Available via license: CC BY-NC-ND
Content may be subject to copyright.
Electronic Physician (ISSN: 2008-5842) http://www.ephysician.ir
April 2018, Volume: 10, Issue: 4, Pages: 6577-6587, DOI: http://dx.doi.org/10.19082/6577
Corresponding author:
Assistant Professor Dr. Malihe Motavasselian, Department of Persian and Complementary Medicine, Mashhad
University of Medical Sciences, Mashhad, Iran.
Tel: +98.5138848930, Fax: +98.5138829279, Email: m_motevasselian@yahoo.com
Received: August 28, 2017, Accepted: October 26, 2017, Published: April 2018
iThenticate screening: October 23, 2017, English editing: January 15, 2018, Quality control: February 12, 2018
This article has been reviewed / commented by six experts
© 2018 The Authors. This is an open access article under the terms of the Creative Commons Attribution -NonCommercial-
NoDerivs License, which permits use and distribution in any medium, provided t he original work is properly cited, the use is
non-commercial and no modifications or adaptations are made.
Page 6577
Effects of a food product (based on Daucus carota) and education based on traditional Persian medicine on
female sexual dysfunction: a randomized clinical trial
Tahereh Molkara1,2, Farideh Akhlaghi3, Mohammad Arash Ramezani4, Roshanak Salari5, Veda Vakili6,
Mohammad Kamalinejad7, Mohammad Reza Fayyazi Bordbar8, Ahmad Ghorbani9, Malihe Motavasselian10
1Ph.D. Student of Persian Medicine, Department of Persian and complementary Medicine, School of Persian and
Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
2Student Research Committee, School of Persian and Complementary Medicine, Mashhad University of Medical
Sciences, Mashhad, Iran
3Gynecologist, Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Mashh ad University of
Medical Sciences, Mashhad, Iran
4Assistant Professor of Sexual Health and Sex therapy-Family and Couple Therapy, Family Research Institute,
Shahid Beheshti University, Tehran, Iran
5Ph.D. of Drug Control, Assistant Professor, Department of Clinical Persian Pharmacy, School of Persian and
Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
6Community Medicine Specialist, Assistant Professor, Department of Community Medicine, Faculty of Medicine,
Mashhad University of Medical Sciences, Mashhad, Iran
7M.Sc., Researcher, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
8Psychiatrist, Professor, Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical
Sciences, Mashhad, Iran
9Ph.D. of Physiology, Associate Professor, Pharmacological Research Center of Medicinal Plants, Mashhad
University of Medical Sciences, Mashhad, Iran
10 Ph.D. of Persian Medicine, Assistant Professor, Department of Persian and Complementar y Medicine, School of
Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Type of article: Original
Abstract
Background: Globally, female sexual dysfunction is a serious concern based on negative family and social
consequences, high side effects of medications and lack of effective treatment. Thus, the evaluation of treatment
approach for this problem is an important priority for healthcare system s. Sexual life and its related disorders are
considered the main aspects of a healthy lifestyle in traditional Persian medicine (TPM).
Objective: The present study aimed to determine and compare the effects of food products containing Daucus
carota, TPM-based training program, and a combination of these two interventions on the improvement of female
sexual dysfunction.
Methods: This randomized clinical trial was conducted on 96 women with sexual dysfunction based on the
Diagnostic and Statistical Manual of Mental Disorders (DSM-5®), aged 18-35 years who referred to the
Gynecology Clinic of Mashhad University of Medical Sciences, Mashhad, Iran, during 2016 and 2017. The
patients were randomly divided into three groups (n=32) and received the intervention ove r an eight-week period.
The first group was provided with TPM-based sexual health training, the second group received 30 g of a
traditional food product (wild carrot halva: mixed Daucus carota and several herbs with honey) on a daily basis,
and the third group received a combination of this traditional food product plus education. Data analysis was
http://www.ephysician.ir
Page 6578
performed using Chi square test, repeated measures ANOVA, two -way ANOVA, ANCOVA, post hoc
Bonferroni, Friedman and Wilcoxon signed-rank test in SPSS version 11.5.
Results: According to the results of this study, there was a significant difference in terms of sexual desire
(p=0.002), lubrication (p=0.002), orgasm (p=0.004) and pain (p<0.001) after eight weeks of the intervention
among the three groups.
Conclusion: The use of two interventions of TPM including a food product containing Daucus carota and this
product with TPM-based education improved desire, arousal, lubrication, orgasm, satisfaction and pain in females
with sexual dysfunction. Furthermore, TPM-based education alone, led to the improvement of all domains of
sexual dysfunction, except for pain in the females with sexual dysfunction.
Trial registration: The trial was registered at the Iranian Registry of Clinical Trials with the IRCT ID:
IRCT2015122425681N1).
Funding: The present study was supported by a grant from the Research Council, Mashhad University of
Medical Sciences, Mashhad, Iran (ref. no.: 941503).
Keywords: Daucus Carota, Herbal Medicine, Phytotherapy; Libido, Sex Education, Traditional Pe rsian Medicine
1. Introduction
Sexual dysfunction is a major problem that may be reported by many individuals or couples during any stage of life.
Based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), this construct is
defined as a problem taking place during the sexual response cycle preventing the experience of satisfaction from
sexual activity by the individual or couple (1). Sexual dysfunction can have a great impact on the quality of sexual
life in young couples (2). Sexual dysfunction is common in both genders, and it has been reported to be higher in the
female population (3). Accordingly, this has been also confirmed by several studies conducted in the USA (4),
reporting a sexual dysfunction prevalence rate of 40% in females (5). In Iran, the prevalence of sexual dysfunction
has been reported to be 30% in this population (6). However, it seems that the rate of sexual dysfunction among
females has been underestimated in Iran due to cultural limitations, shame, and attitude toward intercourse (7).
