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 prompted pharmaceutical companies to focus considerable attention on finding
a comparable treatment for women.
Loss of libido, painful intercourse, and difficulty achieving orgasm trouble
many women. Possible physical causes include side effects from drugs such as
antidepressants or sedatives, hormonal insufficiency, or adrenal insufficiency.
Women experiencing sexual dysfunction should consult a physician to attempt to
find its cause, as the problem may indicate a more serious disorder.
Current conventional treatments for sexual dysfunction depend on its cause:
counseling when the cause is psychological; switching or reducing dosage of
drugs when they are at fault; hormone replacement therapy when there is a
deficiency; treating the cause of painful intercourse; and correcting adrenal
insufficiency. Drugs for sexual dysfunction are currently under active
investigation. Some occasionally helpful options among those presently available
include amantadine, cyproheptadine, buspirone, nefazodone, sildenafil, and
bupropion.
Treatment
Proposed 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, Ginkgo biloba, yohimbine, and arginine.
DHEA
Some evidence suggests that the hormone DHEA (dehydroepiandrosterone) 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. 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.
In addition, two small, double-blind, placebo-controlled studies tested whether a one-time dose of DHEA at 300 mg could increase sexual arousability in pre- or postmenopausal women respectively. 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. 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.
Ginkgo biloba
Numerous case reports and preliminary studies suggest that the herb Ginkgo biloba may be an effective treatment for antidepressant-induced sexual dysfunction. One open trial failed to find benefit, but it appears to have used an inappropriate form of ginkgo.
Investigation of ginkgo began after an elderly man with sexual dysfunction caused by an antidepressant decided to take Ginkgo biloba to improve his memory. His sexual function improved so dramatically (and unexpectedly) that it caught the attention of researchers.
Subsequent open trials found benefits in men and even greater benefits in women. However, double-blind, placebo-controlled studies are needed to reliably evaluate the potential benefits of ginkgo in treating antidepressant-induced sexual dysfunction.
For more information, including dosage and safety issues, see the full ginkgo article.
Combination Products
A recent double-blind placebo-controlled trial evaluated a combination therapy containing the amino acid arginine; the herbs ginseng, ginkgo, and damiana; and multivitamins and minerals. 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.
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 study of yohimbine combined with arginine found an increase in measured physical arousal among 23 women with female sexual arousal disorder. 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 out of nine people, two of whom were women. However, in the absence of a placebo group, these results cant 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).
Other Treatments
One highly preliminary study has been used to claim that the herb ephedra is helpful for women with sexual dysfunction. However, this trial was very small, enrolled women without sexual problems, and only examined sexual responsiveness to visual stimuli. Furthermore, 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.