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Objective The aim of this study was to study the effects of Tribulus terrestris on sexual function in menopausal women. Methods This was a prospective, randomized, double-blind, placebo-controlled clinical trial that included 60 postmenopausal women with sexual dysfunction. The women were divided into two groups, placebo group and Tribulus group, and evaluated by using the Sexual Quotient-female version (SQ-F) and Female Intervention Efficacy Index (FIEI) questionnaires. Results There was no significant difference between the groups in age, age at menopause, civil status, race, and religion. In the evaluation with the SQ-F questionnaire, there were significant differences between the placebo (7.6±3.2) and Tribulus (10.2±3.2) groups in the domains of desire and sexual interest (p d" 0.001), foreplay (3.3±1.5 versus 4.2±1.0) (p d" 0.01), arousal and harmonious interaction with the partner (5.7±2.1 versus 7.2±2.6) (p d" 0.01), and comfort in sexual intercourse (6.5±2.4 versus 8.0±1.9) (p d" 0.01). There was no significant difference between the placebo and Tribulus groups in the domains of orgasm and sexual satisfaction (p = 0.28). In the FIEI questionnaire, there was a significant improvement (p < 0.001) in the domains of vaginal lubrication during coitus and/or foreplay (20 versus 83.3%), sensation in the genitalia during sexual intercourse or other stimuli (16.7 versus 76.7%), sensation in the genital region (20 versus 70%), sexual intercourse and/or other sexual stimulations (13.3 versus 43.3%), and the ability to reach orgasm (20% versus 73.3%). There was no significant difference in adverse effects between the two groups. Conclusions After 90 days of treatment, at the doses used, we found Tribulus terrestris to be effective in treating sexual problems among menopausal women.
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Assessment of the Effects of Tribulus Terrestris
on Sexual Function of Menopausal Women
Avaliação dos efeitos do Tribulus Terrestris na
sexualidade de mulheres no climatério
Sóstenes Postigo1Sônia Maria Rolim Rosa Lima1Silvia Saito Yamada1Benedito Fabiano dos Reis2
Gustavo Maximiliano Dutra da Silva3Tsutomu Aoki1
1Department of Obstetrics and Gynecology, School of Medical
Sciences, Santa Casa de São PauloFCMSCSP, São Paulo, SP, Brazil
2Department of Obstetrics and Gynecology, Universidade do Vale Do
SapucaíUNIVAS, Minas Gerais (MG), Brazil
3Graduate Program, School of Medical Sciences, Santa Casa de São
Paulo, São Paulo, SP; Universidade São Francisco Campus of
Bragança Paulista, Bragança Paulista, SP, Brazil
Rev Bras Ginec Obst
Address for correspondence Sóstenes Postigo, MD, MSc, School of
Medical Sciences, Department of Obstetrics and Gynecology, Santa
Casa de São Paulo FCMSCSP, Rua Doutor Cesário Mota Jr., 61, São
Paulo (SP) 01221-020, Brazil (e-mail: sostenes.p@uol.com.br).
Keywords
sexuality
menopause
physiological sexual
dysfunction
tribulus
phytotherapeutic
medicines
Abstract Objective The aim of this study was to study the effects of Tribulus terrestris on sexual
function in menopausal women.
Methods This was a prospective, randomized, double-blind, placebo-controlled
clinical trial that included 60 postmenopausal women with sexual dysfunction. The
women were divided into two groups, placebo group and Tribulus group, and evaluated
by using the Sexual Quotientfemale version (SQ-F) and Female Intervention Efcacy
Index (FIEI) questionnaires.
Results There was no signicant difference between the groups in age, age at
menopause, civil status, race, and religion. In the evaluation with the SQ-F question-
naire,thereweresignicant differences between the placebo (7.6 3.2) and Tribulus
(10.2 3.2) groups in the domains of desire and sexual interest (p 0.001), foreplay
(3.3 1.5 versus 4.2 1.0) (p 0.01), arousal and harmonious interaction with the
partner (5.7 2.1 versus 7.2 2.6) (p 0.01), and comfort in sexual intercourse
(6.5 2.4 versus 8.0 1.9) (p 0.01). There was no signicant difference between
the placebo and Tribulus groups in the domains of orgasm and sexual satisfaction
(p¼0.28). In the FIEI questionnaire, there was a signicant improvement (p<0.001)
in the domains of vaginal lubrication during coitus and/or foreplay (20 versus 83.3%),
sensation in the genitalia during sexual intercourse or other stimuli (16.7 versus
76.7%), sensation in the genital region (20 versus 70%), sexual intercourse and/or other
sexual stimulations (13.3 versus 43.3%), and the ability to reach orgasm (20% versus
73.3%). There was no signicant difference in adverse effects between the two groups.
Conclusions After 90 days of treatment, at the doses used, we found Tribulus terrestris
to be effective in treating sexual problems among menopausal women.
received
November 18, 2015
accepted
December 2, 2015
DOI http://dx.doi.org/
10.1055/s-0036-1571472.
ISSN 0100-7203.
Copyright © by Thieme Publicações Ltda,
Rio de Janeiro, Brazil
THIEME
Original Article
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Introduction
Sexuality is dynamic and alterable with time and may be
addressed through different scientic angles: through the
physiological and psychological aspects, as well as through
interpersonal and intrapersonal relationships. Sexuality is
directly inuenced by sociocultural aspects, being addressed
by the social sciences, human sciences (biological and genet-
ic domains), and political sciences. Internal factors such as
affectivity, intellect, cognition, and emotion, and external
factors such as geography, religion, economic system, habits
and customs, and the social and cultural environment also
have an inuence. Thus, it constitutes a global expression of
personality and, although it varies among cultures and
individuals, sexuality must be understood as an integral
part of the global history of women.1,2
It is estimated that 43% to 88% of women have at least one
complaint of a sexual problem during their lifetime.3Sexual
desire and arousal disorders are among the most common
problems presented in gynecological clinics.4,5
In a study involving 2,708 Brazilian women, Abdo6
showed that one-third had reduced or absent sexual desire,
26.2% could not reach orgasm, and 18% experienced pain
during sexual intercourse. They also reported a gradual loss
of sexual desire with age.