Psychological and physiological factors play an important role in the sexual function. The main symptoms of sexual
dysfunction, such as decreased libido, vaginal dryness, pain, numbness in the genital area, decreased arous al, and
orgasm dysfunction, occur due to vascular, neurological, hormonal, and psychological disorders (8). In addition,
unpleasant intercourse, psychological disorders, income and social status, and infertility can affect sexual
dysfunction (9, 10). According to the literature, sexual dysfunction plays a key role in the women's self -esteem,
interpersonal relationships, and quality of life (6, 11). Based on TPM, sexual life and intercourse are considered as
the main aspects of a healthy lifestyle (12) which lead to family binding, survival of generations, and individuals’
well-being (13, 14). Health maintenance recommendations and measures are the basis of TPM books. These books
underscore the importance of pleasure during sexual activity and contain many re commendations about the
optimization of sexual intercourse. They also repeatedly discuss the complications caused by infrequent or having
no sexual intercourse (13, 14). The problems caused by sexual dysfunction have received special attention in the
traditional Persian books to the extent that a full chapter of the Canon of Medicine (1025 AD) written by Avicenna
is dedicated to the description of libido, its disorders, and treatment of sexual problems (13). In addition, some
traditional Persian books, including Lezat al-vesal (15) and Tuhfat al-Molouk (16) have covered such sexual issues
as sexual intercourse and the ways of improving the sex life. Some herbal medicines, such as Bindii or Tribulus
terrestris are proposed to be effective in the improvement o f libido and sex drive in the Canon of Medicine (13, 17).
Psychotherapy and pharmacotherapy are two main methods for the treatment of female sexual dysfunction (18). The
effectivness of some drugs, such as estrogen, methyl testostron (18), bupropion (19), saffron (20), and Tribulus
terrestris (7), on the treatment of sexual dysfunction is demonstrated. However, the Food and Drug Administration
Agency (FDA) has recommended no foods or drugs as the effective agents for the treatment of sexual disorders in
females (21). Daucus carota is known as a useful vegetable, which belongs to the family of Umbelliferae or
Apiaceaeis. This plant has been used in traditional medicine (1) since it has therapeutic effects on a wide range of
diseases Daucus carota is a great s ource of antioxidant vitamins, especially beta-carotene, which can enhance the
level of sexual function (22). Beta -carotene leads to elevated levels of sex hormones (23); therefore, we chose this
plant to evaluate its effects on sexual function in females. To the extent of the researchers’ knowledge, there is no
study investigating the effect of Daucus carota on the human sex drive. Therefore, this study was performed to
assess the effectiveness of a food product containing Daucus carota, a type of educatio n (which was based on TPM)
(17), and a combination of these two approaches on the improvement of sexual function in females with sexual
dysfunction.
Electronic physician
Page 6579
2. Material and Methods
2.1. Study design and setting
This randomized clinical trial was conducted durin g eight weeks on females of reproductive age (i.e., 18 -35 years)
with sexual dysfunction. The patients were referred to the Obstetrics and Gynecology Ward of Om al -Banin
Hospital and Traditional Medicine Clinic of Mashhad University of Medical Sciences, Mashhad, Iran, from June
2016 to February 2017 and selected using convenience sampling method. After considering the inclusion and
exclusion criteria, 96 women were enrolled and divided into three groups (32 people in each group). The stages of
sample selection are shown in Figure 1.
Figure 1. CONSORT Flow Diagram of the study
2.2. Ethical considerations
This study was derived from a clinical trial, confirmed by the Ethics Committee of Mashhad University of Medical
Sciences (Ref. no.: IR.MUMS.REC.1395.6 5) and recorded in the clinical trial center (IRCT ID:
IRCT2015122425681N1). Before gathering the data, informed consent was obtained from all the subjects and all of
them were assured of the confidentiality of the data. Also, the objectives of the study were explained to all the
participants. In the next step, personal information forms were completed by all the participants. The participants
were ensured that they could withdraw from the study at any stage.
2.3. Participants
The inclusion criteria were: 1) a history of sexual dysfunction for more than six months, 2) normal gynecologic and
breast exam, and 3) spending at least 21 days a month with the husband. The exclusion criteria were: 1) pregnancy
and lactation, 2) having a chronic disease, 3) husbands’ sexual dysfunction, 4) couple’s addiction to alcohol or
drugs, 5) filing for divorce, 6) the use of drugs affecting the sexual function, 7) any medical side effects and
hemodynamic disorder, and 8) not consuming the food product for more than three conse cutive times.
2.4. Study design
After examining the participants to ensure physical and mental health, they were randomly divided into three groups
using the Power Analysis and Sample Size (PASS) software, and received the intervention for eight weeks. T he first
group received behavioral principle training, which was based on TPM, and the second group consumed 30 g of a
traditional food product containing Daucus carota on a daily basis. Furthermore, the third group received a
combination of the two prior to interventions (i.e., a traditional food product plus behavioral training). The
intervention was started from the second day of menstruation. For the purpose of the study, all the women were
visited by a gynecologist. The presence of sexual dysfunction due to any gynecological diseases and anatomic
causes were rejected in this study. In addition, breast examination, and if necessary, Pap smear, uterus, and ovary
ultrasound were obtained from all the samples. Subsequently, the samples were referred to the traditional medicine
clinic to arrange a medical record for each case based on TPM by an assistant of traditional medication. The
demographic information as well as the details and quality of couples’ relationships were collected. In addition, the
factors related to the stability of marriage were assessed in all samples. The participants’ sexual function was
determined by using a normalized female sexual functioning index (FSFI) Persian version. The validity and
http://www.ephysician.ir
Page 6580
reliability of this index were assessed in a study conducted by Mohammadi et al. (24). According to this scale, a
total score of 28 or less represents the risk of sexual dysfunction.
2.5. Intervention
2.5.1. Training intervention
In this study, we included the health maintenance recommendations de rived from TPM books, such as Al Qanun Fi
Al-Tibb (13) in the training sessions. These recommendations covered several basic principles related to sexual
function, such as time of intercourse, nutrition, drinks, wearing perfume, exercise, movement and rest before and
after intercourse, foreplay, hygiene, use of lubricant, sleeping and waking, mental calmness during intercourse (13).
