Medicinal Plants for Female Sexual Dysfunction

A recent article in The Journal of Sexual Medicine identifies and describes the popular and clinical uses of medicinal plants for Female Sexual Dysfunction (FSD) in climacteric (menopausal) women. Although there is very little evidence from the literature to recommend the use of medicinal plants for treating FSD, Mazaro-Costa, et al, list those plants that are currently used for female reproductive disturbances, most notably the climacteric state to correct aspects of female sexual dysfunction. More research is needed before strong recommendations can be made.

Black cohosh – Cimicifuga racemosa

Current use: Menopausal therapy for hot flashes, profuse sweating and vaginal complaints

Active Ingredients: triterpene glycosides, phenolic acids, flavonoids, volatile oils, tannins

Standardization: 2.5% triterpene glycosides

Research: was not statistically significant in treating hot flashes after 16 weeks; does improve the vaginal maturity index in postmenopausal women; approaches significance in treating vaginal dryness; statistically significant in treating anxiety

Mechanism: SERM (does not affect ERα or ERβ but does have an effect on ERϒ), high affinity for various serotonin receptors

Safety: Relatively safe; however, case reports about liver toxicity. Because of unknown MOA and potential estrogenic effect it should be avoided during pregnancy and lactation and in children under 12.

Ginkgo - Ginkgo biloba

Current use: asthma, fatigue, tinnitus, memory improvement

Active Ingredients: flavonol, glycosides, terpene lactones, bilobalide

Standardization: 6% terpene lactone sna 24% flavones glycosides

Research: 300 mg improved physiological sexual arousal but no subjective sexual arousal; when combined with sex therapy increased sexual desire and contentment; effective in alleviating antidepressant-induced sexual symptoms in 84% of cases

Mechanism: Relaxes smooth muscle, facilitates peripheral blood flow, has NO-scavenging abilities

Safety: Side effects are rare and limited to mild, transient and reversible; drug interactions with warfarin, aspirin, lithium; safety in pregnancy and breastfeeding has not been established

Maca – Lepidium meyenii

Current use: Andean aphrodisiac an/or fertility-enhancing, menopausal therapy

Active Ingredients: sterols which possess phytoestrogen activity

Standardization: Unknown

Research: RDBPCT decreased psychological symptoms including anxiety, depression and sexual dysfunction and did not affect estradiol, FSH, LH or SHBG levels.

Mechanism: Unknown

Safety: Unknown

Puncture vine – Tribulus terristris

Current and traditional use: ancient aphrodisiac, UTI treatment, inflammation, edema and TCM sexual dysfunction

Active Ingredients: Steroidal saponins (tribestane, vitanone and protodioscin)

Standardization: 16.4% protodioscin

Research: 49/50 women experienced improvement in all or some menopausal symptoms (hot flashes, depression, genital discomfort, libido) however, may lack validity due to conflict of interest

Mechanism: increase endogenous androgen production by increasing LH release from the pituitary gland; increases NO release

Safety: Phototoxic reactions; safety during pregnancy and lactation has not been established

Red clover – Trifolium pretense

Current use: Menopausal therapy for hot flashes, profuse sweating and vaginal complaints

Active Ingredients: phytoestrogens such as genistein, formononetin, daidzein and biochanin A

Standardization: 9-15% isoflavones

Research: meta-analysis showed a marginal effect for treating hot flashes with 40-82 mg/day; significant beneficial effect on vaginal and sexual health in postmenopausal women

Mechanism: SERM (does not affect ERα or ERβ but does have an effect on ERϒ), high affinity for various serotonin receptors

Safety: Safe and well-tolerated in women with one first degree relative with breast cancer; supplements containing these isoflavones did not adversely affect breast density, skeletal strength or cardiovascular status; none of the CCT have reported adverse effects at doses upt to 160 mg of isoflavones per day.

Chasteberry fruit – Vitex agnus-castus

Current use: Premenstrual syndrome

Active Ingredients: triterpene glycosides, phenolic acids, flavonoids, volatile oils, tannins

Standardization: 0.05% agnuside and 0.08% casticin

Research: topical application - improvement in vaginal tone, thinning and lubrication with less dyspareunia; increased uterine weight, serum progesterone and estrogen levels in ovariectomized female rats; decreased LH and Prolactin

Mechanism: SERM (affects ERα or ERβ), decreases LH and prolactin; dopaminergic D2 receptor agonist; increases melatonin secretion

Safety: Relatively safe

Dong quai – Angelica sinensis

Current use: replenishing the blood, treating menstrual disorders and menopausal symptoms; when used in Traditional Chinese Medicine is used in conjunction with other herbs

Active Ingredients: ferulic acid and Z-ligustilide; has no phytoestrogens.

