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Female Libido Support Part Two

June 26, 2015 Written by JP       [Font too small?]

Hormones play a pivotal role in sexual desire in both men and women. Perhaps the most recognizable examples are the changes that are precipitated during andropause and menopause. Prescription hormone replacement therapy (HRT) can address some of the symptoms of these processes. But, HRT is not without contra-indications and risks. One of the more interesting aspects of flibanserin, the so called “Female Viagra”, is that it addresses hypoactive sexual desire disorder (HSDD) in older and younger women, whether premenopausal, perimenopausual or postmenopausual. And, flibanserin does so without affecting hormone levels.

Although it may seem that I’m ready to embrace flibanserin as a safe, new wonder drug, far from it. Before taking that leap of faith, I suggest first looking at many possible contributors to HSDD. Environmental toxins, hormonal imbalance, medication side-effects, poor diet and even nutritional supplements could conceivably blunt sexual desire. In fact, there have been a few studies that report that making minor lifestyle changes can significantly improve libido. Simple practices such as correcting iron deficiency, eating an apple a day and switching to a Mediterranean-style diet could all help. These drug-free remedies correct nutritional inadequacies, rather than rely on a chemical that manipulates brain chemistry.

In addition to lifestyle changes and mind-body therapies, there are three primary classes of supplements that are formulated to heighten female sexual function. The first uses traditional herbs to influence sex hormone levels, though no actual hormones are employed. The second class of supplements strives to improve circulation to the brain and genitals. This is very similar to the mechanism used in medications for erectile dysfunction. The third and final type of supplement is a combination pill that aims to correct various aspects of HSDD – circulatory, nutritional and psychological.

Class One: Herbal Hormone Support - The April 2015 issue of Phytotherapy Research reports that 600 mg/day of a standardized fenugreek extract (Libifem) provoked “a significant increase in free testosterone and E2 (estradiol)”. This resulted in greater arousal and sexual desire in a group of women aged 20 to 49. Other herbs used to stimulate testosterone production (Tribulus terrestris and Eurycoma longifolia aka Tongcat Ali) have, likewise, improved multiple HSDD symptoms ranging from inadequate lubrication to anger and tension. Evening primrose and red clover have a long history of use in managing hormonal conditions in women. Supplementing with either 1,000 mg/day of evening primrose oil or 80 mg of red clover isoflavones daily has been shown to boost libido, mood and sexuality in menopausal women.

Class Two: Circulatory Support - Ginkgo biloba and Pycnogenol, a patented pine bark extract, are recognized for their potent antioxidant properties. In addition, numerous experiments confirm that they enhance vascular function and blood flow throughout the body. This may explain why three recent trials have found that 120-240 mg/day of Ginkgo biloba extract and/or a nutraceutical containing Pycnogenol (Lady Prelox) elevate sexual desire and various measures of sexual function. It should be noted that Lady Prelox also contains other ingredients that positively influence circulation including the amino acids L-arginine and L-citrulline.

Class Three: Comprehensive Support - A blend of L-arginine, Damiana, Ginkgo biloba, iron, Korean ginseng and a mineral/vitamin blend is the basis for ArginMax for Women. Two controlled studies verify the ability of this nutraceutical to improve the frequency of sexual desire and intercourse, satisfaction with sexual relationships and vaginal dryness. The two ingredients I have yet to discuss, Damiana and Korean ginseng, are included as synergistic factors which may ease anxiety and further enhance blood flow and vascular function. Importantly, ArginMax for Women is non-estrogenic i.e. it is not thought to carry the risks associated with hormone replacement therapy.

To sum things up: Female sexual function ought to be viewed holistically. It’s important to try to identify the cause or contributing factors. First identify and then make any necessary changes to your environment, healthcare approach or lifestyle. Mind-body techniques and optimized nutrition are key. Supplements can help, but should not replace the previously mentioned options.

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

To learn more about the studies referenced in today’s column, please click on the following links:

Study 1 - Efficacy & Safety of Flibanserin in Postmenopausal Women with (link)

Study 2 - Efficacy of Flibanserin in Women with Hypoactive Sexual Desire (link)

Study 3 – Maintaining Sexuality in Menopause (link)

Study 4 – Impact of Iron Supplementation on Sexual Dysfunction of Women with (link)

Study 5 - Mediterranean Diet Improves Sexual Function in Women with Metabolic (link)

Study 6 - Apple Consumption is Related to Better Sexual Quality of Life in Young (link)

Study 7 - Influence of a Specialized Trigonella Foenum-Graecum Seed Extract (link)

