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Maca (L. meyenii) for improving sexual function: A systematic review


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Maca (Lepidium meyenii) is an Andean plant of the brassica (mustard) family. Preparations from maca root have been reported to improve sexual function. The aim of this review was to assess the clinical evidence for or against the effectiveness of the maca plant as a treatment for sexual dysfunction. We searched 17 databases from their inception to April 2010 and included all randomised clinical trials (RCTs) of any type of maca compared to a placebo for the treatment of healthy people or human patients with sexual dysfunction. The risk of bias for each study was assessed using Cochrane criteria, and statistical pooling of data was performed where possible. The selection of studies, data extraction, and validations were performed independently by two authors. Discrepancies were resolved through discussion by the two authors. Four RCTs met all the inclusion criteria. Two RCTs suggested a significant positive effect of maca on sexual dysfunction or sexual desire in healthy menopausal women or healthy adult men, respectively, while the other RCT failed to show any effects in healthy cyclists. The further RCT assessed the effects of maca in patients with erectile dysfunction using the International Index of Erectile Dysfunction-5 and showed significant effects. The results of our systematic review provide limited evidence for the effectiveness of maca in improving sexual function. However, the total number of trials, the total sample size, and the average methodological quality of the primary studies were too limited to draw firm conclusions. More rigorous studies are warranted.
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Maca (L. meyenii) for improving sexual function:
a systematic review
Byung-Cheul Shin
, Myeong Soo Lee
, Eun Jin Yang
, Hyun-Suk Lim
, Edzard Ernst
Background: Maca (Lepidium meyenii) is an Andean plant of the brassica (mustard) family. Preparations from maca
root have been reported to improve sexual function. The aim of this review was to assess the clinical evidence for
or against the effectiveness of the maca plant as a treatment for sexual dysfunction.
Methods: We searched 17 databases from their inception to April 2010 and included all randomised clinical trials
(RCTs) of any type of maca compared to a placebo for the treatment of healthy people or human patients with
sexual dysfunction. The risk of bias for each study was assessed using Cochrane criteria, and statistical pooling of
data was performed where possible. The selection of studies, data extraction, and validations were performed
independently by two authors. Discrepancies were resolved through discussion by the two authors.
Results: Four RCTs met all the inclusion criteria. Two RCTs suggested a significant positive effect of maca on sexual
dysfunction or sexual desire in healthy menopausal women or healthy adult men, respectively, while the other RCT
failed to show any effects in healthy cyclists. The further RCT assessed the effects of maca in patients with erectile
dysfunction using the International Index of Erectile Dysfunction-5 and showed significant effects.
Conclusion: The resul ts of our systematic review provide limited evidence for the effectiveness of maca in
improving sexual function. However, the total number of trials, the total sample size, and the average
methodological quality of the primary studies were too limited to draw firm conclusions. More rigorous studies are
Sexual problems (or sexual dysfunction) are widespread
and adversely affect mood, well-being, and interpersonal
relationships [1] . They occur in 20%-30% of men a nd
40-45% of women according to 18 descriptive epidemio-
logical studies from around the world [2]. Most sexual
problems relate to sexual desire (interest in sex) in both
females and males and male erectile dysfunction (ED) [2].
Current pharmacological interventions for the manage-
ment of sexual problems include oral drugs, intrapenile
therapies (intra-urethral suppositories and intracavernous
injections) and penile prosthesis implantation for males
and hormonal therapy for females. Although considerable
advances have been made, the ideal treatment for ED
has not been identified. The treatment for sexual pro-
blems in females is also problematic [3]. Furthermore,
pharmacological treatments have been shown to result in
several adverse effects, including risk of cancer, headache,
rhinitis and dyspepsia [4-6]. Non-phar macological treat-
ments of female sexual problems includes vaginal electro-
myography biofeedback, pelvic floor physical therapy,
(group) cognitive behaviouraltherapy,transcutaneous
electrical nerve stimulation, and vestibulectomy [7]. Her-
bal therapies for ED or sexual dysfunction in males and
females include yohimbine ( Pausinvstalia vohimbe),
which is burdened with s erious adve rse effe cts [8-10],
ginkgo (Ginkgo biloba) and red ginseng (Panax ginseng)
[10,11]. Sever al other botanical therapies for sexual dys-
function have also been introduced [8,10,12]. These are
also often used for improving sexual function in healthy
Maca (Lepidium meyenii) is an Andean plant that
belongs to the brassica (mustard) family. Maca has been
used for centuries in the Andes to enhance fertility i n
humans and anim als [12,13] . Prepa rations from the
maca root have been reported to improve sexual
* Correspondence:
Division of Standard Research, Korea Institute of Oriental Medicine, Daejeon,
South Korea
Full list of author information is available at the end of the article
Shin et al. BMC Complementary and Alternative Medicine 2010, 10:44
© 2010 Shin et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the t erms of the Creative Commons
Attribution License (http://crea tivecommons .org/licenses/b y/2.0), which permits unrestr icted u se, distribution, and reproduction in
any medium, provided the original work is properl y cited.