Decline in ovarian hormone function leads to signicant
changes in the internal and external genital organs, which
can inuence sexual response. However, organic modica-
tions that occur in women after menopause do not diminish
sexual pleasure, but only slow the response.2,7
Several studies have conrmed the decline in sexual
function associated with age and the progression of meno-
pause.3,7 Although the role of sex steroids in sexual function
has been demonstrated, particularly in the stage of desire,
the specic functions of sex steroids are unknown.8
The decrease in the serum androgen level in menopause may
be associated with worsening of sexual dysfunction, with a
correlation between sexual desire and free testosterone level.9
Testosterone has a primary role in maintaining sexual
interest and motivation,4,10 and may restore desire and
arousal, besides promoting the sexual fantasies of women
who do not respond to estrogen alone.4
Medicinal plants were always used as therapeutic resour-
ces of great value. For a long time, the Western medical
community did not give credibility to this practice for lack of
scientic evidence. Since the 1980s, however, there was a
larger investment in research with standard drugs and
quality control. Phytotherapeutic agents have a high thera-
peutic index and their use is associated with a low incidence
of adverse effects.2
Tribulus terrestris is a plant originally from India, widely used
as a natural sexual stimulant in Chinese, Indian, and Greek
traditional medicine. The current ndings are limited to animal
studies, which showed a signicant increase in erectile function
after the oral administration of the extract of the plant.11,12
Several studies have demonstrated that products derived from
Resumo Objetivo Estudar os efeitos do Tribulus terrestris na função sexual de mulheres após a
menopausa.
Métodos Ensaio clínico, prospectivo, randomizado, duplo-cego, placebo controlado,
com 60 mulheres após a menopausa com disfunção sexual, divididas em dois grupos:
Grupo Placebo e Grupo Tribulus, avaliadas através dos questionários Quociente Sexual-
versão Feminina (QS-F) e Female Intervention Efcacy Index (FIEI).
Resultados Não houve diferença signicante entre os grupos quanto à idade, idade
de menopausa, estado civil, raça e religião. Na avaliação do questionário QS-F houve
diferença signicante entre os grupos Placebo (7,6 3,2) e Tribulus (10,2 3,2) nos
aspectos desejo e interesse sexual (p 0,001), preliminares (3,3 1,5 versus
4,2 1,0) (p 0,01), excitação da mulher e sintonia com o parceiro (5,7 2,1
versus 7,2 2,6) (p 0,01) e no aspecto conforto na relação sexual (6,5 2,4 versus
8,0 1,9) (p 0,01). O aspecto orgasmo e satisfação sexual não houve diferença
signicante entre o Grupo Placebo e Tribulus (p¼0,28). No questionário FIEI houve
melhora signicante (p<0,001) na lubricação vaginal durante o coito e/ou prelimi-
nares (20 versus 83,3%), na sensação nas genitálias durante a relação sexual ou outros
estímulos (16,7 versus 76,7%), na sensação na área genital (20 versus 70%), nas
relações sexuais e/ou outras estimulações sexuais (13,3 versus 43,3%) e na capacidade
de ter orgasmo (20% versus 73,3%). Quanto aos efeitos colaterais não houve diferença
signicante entre os dois Grupos.
Conclusões Após noventa dias, podemos concluir que o Tribulus terrestris nas doses
utilizadas demonstrou ser efetivo notratamento das queixas sexuais das mulheres após
amenopausa.
Palavras-chave
sexualidade
menopausa
disfuncão sexual
siológica
Tribulus
medicamentos
toterápicos
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Trib ulu s can increase serum levels of endogenous testosterone,
thus justifying the effects seen on erectile function, although it
is not clear how Tribulus inuences this increase.11,13,14
The main constituents of T. terrestris are steroids, saponins,
avonoids, and alkaloids. The hydrolyzed saponins are trans-
formed into steroidal sapogenins, with antispasmodic and
natriuretic properties, and increase the production of luteiniz-
ing hormone (LH), testosterone, estrogen, and other steroids.15
The extract obtained from the aerial parts of the dry plant
contains furostanol-type steroidal glycosides (saponins), of
which the predominant active component is protodioscin
(PTN), which represents45% of the extract.15,16 Other steroidal
saponin glycosides have been described in the literature,
including 3-O-β-D-glucopyranosyl (-- >2)-β-D-glucopyranosyl
(1--4)-β-D-galactopyranoside and neo-hecogenin-3-O-β-D-
glucopyranosyl (1- - >4)-β-D-galactopyranoside.17
Steroidal saponins may be responsible for the intrinsic
hormonal activity by directly stimulating responsive endo-
crine tissues such as the uterus and vagina. It was proposed
that the active components of T. terrestris can be converted
enzymatically to weak androgens similar to dehydroepian-
drosterone (DHEA), which could, in turn, be converted to
more powerful androgens such as testosterone in the gonads
and peripheral tissues, correlating positively with sexual
desire and sexual behavior.12,13,18,19
According to Arsyad20 and Adimoelja,21 in a study
performed in men, PTN increases the serum DHEA levels,
resulting in improved self-esteem and general well-being. It
acts by stimulating the production of the enzyme 5-α-
reductase, which converts testosterone into dihydrotestos-
terone, which has a fundamental role in the formation of
blood cells and muscular development.
According to Adimoelja,21 testosterone and LH levels, as
well as DHEA level, increased after the treatment of erectile
dysfunction with PTN for 30 to 90 days in men. It should be
noted that most of the studies found in the literature report
the action of Tr i bul us in men.20,22
When we analyzed studies in women, we noted that
Akhtari et al23 repor ted, in a randomized double-blind study,
an improvement in sexual desire in women with hypoactive
sexual desire disorder (HSDD).
The knowledge that androgens inuence sexual
desire21,2427 and the already known therapeutic properties
of T. terrestris were the reasons for our interest in studying
the effects of this phytotherapy in the treatment of sexual
dysfunction in menopausal women.
Methods
We performed a prospective, randomized, double-blind, place-
bo-controlled clinical trial in 74 postmenopausal women with
sexual dysfunction. The research was performed at the outpa-
tient clinic of Phytotherapy of the Santa Casa de Misericordia de
São Paulo from January 2009 to April 2011. The women who
completed the study (N¼60) were assigned to two groups. The
project was approved by the research ethics committee of
the ISCMSP through protocol 008/2009 and registered at
www.clinicaltrials.gov under number NCT01407445.
The inclusion criteria were as follows: postmenopausal
women, with full autonomy, and at least 1 year of amenorrhea
and follicle-stimulating hormone level of >30 mUI/mL; those
who were sexually active; those who had a stable partner and
no sexual difculty; and those who experienced sexual dys-
function after menopause. Women undergoing hormonal ther-
apy; those who did not engage in sexual activity; those with
diabetes mellitus, cognitive disorders, a hormone-dependent
tumor, current or previous psychiatric disease, liver diseases,
except prior cholecystectomy, renal disease, or cardiovascular
disease; and those who used drugs that were proven to decrease
sexual desire were excluded from the study.