The participants were informed not to have sexual intercourse during satiety, hunger, excessive sweating, and
menstruation or after phlebotomy and cupping. The trainings were presented to groups by a physician. Each group
contained four participants. These trainings were repeated every two weeks (i.e., pre -intervention, and two, four, and
six weeks post-intervention). They were also recommended to have nutritious food, such as chickens' egg, red meat
(100 g), as well as cooked beans and peas (50 g) every other day. In addition, the participants were instructed not to
drink, bathe with cold water, or play extreme sports after sexual intercourse. Sexual intercourse was encouraged to
be performed in a moderate temperature. Moreover, resting was suggested before and after sexual intercourse. The
patients were trained not to have sexual intercourse at the time of severe anger, happiness , sadness, or shame. The
use of refreshing aromas (i.e., rose and apple), preservation of personal hygiene of the genital area, and the
application of sole foot massage with almond oil before sexual intercourse were recommended to be performed
every night for 5 min. Sexual intercourse was suggested to be performed two or three times a week. The participants
were also informed about the importance of foreplay (25). Additionally, they were recommended not to use carrot
juice or carrot jam.
2.5.2. Food product intervention
In the second group, 420 g of the food product was administered in 28 packages (15 g, twice a day) every two weeks
for eight weeks, commencing from the second day of the menstruation. The instruction for the food product use was
indicated on the package. The dosage was determined using traditional medicine books and consulting with several
professors. In addition, the patients were orally informed to start the food product consumption on the second day of
menstruation and report it to the physician through a phone call. The participants referred to the clinic after 14 days
to determine the possible side effects and receive the food product to continue the treatment. The patients could
easily access their physician during office hours, or make phone calls any time. The subjects were excluded from the
study if they showed hypersensitivity, or if they did not use the food product more than three consecutive times.
They could leave the project at any time that they wished.
2.5.2.1. Food product preparation
In this study, a traditional food product (wild carrot halva), which was a combination of Daucus carota and its seed,
Amygdalus Communis L., Pistacia Vera and Crocus Sativus were provided from the local market in consultation
with an expert botanist. This compound was prepared based on the instructions of traditional medicine books and
consultation with professionals in pharmacology and medicinal herbs in the laboratory of the School of Traditional
Medicine at Mashhad University of Medical Sciences. Based on the Great Qarabadin, to prepare 1 kg of this food
product, we used 300 g Daucus carota, 210 g honey, 90 g rock candy, 1 g saffron, 300 g almond, 60 pistachios, 30 g
seed of Daucus carota, 150 ml Damask rose extract, 36 g wheat flour, and 300 ml water. In the first step, 300 g
Daucus carota was peeled and grated, and then cooked in 150 ml water, so that the water was completely evaporated
and the cooked Daucus carota was mashed. Afterwards, almond, pistachios, and wheat flour were roasted togethe r,
and then sieved. In consultation with experts, 30 g Daucus carota seed was boiled in 150 ml water for 3 min and
screened by a very fine filter. Afterwards, the honey was added to the mashed Daucus carota and mixed under low
temperature, and then the hydro extract of the boiled Daucus carota seeds were added to this mixture and
temperature repeatedly. The powdered saffron was brewed in 150 ml Damask rose extract for 15 min; subsequently,
the crushed candy was added to this mixture. The combination of almo nd and pistachios was added to the mixture of
honey and Daucus carota. Subsequently, the saffron and candy solution were added. The mixture was kept in a low
degree for five minutes.
2.5.2.2. Standardization of the food product
A sample of the food product (30 g) was suspended in 70% ethanol (200 ml) and incubated for 72 h at 40 °C with
gentle shaking (26). Then, the extract was filtered through 250 μm mesh and centrifuged for 10 min at 2000 rpm.
The extract was dried on a water bath (40 °C) to remove the solvent, and the residue was used for standardization.
The hydroalcoholic extract of the food product was standardized based on its total phenol content using Folin -
Ciocalteu method. The extract (20 µL of 10 mg/mL) or gallic acid (20 µL of 0, 50, 100, 150, 250, and 500 mg/L)
were mixed with Folin-Ciocalteu reagent (100 µL) and sodium carbonate solution (300 µL, 1 M). The volume was
Electronic physician
Page 6581
adjusted to 2 mL with deionized water and after 2 h, the absorbance was measured by spectrometer at 765 nm. The
standard curve was prepared for gallic acid, and the total phenol content of the food product extract was expressed
as milligram of gallic acid equivalents (27).
2.5.3. Combined intervention
A combination of both food product and behavioral principles training interventions was presented to the individuals
in the third group for eight weeks. The FSFI was filled out by all the p articipants in three stages, including before the
intervention as well as four, and eight weeks after the intervention.
2.6. Statistical analysis
The data were analyzed using the Chi square test, repeated measures ANOVA, two -way ANOVA, post hoc
Bonferroni, Friedman, ANCOVA, and Wilcoxon signed -rank test through the SPSS version 11.5. The p-value less
than 0.05 was considered statistically significant.
3. Results
The demographic data is outlined in Table 1. According to the obtained results of this study, all data of sexual
function domains had no normal distribution, expect total score. The abnormal distribution was assessed using the
Kolmogorov-Smirnov and Shapiro-Wilk tests. The mean values of sexual function domains are shown in Table 2.