function in healthy populations [13]. Although maca is a
plant extract and not a drug, it is one of the most com-
monly cited natural drugs on the Internet for the
improvement of sexual desire. The hypothesis that maca
may be effective in improving sexual function is sup-
ported by several lines of evidence. Animal experiments
suggest that maca has spermatogenic and fertility-
enhancing activities, which are likely due to the p hyto s-
terols or phytoestrogens present in the maca [14].
Several in vivo studies have shown that maca may
improve sexual behaviour and enhance androgen-like
effects in rats [15,16]. Recent clinical trials have also
suggested significant effects of maca for increasing
sperm count and m obility and im proving sexual func-
tion in humans [17,18]. The potential bioactive ingredi-
ents i n maca include macaridine, macamides, macaene,
gluosinolates, maca alkaloid, a nd maca nutrients [14].
However, these data are insufficient for determining
whether maca is clinically effective. Currently, no sys-
tematic review of this s ubject is available. The aims o f
this systematic review are to summarise and critically
assess the evidence from randomised clinical trials
(RCTs) for or against the effectiveness of maca in the
improvement of sexual fu nction, including sexual desire
and sexual responses.
Data sources
The following el ectronic databases were searched from
inception through April 2010: Medline, AMED, CINAHL,
EMBASE, PsycInfo, the Cochrane Central Register of
Controlled Trials and the Cochrane Database of Systema-
tic Review, DARE, Psychology and Behavioral Scienc es
Collection, six Korean Medical Databases (Korean Studies
Information, DBPIA, Korea Institute of Science and
Technology Information, KERIS, KoreaMed, and Korean
National Assembly Library), Chinese Medical Databases
(CNKI;, and The Japanese Science
and Technology Information Aggregator, Electronic. The
search terms used were Lepidium meyenii AND sexual
dysfunction OR erectile dysfunction OR sexual function).
The search strategy was compose d of a mixture of f ree
text and thesaurus terms [see Additional file 1]. We also
manually searched our departmental files and relevant
journals (Focus on Alternative and Complementary
Therapies and Forschende Komplementärmedizin und
Klassische Naturheilkunde) until April 2010. The refer-
ences in all located articles were manually searche d for
further relevant articles. Dissertations and abstracts were
Study selection
Trials involving pe ople with normal sexual function and
those with sexual dysf unction were incl uded. All articles
that reported an RCT in which humans were treated
with any type of maca (Lepidium meyenii) preparation,
regardless of origin, were included. Trials we re included
if they employed maca as the sole treatment or as an
adjunct to conventional treatments compared to a pla-
cebo control. Studies that used a t least one measure
related to sexual function were included. We excluded
trials comparing two different types o r dosages of maca
and t hose in which no clinical data or insufficient data
for comparison were reported. For duplicate publica-
tions with different outcome measures originating from
one trial published as separate papers, the original publi-
cation was given priority, and all others were excluded.
No language restrictions were imposed.
Extraction of data and assessment of risk of bias
All of the included articles were read in full. Three inde-
pendent reviewers (BCS, MSL, and EJY) extracted the
data, including methods (e.g., design, blinding, duration
of follow-up), sample (e.g., population size, conditions,
age, duration of disease), intervention and control treat-
ment, and outcome measures, according to predeter-
(i.e., sequence gener ation, bl inding, incomplete outcome
measures, and allocation c oncealment) w as applied to
evaluate the risk of bias [19]. Differences in opinions
between the reviewers were settled through discussion.
