Sexual Dysfunction in Women
• Antidepressant-induced Sexual Dysfunction; Female Sexual Arousal Disorder; Hypoactive Sexual Desire Disorder; Low Libido in Women
Principal Proposed Natural Treatments
Other Proposed Natural Treatments
• Combination Herb/Supplement Therapies; Dehydroepiandrosterone (DHEA); Diindolylmethane (DIM); Horny goat weed; Maca; Molybdenum; Rhodiola rosea; Topical Treatment Containing GLA; Vitamin C
Probably Not Effective Treatments
• Ginkgo biloba
Although male sexual problems have long been the subject of intensive medical research, the equivalent problems in women have received relatively little attention until recently. The tremendous commercial success of the drug Viagra has lately prompted pharmaceutical companies to focus attention on finding a comparable treatment for women.
Loss of libido, painful intercourse, and difficulty achieving orgasm trouble many women. In most cases, the cause is unknown. Possible identifiable causes include side effects from drugs such as antidepressants or sedatives, hormonal insufficiency, or adrenal insufficiency.
Current conventional treatments for sexual dysfunction in women are limited, except when a simple fixable cause is present (such as use of an antidepressant in the 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 include DHEA, yohimbine, and arginine.
Some evidence suggests that the hormone dehydroepiandrosterone (DHEA) may be helpful for improving sexual function in older women, but not in 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 12-month, double-blind, placebo-controlled trial evaluated the effects of DHEA (50 mg daily) in 280 individuals between the ages of 60 and 79.1 The results showed that women over age 70 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 period of time.2,3
In addition, 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.24,25 The results again indicate that DHEA is effective for older women but not for younger women.
One 4-month, double-blind, placebo-controlled study of 24 women with adrenal failure found that 50 mg per day of DHEA (along with standard treatment for adrenal failure) improved libido and sexual satisfaction.4 DHEA is not usually prescribed to individuals with adrenal failure, but this study suggests that it should be.
For more information, including dosage and safety issues, see the full DHEA article.
A double-blind, placebo-controlled trial evaluated a combination therapy containing the amino acid arginine; the herbs ginseng, ginkgo, and damiana; and multivitamins and minerals.20 Researchers enrolled a total of 77 women between the ages of 22 and 71 years and followed them for 4 weeks. All participants complained of poor sexual function. The results showed superior sexual satisfaction scores in the treatment group compared to 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 followup study performed by the same research group also reported benefits.32 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 only used 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 23 women with female sexual arousal disorder as compared to placebo.21 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 8 out of 9 people, 2 of whom were women.22 However, in the absence of a placebo group, these results can't be taken as reliable; in addition, there are concerns about the safety of combining yohimbe with antidepressants.
Note: Yohimbine and the herb yohimbe are relatively dangerous substances in general. They should only be used under physician supervision.
The other constituents used in these combination therapies may also present some risks (see the full articles for safety issues).
A very small double-blind trial reported that a proprietary topical treatment containing GLA and a variety of additional supplements and herbs improved sexual function in woman with female sexual arousal disorder.28
A highly preliminary study has been used to claim that the herb ephedra is helpful for women with sexual dysfunction.26 However, this trial was very small, enrolled women without sexual problems, and only examined sexual responsiveness to visual stimuli. In another study, ephedrine improved female sexual dysfunction caused by SSRI antidepressants, but so did placebo, and there was no significant difference between the benefits seen with the two treatments.30 Note: There are serious health risks associated with ephedra. For this reason, we do not recommend that women with sexual dysfunction use ephedra. For more information on the health risks of this herb, see the full Ephedra article.
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.13-17 However, the results of a number of double-blind studies (see Why Does this Database Rely on Double-blind Studies?) indicate that ginkgo is no more effective than placebo, whether or not subjects are taking antidepressants.27,31,33
Other treatments often proposed for treating female sexual dysfunction, but that lack any meaningful supporting evidence, include horny goat weed, maca, molybdenum, diindolylmethane (DIM) and Rhodiola rosea.
References [ + ]
1. Baulieu E-E, Thomas G, Legrain S, et al. Dehydroepiandrosterone (DHEA), DHEA sulfate, and aging: Contribution of the DHEAge Study to a sociobiomedical issue. Proc Natl Acad Sci. 2000;97:4279-4284.