The results of six domains of these women’s sexual function are as follows:
Table1. Comparison of Demographic characteristic among study groups
Variables
Group; n (%)
Total; n
(%)
p-value
Education
Food
production
Education plus
Food production
Education
Illiterate
0 (0.0)
1 (3.2)
0 (0.0)
1 (1.1)
0.763
(Kruskal-
Wallis)
Primary school
4 (12.5)
2 (6.5)
3 (9.4)
9 (9.5)
Junior high school
3 (9.4)
4 (12.9)
3 (9.4)
10 (10.5)
High school diploma
14 (43.8)
12 (38.7)
19 (59.4)
45 (47.4)
Associate Degree
8 (25)
8 (25.8)
4 (12.5)
20 (21.1)
Bachelor and above
3 (9.4)
4 (12.9)
3 (9.4)
10 (10.5)
Total
32 (100)
31 (100)
32 (100)
95 (100)
Occupational
status
Unemployed
2 (6.9)
3 (10.3)
1 (3.3)
6 (6.8)
0.888 (Mont
Carlo Chi
square)
Employed
3 (10.3)
4 (13.8)
4 (13.3)
11 (12.5)
Student
2 (6.9)
3 (10.3)
1 (3.3)
6 (6.8)
Housewife
20 (69)
15 (51.7)
21 (70)
56 (63.6)
Self- employed
2 (6.9)
4 (13.8)
3 (10)
9 (10.2)
Total
29 (100)
29 (100)
30 (100)
88 (100)
Place of
residence
Urban
31 (100)
31 (96.9)
31 (100)
94 (98.9)
1.000 (Mont
Carlo Chi
square)
Rural
0 (0.0)
1 (3.1)
0 (0.0)
1 (1.1)
Total
31 (100)
32 (100)
31 (100)
95 (100)
Housing status
Landlord
8 (27.6)
20 (64.5)
16 (51.6)
44 (48.4)
0.015 (Chi
square)
Tenant
21 (72.4)
11 (35.5)
15 (48.4)
47 (51.6)
Total
29 (100)
31 (100)
31 (100)
91 (100)
Alcohol
consumption
Spouse
4 (12.5)
0 (0.0)
3 (10)
7 (7.4)
0.174 (Mont
Carlo Chi
square)
Neither
28 (87.5)
32 (100)
27 (90)
87 (92.6)
Total
32 (100)
32 (100)
30 (100)
94 (100)
Smoking
Spouse
7 (21.9)
7 (21.9)
7 (21.9)
21 (21.9)
1.000 (Mont
Carlo Chi
square)
Both
0 (0.0)
0 (0.0)
1 (3.1)
1 (1.0)
Neither
25 (78.1)
25 (78.1)
24 (75)
74 (77.1)
Total
32 (100)
32 (100)
32 (100)
96 (100)
Marital status
Women
1 (3.2)
0 (0.0)
2 (6.5)
3 (3.2)
0.609 (Mont
Carlo Chi
square)
Spouse
1 (3.2)
0 (0.0)
1 (3.2)
2 (2.1)
Both
1 (3.2)
0 (0.0)
1 (3.2)
2 (2.1)
Neither
28 (90.3)
32 (100)
27 (87.1)
87 (92.6)
Total
31 (100)
0 (0.0)
31 (100)
94 (100)
http://www.ephysician.ir
Page 6582
Table 2. Comparison of Mean values of sexual function domains among study groups
Domains of sexual
function
Stages
Education plus
food product1
Food
product1
Education1
p-value
Desire
Pre-intervention
2.9±0.8
2.6±0.8
2.8±0.8
0.313
After four weeks
3.4±0.8
3.2±0.8
3.4±0.7
0.327
After eight weeks
4.4±0.4
4.1±0.6
3.9±0.6
0.002
Mean paired difference of
desire
Pre-intervention and four week after
treatment
0.5±0.7
0.6±0.8
0.5±0.8
0.98
Four and eight weeks difference
1±0.9
1±0.8
0.5±0.9
0.19
Eight and Pre-intervention
1.6±0.7
1.6±0.9
1.1±0.8
0.024
Arousal
Pre-intervention
3±0.8
2.9±0.8
3.4±1
0.007
After four weeks
3.6±0.8
3.7±0.6
3.8±0.9
0.757
After eight weeks
4.7±0.6
4.5±0.7
4.3±0.8
0.213
Mean paired difference of
arousal
Pre-intervention and four week after
treatment
0.7±0.8
0.8±0.8
0.4±0.8
0.15
Four and eight weeks
1.1±1
0.8±0.6
0.5±0.9
0.123
Eight and Pre-intervention
1.7±1
1.7±1
0.9±1
0.002
Orgasm
Pre-intervention
2.8±0.8
3.2±1.1
3.2±0.9
0.087
After four weeks
3.7±0.9
3.8±1
3.6±1.1
0.902
After eight weeks
5±0.6
4.6±1
4.3±0.9
0.004
Mean paired difference of
orgasm
Pre-intervention and four week after
treatment
0.9±1
0.6±1.1
0.4±1
0.11
Four and eight weeks difference
1.3±1
0.8±0.8
0.7±1.2
0.023
Eight and Pre-intervention
2.2±0.9
1.4±1
1.1±0.9
<0.001
Lubrication
Pre-intervention
3.7±0.7
3.8±0.9
3.8±1
0.794
After four weeks
4.3±0.9
4.6±0.8
4.2±0.9
0.172
After eight weeks
5.3±0.5
5.2±0.6
4.6±0.9
0.002
Mean paired difference of
lubrication
Pre-intervention and four week after
treatment
0.6±1
0.8±1
0.4±1
0.24
Four and eight weeks difference
1±0.8
0.7±0.6
0.4±0.7
0.006
Eight and Pre-intervention
1.6±0.8
1.0±0.8
0.8±1.1
0.207
Satisfaction
Pre-intervention
3.5±0.9
3.7±1
4±1.1
0.204
After four weeks
4.3±0.9
4.4±1
4.1±1
0.616
After eight weeks
5.2±0.5
5±0.8
4.9±0.8
0.202
Mean paired difference of
satisfaction
Pre-intervention and four week after
treatment
0.8±.1.1
0.7±0.8
1±0.9
0.004
Four and eight weeks
0.9±0.9
0.7±0.8
0.8±1.1
0.504
Eight and Pre-intervention
1.7±1
1.3±1
0.9±1.3
0.017
Pain
Pre-intervention
3.7±1.2
4±1.2
4±1.1
0.419
After four weeks
4.3±1.1
4.4±1.2
4.2±1
0.741
After eight weeks
5.3±0.7
4.9±1
4.2±1.1
<0.001
Mean paired difference of
pain
Pre-intervention and four week after
treatment
0.6±1.2
0.4±1.2
0.1±1
0.252
Four and eight weeks
1±1.2
0.5±0.9
1±1.1
0.008
Eight and Pre-intervention
1.6±1.2
0.9±1.3
0.2±1.2
<0.001
Total sexual function
Pre-intervention
19.5±3.4
20±3.8
21.2±3.8
0.151
After four weeks
23.7±4
23.9±3.9
23.3±3.3
0.77
After eight weeks
29.8±2.2
28.6±2.9
26.2±3.4
<0.001
Mean paired difference of
total sexual function
Pre-intervention and four week after
treatment
4.3±3.5
3.9±3.3
2.1±3.3
0.026
Four and eight weeks
4.6±4
4.6±2.9
2.8±3
<0.001
Eight and Pre-intervention
10.6±3.8
8.6±3.5
5±3.6
<0.001
1: Data is presented as Mean±SD
Electronic physician
Page 6583
3.1. Desire
The three groups were not significantly different in terms of sexual desire before the initiation of the intervention
(p=0.31) and four weeks after treatment (p=0.32). However, a significant difference was observed eight we eks after
the intervention in this regard (p=0.002). The paired comparison of the mean difference in terms of sexual desire
showed no significant difference between the food product and the food product plus education groups in this
