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Effect of Melissa officinalis (Lemon balm) on Sexual Dysfunction in Women: A Double- blind, Randomized, Placebo-controlled Study
Abstract and Figures
Hypoactive sexual desire disorder (HSDD) is the most prevalent female sexual dysfunction (FSD) and its bio-psychosocial multifactorial etiology justifies its multifaceted treatment. In Persian Medicine (PM), the weakness of the main organs (heart, brain and liver) is one of the important causes of lack of sexual desire; hence, their strengthening is a priority during treatment. Melissa officinalis is one of the medicinal plants with tonic characteristics for the main organs in PM and was used for treatment in this study. The aim of the present study was to evaluate the efficacy and safety of M. officinalis in the improvement of HSDD in women. Eighty nine (89) eligible women suffering from decreased sexual desire were randomly assigned to groups. The participants received medication (500 mg of aqueous extract of M. officinalis) or placebo 2 times a day for 4 weeks. Changes in scores of desire, arousal, lubrication, orgasm, satisfaction and pain were evaluated at the end of 4 weeks of treatment using the Female Sexual Function Index (FSFI) questionnaire in the two groups. Forty three participants completed the study. The increase in desire (P < 0.001), arousal (P < 0.001), lubrication (P < 0.005), orgasm (P < 0.001), satisfaction (P < 0.001), pain (P < 0.002) and FSFI total score (P < 0.001) in the M. officinalis group was significantly more than that of the placebo group. The willingness to continue treatment was significantly higher in the M. officinalis as compared to the placebo group (P < 0.001). M. officinalis may be a safe and effective herbal medicine for the improvement of HSDD in women.
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... In premenopausal women treated with HSSD extracts of Tribulus terrestris (A plant of the caltrop family, widely distributed around the world) it was observed an increase of bioavailable testosterone in serum (Although the mechanisms involved are not still elucidated) and, interestingly, some symptoms as sexual arousal, excitation/lubrication or orgasms were improved versus the control group (Vale et al. 2018) [22] . In another study, 89 women suffering from HSSD were administered with extract of Melissa officinalis (a perennial herb of the Lamiaceae family), which demonstrated an improvement in: arousal, lubrication, orgasms and satisfaction (Darvish-Mofrad- Kashani et al. 2018) [23] . ...
... In premenopausal women treated with HSSD extracts of Tribulus terrestris (A plant of the caltrop family, widely distributed around the world) it was observed an increase of bioavailable testosterone in serum (Although the mechanisms involved are not still elucidated) and, interestingly, some symptoms as sexual arousal, excitation/lubrication or orgasms were improved versus the control group (Vale et al. 2018) [22] . In another study, 89 women suffering from HSSD were administered with extract of Melissa officinalis (a perennial herb of the Lamiaceae family), which demonstrated an improvement in: arousal, lubrication, orgasms and satisfaction (Darvish-Mofrad- Kashani et al. 2018) [23] . ...
... This plant is a perennial herb of the family Lamiaceae (mint), and lemon balm (Melissa officinalis) and belongs to a genus that includes 5 species of perennial herbs native from Europe, Central Asia and Iran (Akhlaghi et al. 2011) [47] . The leaves of lemon balm are used in Iranian folk medicine for its digestive, carminative, antispasmodic, sedative, analgesic, tonic and diuretic properties, as well as for functional gastrointestinal disorders, and in Persian medicine it is used to treat lack of sexual desire because it increases lubrication, orgasm and decreases the pain (Darvish-Mofrad- Kashani et al. 2018;Setorki et al. 2013) [23,48] so, it could be used in the treatment of vaginismus. ...
... In premenopausal women treated with HSSD extracts of Tribulus terrestris (A plant of the caltrop family, widely distributed around the world) it was observed an increase of bioavailable testosterone in serum (Although the mechanisms involved are not still elucidated) and, interestingly, some symptoms as sexual arousal, excitation/lubrication or orgasms were improved versus the control group (Vale et al. 2018) [22] . In another study, 89 women suffering from HSSD were administered with extract of Melissa officinalis (a perennial herb of the Lamiaceae family), which demonstrated an improvement in: arousal, lubrication, orgasms and satisfaction (Darvish-Mofrad- Kashani et al. 2018) [23] . ...