Data Synthesis
We had originally intended to conduct a formal meta-
analysis. However, statistical an d clinical heterogeneity
prevented us from doing so. The main ways we would
have done were like followings. The post-treatment
values (the end of treatment) of the outcome measures
were used to assess differences between the intervention
groups and the control groups. We did not include the
follow-up treatment values. S tandardised mean differ-
ences (SMDs) were used for pooling the outcomes
related with sexual function with a random effects
model. SMDs and 95% confidence intervals (CIs) were
calculated using Cochrane Collaboration ssoftware
(Review Manager Version 5.0 for Windows, Copenha-
gen: The Nordic Cochrane Centre). The mean difference
(MD) for each outcome measure was calculated using
the same software. Statistical heterogeneity was evalu-
ated usi ng a c
test and I
statistics (low = 25 %; moder-
ate = 50%; high = 75%).
Study description
The literature search es rev ealed 88 articles, of which 84
had to be excluded (Figure 1). Among these, one RCT
was excluded because it compared two different dosages
[20] and another because it reported different outcome
Shin et al. BMC Complementary and Alternative Medicine 2010, 10:44
Page 2 of 6
measures from one trial [18]. One trial was excluded
because of the absence of a control group [17]. Four
RCTs met our inclusion criteria, and their key data are
summarised in Table 1 [21-24]. Of the fo ur studies, one
RCT was conducted in Italy [21], one in Peru [23], one
in Austra lia [22], and one in the UK [24]. One RCT
adopted a two-armed parallel group design [21], one
employed a three-armed parallel group design [23], and
the other two used a crossover design [22,24]. The four
trials included a total of 131 subjects. Two RCTs con-
tributed most to the sample ( n = 50, and 57) [21,23 ],
while the other tw o RCTs were relatively small (n = 8,
and 16) [22,24]. T wo RCT s [21 ,22] employed dried
maca, a nd the other two [23,24] used gelatinised maca.
All of the participants in the four studies ingested the
maca orally. Dosages were 1.5 g to 3.5 g of maca daily
for 2 or 12 we eks. The age ra nge of male participan ts
was from 21 to 56 years for healthy subjects and 36 ± 5
years for patients with ED, while the age range of post-
menopausal women was 54 ± 11 years. The outcome
measures used in these trials included the International
Index of Erectile Dysfunction (IIEF-5) [21], the sexual
dysfunction Green Climacteric Scale [22], sexual desire
according to the 6-point Likert scale [23], and the Sex-
ual Desire Inventory [24]. T hree RCTs [22-24] used
commercial products, and one RCT [21] tested natural
dried maca.
Risk of bias
None of the included RCTs reported their methods of
sequence generation. All of the included trials employed
a double-blind desi gn. One trial reported complete out-
come measures [22]. None employed allocation
Table 1 Summary of randomised clinical trials with maca for sexual function
Sample size/
condition Age
(years) Sex (M/F)
Duration of disease
Intervention (regimen) Control
Results Adverse
[21] Italy
50 mild ED
36 (SDs, 5)
(A) Maca (pulverised dehydrated
maca roots directly imported from
Peruvian Andes, tablets, 2400 mg/d,
1200 mg/d, 2 daily for 12 weeks, n
= 25), no follow-up
(B) Placebo tablets
(2400 mg/d, 1200
mg/d, 2 daily for
12 weeks, n = 25)
IIEF-5 Intergroup: MD,
1.10 [0.61, 1.59],
P < 0.001
Within group:
(A) P < 0.05,
(B) P < 0.05
16 healthy
women with
moderate severity of
(A) Maca (company commercial
product, dried maca powder, 3500
mg/d, daily for 6 weeks, n = 14), 6
weeks follow-up
(B) Placebo
(refined white rice
flour, 3500 mg/d,
daily for 6 weeks,
n = 14)
Intergroup: MD,
0.70 [0.08, 1.32], P < 0.05
54 (SDs, 11)
>12 months
Within group:
A) P < 0.05,
(B) NS
[23] Peru
57 adult healthy men
(A) Maca (company commercial
product, gelatinised maca, 1500 mg/
d; 500 mg/d, 3 tablets, daily for 12
weeks, n = 30), no follow-up
(C) Placebo tablets
(n.r., daily for 12
weeks, n = 12)
on sexual
Intergroup: MD,
0.51 [-0.35, 1.37], NS at 4
weeks; MD, 1.64 [1.07, 2.21], P
