (43 percent) among women. This article addresses the sexual health of women, and nutraceuticals that may be beneficial for this purpose (I will address the sexual health of men in the March 2015 issue of Vitamin Retailer).
Libifem
Libifem is a fenugreek seed extract standardized to 50 percent Fenuside, a proprietary term used to describe phytochemical constituents, which include furostanol saponins and steroidal saponins. In a double-blind, randomized, placebo-controlled study,4 80 healthy women (aged 21 to 49) in stable relationships received 300 mg Libifem twice daily over two menstrual cycles (starting in follicular phase). The results of validated questionnaires showed a significant increase in scores for sexual functioning in those participants in the Libifem group, including increases in sexual cognition/fantasy, sexual arousal, sexual experience, orgasm and sexual drive/relationship. The placebo group showed no difference except for a significant increase in sexual drive/relationship at week 8 of treatment.
After eight weeks, the Libifem group also experienced a significant increase in estradiol (an estrogen) compared to the placebo group (p<0.05).
DHEA
Produced in the adrenal glands and testes, dehydroepiandrosterone or dehydroepiandrostenedione (DHEA) is a prohormone, which is transformed into testosterone and/or estrogens.5 In females, adrenal-derived testosterone is important in maintaining normal pubic and axillary hair, and after the menopause DHEA may also be an important source of estradiol once converted peripherally. However, plasma DHEA decreases about 80 percent between ages 25 to 75,6 and DHEA secretion has already decreased by a mean of 60 percent at time of menopause.7 DHEA-S is the blood marker for measuring DHEA.
In a double-blind, placebo-controlled study,8 280 healthy women and men (60-79 years old) were given 50 mg DHEA or placebo daily for a year. Besides the reestablishment of a "young" concentration of DHEA-S, women also experienced a small increase in testosterone and estradiol. Furthermore, there was a significant increase in most libido parameters was in women >70 years old. In a randomized, double-blind, placebo-controlled study,9 24 women with adrenal insufficiency received 50 mg DHEA or placebo daily for four months. Treatment with DHEA corrected the initially low serum concentrations of DHEA, DHEA-S, androstenedione and testosterone. Furthermore, DHEA significantly increased the frequency of sexual thoughts (P=0.006), sexual interest (P=0.002) and satisfaction with both mental and physical aspects of sexuality (P=0.009 and P=0.02, respectively). DHEA also significantly improved overall well-being, as well as scores for depression and anxiety.
L-arginine + Yohimbine
L-arginine is a semi-essential amino acid,10 which is converted into nitric oxide (NO) in the body. NO, causes blood vessel vasodilation,11 which promotes circulation. Consequently, through its role as an NO precursor, L-arginine offers many benefits for cardiovascular health, as well as for sexual function due to increased circulation to the genital region.12
The bark of the yohimbe tree (Pausinystalia johimbe, syn. Pausinystalia yohimbe) has a history of use as an aphrodisiac in West Africa.13 It is the alkaloid yohimbine, typically derived from yohimbe bark, which provides the predominant pharmacological activity, and has been used for about 90 years as a treatment for male and female sexual difficulties.14
In a randomized, double-blind, placebo-controlled, three-way cross-over study,15 24 postmenopausal women with Female Sexual Arousal Disorder received treatment with either L-arginine glutamate (6 g) plus yohimbine HCl (6 mg), yohimbine alone (6 mg) or placebo. Sexual responses to erotic stimuli were measured approximately 30, 60 and 90 minutes following treatment, and resulted in substantially increased vaginal-pulse amplitude responses to the erotic film at 60 minutes post administration compared with placebo.
Vitex Agnus Castus
Menstrual irregularities and imbalances in certain hormones can also have a negative effect on sexual health in women. That’s where the herb Vitex agnus castus (aka, chaste berry, chaste tree) can help.