... In premenopausal women treated with HSSD extracts of Tribulus terrestris (A plant of the caltrop family, widely distributed around the world) it was observed an increase of bioavailable testosterone in serum (Although the mechanisms involved are not still elucidated) and, interestingly, some symptoms as sexual arousal, excitation/lubrication or orgasms were improved versus the control group (Vale et al. 2018) [22] . In another study, 89 women suffering from HSSD were administered with extract of Melissa officinalis (a perennial herb of the Lamiaceae family), which demonstrated an improvement in: arousal, lubrication, orgasms and satisfaction (Darvish-Mofrad- Kashani et al. 2018) [23] . ...
... This plant is a perennial herb of the family Lamiaceae (mint), and lemon balm (Melissa officinalis) and belongs to a genus that includes 5 species of perennial herbs native from Europe, Central Asia and Iran (Akhlaghi et al. 2011) [47] . The leaves of lemon balm are used in Iranian folk medicine for its digestive, carminative, antispasmodic, sedative, analgesic, tonic and diuretic properties, as well as for functional gastrointestinal disorders, and in Persian medicine it is used to treat lack of sexual desire because it increases lubrication, orgasm and decreases the pain (Darvish-Mofrad- Kashani et al. 2018;Setorki et al. 2013) [23,48] so, it could be used in the treatment of vaginismus. ...
Cancer stem cells (CSC) are a particular and unique subpopulation of malignant cells inside solid tumors and they are mostly responsible of tumor resistance to conventional pharmaco-therapies and radiation, growth, relapse, invasiveness, motility and metastasis to distant organs. In addition, current anti-cancer therapies do not target CSC. Epithelial- mesenchymal transition (EMT) is a key mechanism to metastasis progression, the principal cause of death in cancer patients, and it is a feature of CSC. EMT favors that epithelial cancer cells acquire fibroblastoid morphology and motility, induce the secretion of matrix metalloproteases to permit the invasiveness to blood vessels and the metastasis progression. However, until now, very few strategies that target directly and specifically EMT in CSC are in clinical phases, mainly due to the non-specificity and to the many side effects of the drugs used for this purpose. For this reason, new and off target strategies are required to inhibit EMT and sensitize CSC to conventional therapies. In this sense, phytodrugs (plant-derived compounds) emerge as a feasible option because their low toxicity to non-tumor cells. In effect, most of the plant- derived compounds come from vegetables that have already been used widely in the allophatic or traditional medicine, in the food industry, or even used as an ornament with previous registers of non-toxicity to humans. In this chapter, we reviewed proteins and transcription factors involved in the process of EMT and analyzed the potential of proved or non-proved phytodrug to inhibit resistance to conventional therapies and
/or metastasis, emphasizing their specificity.
... Journal of Herbal Medicine 42 (2023) 100751 Almost all included studies used capsules and only one study used a tea bag (Safdari Dehcheshmeh and Parvin, 2016). More specifically, ten studies used placebo starch capsules (Akbarzadeh et al., 2015;Akbarzadeh et al., 2018;Afshar et al., 2020;Darvish-Mofrad-Kashani et al., 2018;Heydari et al., 2019;Mirabi et al., 2017;Mirabi et al., 2018;Mirghafourvand et al., 2016aMirghafourvand et al., , 2016bShirazi et al., 2021), two studies used capsules with 250 mg mefenamic acid (Dastjerdi et al., 2019;Safdari Dehcheshmeh and Parvin, 2016), and two used citalopram capsules (Amin et al., 2018;Shirazi et al., 2021). One study used a normal tea bag as placebo (Safdari Dehcheshmeh and Parvin, 2016). ...
... For symptoms of premenstrual syndrome (Akbarzadeh et al., 2018;Darvish-Mofrad-Kashani et al., 2018;Heydari et al., 2019;Mirghafourvand et al., 2016a), the effectiveness of M. officinalis was compared to placebo (capsules containing starch). All participants were female adolescents at high school or college. ...
... The effectiveness of M. officinalis on sexual functioning was investigated using 500 mg capsules (Darvish- Mofrad-Kashani et al., 2018) and 1000 mg capsules (Afshar et al., 2020) compared to placebo capsules of starch. Two treatment patterns of twice a day for 4 weeks (Darvish-Mofrad-Kashani et al., 2018) and one capsule per day for 8 weeks (Afshar et al., 2020) were used (both provided the same dose of 1000 mg M. officinalis daily). ...