Seventy-four women were initially selected; however,
10 did not fulll the inclusion and exclusion criteria and
4 discontinued the follow-up subsequently, citing personal
reasons (change of city, separation from husband, hospitali-
zation of husband for acute myocardial infarction, and
discovery of prostatic pathology in the spouse). After an
interview, the women signed an informed consent form and,
after randomization, they were divided into two groups. The
placebo group (n¼30) received placebo in blister packs
identical to those of medicinal products (batch 168159):
one tablet, orally, three times a day for 90 days. The Trib ulu s
group (n¼30) received T. terrestris as one tablet (250 mg)
orally three times a day for 90 days.
The questionnaires used in the Sex Interview of the
Sexology outpatient clinic of the School of Medical Sciences
of Santa Casa de São Paulo, with the purpose of obtaining
epidemiological data were the Sexual Quotientfemale ver-
sion (SQ-F),6in addition to the Female Intervention Efcacy
Index (FIEI) questionnaire.28
The questionnaires were applied individually and by the
same researcher. The results were analyzed and interpreted
within the theoretical framework of sociohistorical psychol-
ogy, which is associated with the understanding of the
structure of culture, social organization, and the redemption
of human subjectivity.
The data obtained in the rst interview and in return visits
were tabulated and the frequencies were distributed between
the groups (placebo and Tribu lus groups), according to the
variable analyzed. The statistical signicance was analyzed by
using Studentst-test for independent samples comparing the
means of the two groups, the chi-square test with Yates
correction, the chi-square test, and the Mann-Whitney Utest.
In all tests, the signicance level was set at 5% (p<0.05). The
analysis was performed with the EPI-INFO program for Win-
dows v. 3.3.2 and SPSS software v. 13.0 for Windows.
Results
The demographic and clinical characteristics of the studied
women are presented in Table 1. There was no signicant
difference between the groups in age, age at menopause, civil
status, race, and religion.
The data from the SQ-F questionnaire that were analyzed
at the beginning of the study indicated no signicant differ-
ence between the placebo and Tr ibulus groups (p¼0.16).
After 3 months of treatment, there was a signicant
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difference between the placebo and Trib ulus groups in the
domains of desire and sexual interest (7.6 3.2 versus
10.2 3.2) (items 1, 2, and 8) (p 0.001), foreplay
(3.3 1.5 versus 4.2 1.0) (item 3) (p 0.01), arousal in
women and harmonious interaction with the partner
(5.7 2.1 versus 7.2 2.6) (items 4 and 5) (p 0.01), and
comfort in sexual intercourse (6.5 2.4 versus 8.0 1.9)
(items 6 and 7) (p 0.01). In the domains of orgasm and
sexual satisfaction (items 9 and 10), there was no signicant
difference between the placebo and Tr ibul us groups
(5.2 2.5 versus 5.9 2.6) (p¼0.3) (Table 2).
Analysis of the data from the FIEI questionnaire revealed
that in item 1 that included vaginal lubrication during coitus
and/or foreplay, there was a 20% improvement in the placebo
group and 83.3% improvement in the Tr i bulus group after
treatment, with a signicant difference between the two
groups (p<0.001). Concerning the sensation in the genitalia
during sexual intercourse or other stimuli (item 2), 16.7% of
women in the placebo group and 76.7% in the Tr i bul us group
(p<0.001) presented an improvement. In the item the
perception of change in sensation in the genital areaof
the FIEI questionnaire (item 3), there was an improvement of
20% in the placebo group and 70% in the Trib ulus group
(p<0.001). Concerning the perception of change in sexual
intercourse and/or other sexual stimulations (item 4) after
the treatment, 13.3% in the placebo group evaluated it as
pleasant, 56.7% as unpleasant, and 30% as indifferent, and in
the Trib ulu s group, 43.3% evaluated it as pleasant, 16.7% as
unpleasant, and 40% as indifferent. There was a signicant
difference between the gro ups (p¼0.003). After 3 months of
treatment, the analysis of the ability to reach an orgasm
(item 5) showed that 73.3% of the interviewees of the Tr ibu lus
group indicated an improvement and 26.7% reported no
change. In the placebo group, 20% reported an increased
ability to have an orgasm and 80% reported no change
(p<0.001) (Fig. 1).
With regard to the use of the medication (item 7), in the
placebo group, 20% of the women reported an improvement
in sexual experience and wished to continue using the
medication, 23.3% did not perceive changes in their sexual
experience but wished to continue taking the medication,
and 56.7% reported that their sexual experience was un-
changed and they did not want to continue the medication.
In the Trib ulu s group, 80% reported an improvement in their
sexual experience and wanted to continue taking the medi-
cation, 10% reported no change but wished to continue using
the medication, and 10% reported no change and did not
wish to continue the medication (p<0.001).
In relation to adverse effects (item 6), we observed a
greater incidence in the Tr i bul us group than in the placebo
group; the most frequent adverse effects were diarrhea
(13.3%), nervousness (13.3%), dizziness (10%), and nausea
(10%) in the Tr ibu lus group, and nervousness (13.3%), facial
ushing (13.3%), dizziness (10%), and nausea (10%) in the
placebo group. However, there was no signicant difference
in relation to the general reference and also to each one of the
adverse effects, by overlap of the signicance index.
Discussion
In contrast to male sexual problems, for which many treat-
ment strategies have been formulated, female sexual dys-
function (FSD) remains an area that requires more studies
Table 2 Domains evaluated according to the Sexual Quotient female version questionnaire before and after the study of the
placebo group and the Tribulus group
Domains evaluated Placebo Tribu lus pValue
Before After Before After Before After
Desire 7.5 3.1 7.6 3.2 7.4 3.3 10.2 3.2 0.7 0.001
Foreplay 2.9 1.4 3.3 1.5 3.2 1.5 4.2 1.0 0.5 0.006
Arousal 5.2 2.0 5.7 2.1 4.9 2.3 7.2 2.6 0.6 0.006
Comfort 6.4 2.3 6.5 2.4 5.7 2.8 8.0 1.9 0.3 0.008
Orgasm 5.2 2.8 5.2 2.5 3.6 2.8 5.9 2.6 0.01 0.2
Tot a l 54 . 5 16.9 56.6 17.9 49.5 19.1 70.9 17.6 0.1 0.003
The p values refer to the outcome of Studentst-test for two independent samples (p<0.05). Data are presented as mean standard deviation.