2. Morales AJ, Nolan JJ, Nelson JC, et al. Effects of replacement dose of dehydroepiandrosterone in men and women of advancing age. J Clin Endocrinol Metab. 1994;78:1360-1367.
3. Flynn MA, Weaver-Osterholtz D, Sharpe-Timms KL, et al. Dehydroepiandrosterone replacement in aging humans. J Clin Endocrinol Metab. 1999;84:1527-1533.
4. Arlt W, Callies F, van Vlijmen JC, et al. Dehydroepiandrosterone replacement in women with adrenal insufficiency. N Engl J Med. 1999;341:1013-1020.
13. Cohen AJ, Bartlik B. Ginkgo biloba for antidepressant-induced sexual dysfunction. J Sex Marital Ther. 1998;24:139-143.
14. McCann B. Botanical could improve sex life of patients on SSRIs. Drug Topics. 1997;141:33.
15. Cohen A, Bartlik B. Treatment of sexual dysfunction with Ginkgo biloba extract [scientific reports]. Presented at: 150th Annual Meeting of the American Psychiatric Association; May 18-21, 1997; San Diego, CA.
16. Cohen A. Treatment of antidepressant-induced sexual dysfunction with Ginkgo biloba extract (abstract #716). Presented at: 149th Annual Meeting of the American Psychiatric Association; May 5-8, 1996; New York, NY.
17. Cohen A. Long-term safety and efficacy of Ginkgo biloba extract in the treatment of antidepressant-induced sexual dysfunction. Available at: http://www.priory.com/pharmol/gingko. Accessed June 15, 1997
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19. Cohen AJ, Bartlik B. Ginkgo biloba for antidepressant-induced sexual dysfunction. J Sex Marital Ther. 1998;24:139-143.
20. Ito TY, Trant AS, Polan ML. A double-blind placebo-controlled study of ArginMax, a nutritional supplement for enhancement of female sexual function. J Sex Marital Ther. 2001;27:541-549.
21. 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;31:323-332.
22. Jacobsen FM. Fluoxetine-induced sexual dysfunction and an open trial of yohimbine. J Clin Psychiatry. 1992;53:119-122.
23. Ashton AK, Ahrens K, Gupta S, et al. Antidepressant-induced sexual dysfunction and Ginkgo biloba [letter]. Am J Psychiatry. 2000;157:836-837.
24. Meston CM, Heiman JR. Acute dehydroepiandrosterone effects on sexual arousal in premenopausal women. J Sex Marital Ther. 2002;28:53-60.
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26. Meston CM, Heiman JR. Ephedrine-activated physiological sexual arousal in women. Arch Gen Psychiatry. 1998;55:652-656.
27. Kang BH, Lee SJ, Kim MD, et al. A placebo-controlled, double-blind trial of Ginkgo bilboa for antidepressant-induced sexual dysfunction. Hum Psychopharmacol Clin Exp. 2002;17:279-284.
28. Ferguson DM, Singh GS, Steidle CP, et al. Randomized, placebo-controlled, double blind, crossover design trial of the efficacy and safety of Zestra for women in women with and without female sexual arousal disorder. J SexMarital Ther. 2003;29(Suppl 1):33-44.
29. Brody S. High-dose ascorbic acid increases intercourse frequency and improves mood: a randomized controlled clinical trial. Biol Psychiatry. 2002;52:371.
30. Meston CM. A randomized, placebo-controlled, crossover study of ephedrine for SSRI-induced female sexual dysfunction. J Sex Marital Ther. 2004;30:57-68.
31. Wheatley D. Triple-blind, placebo-controlled trial of Ginkgo biloba in sexual dysfunction due to antidepressant drugs. Hum Psychopharmacol. 2004 Sep 20 [Epub ahead of print]
32. Ito TY, Polan ML, Whipple B, et al. The enhancement of female sexual function with ArginMax, a nutritional supplement, among women differing in menopausal status. J Sex Marital Ther. 2006;32:369-378.
33. Meston CM, Rellini AH, Telch MJ. Short- and long-term effects of Ginkgo biloba extract on sexual dysfunction in women. Arch Sex Behav. 2008 Feb 15.
Last reviewed December 2015 by EBSCO CAM Review Board