... 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. ...
... Seventeen studies found that there were changes in the total score on the scale used to measure female sexual function, and 11 studies reported significant changes when exposed to a natural product (Abedi et al., 2018;Akhtari et al., 2014;Brooks et al., 2008;Cai et al., 2014;Darvish-Mofrad-Kashani et al., 2018;Eliasvandi et al., 2018;Ferguson et al., 2003;Ghorbani et al., 2019;Malakouti et al., 2017;Palacios et al., 2019;Postigo et al., 2016). This indicates that exposure to a specific natural product causes changes in the total score of the female sexual function scale, resulting in FSD improvement. ...
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.
... Darvish-Mofrad-Kashani et al. described the efficacy and safety of M. officinalis in the improvement of hypoactive sexual desire disorder in women [133]. A total of 89 women suffering from the disease participated in the study and were treated with the aqueous extract of M. officinalis or placebo with a dose of two 500 mg capsules per day for 4 weeks. ...
... A total of 89 women suffering from the disease participated in the study and were treated with the aqueous extract of M. officinalis or placebo with a dose of two 500 mg capsules per day for 4 weeks. The results of the 4-week study demonstrated that M. officinalis extract significantly increased the scores of desire, arousal, lubrication, orgasm, satisfaction, and pain compared to placebo in hypoactive sexual desire disorder in women [133]. Another research group from Iran also discovered the combination of M. officinalis and Nepeta menthoides Boiss. ...
Melissa officinalis has long been used in folk medicine as an integrated pharmacy, used in the treatment of many diseases since ancient times, as a remedy for headaches, indigestion, abdominal cramps, and heart failure. Lemon balm is characterized by antibacterial, antiviral and antidiabetic properties. The therapeutic benefit of this species is that it contains a wide variety of secondary metabolites such as essential oils, flavonoids, phenolic acid, and terpenes. Lemon balm contains many secondary metabolites such as eugenol, octinol, octyin, octinone, citral, hexenol and haramin, in addition to high levels of rosmarinic acid, which is used to treat many diseases in the field of alternative medicine. Lemon balm essential oils are concentrated hydrophobic oils that contain volatile chemicals that are used in food processing, where they are added to food, and in the cosmetics and perfumery industry. Despite the enormous benefits of M. officinalis aromatic oils, they do have side effects if not used properly. They can cause skin irritations, especially in children. The essential oils of this plant are effective against many types of bacteria, such as Salmonella, Escherichia coli, Staphylococcus, Pseudomonas, Bacillus and have an effective antifungal activity, especially against Candida and yeasts.
... Darvish-Mofrad-Kashani et al. described the efficacy and safety of M. officinalis in the improvement of hypoactive sexual desire disorder in women [133]. A total of 89 women suffering from the disease participated in the study and were treated with the aqueous extract of M. officinalis or placebo with a dose of two 500 mg capsules per day for 4 weeks. ...
... A total of 89 women suffering from the disease participated in the study and were treated with the aqueous extract of M. officinalis or placebo with a dose of two 500 mg capsules per day for 4 weeks. The results of the 4-week study demonstrated that M. officinalis extract significantly increased the scores of desire, arousal, lubrication, orgasm, satisfaction, and pain compared to placebo in hypoactive sexual desire disorder in women [133]. Another research group from Iran also discovered the combination of M. officinalis and Nepeta menthoides Boiss. ...
Medicinal plants are being used worldwide for centuries for their beneficial properties. Some of the most popular medicinal plants belong to the Melissa genus, and different health beneficial effects have already been identified for this genus. Among these species, in particular, the Melissa officinalis L. has been reported as having many biological activities, such as antioxidant, antimicrobial, antitumour, antiviral, antiallergic, anti-inflammatory, and also flatulence inhibiting effects. The beneficial properties of the Melissa officinalis, also known as “lemon balm herb”, can be related to the bioactive compounds such as terpenoids, alcohols, rosmarinic acid, and phenolic antioxidants which are present in the plant. In this updated review, the botanical, geographical, nutritional, phytochemical, and traditional medical aspects of M. officinalis have been considered as well as in vitro and in vivo and clinically proven therapeutic properties have been reviewed with a special focus on health-promoting effects and possible perspective nutraceutical applications. To evidence the relevance of this plant in the research and completely assess the context, a literature quantitative research analysis has been performed indicating the great interest towards this plant for its beneficial properties.