< 0.008 at 8 weeks; MD, 1.64
[1.07, 2.21], P < 0.006 at 12
(B) Maca (company commercial
product, gelatinised maca, 3000 mg/
d; 500 mg/d, 6 tablets, daily for 12
weeks, n = 15), no follow-up
Within group:
(A) P < 0.05 at 4, 8, and 12
(B) NS at 4, 8, and 12 weeks
[24] UK
8 experienced and
endurance trained
male (cyclists)
(A) Maca (company commercial
product, gelatinised maca, 2000 mg/
d for 2 weeks, n = 8), no follow-up
(B) Placebo
capsules (Arabic
gum, n = 8)
Intergroup: MD,
6.38 [-11.32, 24.08], NS
30 (SDs, 7)
Cross-over (1 week
washout period)
Within group:
(A) P = 0.01,
(B) P = 0.90
ED: erectile dysfunction; GCS: Greene Climacteric Scale; IIEF-5: International Index of Erectile Dysfunction; NS: not significant; n.r.: not reported; SDs: standard
Shin et al. BMC Complementary and Alternative Medicine 2010, 10:44
Page 3 of 6
Patients with sexual dysfunction
One RCT compared the effects of maca vs. placebo
treatments in patients with erectile dysfunction. This
trial [21] showed positive e ffects of maca on the IIEF-5
in patients with mild ED compared to the placebo con-
trol (MD, 1.10, 95% CIs, 0.61 to 1.59, P < 0.001) [21].
Healthy volunteers
Three RCTs tested the effects of maca vs. placebo on
sexual function in healthy postmenopausal women [22],
healthy adult men [23] o r male cyclists [24]. One RCT
[22] reported positive effects of maca on sexual function
in healthy menopausal women compared with the pla-
cebo control (MD, 0.70, 95% CIs, 0.08 to 1.32, P < 0.05).
The other RCT [23] tested both a high dosage of maca
(3 g/d) and a low dosage of maca (1.5 g/d) on sexual
desire compared to a placebo control and reported posi-
tive effects of both dosages of mac a after 8 weeks (MD,
1.64, 95% CIs, 1.07 to 2.21, P < 0.01) and 12 weeks
(MD, 1.64, 95% CIs, 1. 07 to 2.21, P < 0.01). The further
RCT [24], which had a very small sample size, failed to
show positive effects of maca in the improvement of
sexual desire (MD, 6.38, 95% CIs, -11.32 to 24.08, NS).
Adverse effects
None of included trials attempted to asse ss the adverse
effects of maca.
Few RCTs have tested the effects of maca on sexual
function. This review found limited evidence from four
small trials that suggested that maca is effective in
Figure 1 Flow chart for the selection of included trials. RCT: randomised clinical trial; UOS: uncontrolled observational study.
Shin et al. BMC Complementary and Alternative Medicine 2010, 10:44
Page 4 of 6
improving sexual des ire after at least 6 weeks. However,
this finding is limited because the studi es were un der-
powered. In particul ar, two studies found no effect after
2 or 4 weeks of treatment. Evidence from other studies
suggests that maca may be effective for sexual dysfunc-
tion in patients with ED and postmenopausal women
after 12 weeks or 6 weeks, respectively. However, the
total numb er of trials, the total sample size, and the
average risk of bias in the primary stud ies were too lim-
ited to draw firm conclusions.
All o f the RCTs employed double-blind methods, but
none of the included trials reported methods of
sequence generation for randomisation and allocation
concealment. Trials with inadequate sequence genera-
tion and inadequate allocation concealment are likely to
show exaggerated treatment effects [25] and thus limit
the reliability of the study results. Although all included
RCTs used placebo controls, none reported the success
of blinding. None of the studies reported a power calcu-
lation, and sample sizes were very small in some of the
RCTs (ranging from 8 to 57). One article h as a poor
description of the outcome and was therefore difficult to
interpret [23]. In this trial, only the mean average of two
active groups (high and low dosage of maca) was c om-
pared with the control group. One RCT failed to include
washout periods between cross over periods [22]. One of
the main problems in crossover trials is the possibility
of a carry-over effect. Therefore, this RCT is diff icult to
interpret. The other RCT has a smal l sample size and is
therefore susceptible to a type II error [24].