regard. The score of sexual desire was higher in two groups of food product and food product plus education,
compared to that of the education group. The evaluation of the changes of sexual function in terms of desire in
education (p<0.001), food product (p<0.001), and education plus food product (p<0.001) groups demonstrated a
significant difference among the three stages of the intervention. The paired comparison of different stages showed
that the desire domain increased in each stage, compared to the previous stage.
3.2. Arousal
No significant differences were observed among the three groups with respect to arousal score before treatment
(p=0.07) and four (p=0.75) and eight (p=0.21) weeks after the intervention. The evaluation of the changes of sexual
function in terms of arousal in education (p<0.001), food product (p<0.001), and education plus food product
(p<0.001) groups revealed a significant difference among the three stages of the study in this regard. The arousal
domain was also found to increase in each stage as compa red to the previous one.
3.3. Orgasm
The three groups were not significantly different in terms of orgasm before treatment (p=0.08) and four weeks after
the intervention (p=0.902). However, a significant difference was noted at eight weeks after the inte rvention
(p=0.004). In addition, the food product plus training group obtained the highest orgasm scores at eight weeks post -
intervention, while the training group had the lowest score in this respect. There was a significant difference among
the three stages of the intervention regarding the changes of orgasm score in the education (p<0.001), food product
(p<0.001), and education plus food product (p<0.001) groups. In other words, the orgasm score increased in each
stage, compared to the previous stage.
3.4. Lubrication
No significant differences were found among the three groups in terms of lubrication before the treatment (p=0.79)
and four weeks after the treatment (p=0.17). We observed a significant difference in lubrication score at eight weeks
after the intervention (p=0.002). The score of the lubrication domain was higher in the food product plus education
group, compared to that in the education group. The evaluation of the lubrication changes in the education
(p<0.001), food product (p<0.001), and education plus food product (p<0.001) groups indicated a significant
difference among the three stages of the intervention in this regard. This indicated that the desire domain improved
in each stage, compared to the previous one.
3.5. Sexual satisfaction
No significant difference was observed among the three groups regarding sexual satisfaction at the pre-treatment
stage (p=0.204), and four (p=0.61) and eight (p=0.202) weeks after the intervention. The evaluation of the changes
of sexual satisfaction score in the education (p<0.001), food product (p<0.001), and education plus food product
(p<0.001) groups showed a significant difference among the three stages of the study. The study of this variable in
the food product and food product plus education groups revealed that it increased in each stage, compared to the
previous one. However, in the case of the education group, this enhancement was observed just eight weeks after the
intervention.
3.6. Pain
There was no significant difference among the three groups before the intervention (p =0.41) and four weeks after
treatment (p=0.74) in terms of pain. Nevertheless, a significant difference was observed eight weeks after the
intervention. Additionally, paired comparison of different stages demonstrated that the pain scores were higher at
eight weeks after the intervention in the food product plus education group than those in the other groups. There was
a significant difference among the three stages of the intervention in the pain scores of the food product (p <0.001)
and education plus food product (p<0.001) groups. Nonetheless, in the education group, no significant difference
was observed in this regard (p=0.15). The paired comparison of different stages in the food product and education
plus food product groups showed that the pain scores increased in each stage, compared to the previous one.
http://www.ephysician.ir
Page 6584
3.7. Total scores
There was no significant difference among the three groups before the treatment (p=0.15) and four weeks after the
treatment (p=0.77) in terms of total sexual function score. However, a significant difference was observed eight
weeks after the intervention in this respect (p<0.001). The mean total sexual function score eight weeks post -
intervention was higher in the food product plus education group tha n those in the other groups. Additionally, there
was a significant difference among the three stages of the intervention regarding the changes of the sexual function
score in the education (p<0.001), food product (p<0.001), and education plus food product groups (p<0.001). The
paired comparison of the different stages of the intervention revealed that the total score of sexual function increased
in each stage, compared to the previous one. Finally, successful treatment was observed in 28%, 52%, and 74% of
the patients in the education, food product, and food product plus education groups, respectively, indicating a
significant difference among the three groups (p<0.001).