... Darvish-Mofrad-Kashani et al. described the efficacy and safety of M. officinalis in the improvement of hypoactive sexual desire disorder in women [133]. A total of 89 women suffering from the disease participated in the study and were treated with the aqueous extract of M. officinalis or placebo with a dose of two 500 mg capsules per day for 4 weeks. ...
... A total of 89 women suffering from the disease participated in the study and were treated with the aqueous extract of M. officinalis or placebo with a dose of two 500 mg capsules per day for 4 weeks. The results of the 4-week study demonstrated that M. officinalis extract significantly increased the scores of desire, arousal, lubrication, orgasm, satisfaction, and pain compared to placebo in hypoactive sexual desire disorder in women [133]. Another research group from Iran also discovered the combination of M. officinalis and Nepeta menthoides Boiss. ...
... Lemon balm extract increased the desire and sexual satisfaction of reproductive-age women (33). T. terrestris L. (Bindii) was the subject of 5 studies that examined its impact on sexual health. ...
Background: The quality of life of a person and her sexual partner is impacted by sexual function. Sexual function disorders have a significant prevalence in society. There are different treatments for sexual disorders, including herbal therapies. Objective: This study aimed to do a comparison of phytoestrogens and non-phytoestrogens medicinal plant’s effects on sexual health in pre- and postmenopausal women. Materials and Methods: This systematic review and meta-analysis was performed to identify relevant articles in electronic databases such as Web of Science, Scopus, PubMed, Cochrane Library, Google Scholar, and SID for English- and Persian-language articles published up to December 2021. The Cochrane collaboration tool was used to assess the risk of bias. Heterogeneity was assessed using I2 statistics. Results: Of 5428 records retrieved by searching the databases, after removing duplicate and irrelevant articles, 39 articles were included based on the inclusion criteria in the study. Finally, 18 articles with 1299 participants were included in the meta-analysis. 18 randomized clinical trial studies of phytoestrogens (n = 13) and non-phytoestrogens (n = 5) plants that used the female sexual function index questionnaire and reported the mean difference (MD) and standard deviation were included in the meta-analysis. The effects of phytoestrogens and non-phytoestrogens plants on the sexual health of postmenopausal women appear to differ significantly from one another, according to the meta-analysis (MD = 7.59; 95% CI = 4.56-10.60 and MD = 3.19; 95% CI = 1.25-5.13, respectively) but this difference was not observed in premenopausal women. Conclusion: The effect of phytoestrogens plants is more in menopausal women, and they can be advised to use these herbs. Key words: Medicinal, Plants, Sexual health, Women, Meta-analysis.
... Some other studies were redirected to other problems. Darvish-Mofrad-Kashani and collaborators studied the response of M. officinalis in behavior modifications [93]. In this work, the efficacy and safety of M. officinalis in improving hypoactive sexual desire disorder in 89 women were evaluated. ...
The authors would like to make a correction to the article [1]. The authors clarify that the reference [2] in the Fig. 5 caption is not cited in this review article in error. We apologise to readers for any inconvenience caused and state that the scientific conclusions are unaffected. This correction was approved by the Academic Editor. The references in the article have also been updated.
... Some other studies were redirected to other problems. Darvish-Mofrad-Kashani and collaborators studied the response of M. officinalis in behavior modifications [92]. In this work, the efficacy and safety of M. officinalis in improving hypoactive sexual desire disorder in 89 women were evaluated. ...