It has been clinically established that vitex increases luteinizing hormone (LH) and progesterone production through its activity on the neurotransmitter dopamine.16 Vitex also decreases elevated prolactin levels.17 The net result is helping re-establish normal balance of estrogen and progesterone during the menstrual cycle.
Hormone balance is important because some women suffer from PMS and other menstrual irregularities due to underproduction of the hormone progesterone during the second half of their cycle. Studies have shown that using vitex once in the morning over a period of several months helps normalize hormone balance and alleviate the symptoms of PMS.18 In another placebo-controlled clinical study, women with PMS were given vitex or a placebo.19 By the end of the study, women taking the vitex had a significantly greater reduction in overall PMS symptoms (including irritability, headache, breast tenderness, etc.) than the placebo group.
Vitex has other benefits for the female reproductive system. Research has shown that women with menorrhagia (i.e., heavy menstrual flow) have elevated levels of the hormone prolactin.20 Vitex may therefore be valuable in cases of menorrhagia, as it has been shown decreasing elevated prolactin levels.21 It has certainly been shown to be helpful in other menstrual-related situations, such as breast pain and amenorrhoea or scanty/irregular periods.22 Vitex, however, is not a fast-acting herb. Consequently, it may need to be used continuously for three to six menstrual cycles before results are forthcoming.
Other current and evidence based uses for vitex include, but are not limited to: insufficient lactation, infertility (due to decreased progesterone levels or hyperprolactinemia) and teenage acne.24, 25 A good daily dose of vitex is 40 mg, standardized 0.5 percent agnuside.
Conclusion
There is no single nutraceutical that will work well for every woman with a sexual dysfunction. Nevertheless, the nutraceuticals presented in this article are likely to offer some level of benefit to many women with sexual dysfunctions. VR
References:
1 Lewis RW, Fugl-Meyer KS, Bosch R, Fugl-Meyer AR, Laumann EO, Lizza E, Martin-Morales A. Epidemiology/Risk Factors of Sexual Dysfunction. J Sex Med. 2004;1(1):34-9.
2 Laumann EO, Paik A, Rosen RC. Sexual Dysfunction in the United States: Prevalence and Predictors. JAMA. 1999;281:537-544.
3 Kingsberg SA, Rezaee RL. Hypoactive sexual desire in women. Menopause. 2013 Dec;20(12):1284-300.
4 Rao A, Steels E, Beccaria G, Vitetta L. Influence of Libifem, a specialized extract of Trigonella foenum-graecum (Fenugreek) on sexual function, hormones and metabolism is healthy menstruating women, in a randomized placebo controlled study. Gencor Pacific Pty. Ltd. Unpublished. 2013:18 pgs.
5 Labrie, F., Luu-The, V., Bélanger, A., Lin, SX., Simard, J., Pelletier, G. and Labrie, C. Is dehydroepiandrosterone a hormone? J Endocrinol 2005;187:169-96.
6 Weiss, E.P., Villareal, D.T., Fontana, L., Han, D-H. and Holloszy, J.O. Dehydroepiandrosterone (DHEA) replacement decreases insulin resistance and lowers inflammatory cytokines in aging humans. Aging 2011;3:533-542.
7 Labrie, F. DHEA, important source of sex steroids in men and even more in women. Prog Brain Res 2010;182:97-148.
8 Baulieu, E.E., Thomas, G., Legrain, S., Lahlou, N., Roger, M., Debuire, B., Faucounau, V., Girard, L., Hervy, M.P., Latour, F., Leaud, M.C., Mokrane, A., Pitti-Ferrandi, H., Trivalle, C., de Lacharrière, O., Nouveau, S., Rakoto-Arison, B., Souberbielle, J.C., Raison, J., Le Bouc, Y., Raynaud, A., Girerd, X., Forette, F. Dehydroepiandrosterone (DHEA), DHEA sulfate, and aging: contribution of the DHEAge Study to a sociobiomedical issue. Proc Natl Acad Sci USA 2000;97:4279-84.