Study 8 - Tribulus Terrestris for Treatment of Sexual Dysfunction in Women (link)

Study 9 - Effect of Tongkat Ali on Stress Hormones & Psychological Mood (link)

Study 10 - Effect of Red Clover Isoflavones over Skin, Appendages & Mucosal (link)

Study 11 - Effect of Oral Evening Primrose Oil on Menopausal Hot Flashes (link)

Study 12 - Triple-Blind, Placebo-Controlled Trial of Ginkgo Biloba Extract on (link)

Study 13 - Lady Prelox® Improves Sexual Function in Generally Healthy Women (link)

Study 14 - Lady Prelox® Improves Sexual Function in Post-Menopausal Women (link)

Study 15 – Supplementation with Pycnogenol® Improves Signs and Symptoms (link)

Study 16 - Enhancement of Female Sexual Function with ArginMax, a Nutritional (link)

Study 17 - A Double-Blind Placebo-Controlled Study of ArginMax, a Nutritional (link)

Study 18 - Effects of Korean Red Ginseng on Sexual Arousal in Menopausal Women (link)

Study 19 - Modulation of Endothelial Function by Korean Red Ginseng (link)

Study 20 - Clinical Efficacy of Korean Red Ginseng for Erectile Dysfunction (link)

Study 21 - Estimation of Apigenin, an Anxiolytic Constituent, in Turnera (link)

Study 22 - Anti-Anxiety Activity Studies of Various Extracts of Turnera (link)

Free Testosterone Declines in Aging Women

Source: Clinics (Sao Paulo). 2014;69(4):294-303. (link)

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9 Comments & Updates to “Female Libido Support Part Two”

  1. JP Says:

    Update 06/26/15:

    http://www.hindawi.com/journals/ecam/2015/949036/

    Evid Based Complement Alternat Med.

    A double-blind placebo-controlled trial of maca root as treatment for antidepressant-induced sexual dysfunction in women.

    Objective: We sought to demonstrate that maca root may be an effective treatment for antidepressant-induced sexual dysfunction (AISD) in women.

    Method: We conducted a 12-week, double-blind, placebo-controlled trial of maca root (3.0 g/day) in 45 female outpatients (mean age of 41.5 ± 12.5 years) with SSRI/SNRI-induced sexual dysfunction whose depression remitted. Endpoints were improvement in sexual functioning as per the Arizona Sexual Experience Scale (ASEX) and the Massachusetts General Hospital Sexual Function Questionnaire (MGH-SFQ).

    Results: 45 of 57 consented females were randomized, and 42 (30 premenopausal and 12 postmenopausal women) were eligible for a modified intent-to-treat analysis based on having had at least one postmedication visit. Remission rates by the end of treatment were higher for the maca than the placebo group, based on attainment of an ASEX total score ≤ 10 (9.5% for maca versus 4.8% for placebo), attaining an MGH-SFQ score ≤ 12 (30.0% for maca versus 20.0% for placebo) and reaching an MGH-SFQ score ≤ 8 (9.5% for maca versus 5.0% for placebo). Higher remission rates for the maca versus placebo group were associated with postmenopausal status. Maca was well tolerated.

    Conclusion: Maca root may alleviate SSRI-induced sexual dysfunction in postmenopausal women.

    Be well!

    JP

  2. JP Says:

    Update 06/26/15:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4227976/

    J Reprod Infertil. 2014 Oct;15(4):190-8.

    Comparison of Elaeagnus angustifolia Extract and Sildenafil Citrate on Female Orgasmic Disorders: A Randomized Clinical Trial.

    BACKGROUND: Orgasmic disorder can create a feeling of deprivation and failure and provide mental problems, incompatibility and marital discord. This study aimed to compare the effects of Elaeagnus angustifolia flower extract and sildenafil citrate on female orgasmic disorder in women in 2013.

    METHODS: In this randomized clinical trial, 125 women between 18-40 years old who suffered from orgasmic disorder were divided into three E. angustifolia, sildenafil citrate and control groups. The data were gathered using Female Sexual Function Index and through measurement of TSH and prolactin. The first intervention group had to consume 4.5 gr E. angustifolia extract in two divided doses for 35 days and the second one had to use 50 mg sildenafil citrate tablets for 4 weeks one hour before their sexual relationship. However, the control group had to consume the placebo. The data were analyzed using paired t-test, one-way ANOVA, and Bonferroni posthoc test and p<0.05 was considered significant.