4. Discussion
The present study was the first attempt in investigating the effect of a food product containing Daucus carota and
education (based on TPM) on the improvement of sexual function among women of reproductive age. According to
the results of this study, the use of a food product containing Daucus carota was more effective in the desire,
orgasm, sexual satisfaction, and pain domains of the food product and food product plus education groups,
compared to those of the education group. However, the lubrication score was not significantly different among the
three groups. Although the three interventions improved the sexual function in the females, the food product and
education plus food product were found to be more effective in the improvement of sexual function, compared to the
education alone. TPM has underscored the necessity of female orgasm and made many recommendations to increase
sexual desire. Our study showed that TPM-based training had a positive effect on the improvement of sexual
function among women of reproductive age (13, 28). Healthy sexuality largely depends on a heal thy diet, such as the
consumption of vitamin-rich foods (e.g., fresh spices, herbs, fruits, and vegetables) (29). In this study, we
recommended the subjects to use nutritious food, such as chickens' eggs and red meat. The effectiveness of the
vitamins of eggs and meat on the increase of sexual desire has been demonstrated (30). The sexual behavior of male
was improved after the use of mineral supplements, eggs, and green leaves (31). Eskeland et al. used a product
containing chickens' eggs to treat decreased sexual desire in males. They showed that this product had a significant
positive effect on the frequency of sexual intercourse (32). Furthermore, the benefits of various food groups, such as
seeds and nuts, spices (e.g., cinnamon, ginger, and cayenne pep per) on sexual desire have been indicated (30). In
addition, cooked beans and peas, have been shown to have a positive effect on the sexual desire (33). TPM has
emphasized the importance of foreplay as a main factor in sexual satisfaction. Although forepla y is considered as a
key variable to understanding female sexual satisfaction, its duration is not associated with women's consistency of
orgasm (34). The effectiveness of exercise on the treatment of orgasmic dysfunction has not been indicated yet. This
variable was believed to have no positive effects on the treatment of orgasmic dysfunction in women (35). However,
exercise can lead to the reduction of free radicals (36), reactive oxygen species (37), and regulation of blood flow
(38); therefore, it can indirectly affect sexual function. Based on TPM, sexual intercourse should be performed in a
moderate temperature (39). However, since temperature is only one of the recommendations of TPM and given that
there is no study on the relationship of these two variables, we cannot make a general conclusion in this regard. No
study has investigated the effect of temperature, cool water bathing, drinking cool water, or other recommended
variables on sexual desire. Therefore, it is not possible to obtain a general co nclusion and compare these
recommendations. However, the effectiveness of these suggestions in sexual intercourse was demonstrated in our
study. Our results showed that a food product based on Daucus carota and education plus this food product had
comparable effects on all domains of sexual function. There are no similar studies assessing the effect of Daucus
carota on sexual activity; however, the positive effects of this plant are suggested in the Persian (14) and Indian (40)
traditional medicine books. Some studies have identified the active components of this plant, including volatile oils,
steroids, tannins, flavonoids, and carotene, and evaluated its chemical components. Daucus carota has been revealed
to have some therapeutic effects on a wide range o f diseases, including kidney dysfunction, asthma, inflammation,
and leprosy in several studies (41). Furthermore, this vegetable was reported to have anti-infertility properties in
females, and the extract of its seed has been revealed to arrest the estrus cycle of adult rats and decrease the weight
of ovaries (42). The antioxidants found in carrots are relatively high (43), and its properties can enhance sperm
reserves in cauda epididymis (44). Carrot leaves contain remarkable amounts of porphyrins, which have stimulating
effects on the pituitary gland, resulting in enhanced sex hormone levels (22). However, it has not been examined on
women. Regarding the emphasis of TPM on the effects of Daucus carota on sexual potency in males and its
stimulating effects on the menstruation in the females (14, 43), we studied the effect of a food product containing
Daucus carota on the sexual function of females. Persian medicine has shown that carrots have therapeutic effects on
Electronic physician
Page 6585
human fertility. Accordingly, the benefits of carrots are indicated in the Zakhireh Kharazmshahi book, written by
Seyyed-Esmail Jorjani in the 11th century (14). Our study showed that our food product could increase all aspects of
sexual function in females with sexual dysfunction. Daucus carota i s rich in beta-carotene, which is an antioxidant
vitamin protecting both inside and outside of the cells against free radical damage (22, 45, 46). Beta -carotene is
converted into vitamin A in the body, which helps keep the vagina in good shape and leads to increased sex
hormones. This anti-oxidant is also found in some plants or vegetables containing pigment, such as sweet potato,
tomato (47), and saffron (23). In another study, saffron’s positive effect on female sexual dysfunction is also proven
(20). Sexual health is a critical issue which directly affects quality of life. The treatment of sexual disorder in the
females is very difficult (48). Given the adverse effects of the pharmacological interventions, the use of herbal
medicine as a method with fewer complications is more favorable. TPM is developing and providing new
therapeutic methods for the treatment of different diseases. Today, there is limited knowledge about the effect of
herbal medicine on sexual dysfunction treatment.
5. Strengths and Limitations
The strength of this study is its randomization, which leads to the homogeneity of data and control of the underlying
and probabilistic factors in the three groups. However, we did not consider the role of interfering factors, which
should be considered to interpret our findings. Lack of knowledge about sexual dysfunction and intercourse in
Persian culture and absence of spouse were limitations of our study. Also lack of blinding was another limitation of
this study. We recommend adopting methods to control these variables and considering some parameters such as
nutrition, psychological factors, family, and social conditions in future studies. Moreover, further studies examining
the effects of herbal medicine, which is less costly compared to other d rugs, and education on different domains of
sexual function, are essential.
6. Conclusions
As the findings of the present study indicated, TPM-based education led to the improvement of all domains of
sexual dysfunction, except for pain in females with se xual dysfunction. The use of a food product containing Daucus
carota improved all domains of sexual function in the females. Although education had a positive effect on sexual
function, Daucus carota and education plus Daucus carota had more significant effects on the females’ sexual
dysfunction, compared to that of the education alone.