9 Arlt, W., Callies, F., van Vlijmen, J.C., Koehler, I., Reincke, M., Bidlingmaier, M., Huebler, D., Oettel ,M., Ernst, M., Schulte, H.M. and Allolio, B. Dehydroepiandrosterone replacement in women with adrenal insufficiency. N Eng J Med 1999;341:1013–1020.
10 Castillo, L., Chapman, T.E., Sanchez, M., Yu, Y.M., Burke, J.F., Ajami, A.M., Vogt, J., Young, V.R. Plasma arginine and citrulline kinetics in adults given adequate and arginine-free diets. Proc Natl Acad Sci USA 1993;90:7749-7753.
11 Appleton, J. Arginine: Clinical potential of a semi-essential amino. Altern Med Rev 2002;7(6):512-22.
12 Wang, R., Ghahary, A., Shen, Y.J., Scott, P.G., Tredget, E.E. Human dermal fibroblasts produce nitric oxide and express both constitutive and inducible nitric oxide synthase isoforms. J Invest Dermatol 1996;106:419-27.
13 Betz, J.M., White, K.D., and der Marderosian, A.H. Gas chromatographic determination of yohimbine in commercial yohimbe products. J AOAC Int 1995;78:1189-94.
14 Riley, A.J. Yohimbine in the treatment of erectile disorder. Br J Clin Pract 1994;48:133-6.
15 Meston CM, Worcel M. The effects of yohimbine plus L-arginine glutamate on sexual arousal in postmenopausal women with sexual arousal disorder. Arch Sex Behav 2002;31:323-32.
16 Wutke W, et al in Loew, Dand Rietbrock N, eds: Phytopharmaka in Forschung und Klinischer Anwendung; 1995. Steinkopff, Darmstadt.
17 Milewicz A, Gejdel E, Sworen H, Sienkiewicz K, et al. [Vitex agnus castus extract in the treatment of luteal phase defects due to latent hyperprolactinemia. Results of a randomized placebo-controlled double-blind study]. Arzneimittelforschung 1993; 43(7):752-6.
18 Dittmar FW, Böhnert KJ, et al. Premenstrual syndrome: Treatment with a phytopharmaceutical. Therapiwoche Gynäkol 1992; 5:60-68.
19 Schellenberg R. Treatment of the premenstrual syndrome with agnus castus fruit extract: prospective, randomized, placebo controlled study. BMJ 2001; 332:134-7.
20 Ballinger CB, Browning MCK, Smith AHW. Hormone profiles and psychological symptoms in peri-menopausal women. Maturitas 1987; 9(3):235-51.
21 Milewicz A, Gejdel E, Sworen H, Sienkiewicz K, et al. [Vitex agnus castus extract in the treatment of luteal phase defects due to latent hyperprolactinemia. Results of a randomized placebo-controlled double-blind study]. Arzneimittelforschung 1993; 43(7):752-6.
22 Halaska M, Beles P, Gorkow C, Sieder C. Treatment of cyclical mastalgia with a solution containing Vitex agnus extract: results of a placebo-controlled double-blind study. The Breast 1999; 8:175-81.
23 Veal L. Complementary therapy and infertility: an Icelandic perspective. Complement Ther Nurs Midwifery 1998; 4(1):3-6.
24 Kuhn MA, Winston D. Herbal Therapy & Supplements: A Scientific & Traditional Approach. Philadelphia:Lippincott; 2000.
25 Presser A. Pharmacist’s Guide to Medicinal Herbs. Petaluma, California: Smart Publications; 2000
Gene Bruno, MS, MHS, the dean of academics for Huntington College of Health Sciences, is a nutritionist, herbalist, writer and educator. For more than 30 years he has educated and trained natural product retailers and health care professionals, has researched and formulated natural products for dozens of dietary supplement companies, and has written articles on nutrition, herbal medicine, nutraceuticals and integrative health issues for trade, consumer magazines and peer-reviewed publications.
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