Melissa officinalis L. is a plant of the Lamiaceae family known in numerous countries for its medicinal activities. This plant has been used since ancient times to treat different disorders, including gastrointestinal, cardiovascular, neurological, psychological conditions. M. officinalis contains several phytochemicals such as phenolic acids, flavonoids, terpenoids, and many others at the basis of its pharmacological activities. Indeed, the plant can have antioxidant, anti-inflammatory, antispasmodic, antimicrobial, neuroprotective, nephroprotective, antinociceptive effects. Given its consolidated use, M. officinalis has also been experimented with clinical settings, demonstrating interesting properties against different human diseases, such as anxiety, sleeping difficulties, palpitation, hypertension, depression, dementia, infantile colic, bruxism, metabolic problems, Alzheimer’s disease, and sexual disorders. As for any natural compound, drug, or plant extract, also M. officinalis can have adverse effects, even though the reported events are very rare and the plant can be considered substantially safe. This review has been prepared with a specific research strategy, interrogating different databases with the keyword M. officinalis. Moreover, this work analyzes the properties of this plant updating currently available literature, with a special emphasis on human studies.
Abstract
Introduction: The sexual health is a major factor in the stability of
marriage. High prevalence of sexual dysfunction and an undeniable
effect on individual diseases, family conflicts and social problems,
which led to the increase of divorce in the society therefore prevention
of these disorders, is necessary. Iranian traditional medicine as a
holistic medicine has specific recommendation in this area. The
purpose of this study is to evaluate sexual health opinion from the
perspective of traditional medicine in Iran.
Method: In this narrative-descriptive study, authentic texts of
traditional medicine, such as "Kamelossanaeh", Canon of Ibn-Sina,
Hefzol-sehhe Naseri ... were searched in sex problems with the key
words "Bah", "intercourse" and "Mobahi" and then sexual health
measures as classified has been provided.
Results: The studies of traditional medicine in the field of sexual
health show the important relationship between normal sexual activity
and mental and physical health, and correct sexual activity lead to an
increase in the physical force and resolved mental illness. Sexual
recommendations are including sexual intercourse only with a real
desire and in proper time and avoid intercourse in improper time.
Other recommendation in this area is the appropriate amount of
cohabitation due to the strength of the body, age, season, sex and also
use of effective composition for the sexual enhancement.
Addiction is a chronic and recurring disease that recurrence phenomenon is the most important challenge in treatment of this disease. Recent experiences have shown that synthetic drugs have undesirable side effects. Recent studies on medicinal plants have shown that they might be effective in treatment of different stages of addiction with lower side effects and costs. The aim of this study was to review the effects of medicinal plants in the treatment of morphine addiction in experimental animals. In this review article, by using keywords of morphine, withdrawal, and plants or herbal medicine in databases of indexing cites, desired articles were obtained since 1994. Inclusion criteria for selecting articles were the articles related to application of medicinal plants in decreasing symptoms resulting from morphine withdrawal were selected. Results of this study on experimental studies have shown that medicinal plants such as Trachyspermum copticum L and Melissa officinalis decrease the symptoms of withdrawal syndrome in a dose-dependent. Also, medicinal plants like Avena sativa, Hypericum perforatu, Passiflora incarnate, Valeriana officinalis, Satureja hortensis L, and Mentha piperita can have effects on behavior, emotions, and other problems of addicts, decreasing withdrawal symptoms. Results of this study showed that medicinal plants can be effective in controlling deprivation, decreasing dependency creation, and possibly detoxification of opioid addicts.
Orgasmic disorder can create a feeling of deprivation and failure and provide mental problems, incompatibility and marital discord. This study aimed to compare the effects of Elaeagnus angustifolia flower extract and sildenafil citrate on female orgasmic disorder in women in 2013.
In this randomized clinical trial, 125 women between 18-40 years old who suffered from orgasmic disorder were divided into three E. angustifolia, sildenafil citrate and control groups. The data were gathered using Female Sexual Function Index and through measurement of TSH and prolactin. The first intervention group had to consume 4.5 gr E. angustifolia extract in two divided doses for 35 days and the second one had to use 50 mg sildenafil citrate tablets for 4 weeks one hour before their sexual relationship. However, the control group had to consume the placebo. The data were analyzed using paired t-test, one-way ANOVA, and Bonferroni posthoc test and p<0.05 was considered significant.
The frequency of orgasmic disorder before the intervention was 41.5%, 40.5%, and 57.1% in E. angustifolia, sildenafil citrate, and control groups, respectively (p=0.23). However, these measures were respectively 29.3%, 16.7%, and 50% after the intervention (p=0.004). A significant difference between the two groups regarding sexual satisfaction after the intervention (p=0.003) compared to the beginning of the study (p=0.356). Besides, the highest reduction of changes after the intervention (58.82%) was observed in the sildenafil citrate group.