Table 1 Clinical and demographic characteristics of
menopausal women in the placebo group and the Tribulus
group
Characteristics Placebo Tribulus pValue
Age (years) 54 5.1 56 5.8 0.1
Menopausal age (years) 45 4.7 47 5.3 0.1
Civil status
Married 86.2% 93.3% 0.3
Single 13.8% 6.7% 0.3
Race
White 60.0% 53.3% 0.6
Black and mulatto 40.0% 46.7% 0.6
Religion
Catholic 63.3% 65.5 0.8
Evangelical 36.7% 35.5 0.8
The p values refer to the outcome of Studentst-test for two indepen-
dent samples (p<0.05). Data are presented as mean standard
deviation.
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and clinical trials to identify the most effective treatment
option.19
The inuence of age on sexual desire in both sexes is
known, with age-related problems being a particularly
frequent complaint among women in the menopausal peri-
od.5FSD is the most common complaint in this age group.4
To contribute to the management of this condition, we
studied the effects of T. terrestris, the properties of which
have already been tested in men for improving sexual
complaints.22 Thus, in this study, we aimed to contribute
to the study of the effects of T. terrestris on the sexuality of
women after menopause.
This study was performed because only few studies have
focused on phytotherapy for the treatment of FSD29 and no
studies have examined the effects of T. terrestris on sexual
function in meno pausal women, which makes this a pioneer-
ing study. In fact, the few existing studies are questionable
because of a possible conict of interest and a lack of
information about the evaluation instrument.10,23
Another relevant issue in the study of female sexuality is
the availability of questionnaires for its evaluation. In fact,
the great diversity of the instruments used in the study of
FSD may reect the lack of consensus or even the lack of a
complete method that allows for a full evaluation of sexual
function in all its areas, applicable to all cultures. In our
study, we chose to use two questionnaires: a multidimen-
sional questionnaire used in studies developed with a popu-
lation of Brazilian women (SQ-F) and the FIEI questionnaire
(validated for the Portuguese language), a measuring tool
with immediate results in medical intervention for treating
FSD.5,6
When analyzing the domains evaluated by using the SQ-F
questionnaire, after 3 months of treatment, we observed a
signicant improvement in the Tribu lus group in the do-
mains of desire and sexual interest (p 0.001), foreplay
(p 0.01), arousal and harmonious interaction with partner
(p 0.01), and comfort in sexual intercourse (p 0.01),
when compared with the placebo group.
The results obtained by both questionnaires were concor-
dant with those of published studies that used medications
with androgenic effect to evaluate the improvement of
sexual response.2023,2528
When we analyzed the SQ-F, we found that there was no
improvement in the domains of orgasm and sexual satisfaction,
which are analyzed in items 9 (Are you able to reach orgasm
maximum pleasurein sexual intercourse?) and 10 (Does the
level of satisfaction you achieve from sexual intercourse make
youwanttoengageinsexagainonotherdays?).Infact,in
accordance with our ndings, no medicinal products have been
reported to have a direct action on female orgasm.30
Androgens are involved in the sexual response, and their
decit can result in FSD.31 Low testosterone levels are
associated with a decrease in libido, arousal, genital sensa-
tion, and orgasm.11 Furthermore, androgens have an impor-
tant anabolic effect, improving muscle mass, muscular
strength, and vigor, which may lead to improvement of
sexual desire.25,26 Women who received androgen replace-
ment therapy perceived important changes in the level of
energy and willingness to work, as well as improvement in
their libido.22,25
In a randomized, double-blind, placebo controlled study
in Europe and Australia that included oophorectomized
women with HSDD who used concurrent transdermal estro-
gen, the group treated with testosterone obtained better
scores in the sexual desire domain than the placebo-treated
group. The scores in the domains of sexual arousal, orgasm,
and responsiveness were signicantly higher in the testos-
terone group.27
To evaluate the efcacy and safety of transdermal testos-
terone (300 μg/day) in naturally menopausal women with
Fig. 1 Female Intervention Efcacy Index: frequency of response to the items as improved (A), worsened (B), indifferent (C). Item 1: Vaginal
lubrication during coitus and/or other sexual stimulations (e.g., foreplay) after taking the medication. Item 2: The sensation in genitals (vagina,
labia majora, and clitoris) during sexual intercourse or other stimuli (e.g., foreplay) after taking the medication. Item 3: Noticed sensation
change in genital area after the study. Item 4: Sexual intercourse and/or other sexual stimulations after taking the medication. Item 5: Ability to
have an orgasm after taking the medication.
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HSDD, Panay et al27 analyzed 272 women for 6 months in a
randomized, multicenter, double-blind, placebo-controlled
study, observing an improvement in the domains of sexual
desire (p¼0.001) and sexual satisfaction (p¼0.01).
Steroidal saponins may be responsible for the intrinsic
hormonal activity of T. terrestris, directly stimulating the
endocrine-sensitive female tissues such as the uterus and
vagina.19 It has been proposed that the active components of
T. terrestris can be converted enzymatically into weak
androgens similar to DHEA, which could, in turn, be con-
verted into more powerful androgens such as testosterone in
the gonads and peripheral tissues.13,14,19,20
The results of the FIEI questionnaire revealed signicant
improvement in all variables. There was an improvement of
73.3% in the ability to reach orgasm (p<0.001) (item 5), in
contrast with the results for the domain of orgasm (item 9) of
the SQ-F questionnaire. This was probably due to the per-
sonal interpretation of each question, thus demonstrating
the importance of a critical analysis of the different instru-
ments used. It should be emphasized that the questionnaires
were applied by the same researcher to avoid this bias.
Another factor to be analyzed is the personal interpretation
of each woman, as the questionnaires are self-explanatory.
When we compared the dat a from the two questionnaires,
we observed a concordance after treatment with improve-
ment in the domains of s exual desire, vaginal lubrication, and
arousal.
With regard to the placebo group, all items evaluated by
using the FIEI questionnaire showed improvement, ranging
from 13 to 20%; nevertheless, the signicant difference
compared with the Tr ibu lus group was maintained. Bradford
and Meston32 veried that one-third of women experienced
clinically signicant improvement in sexual function during
treatment with placebo, emphasizing the importance of
sexual behavior during the initial interview, in addition to
age and the severit y of symptoms as important determinants
in the result.
The placebo effect does not exist outside the therapeutic
context, nor is it limited to speciceffectsofamedicinal
product or compliance with a process.33 A contextualized
view of the placebo effect, in which internal and external
factors may promote change in symptoms, provides a broad
framework for the understanding of the response to placebo
in the treatment of FSD. The existence of what seems to be a
placebo response in the population reects an opportunity
to understand the fundamental processes involved in the
reduction of the symptoms.32 In our study, the data were
concordant in relation to the placebo effect, with an im-
provement in vaginal lubrication, perception of change in
the genital region, and in the ability to reach orgasm (13
20%).