Acknowledgments:
We wish to thank the Mashhad University of Medical Sciences for their cooperation in the present study.
Trial registration:
The trial was registered at the Iranian Registry of Clinical Trials with the IRCT ID: IRCT2015122425681N1).
Funding:
The present study was supported by a grant from the Research Council, Mashhad University of Medical Sciences,
Mashhad, Iran (ref. no.: 941503).
Conflict of Interest:
There is no conflict of interest to be declared.
Authors' contributions:
All authors contributed to this project and article equally. All authors read and approved the final manuscript.
References:
1) Association AP. Diagnostic and Statistical Manual of Mental Disorders (DSM-5®): American Psychiatric
Publishing. 2013. doi: 10.1176/appi.books.9780890425596.
2) Hisasue Si, Kumamoto Y, Sato Y, Masumori N, Horita H, Kato R, et al. Prevalence of female sexual
dysfunction symptoms and its relationship to quality of life: a Japanese female cohort study. Urology.
2005; 65(1): 143-8. doi: 10.1016/j.urology.2004.08.003.
3) Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors.
JAMA. 1999; 281(6): 537-44. doi: 10.1001/jama.281.6.537. PMID: 10022110
http://www.ephysician.ir
Page 6586
4) Ito TY, Trant AS, Polan ML. A double -blind placebo-controlled study of Argin Max, a nutritional
supplement for enhancement of female sexual function. Journal of Sex &Marital Therapy. 2001; 27(5):
541-9. doi: 10.1080/713846828.
5) Shifren JL, Monz BU, Russo PA, Segreti A, Johannes CB. Sexual problems and distress in United States
women: prevalence and correlates. Obstetrics & Gynecology. 2008; 112(5): 970 -8. doi:
10.1097/AOG.0b013e3181898cdb.
6) Safarinejad M. Female sexual dysfunction in a pop ulation-based study in Iran: prevalence and associated
risk factors. International Journal of Impotence Research. 2006; 18(4): 382 -95. doi:
10.1038/sj.ijir.3901440.
7) Akhtari E, Raisi F, Keshavarz M, Hosseini H, Sohrabvand F, Bioos S, et al. Tribulus terrest ris for treatment
of sexual dysfunction in women: randomized double-blind placebo-controlled study. Daru. 2014; 22(1): 40.
doi: 10.1186/2008-2231-22-40. PMID: 24773615, PMCID: PMC4045980.
8) Berman JR, Berman LA, Werbin TJ, Goldstein I. Female sexual dysfunction: anatomy, physiology,
evaluation and treatment options. Current opinion in urology. 1999; 9(6): 563 -8. doi: 10.1097/00042307-
199911000-00012. PMID: 10668578.
9) Kadri N, Mchichi Alami K, Mchakra Tahiri S. Sexual dysfunction in women: population based
epidemiological study. Archives of women's mental health. 2002; 5(2): 59-63. doi: 10.1007/s00737-002-
0141-7
10) Bakhtiari A, Basirat Z, Nasiri -Amiri F. Sexual dysfunction in women undergoing fertility treatment in Iran:
prevalence and associated risk factors. Jou rnal of reproduction & infertility. 2016; 17(1): 26. PMID:
26962480, PMCID: PMC4769852.
11) Safarinejad MR, Kolahi AA, Hosseini L. The effect of the mode of delivery on the quality of life, sexual
function, and sexual satisfaction in primiparous women and their husbands. The journal of sexual medicine.
2009; 6(6): 1645-67.doi: 10.1111/j.1743-6109.2009.01232.x.
12) Vand FS, Akhtari E. To increase health of intercourse with Iranian Traditional Medicine. History of
Medicine Journal. 2016; 5(14): 97 -111.
13) Sina I. Al-qanun fi al-tibb [the canon of medicine], in Alaalami Library, Beirut. 2013, Ambassador Ardehal
with the assistance of the Faculty of Traditional Medicine, Tehran University of Medical Sciences: Tehran.
389-99.
14) Gorgani Z, Kharazmshahi Zi. Qom. Rehabilitation Institute of natural medicine. 2012; 2.
15) Sekandaripour MAG. Lezat Alvesal. Tehran: Institution of Medical History Studies, Islamic and
Complementary Medicine, Iran University of Medical Sciences; 2009.
16) Zeyd -Ibn- heybat- allah- al- Basari. Tuhfat al molouk. Tehran Institute for the Study of Medical History.
Islamic Medicine and Supplement of Iran University of Medical Sciences.1999.
17) Aghili MH. Makhzan-al-Advia. Tehran: Tehran University of Medical Sciences. 2009; 328.
18) Davis SR, van Der Mooren M, van Lunsen R H, Lopes P, Ribot J, Rees M, et al. Efficacy and safety of a
testosterone patch for the treatment of hypoactive sexual desire disorder in surgically menopausal women:
a randomized, placebo-controlled trial. Menopause. 2006; 13(3): 387-96. doi:
10.1097/01.gme.0000179049.08371.c7.
19) Taylor Segraves R, Croft H, Kavoussi R, Ascher JA, Batey SA, Foster VJ, et al. Bupropion sustained
release (SR) for the treatment of hypoactive sexual desire disorder (HSDD) in nondepressed women.
Journal of Sex &Marital Therapy. 2001; 27(3): 303-16. doi: 10.1080/009262301750257155.
20) Kashani L, Raisi F, Saroukhani S, Sohrabi H, Modabbernia A, Nasehi AA, et al. Saffron for treatment of
fluoxetine‐induced sexual dysfunction in women: randomized double‐blind placebo‐controlled study.
Human Psychopharmacology: Clinical and Experimental. 20 13; 28(1): 54-60. doi: 10.1002/hup.2282.
21) Belkin ZR, Krapf JM, Goldstein AT. Drugs in early clinical development for the treatment of female sexual
dysfunction. Expert opinion on investigational drugs. 2015; 24(2): 159 -67. doi:
10.1517/13543784.2015.978283.