Both E. angustifolia extract and sildenafil citrate were effective in reduction of the frequency of orgasmic disorder in women.
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.
Introduction
Hypoactive Sexual Desire Disorder (HSDD) is defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Revised (DSM-IV-TR) as persistent deficient sexual fantasies and desire for sexual activity that causes marked distress or interpersonal difficulty. In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), HSDD has been subsumed by Female Sexual Interest/Arousal Disorder. However, decades of research based on DSM-IV-TR HSDD criteria form the foundation of our understanding of the essential symptom of distressing low sexual desire, its epidemiology, clinical management, and treatment.
Aim
This publication reviews the state of knowledge about HSDD.
Methods
A literature search was performed using terms HSDD and female sexual dysfunction (FSD).
Main Outcome Measures
Physicians acknowledge that FSD is common and distressing; however, they infrequently address it, citing low confidence, time constraints, and lack of treatment as barriers.
Results
HSDD is present in 8.9% of women ages 18 to 44, 12.3% ages 45 to 64, and 7.4% over 65. Although low sexual desire increases with age, distress decreases; so prevalence of HSDD remains relatively constant across age. HSDD is associated with lower health-related quality of life; lower general happiness and satisfaction with partners; and more frequent negative emotional states. HSDD is underdetected and undertreated. Less than half of patients with sexual problems seek help from or initiate discussions with physicians. Patients are inhibited by fear of embarrassing physicians and believe that physicians should initiate discussions. The Decreased Sexual Desire Screener, a tool for detecting and diagnosing HSDD, is validated for use in general practice.
Conclusion
Women can benefit from intervention in primary care, behavioral health and sexual medicine settings. Psychotherapeutic and pharmacological interventions aim to enhance sexual excitatory process and decrease inhibitory processes. Flibanserin, the first centrally acting daily medication for HSDD, was recently approved in the US for premenopausal women.
Many women will likely experience a sexual problem in their lifetimes. Female sexual dysfunction (FSD) is a broad term used to describe three categories of disorders of a multifactorial nature. Efficacious but limited pharmacotherapeutic options exist to address FSD. The FDA recently approved the first agent for treatment of hypoactive sexual desire disorder (HSDD) in premenopausal women. Off-label use of hormonal therapies, particularly estrogen and testosterone, are the most widely employed for FSD, particularly in postmenopausal women. Other drugs currently under investigation include phosphodiesterase inhibitors and agents that modulate dopamine or melanocortin receptors. Pharmacists should be aware of the classifications of FSD and the options that are currently available for treatment. © 2000 - 2015 Jobson Medical Information LLC unless otherwise noted. All rights reserved.
Low or absent sexual desire is the most common sexual dysfunction in women, and its prevalence peaks during midlife. Its etiology is complex and may include biologic, psychologic, and social elements. Major risk factors for its development include poor health status, depression, certain medications, dissatisfaction with partner relationship, and history of physical abuse, sexual abuse, or both. Diagnosis is based on criteria set by the Diagnostic and Statistical Manual of Mental Disorders (5th Edition) and requires that a woman experience personal distress. Clinical evaluation should include medical history, sexual history, and, sometimes, a physical examination. Laboratory data are of limited value, except when warranted by history or physical examination. Treatment options include nonpharmacologic interventions such as education, office-based counseling, and psychotherapy. Although there are no U.S. Food and Drug Administration (FDA)-approved treatments for low desire, pharmacologic agents have been used off-label for this purpose. Bupropion is an antidepressant that has been shown to improve desire in some women with and without depression. Systemic estrogen therapy is not recommended in the absence of vasomotor symptoms and is not directly associated with desire. However, vaginal estrogen is useful in patients presenting with concomitant vaginal atrophy and dyspareunia. Ospemifene is a selective estrogen receptor modulator that can be used as an alternative to vaginal estrogen. Exogenous testosterone has demonstrated efficacy in treating loss of desire in postmenopausal women. However, patients should be counseled that it is not FDA-approved for this purpose and there are limited published long-term safety data. Several agents for the treatment of low desire are currently in development. Gynecologists are in a unique position to address concerns about sexual desire in women.