Standardization: ferulic acid 0.4-0.7%, 0.5-5.0% ligustilide

Research: When used alone has not effect in treating menopausal symptoms; has no estrogenic effect in humans but did in rat studies; when combined with Matricaria chamomilla demonstrated a reduction in hot flashes, improved sleep; when combined with Astragalus membranaceus helped decrease mild hot flashes; the improvement of sexual symptoms was not explored

Mechanism: not mentioned

Safety: few side effects including headache and potentiates anticoagulant therapy; do not use in children or adults with diarrhea, hemorrhagic diseases, hypermenorrhea, pregnancy or lactation; some concerns about liver toxicity

Zalloh – Ferula hermonis

Current use: native to Syria and Lebanon, used as a strong aphrodisiac for both sexes, treatment of frigidity and circulation enhancement

Active Ingredients: ferutinin has binding capacity for estrogen receptor α and β equivalent to about 1/10 of the binding affinity of estradiol

Standardization: not mentioned

Research: may be suggested for female sexual dysfunction associated with desire disorder

Mechanism: estrogenic effect, increased production of progesterone and therefore stimulate female sexual behavior

Safety: Unknown

Hops - Humulus lupulus

Current use: in Germany hops baths are used for treatment of gynecological disorders and hops extracts have been reported to reduce hot flashes in menopausal women

Active Ingredients: 8-prenylanaringenin; isoxanthohumol which can readily be converted to 8-prenylnaringenin by intestinal microbes; three flavonoids with estrogenic activity including: 6-prenylnaringenin, 8-geranylnaringenin and 6,8-diprenylnaringenin

Standardization: 0.11 + 0.01 mg of 8-prenylnaringenin/capsule

Research: RPCCO studies with 50 postmenopausal women over 16 weeks showed superiority over placebo for treating hot flashes; other studies have shown improvement in climacteric symptoms; topical application combined with hyaluronic acid, liposomes and Vitamin E showed significant improvement in vaginal dryness. Animal studies demonstrate an estrogenic effect on the uterus, vagina and mammary gland secretion however in vitro study did not confirm androgenic or progestogenic activity of the active ingredient.

Mechanism: may act as a SERM

Safety: safe alternative treatment for genital atrophy in postmenopausal women when HRT is not recommended; causes drowsiness; inhibits cytochrome P450; unknown safety during pregnancy and nursing.

Reference: J Sex Med 2010;7:3695-3714

Natural Hot Flash Remedies

Are you suffering from hot flashes or night sweats? If so, you are in good company. Approximately 75% of American women experience vasomotor symptoms as they transition through menopause. Prescription hormonal therapy is available - if you find your symptoms intolerable. However, safety concerns are mounting.

Here are 6 natural ways to cool down when the heat is rising:

1. Use the 3-4-5 method of breathing to calm down when the heat starts to rise. Breathe in through your nose to the silent count of three, hold for four and breathe out through your mouth for five. Really focus on distending your lower abdomen with each inhalation, and count slowly. You should continue this pattern until your hot flash subsides.
2. Eat a healthy diet filled with vegetables, fruits, whole grains and omega-three fatty acids (found in cold water fish, green leafy vegetables, walnuts and ground flax seed). And, sip plenty of cool water throughout the day; this decreases your core body temperature thereby reducing the frequency of hot flashes.
3. Avoid dietary triggers like spicy food, alcohol and most caffeine. Although it does contain caffeine, it is okay to drink green tea. Here's the trick. Steep fresh green tea in hot water for 45 seconds, poor off that water, and then steep the same tea as you normally would. This way you will remove 80% of the caffeine and retain all the good anti-oxidants. The occasional morsel of dark chocolate is fine, too.
4. Try an herbal therapy shown to decrease the frequency and severity of hot flashes: St. John's Wort 300 mg three times daily. Black cohosh, although used for centuries, has not been found to be effective when subjected to scientific analysis. Teas containing lemon balm, hops and valerian decrease anxiety and promote sleep, countering night sweats.
5. Use bedtime rituals to decrease disruptive night sweats. Take a cool shower before bed, turn on a small bedside fan, and listen to calming music. Sleep under sheets made of 100% cotton. Just in case, keep a change of clothes and sheets in your nightstand to ease the pain of awakening to drenched pajamas and soaked sheets that need changing.
6. Stop smoking.

Take heart - hot flashes and night sweats are usually temporary. Most women experience resolution within 2 years. Use this period of transition to nurture yourself. Embrace your passage from one stage of life to the next. Hang in there. The best is yet to come!!