    RESULTS: The frequency of orgasmic disorder before the intervention was 41.5%, 40.5%, and 57.1% in E. angustifolia, sildenafil citrate, and control groups, respectively (p=0.23). However, these measures were respectively 29.3%, 16.7%, and 50% after the intervention (p=0.004). A significant difference between the two groups regarding sexual satisfaction after the intervention (p=0.003) compared to the beginning of the study (p=0.356). Besides, the highest reduction of changes after the intervention (58.82%) was observed in the sildenafil citrate group.

    CONCLUSION: Both E. angustifolia extract and sildenafil citrate were effective in reduction of the frequency of orgasmic disorder in women.

    Be well!

    JP

  3. JP Says:

    Update 06/26/15:

    http://journals.lww.com/menopausejournal/pages/articleviewer.aspx?year=2014&issue=06000&article=00013&type=abstract

    Menopause. 2014 Jun;21(6):612-23.

    Testosterone dose-response relationships in hysterectomized women with or without oophorectomy: effects on sexual function, body composition, muscle performance and physical function in a randomized trial.

    OBJECTIVE: This study aims to determine the dose-dependent effects of testosterone on sexual function, body composition, muscle performance, and physical function in hysterectomized women with or without oophorectomy.

    METHODS: Seventy-one postmenopausal women who previously underwent hysterectomy with or without oophorectomy and had total testosterone levels less than 31 ng/dL or free testosterone levels less than 3.5 pg/mL received a standardized transdermal estradiol regimen during the 12-week run-in period and were randomized to receive weekly intramuscular injections of placebo or 3, 6.25, 12.5, or 25 mg of testosterone enanthate for 24 weeks. Total and free testosterone levels were measured by liquid chromatography-tandem mass spectrometry and equilibrium dialysis, respectively. The primary outcome was change in sexual function measured by the Brief Index of Sexual Functioning for Women. Secondary outcomes included changes in sexual activity, sexual distress, Derogatis Interview for Sexual Functioning, lean body mass, fat mass, muscle strength and power, and physical function.

    RESULTS: Seventy-one women were randomized; five groups were similar at baseline. Sixty-two women with analyzable data for the primary outcome were included in the final analysis. The mean on-treatment total testosterone concentrations were 19, 78, 102, 128, and 210 ng/dL in the placebo, 3-mg, 6.25-mg, 12.5-mg, and 25-mg groups, respectively. Changes in composite Brief Index of Sexual Functioning for Women scores, thoughts/desire, arousal, frequency of sexual activity, lean body mass, chest-press power, and loaded stair-climb power were significantly related to increases in free testosterone concentrations; compared with placebo, changes were significantly greater in women assigned to the 25-mg group, but not in women in the lower-dose groups. Sexual activity increased by 2.7 encounters per week in the 25-mg group. The frequency of androgenic adverse events was low.

    CONCLUSIONS: Testosterone administration in hysterectomized women with or without oophorectomy for 24 weeks was associated with dose and concentration-dependent gains in several domains of sexual function, lean body mass, chest-press power, and loaded stair-climb power. Long-term trials are needed to weigh improvements in these outcomes against potential long-term adverse effects.

    Be well!

    JP

  4. JP Says:

    Updated 07/29/16:

    http://care.diabetesjournals.org/content/diacare/early/2016/06/22/dc16-0910.full.pdf

    Diabetes Care. 2016 Jun 28. pii: dc160910.

    Primary Prevention of Sexual Dysfunction With Mediterranean Diet in Type 2 Diabetes: The MÈDITA Randomized Trial.

    The current study is the first long-term dietary trial demonstrating that the Mediterranean diet conferred benefit on both prevention (56% relative risk reduction) and deterioration of sexual dysfunction in both men and women with newly diagnosed type 2 diabetes. In adults with type 2 diabetes, a Mediterranean-style dietary pattern may improve the inflammatory milieu and cardiovascular risk (4), both these effects being beneficial to achieving improvement of sexual dysfunction in people with diabetes (5). Although the evaluation of sexual function was not planned in the original study protocol, both primary and secondary outcomes were similar, suggesting that the results were robust.

    Be well!

    JP

  5. JP Says:

    Updated 10/24/16:

    http://journals.lww.com/menopausejournal/pages/articleviewer.aspx?year=9000&issue=00000&article=97901&type=abstract

    Menopause. 2016 Oct 10.

    Efficacy of Tribulus terrestris for the treatment of hypoactive sexual desire disorder in postmenopausal women: a randomized, double-blinded, placebo-controlled trial.

    OBJECTIVE: The objective of this study was to evaluate the efficacy of Tribulus terrestris for the treatment of hypoactive sexual desire disorder in postmenopausal women and evaluate its effect on the serum levels of testosterone.