Four kinds of questionnaires were used for measuring
sexual function or sexual desire, including the IIEF-5
[21], Gre en Climacteric Scal e (GCS) [22], subjective
Likert scale [ 23], and Sexua l Desire Inv entory [24].
Three RCTs [21,22,24] employe d validated que stion-
naires , while one RCT [23] d id not. Because the GCS is
not specified for sexual function, it might not be sen si-
tive en ough to detect changes in sexual dysfunction.
One t rial tested changes in sexual desire compared to a
baseline value with a 6-point Likert scale. It is not clear
whether the authors used validated scales. It is impor-
tant that only valida ted questionnaires are employed;
otherwise, the outcome measures used have less estab-
lished reliability and validity, data derived from them are
subject to bias, and comparisons between the results of
different studies are problematic.
The extent to which the therapeutic effects of maca
various constituents in the preparation is unclear. The
optimum dose of maca is unknown. Single-dose studies
used extract quan tities ranging from 1.5 g/d to 3.0 g/d.
One excluded RCT compared two dosages of maca, 1.5
g/d and 3.0 g/d, for the management of SSRI-induced
sexual dysfunction, but the results of that study failed to
show differences b etween the two doses [20]. Fu rther
studies are required to identify the optimal dose.
One argument for the use of maca for the management
of sexual function might be that it causes fewer adverse
effects than conventional drug treatments. However, none
of the four RCTs described here assessed the adverse
effects of maca. This should be tested in future studies.
One could question the validity o f our conclusions by
pointing to the review m ethod used (reviewing a small
number of trials with many limitat ions). However, the
reasons for doing a systematic review include answering
questions not addressed by individual studies, settling
controversies arising from apparently conflicting studies,
and generating new hypotheses [19].
The limitations of our systematic review pertain to the
paucity of da ta and the potential incompleteness of the
evidence reviewed. None of the three RCTs have been
submitted for independent replication. We aimed to
identify all studies on the topic. The distorting effects of
publication bias and location bias on systematic reviews
and meta-analyses are well documented [26]. None of
the RCTs included in our review were fully successful in
minimising bias. Co llectively, these facts seriously limit
the conclusiveness of our systematic review.
Our decision to exclude non-randomised trials might
also be criticised. However, we strongly feel that non-
randomisation introduces a selection bias that, in turn,
would render any results uninterpreptible. The exclusion
of RCTs comparing different dosages might be criticised.
We feel that such trials would not give objective clinical
information of value. Moreover, these studies cannot
provide reliable data on the effectiveness of maca.
Therefore, we believe the exclusion of such studies w as
the correct decision.
Regarding an implication for practice, this review
identifies limited evidencefortheuseofmacain
improving sexual function in healthy subjects or patients
with ED. However, practitioners and clinical decision
makers need to be aware that there are too many limita-
tions to draw firm conclusion. Future trials testing the
effects of maca should adhere to rigorous trial designs
that adequately suit the research question being asked.
Such trials should preferably be randomised , control for
placebo effects, be double-blinded, adequately conceal
allocation, have optimal treatment dosages and sample
sizes based on proper sample size calculations, use vali-
dated outco me measures, asse ss other outcomes such as
quality of life or partner outcome as well as adverse
effects, and include a full description of the actual inter-
ventions being tested.
The results of our systematic review provide limited evi-
dence for the effectiveness o f maca in the improvement
Shin et al. BMC Complementary and Alternative Medicine 2010, 10:44
Page 5 of 6
of sexual function . However, the total number of trials,
the total s ample size, and the a verage methodological
quality of the primary studies were too limited to draw
firm conclusions. Moreo ver, our c urrent knowl edge of
the risks of maca intake is insufficient. More rigorous
studies are warranted.
Additional material
Additional file 1: The search strategies for MEDLINE. The data
provided the details of search strategies for MEDLINE.