22) Khare CP. Indian Herbal Remedies: Rational Western Therapy, Ayurvedic and Other Traditional Usage,
Botany: Springer Berlin Heidelberg; 2011.
23) Raghavan S. Handbook of Spices, Seasonings, and Flavorings. Second Edition. CRC Press; 2006.
24) Mohammadi K, Heydari M, Faghihzadeh S. The Female Sexual Function Index-FSFI: Validation of the
iranian version. Payesh. 2008; 7(3): 269-78.
25) Gilani, M. Hefz al- Sehe Naseri. Traditional Iranian Medicine. 2011; 2: 157 -67.
26) Shafiee-Nick R, Ghorbani A, Vafaee Bagheri F, Rakhshandeh H. Chronic administration of a combination
of six herbs inhibits the progression of hyperglycemia and decreases serum lipids and aspartate amino
Electronic physician
Page 6587
transferase activity in diabetic rats. Advances in pharmacological sciences. 2012; 2012. doi:
10.1155/2012/789796.
27) Hosseini A, Mollazadeh H, Amiri MS, Sadeghnia HR, Ghorbani A. Effects of a standardized extract of
Rheum turkestanicum Janischew root on diabetic changes in the kidney, liver and heart of streptozotocin -
induced diabetic rats. Biomedicine & Pharmacoth erapy. 2017; 86: 605-11. doi:
10.1016/j.biopha.2016.12.059. PMID: 28027536.
28) Jala-al-din. Tib-Al-Akbari. Iran, Ghom: Rehabilitation Institute of Natural Medicine; 2008.
29) Orlova A. Sex Diet: A Guidebook to a Healthy Libido: Author House; 2012.
30) Adcock P. Jungle King Secrets: A Libido-Liberating Lifestyle for Superior Sexual Satisfaction. Loving
Healing Press; 2008.
31) Mahto D, Singh B, Ahmad M. Effect of feeding concentrate mixture and nutritional supplement in bucks
with reduced libido and poor semen quality. Indian Journal of Animal Production and Management. 2009;
25(1/2): 76-7.
32) Eskeland B, Thom E, Svendsen K. Sexual desire in men: effects of oral ingestion of a product derived from
fertilized eggs. Journal of international medical research. 1997; 25(2): 62 -70. doi:
10.1177/030006059702500202.
33) Guide MS, Chart P-BP, Guide TS, Guide TF, Guide TTH, Guide TJ, et al. Best Natural Ways to Boost
Libido in Men.
34) Hurlbert DF, Apt C, Rabehl SM. Key variables to understanding female sexual satisfaction: An
examination of women in nondistressed marriages. Journal of sex & marital therapy. 1993; 19(2): 154 -65.
doi: 10.1080/00926239308404899. PMID: 8336347.
35) Chambless DL, Sultan FE, Stern TE, O'Neill C, Garrison S, Jackson A. Effect of pubococcygeal exercise
on coital orgasm in women. Journal of consulting and clinical psychology. 1984; 52(1): 114. PMID:
6538208.
36) Sjödin B, Westing YH, Apple FS. Biochemical mechanisms for oxygen free radical formation during
exercise. Sports Medicine. 1990; 10(4): 236-54. PMID: 2247725.
37) Alessio HM, Hagerman AE, Fulkerson BK, Ambrose J, Rice RE, Wiley RL. Generation of reactive oxygen
species after exhaustive aerobic and isometric exercise. Medicine and science in sports and exercise. 2000;
32(9): 1576-81. PMID: 10994907.
38) Drummond MJ, Fujita S, Takashi A, Dreyer HC, Volpi E, Rasmussen BB. Human muscle gene expression
following resistance exercise and blood flow restriction. Medicine and science in sports and exercise. 2008;
40(4): 691. doi: 10.1249/MSS.0b013e318160ff84. PMID: 18317375, PMCID: PMC50887 19.
39) Shirazi MA. Kholase al Hekmat. Ghom, Iran: esmailian; 2006: 679.
40) Khare CP. Indian herbal remedies: rational Western therapy, ayurvedic, and other traditional usage,
Botany: Springer science & business media; 2004.
41) Jasicka-Misiak I, Wieczorek PP, Kafarski P. Crotonic acid as a bioactive factor in carrot seeds (Daucus
carota L.). Phytochemistry. 2005; 66(12): 1485-91. doi: 10.1016/j.phytochem.2005.04.005. PMID:
15960983.
42) Majumder P, Dasgupta S, Mukhopadhaya R, Mazumdar U, Gupta M. Anti-steroidogenic activity of the
petroleum ether extract and fraction 5 (fatty acids) of carrot (Daucus carota L.) seeds in mouse ovary. J
Ethnopharmacol. 1997; 57(3): 209-12. PMID: 9292415.
43) Nouri M, Khaki A, Fathi Azad F, Rashidi MR. The protective effects of carrot seed extr act on
spermatogenesis and cauda epididymal sperm reserves in gentamicin treated rats. Yakhteh Medical Journal.
2009; 11(3): 327-33.
44) Yu LL, Zhou KK, Parry J. Antioxidant properties of cold -pressed black caraway, carrot, cranberry, and
hemp seed oils. Food chemistry. 2005; 91(4): 723-9. doi: 10.1016/j.foodchem.2004.06.044.
45) Acton QA. Leukemia: New Insights for the Healthcare Professional: 2013 Edition: ScholarlyEditions;
2013.
46) Rhodes B. Biosynthesis of Alpha-carotene and Beta-carotene in Roots and Tops of Daucus Carota, L: Ann
Arbor: UMI; 1983.
47) Murray MT, Pizzorno JE, Pizzorno L. The Encyclopedia of Healing Foods. Atria Books; 2005.
48) Phillips NA. Female sexual dysfunction: evaluation and treatment. American Family Physician. 2000;
62(1): 127-48. PMID: 10905784.