    METHODS: We performed a prospective randomized, double-blinded, placebo-controlled study, during 18 months. A total of 45 healthy sexually active postmenopausal women reporting diminished libido were selected to participate in the study and were randomly assigned to receive 750 mg/d of T terrestris or placebo for 120 days. Randomization was performed using sealed envelopes. All participants answered the Female Sexual Function Index and the Sexual Quotient-female version questionnaires and had their serum levels of prolactin, thyroid-stimulating hormone, total testosterone, and sex hormone-binding globulin measured.

    RESULTS: A total of 36 participants completed the study, because 3 from each group were excluded due to side effects and 3 dropped out due to personal reasons. FSFI questionnaire results demonstrated an improvement in all domains in both groups (P < 0.05) except for lubrication which was improved only in the study group. QS-F results showed a significant improvement in the domains of desire (P < 0.01), arousal/lubrication (P = 0.02), pain (P = 0.02), and anorgasmia (P  0.05). Moreover, free and bioavailable testosterone levels showed a significant increase in the T terrestris group (P < 0.05).

    CONCLUSIONS: Tribulus terrestris might be a safe alternative for the treatment of hypoactive sexual desire disorder in postmenopausal women, because it was effective in reducing symptoms with few side effects. Its probable mechanism of action involves an increase in the serum levels of free and bioavailable testosterone.

    Be well!

    JP

  6. JP Says:

    Updated 06/02/18:

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5958328/

    Iran J Pharm Res. 2018 Winter;17(Suppl):89-100.

    Effect of Melissa officinalis (Lemon balm) on Sexual Dysfunction in Women: A Double- blind, Randomized, Placebo-controlled Study.

    Hypoactive sexual desire disorder (HSDD) is the most prevalent female sexual dysfunction (FSD) and its bio-psychosocial multifactorial etiology justifies its multifaceted treatment. In Persian Medicine (PM), the weakness of the main organs (heart, brain and liver) is one of the important causes of lack of sexual desire; hence, their strengthening is a priority during treatment. Melissa officinalis is one of the medicinal plants with tonic characteristics for the main organs in PM and was used for treatment in this study. The aim of the present study was to evaluate the efficacy and safety of M. officinalis in the improvement of HSDD in women. Eighty nine (89) eligible women suffering from decreased sexual desire were randomly assigned to groups. The participants received medication (500 mg of aqueous extract of M. officinalis) or placebo 2 times a day for 4 weeks. Changes in scores of desire, arousal, lubrication, orgasm, satisfaction and pain were evaluated at the end of 4 weeks of treatment using the Female Sexual Function Index (FSFI) questionnaire in the two groups. Forty three participants completed the study. The increase in desire (P < 0.001), arousal (P < 0.001), lubrication (P < 0.005), orgasm (P < 0.001), satisfaction (P < 0.001), pain (P < 0.002) and FSFI total score (P < 0.001) in the M. officinalis group was significantly more than that of the placebo group. The willingness to continue treatment was significantly higher in the M. officinalis as compared to the placebo group (P < 0.001). M. officinalis may be a safe and effective herbal medicine for the improvement of HSDD in women.

    Be well!

    JP

  7. JP Says:

    Updated 11/06/18:

    https://www.jurology.com/article/S0022-5347(18)44048-7/pdf

    J Urol. 2018 Nov 2.

    Effect of Vitamin D Therapy on Sexual Function in Women with Sexual Dysfunction and Vitamin D Deficiency: a Randomized, Double-blind, Placebo-controlled Clinical Trial.

    PURPOSE: To investigate the effect of vitamin D therapy on sexual function in women with low vitamin D levels and sexual dysfunction.

    MATERIALS AND METHODS: This randomized, double-blind, placebo-controlled trial was conducted on women aged 18-45 years with sexual dysfunction (Female Sexual Functioning Index score of <26.55) and a serum 25[OH]D level of <30 ng/mL. Participants received an intramuscular injection of 300,000 IU cholecalciferol or a placebo at baseline and then after four weeks. Sexual function was evaluated using the Female Sexual Function Index at baseline, and then after four and eight weeks. The serum level of 25[OH]D and depression symptoms (Beck Depression Inventory) were evaluated at baseline and then after eight weeks.