The study of sexuality in women after menopause is a
topic of current and growing interest. Our study aims to
contribute to the knowledge on the treatment of sexual
dysfunction in this phase of life, by using herbal remedies
derived from T. terrestris, which may also give rise to new
therapeutic perspectives.
Conict of Interest
The authors declare no conict of interest in conducting
this study.
Acknowledgments
We thank the Fundação de Amparo à Pesquisa do Estado
de São Paulo (FAPESP) for the nancial aid (research
funding 2009/027731) and the Coordenação de Aperfei-
çoamento de Pessoal de Nível Superior (CAPES) for the
research fellowship.
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... The NHMRC evidence hierarchy was used to assess the level of evidence of the included studies. Seventeen studies were rated level II (randomized controlled trial; RCT) (Abedi et al., 2018;Akhtari et al., 2014;Brooks et al., 2008;Chung et al., 2015;Darvish-Mofrad-Kashani et al., 2018;de Souza et al., 2016;Del Giorno et al., 2010;Eliasvandi et al., 2018;Ferguson et al., 2003;Ghorbani et al., 2019;Khayatan et al., 2019;Malakouti et al., 2017;Meston et al., 2008;Oh et al., 2010;Postigo et al., 2016;Shabanian et al., 2018;Vale et al., 2018), whereas two studies adopted a crossover design (Brooks et al., 2008;Chung et al., 2015), two studies were rated level III-2 (cohort study) (Palacios et al., 2019;Waynberg and Brewer, 2000) and one study was rated level IV (cross-sectional study) (Cai et al., 2014). The risk of bias was determined using a modified McMaster Critical Appraisal Tool for quantitative studies and was measured in percentage as per criteria fulfilled (see Supplementary Table S1). ...
... The risk of bias was determined using a modified McMaster Critical Appraisal Tool for quantitative studies and was measured in percentage as per criteria fulfilled (see Supplementary Table S1). Eleven studies were rated >90% (Abedi et al., 2018;Akhtari et al., 2014;Cai et al., 2014;Darvish-Mofrad-Kashani et al., 2018;de Souza et al., 2016;Eliasvandi et al., 2018;Ghorbani et al., 2019;Khayatan et al., 2019;Malakouti et al., 2017;Oh et al., 2010;Palacios et al., 2019), six studies were rated 80-90% (Brooks et al., 2008;Del Giorno et al., 2010;Ferguson et al., 2003;Meston et al., 2008;Postigo et al., 2016;Vale et al., 2018) and each one of the three studies was rated 70-80% (Shabanian et al., 2018), 60-70% (Chung et al., 2015), and <60% (Waynberg and Brewer, 2000). All of the included RCTs reported how randomization was carried out. ...
... The study outcomes for FSD were measured using various scales: Female Sexual Function Index (FSFI), Greene Climacteric Scale (GCS), (Ferguson et al., 2003;Meston et al., 2008), whereas three studies used a combination of two of the aforementioned scales (de Souza et al., 2016;Postigo et al., 2016;Vale et al., 2018). The remaining studies used only one scale to access study outcomes, and one of them used a self-assessment questionnaire on various aspects of sexual function and their effects on the relationship that was specifically designed for that study (Waynberg and Brewer, 2000). ...
Article
Background : Female sexual dysfunction (FSD) includes female orgasmic disorder, female sexual interest or arousal disorder, and genito-pelvic pain or penetration disorder. FSD affects 40% of women worldwide, but it is understudied and likely undertreated. Natural products are frequently used by women to treat FSD, but scientific evidence of their efficacy is lacking. Objective : This systematic review and meta-analysis focused on the study of the efficacy of natural products on FSD. Study design : Systematic review and meta-analysis of existing studies on natural products in the treatment of FSD. Methods : The literature search included MEDLINE, EMBASE, PsycINFO, and the Cochrane Central Register of Controlled Trial databases for studies published from January 2000 to February 2020. The quality and the level of evidence of the studies were assessed. The association between natural products and FSD was summarized using standardized mean differences (SMD) with a 95% confidence interval (CI). Results : A total of 536 studies were identified, with 20 of them meeting the criteria. According to this meta-analysis, Tribulus terrestris showed a significant positive effect in improving overall female sexual function (SMD = 1.12, 95% CI = 0.46 - 1.79, p = 0.001) and individual sexual arousal (SMD = 1.03, 95% CI = 0.22 - 1.84, p = 0.013), sexual desire (SMD = 1.08, 95% CI = 0.52 - 1.63, p = <0.001) and sexual orgasm (SMD = 0.51, 95% CI = 0.02 - 1.00, p = 0.040) domains compared to placebo. Panax ginseng was found to be effective in treating sexual arousal (SMD = 0.54, 95% CI = 0.11 - 0.97, p = 0.014) and sexual desire (SMD = 0.59, 95% CI = 0.27 - 0.90, p < 0.001) compared to placebo. Meanwhile, other natural products reviewed in this study, such as Trifolium pretense, did not differ significantly from placebo in terms of improving FSD. Conclusion : Preliminary evidence suggests that Tribulus terrestris and Panax ginseng may be effective as alternative treatments for FSD in a clinical setting.
... T. terrestris treatment (250 mg orally three times a day for 90 days) was considered to be effective in treating sexual problems among menopausal women (Postigo et al., 2016). ...
... (P < 0.01) increased after intervention, but there was no significant change in orgasm and sexual satisfaction between the two groups (P = 0.28). Also, using the FIEI, sexual function increased in all areas and the ability to reach orgasm increased by 73.3% compared to the SQ-F questionnaire, indicating the effectiveness of bindii (30). Another study conducted by Tadayon et al in 2017 examined the effect of bindii on the sexual satisfaction of menopausal women, and the results showed that after 8 weeks of bindii syrup intake, the average score of sexual satisfaction increased from 34.8 to 37.56 after intervention (P < 0.05). ...
Article
Full-text available
Sexual function is one of the most important aspects of menopausal women, and its disorder is a common condition among this group of women. The long-term side effects of hormone replacement therapy to improve this disorder have led women to seek alternative therapies. The purpose of this review is to summarize clinical trials of herbal medicines that improve the sexual function of menopausal women. In this review article the content was searched in 6 databases to identify double- and triple-blind clinical trial studies from January 2000 to April 2020. The search was conducted in English and Persian. Studies were considered if they were related to menopausal woman, sexual function and its various domains. A total of 479 articles were reviewed, 31 of which were included in the study after reviewing the full text. In this study, 3 articles on ginseng, 4 articles on fennel, 2 articles on Fenugreek, 3 articles on bindii, 3 articles on Red clover, 1 article on Schisandra, 2 articles on Hops; 3 articles about Black cohosh, 2 articles about soy, 2 articles about Ginkgo biloba, 1 article about Nigella sativa, 1 article about neroli oil, 1 article about maca, 1 article about Date pollen, 1 article about Aphrodite and 1 article on the combination of St John’s wort and vitex were evaluated. Red ginseng, fennel, bindii, Red clover and Black cohosh have the greatest effect on improving the sexual function of menopausal women, and people can be encouraged to use these plants.