Funding to pay the Open Access publication charge for this article was
provided by KIOM (K10251). M.S. Lee was supported by KIOM (K10251) and
E.J. Yang was supported by KIOM (K10010). The fund for professional proof
reading of this article was supported by KIOM (K10010 and C10040).
Author details
Division of Clinical Medicine, School of Oriental Medicine, Pusan National
University, Yangsan, South Korea.
Division of Standard Research, Korea
Institute of Oriental Medicine, Daejeon, South Korea.
Department of
Nursing, Hanyang University Kuri Hospital, Kuri, Gyeonggi-Do, South Korea.
Complementary Medicine, Peninsula Medical School, University of Exeter,
Exeter, UK.
Authors contributions
BCS and MSL designed the review, performed searches, appraised and
selected trials, extracted data, contacted authors for additional data, carried
out analyses and interpretations of the data, and drafted this report. EJY
reviewed and critiqued this review and report and assisted with
interpretation of the data. HSL and EE reviewed and critiqued the review
protocol and this report and assisted in designing the review. All authors
read and approved the final manuscript.
Competing interests
The authors declare that they have no competing interests.
Received: 20 March 2010 Accepted: 6 August 2010
Published: 6 August 2010
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Pre-publication history
The pre-publication history for this paper can be accessed here:
Cite this article as: Shin et al.: Maca (L. meyenii) for improving sexual
function: a systematic review. BMC Complementary and Alternative
Medicine 2010 10:44.
Shin et al. BMC Complementary and Alternative Medicine 2010, 10:44
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... In particular, it was evidenced that men who received maca tablets for 4 months had increased seminal volume, sperm count by ejaculation, mobile sperm count, and sperm motility. These studies provided preliminary evidence supporting the efficacy of maca (Shin et al., 2010). ...
... On the other hand, systematic reviews that evaluated randomized clinical trials of several varieties of maca in comparison with a placebo for the treatment of healthy people or patients with sexual dysfunction have shown that the results provide limited evidence for an efficacy of maca in improving the sexual function (Lee et al., 2016;Shin et al., 2010). In addition, there are few studies assessing the toxicity of L. meyenii. ...
Background: Maca (Lepidium meyenii Walp.) has been used in folk medicine to treat fertility disturbances, a claim that has been evidenced in some studies. However, the clinical trials validating this use have shown paradoxical findings and then maca safety is not well known. Purpose: This study investigated the effects and mechanisms by which maca affects the reproductive system using an in vivo model, the nematode Caenorhabditis elegans. Materials and methods: Tuber maca powder, obtained from local commerce, was used to prepare the aqueous extract. Worms were acutely exposed to maca extracts (40, 120, 240 and 330 μg/μl) and 48h after treatments, physiological and biochemical assays were conducted. Results: Maca extract caused a significant decrease in total number of eggs and in the number of eggs per worm. These effects were associated to increased lipid peroxidation, reduced triacylglycerol levels and also impaired vit-2 (vitellogenin) expression, besides increase in the number of apoptotic germline cells. We have found quantifiable levels of alkaloids in this maca extract, which presence could be related to this toxicity. Conclusions: Collectively, our data suggest that maca extract exposure causes reproductive toxicity to worms which could be, at least in part, associated to both an increase in apoptosis of germline cells and also to a decrease in vitellogenin expression, needed for egg yolk production, and consequently, successful reproduction.
... Women's sexual disorder is an umbrella term including several worrying factors related to women's sexual health, in which aging plays a major role by causing hormonal changes. Using herbal medicines such as Tribulus terrestris, Hop, Rosa damascena, Cannabis, and Ginseng to establish hormonal balance has been studied [21][22][23][24][25] . A similar study by Bommer et al., on the effectiveness and safety of Salvia Officinalis extract on hot flashes in postmenopausal women and other climacteric symptoms for 8 weeks concluded that daily consumption of one Salvia Officinalis extract tablet significantly reduced and cured the severity and frequency of hot flashes in postmenopausal women. ...