    RESULTS: Thirty-eight women in each group completed the study. The serum levels of 25[OH]D increased only in the cholecalciferol group by 14.4 ± 3.2 ng/mL (P<0.001). The Female Sexual Function Index score was higher in the intervention group at the 4th (19.6 vs. 16.3, P=0.002) and 8th (25.0 vs. 17.1, P <0.001) weeks of the study. The Beck Depression Inventory score was significantly decreased only in the cholecalciferol group by -21.0 ± 12.3 (P<0.001). The effect of treatment on sexual function was independent from its effect on symptoms of depression.

    CONCLUSION: Vitamin D therapy in women with sexual dysfunction and vitamin D deficiency can improve their sexual function. This effect does not seem to be mediated by the improvement of depression symptoms.

    Be well!

    JP

  8. JP Says:

    Updated 02/27/19:

    https://www.sciencedirect.com/science/article/pii/S2225411019302445

    Journal of Traditional and Complementary Medicine – 27 February 2019

    Impact of Glycyrrhiza glabra (licorice) vaginal cream on vaginal signs and symptoms of vaginal atrophy in postmenopausal women: A randomized double blind controlled trial

    Background: Vaginal atrophy is one of the most common menopausal complications affecting women’s quality of life. The present study aimed to investigate the impact of Glycyrrhiza glabra (licorice) vaginal cream on vaginal signs and symptoms of vaginal atrophy in postmenopausal women.

    Methods: This randomized controlled trial was conducted on 70 menopausal women, referring to health centers of Izeh city, located in the south west of Iran, from May to November 2017. The participants with vaginal atrophy were randomly assigned into two groups of 35. One of the groups received licorice 2% vaginal cream while the other was given placebo over a period of 8 weeks. Data were analyzed using SPSS software at the significance level of 0.05.

    Results: The results indicated that at the baseline, none of the subjects (0%) in either groups had a vaginal cells maturation Index within 65-100 in MVI category. However, after 8 weeks of therapy, it improved significantly to 82.9% in Licorice group and 11.4 % in the placebo group (p < 0.001).

    Also, the vaginal mucus cells changed from the baseline cells to intermediate and superficial cells within and between the two groups after the treatment (p < 0.001). Finally, the pH level significantly decreased in licorice group over time (p < 0.001).

    Conclusion: Therapeutic use of licorice vaginal cream can improve the signs and symptoms of vaginal atrophy in postmenopausal women. Accordingly, use of licorice as a natural vaginal cream in vaginal atrophy can be suggested.

    Be well!

    JP

  9. JP Says:

    Updated 05/02/19:

    https://www.ncbi.nlm.nih.gov/pubmed/31039769

    BMC Womens Health. 2019 Apr 30;19(1):58.

    Effect of a multi-ingredient based food supplement on sexual function in women with low sexual desire.

    BACKGROUND: Studies have demonstrated that women with low desire and low excitement have negative feelings regarding their physical and emotional satisfaction, as well as their happiness. In this study, we evaluate the efficacy of Libicare® – a multi-ingredient food supplement – to improve sexual function in postmenopausal women.

    METHODS: This was an exploratory, prospective, non-controlled, observational study. Postmenopausal women aged 45-65 with a risk of sexual dysfunction (Female Sexual Function Index (FSFI) < 25.83) were included during routine clinical visits and treated with 2 tablets of Libicare® daily for 2 months. Libicare® is an oral food supplement containing Trigonella foenum graecum, Turnera diffusa, Tribulus terrestris, and Ginkgo biloba dry extracts. Primary endpoint: change vs. baseline in FSFI score. Secondary endpoints: 1) changes in testosterone and serum steroid levels of free testosterone and sex hormone-binding globulin (SHBG) levels and 2) tolerability.

    RESULTS: A total of 29 patients (mean age: 54.69 years) were included. FSFI mean (SD) score showed a significant increase: 20.15 (4.48) vs 25.03 (6.94), baseline vs final; p = 0.0011, paired t-test. Most patients (86.2%) increased their FSFI score. All FSFI domains, except dyspareunia, showed significant increases. The highest increase was observed in the desire domain (p = 0.0004). Testosterone and SHBG levels were assessed in 21 patients. A significant increase in testosterone level was observed: 0.41 (0.26) vs. 0.50 (0.34) pg/mL, baseline vs. final; p = 0.038, Wilcoxon test. 52.4% of patients increased their testosterone levels. Finally, a significant decrease was observed in SHBG level: 85 (32.9) vs. 73 (26.8) nmol/L, baseline vs. final; p = 0.0001; paired t-test. 95.2% of patients decreased their SHBG levels.

    CONCLUSION: In this pilot study, a significant improvement in sexual function and related hormone levels was observed with Libicare®. Further studies must be conducted to confirm these exciting results.

    Be well!

    JP

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