... (P < 0.01) increased after intervention, but there was no significant change in orgasm and sexual satisfaction between the two groups (P = 0.28). Also, using the FIEI, sexual function increased in all areas and the ability to reach orgasm increased by 73.3% compared to the SQ-F questionnaire, indicating the effectiveness of bindii (30). Another study conducted by Tadayon et al in 2017 examined the effect of bindii on the sexual satisfaction of menopausal women, and the results showed that after 8 weeks of bindii syrup intake, the average score of sexual satisfaction increased from 34.8 to 37.56 after intervention (P < 0.05). ...
Article
Full-text available
Sexual function is one of the most important aspects of menopausal women, and its disorder is a common condition among this group of women. The long-term side effects of hormone replacement therapy to improve this disorder have led women to seek alternative therapies. The purpose of this review is to summarize clinical trials of herbal medicines that improve the sexual function of menopausal women. In this review article the content was searched in 6 databases to identify double-and triple-blind clinical trial studies from January 2000 to April 2020. The search was conducted in English and Persian. Studies were considered if they were related to menopausal woman, sexual function and its various domains. A total of 479 articles were reviewed, 31 of which were included in the study after reviewing the full text. In this study, 3 articles on ginseng, 4 articles on fennel, 2 articles on Fenugreek, 3 articles on Bindii, 3 articles on Red clover, 1 article on Schisandra, 2 articles on Hops; 3 articles about Black cohosh, 2 articles about soy, 2 articles about Ginkgo biloba, 1 article about Nigella sativa, 1 article about neroli oil, 1 article about Maca, 1 article about Date pollen, 1 article about Aphrodite and 1 article on the combination of St John's wort and vitex were evaluated. Red ginseng, fennel, bindii, Red clover and Black cohosh have the greatest effect on improving the sexual function of menopausal women, and people can be encouraged to use these plants. A B S T R A C T
... The 5-parallel design RCTs were published between 2014 and 2017 in Brazil (N ¼ 4) and Iran (N ¼ 1) and enrolled a total of 279 women with HSDD or loss of libido that caused distress. Three studies [11][12][13] included only postmenopausal women (N ¼ 172; age range 43-65 years), and 2 studies 10,14 included only premenopausal women (N¼ 107; 18-44 years). Most trials excluded women with any psychiatric condition, smokers, with a history of breast or endometrial cancers, or with diabetes mellitus, cardiovascular or renal disease, and/or using any drugs that could interfere with sexual desire, including hormone therapy. ...
Article
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Objective We performed a systematic review to assess the effectiveness and safety of Tribulus terrestris to treat female sexual dysfunction (FSD). Data sources We performed unrestricted electronic searches in the MEDLINE, CENTRAL, EMBASE, LILACS, CINAHL, PsycINFO, WHO-ICTR, Clinicaltrials.gov and OpenGrey databases. Selection of studies We included any randomized controlled trials (RCTs) that compared T. terrestris versus inactive/active interventions. After the selection process, conducted by two reviewers, 5 RCTs (n = 279 participants) were included. Data collection Data extraction was performed by two reviewers with a preestablished data collection formulary. Data synthesis Due to lack of data and clinical heterogeneity, we could not perform meta-analyses. The risk of bias was assessed by the Cochrane Risk of Bias (RoB) tool, and the certainty of evidence was assessed with Grading of Recommendations, Assessment, Development and Evaluations (GRADE). Results After 1 to 3 months of treatment, premenopausal and postmenopausal women randomized to T. terrestris had a significant increase in sexual function scores. Three months of treatment with T. terrestris showed a significant increase in the serum testosterone levels of premenopausal women. There was no report of serious adverse events, and none of the studies assessed health-related quality of life. The certainty of the evidence was very low, which means that we have very little confidence in the effect estimates, and future studies are likely to change these estimates. Conclusion More RCTs are needed to support or refute the use of T. terrestris. The decision to use this intervention should be shared with the patients, and the uncertainties around its effects should be discussed in the clinical decision-making process. Number of Protocol registration in PROSPERO database: CRD42019121130
... As shown in Figure 1 Regarding the characteristics of the intervention, in FSD or HSDD, Tribulus terrestris was used for four studies [9] [12] [13] [14], visnadine (Ammi visnaga) was used for three [15] [20] [21], and ArginMax was used for one [7], red clover (Trifoliumpratense) is used in one [8], Libifem (Trigonellafoenum-graecum) in one [10], Elaeagnus angustifolia in one [11]. Ginkgo biloba leaves were used in one study [16], saffron (Crocus sativus) was used in one [17], and Rosa damascena oil was used in two studies [18] [19]. ...
Article
We evaluated the efficacy of Tribulus terrestris in two different dosage regimes for the treatment of sexual dysfunction in pre and postmenopausal women and its effect on the vascular resistance of the clitoral artery using Power Doppler. A total of 104 women were randomly assigned to receive 94mg, three times/day (TT3) or 280mg once/day for 90 days (TT1). Evaluation was performed using FSFI and QS-F questionnaires, serum levels of prolactin, TSH, total testosterone and SHBG, and clitoral artery assessment with Power Doppler ultrasound. FSFI results demonstrated an improvement in all domains in both groups (P < 0.05) except for the “Satisfaction” in the TT3 premenopausal group. QS-F results showed a significant improvement in the mean total score in women of both reproductive phases, for both groups. Postmenopausal patients improved in all sexual domains, except for “orgasm” in the TT1 group. PI of the clitoral artery showed no difference in both reproductive phases, in both groups. We conclude that TTerrestris can be a safe alternative for the treatment of sexual dysfunction in pre and postmenopausal women as it is effective in reducing the symptoms with no side effects. Moreover, its use, increased total, free and bioavailable testosterone.
Article
Background: Tribulus terrestris L. (T. terrestris) positive performance on the male sexual system has been confirmed, but little is known about its effects on the female reproductive system. Purpose: This review discussed in detail the beneficial impact of T. terrestris and its secondary metabolites on the female reproductive system. Study design and methods: In this review, the scientific Databases of Science direct, Pubmed, Web of Science, Google, Google Scholar, Researchgate, EMBASE, Scientific Information (SID), and Elsevier were searched profoundly. Studies about the pharmacological activities of T. terrestris on the female reproductive system in each aspect of investigations: human, in vivo, and in vitro studies, in the period from 1998 to 2020 were admitted. Our study was not limited by the language of publications. Results: 23 articles about the effects of T. terrestris on the female reproductive system were found. These studies approved the T. terrestris efficacy on improvements in histological features of the ovary and uterus of polycystic ovary syndrome patients as well as the well-working of normal ovaries, enhancements in the sexual desire of postmenopausal syndrome, improve ovarian and breast cancers. Conclusion: These studies showed that the positive effect of T. terrestris on the female reproductive system was due to the presence of a secondary metabolite called protodioscin; a steroidal saponin compound, as the dominant active component of this plant.
Article
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PURPOSE: to evaluate the effects of the association of estrogen and androgen on the quality of life and sexuality of women during climacterium. METHODS: ninety-six postmenopausal women with vasomotor symptoms and sexual dysfunction were included. The participants were randomly divided into three treatment groups with 32 pacients each: placebo, conjugated equine estrogens (CEE) (0.625 mg per day) and CEE (0.625 mg per day) associated with methyltestosterone (2.5 mg per day). The length of the treatment period was three months. The Women Health Questionnaire (WHQ) and the Modified Sexuality Questionnaire were applied to evaluate the quality of life and sexuality before and after the treatment. Some parameters of cardiovascular risk, endometrial echo and hepatic toxicity were evaluated. ANOVA was used for data analysis followed by the Fisher test and the Shapiro-Wilk post hoc test. RESULTS: the improvement in WHQ parameters was significant in the hormonal treatment groups (CEE and CEE + methyltestosterone) compared to the placebo group. However, there were no differences in somatic symptoms among the three groups. The association of estrogen with androgen significantly improved sexual function (score (mean): 64 vs 67, p<0.05) and depressive humor (score (mean): 75 vs 80, p<0.05) compared to estrogen alone. This therapy also presented a large number of WHQ questions with a high score (p<0.05). The use of CEE associated with methyltestosterone decreased the total cholesterol (212±42 and 194±43, before and after the treatment, respectively) and HDL colesterol (56±16 and 48±14, before and after the treatment, respectively), and slightly increased the endometrial echo (4.7±2.3 and 5.5±2.3, before and after the treatment, respectively). No signifcant changes in liver enzymes during the treatment period was detected. CONCLUSIONS: estrogen associated with methyltestosterone resulted in significant improvement in the quality of life and sexuality of postmenopausal women. This effect was superior to estrogen alone and placebo. The effect of treatment with the estrogen-androgen association was evident regarding depressive humor and sexual function questions of the WHQ.
Article
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Tribulus terrestris as a herbal remedy has shown beneficial aphrodisiac effects in a number of animal and human experiments. This study was designed as a randomized double-blind placebo-controlled trial to assess the safety and efficacy of Tribulus terrestris in women with hypoactive sexual desire disorder during their fertile years. Sixty seven women with hypoactive sexual desire disorder were randomly assigned to Tribulus terrestris extract (7.5 mg/day) or placebo for 4 weeks. Desire, arousal, lubrication, orgasm, satisfaction, and pain were measured at baseline and after 4 weeks after the end of the treatment by using the Female Sexual Function Index (FSFI). Two groups were compared by repeated measurement ANOVA test. Thirty women in placebo group and thirty women in drug group completed the study. At the end of the fourth week, patients in the Tribulus terrestris group had experienced significant improvement in their total FSFI (p < 0.001), desire (p < 0.001), arousal (p = 0.037), lubrication (p < 0.001), satisfaction (p < 0.001) and pain (p = 0.041) domains of FSFI. Frequency of side effects was similar between the two groups. Tribulus terrestris may safely and effectively improve desire in women with hypoactive sexual desire disorder. Further investigation of Tribulus terrestris in women is warranted.
Article
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Introduction: In clinical trials of drug treatments for women's sexual dysfunction, placebo responses have often been substantial. However, little is known about the clinical significance, specificity, predictors, and potential mechanisms of placebo response in sexual dysfunction. Aim: We aimed to determine the nature and predictors of sexual function outcomes in women treated with placebo for female sexual arousal disorder (FSAD). Methods: We conducted a secondary analysis of data from the placebo arm of a 12-week, multisite, randomized controlled pharmaceutical trial for FSAD (N=50). We analyzed the magnitude, domain specificity, and clinical significance of sexual function scores at baseline, 4, 8, and 12 weeks (post-treatment). We examined longitudinal change in sexual function outcomes as a function of several baseline variables (e.g., age, symptom-related distress) and in relation to changes in sexual behavior frequency during the trial. Main outcome measure: Female Sexual Function Index total score. Results: The magnitude of change at post-treatment was clinically significant in approximately one-third of placebo recipients. Effect sizes were similar across multiple aspects of sexual function. Symptom improvement was strongly related to the frequency of satisfying sexual encounters during treatment. However, the relationship between sexual encounter frequency and outcome varied significantly between participants. Conclusions: A substantial number of women experienced clinically significant improvement in sexual function during treatment with placebo. Changes in sexual behavior during the trial, more so than participant age or symptom severity at baseline, appeared to be an important determinant of outcome. Contextual and procedural aspects of the clinical trial may have influenced outcomes in the absence of an active drug treatment.
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Tribulus terrestris is a valuable herb known for its application in the folk medicine in many parts of the world. Furostanol and spirostanol saponins of tigogenin, neotigogenin, gitogenin, neogitogenin, hecogenin, neohecogenin, diosgenin, chlorogenin, ruscogenin and sarsasapogenin type are frequently found in this plant. Four sulphated saponins of tigogenin and diosgenin type are also isolated. Extracts and steroidal saponins have been found to possess various pharmacological activities. Preparations based on the saponin fraction of T. terrestris are used for treatment of infertility and libido disorders in men and women, as well as for treatment of cardiac diseases. Food supplements containing T. terrestris extracts are on sale in USA and Europe with claim of a general stimulating action.
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To evaluate the efficacy and safety of a transdermal testosterone patch (TTP, 300 microg/day) in naturally menopausal women with hypoactive sexual desire disorder (HSDD). A total of 272 naturally menopausal women, predominantly not using hormone therapy, were randomized in this 6-month, placebo-controlled, double-blind, multicenter study to receive twice weekly either TTP or an identical placebo. Efficacy endpoints measured were the 4-week frequency of satisfying sexual episodes (SSE) using the Sexual Activity Log, the sexual desire domain of the Profile of Female Sexual Function and distress by the Personal Distress Scale. Safety was assessed by adverse events, laboratory parameters and hormone levels. The TTP group demonstrated significant improvements in SSE (p = 0.0089) as well as in sexual desire (p = 0.0007) and reduced personal distress (p = 0.0024) versus placebo at 6 months (intent-to-treat analysis, n = 247). The results were significant for all three endpoints in the subgroup (n = 199) not using hormone therapy. Similar numbers of women treated with placebo and TTP discontinued (n = 39, 27.5% vs. n = 26, 20%), reported adverse events (including application site reactions) (n = 101, 71.1% vs. n = 81, 62.3%) and withdrew due to adverse events (n = 20, 14.1% vs. n = 9, 6.9%). No clinically relevant changes were noted in laboratory parameters. Serum free and total testosterone levels increased from baseline in the TTP group (geometric means 5.65 pg/ml and 67.8 ng/dl, respectively, at week 24) within the physiological range; no changes were seen in estradiol and sex hormone binding globulin levels. TTP was effective in treating HSDD and improving sexual function in this study of naturally menopausal women with and without concurrent hormone therapy.
Article
Introduction: Aspects of women's sexual functioning that have received relatively little attention are its stability and how changes in the different sexual response domains influence each other over time. Aim: The aim of this study was to describe the changes and to evaluate the stability of self-reported sexual functioning over a 4-year period in a population sample of British women. Methods: A 4-year follow-up study on N = 507 women, including 178 pre- and 329 postmenopausal women, was conducted. The validated Female Sexual Function Index (FSFI) was applied. Main outcome measure: A multigroup path analytical model was used to examine autoregressive effects (the effect of a domain on itself at a later point in time) and cross-lag effects (one variable affecting another variable at a later point in time) across all FSFI domains of sexual functioning between pre- and postmenopausal women. Results: Overall, the proportion of postmenopausal women suffering from a sexual dysfunction at measurement point 1 (T1) was higher compared with premenopausal women (pre: 34.3% vs. post: 14.5%). However, both groups showed a comparable number of women developing a sexual problem (pre: 22.2% vs. post: 23.2%) or improving their sexual functioning (7.4% vs. 7.6%) after the 4 years. Furthermore, path model analyses revealed that each domain at T1 significantly predicted its level 4 years later (βs ranging from 0.33 for arousal to 0.57 for lubrication), with the exception of sexual satisfaction. In terms of cross-lag effects, the changes in all domains except for pain were predicted either by levels of desire, arousal, or orgasm at T1 (βs ranging from 0.18 to 0.36) in both groups. Conclusions: Women's sexual functioning was moderately stable across the 4 years. The main predictors of changes in sexual functioning and satisfaction were desire and arousal, highlighting their role as possible key players in women's sexual health.
Article
IntroductionThere is a paucity of longitudinal studies assessing sexual function of women in the late postmenopause.AimThis study aims to describe sexual function of women in the late postmenopause and to investigate change from early postmenopause.Methods Cross-sectional analysis of 2012/13 and longitudinal analysis from 2002/04 of the population based, Australian cohort of the Women's Healthy Ageing Project, applying validated instruments: Short Personal Experience Questionnaire (SPEQ), Female Sexual Distress Scale (FSDS), Hospital Anxiety and Depression Scale, Geriatric Depression Scale, and California Verbal Learning Test.Main Outcome MeasuresSexual activity, SPEQ, and FSDS.ResultsTwo hundred thirty women responded in 2012/13 (follow-up rate 53%), 49.8% were sexually active. FSDS scores showed more distress for sexually active women (8.3 vs. 3.2, P < 0.001). For 23 (23%) sexually active and for five (7%) inactive women, the diagnosis of female sexual dysfunction could be made. After adjustment, available partner (odds ratio [OR] 4.31, P < 0.001), no history of depression (OR 0.49, P = 0.036), moderate compared with no alcohol consumption (OR 2.43, P = 0.019), and better cognitive function score (OR1.09, P = 0.050) were significantly predictive for sexual activity. Compared with early postmenopause, 18% more women had ceased sexual activity. For women maintaining their sexual activity through to late postmenopause (n = 82), SPEQ and FSDS scores had not changed significantly, but frequency of sexual activity had decreased (P = 0.003) and partner difficulties had increased (P = 0.043).Conclusions In late postmenopause, half of the women were sexually active. Most important predictors were partner availability and no history of depression. However, being sexually active or having a partner were associated with higher levels of sexual distress. Compared with early postmenopause, sexual function scores had declined overall but were stable for women maintaining sexual activity. Further research into causes of sexual distress and reasons for sexual inactivity at this reproductive stage is warranted. Lonnèe-Hoffmann RAM, Dennerstein L, Lehert P, and Szoeke C. Sexual function in the late postmenopause: A decade of follow-up in a population-based cohort of Australian women. J Sex Med **;**:**–**.
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Female sexual dysfunction (FSD) is a complex and multifactorial condition. An increased incidence of FSD is especially associated with the decline of estrogen. Thus, menopause is a critical phase for FSD complaints. In this context, medicinal plants may be a therapeutic option. To identify and describe the popular and clinical uses of medicinal plants for FSD treatment in climacteric women. We highlighted the majority of the plants commonly involved with the female reproductive system including: Angelica sinensis, Cimicifuga racemosa, Ferula hermonis, Ginkgo biloba, Humulus lupulus, Lepidium meyenii, Tribulus terrestris, Trifolium pratense, and Vitex agnus-castus. This study is a narrative review of studies of plants that are possible alternative treatments for FSD. The species described have clinical and popular uses in different cultures as well as medical indications for female reproductive disturbances, mainly in climacteric women. We have also analyzed the evidence level of clinical studies. The main outcome assessed is the efficacy of plants in improving the symptoms of FSD. There is little evidence from the literature to recommend the use of medicinal plants when treating FSD. The majority of studies with a strong level of evidence are associated with the treatment of the vasomotor symptoms of menopause. Ferula hermonis, Angelica sinensis, and Gingko biloba may be suggested for arousal disorder studies. Cimicifuga racemosa, Trifolium pratense, and Vitex agnus-castus may be recommended for several FSD. Humulus lupulus and Tribulus terrestris may help with desire disorder studies. Lepidium meyenii should be studied further. Studies of these plants indicate that they may be useful as a possible alternative and/or complementary approach for studies aimed at the treatment of FSD. At this time, however, this review cannot recommend a plant that has a strong enough level of evidence for treatment of FSD. Thus, there is a need for clinical (double-blinded and randomized) studies to evaluate the efficacy and safety of several plants that can exert a positive effect on the management of FSD.