... In addition to the above, other criteria mentioned in the tool for measuring menopausal symptoms such as sleep disorders, psychological symptoms and Genitourinary syndrome of menopause (GSM) have also improved. Also, no side effects or laboratory disorders were observed during the study 15 25 . Besides, in another study Hot flashes can be controlled with Salvia officinalis, which has EA. ...
... Individuals have hunted for various habits to attain intimate fancy or sexual ways from really old times [8]. Victorious handling of sexual dysfunctions may perk up not only sexual associations but also the large dominance of life [9]. It can be treated by both checkups and surgical modalities. ...
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Objective: The objective of the study was to study aphrodisiac activity of polyherbals on albino Wistar rats. Methods: Play Win and Ayurex are examples of the already marketed polyherbal formulations (PHFs), which are used in this study to determine their mating behavior and mating performance test activities in albino Wistar rats. Results: Both the test drugs Play Win and Ayurex created noteworthy increase in the mounting behavior of animals. It was also observed that mounting behavior activity (number of mounts) in Play Win, in the 1st h and the 3rd h, was greater than Ayurex. Administration of suspension of a single dose of Play Win, Ayurex, and sildenafil citrate concluded in the increase in the mating performance of the rats. The result of Play Win was found to be less than that of Ayurex and nearly the same as that of sildenafil citrate. Conclusion: From the research of the above-mentioned formulations with comparison to the standard drug (sildenafil), it is concluded that the PHFs are capable of producing aphrodisiac activity.
... It has been consumed worldwide for centuries as a dietary supplement of its nutritional and medicinal properties. And previous studies have proved various biological effects of Maca in the field of male reproductive functions [8][9][10][11][12]. In particular, a study that improved sexual desire without effecting testosterone concentration in adult men could be an advantage in LOH treatment [11]. ...
Purpose: To evaluated the efficacy and safety of gelatinized Maca (Lepidium meyenii) for eugonadal patients with late onset hypogonadism symptoms (LOH). Materials and methods: Participants were instructed to receive 1,000 mg of Maca or placebo, two pills at a time, three times per day for 12 weeks before food intake. To evaluate the efficacy of the drug, Aging Males' Symptoms scale (AMS), Androgen Deficiency in the Aging Males (ADAM), International Prostate Symptom Score (IPSS), and International Index of Erectile Function (IIEF) questionnaires, serologic tests (total testosterone and free testosterone, total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, triglyceride), body weight, and waist circumference were assessed at 4 and 12 weeks after treatment. Results: A total of 80 participants were enrolled and randomly assigned to Maca treated group (n=41) or the placebo group (n=39). AMS, IIEF, and IPSS were significantly (p<0.05) improved in Maca treated group than in the placebo group. ADAM positive rate was also significantly (p<0.0001) decreased in Maca treated group. Conclusions: Maca may be considered an effective and safe treatment for eugonadal patients with late onset hypogonadism symptoms.
... Supplemental Fig. 1A). Its potential health benefits, particularly to reproduction and fertility, have drawn great investments from pharmacological and nutritional research in recent years (Piacente et al. 2002;Shin et al. 2010). On account of its restricted cultivation area at high altitude, maca manifests robust endurance to the extreme environmental stresses, including cold, strong wind and UV-B exposure. ...
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Maca (Lepidium meyenii Walp, 2n = 8x = 64) of Brassicaceae family is an Andean economic plant cultivated on the 4000-4500 meters central sierra in Peru. Considering the rapid uplift of central Andes occurred 5 to 10 million years ago (Mya), an evolutionary question arises on how plants like maca acquire high altitude adaptation within short geological period. Here, we report the high-quality genome assembly of maca, in which two close-spaced maca-specific whole genome duplications (WGDs, ~ 6.7 Mya) were identified. Comparative genomics between maca and close-related Brassicaceae species revealed expansions of maca genes and gene families involved in abiotic stress response, hormone signaling pathway and secondary metabolite biosynthesis via WGDs. Retention and subsequent evolution of many duplicated genes may account for the morphological and physiological changes (i.e. small leaf shape and loss of vernalization) in maca for high altitude environment. Additionally, some duplicated maca genes under positive selection were identified with functions in morphological adaptation (i.e. MYB59) and development (i.e. GDPD5 and HDA9). Collectively, the octoploid maca genome sheds light on the important roles of WGDs in plant high altitude adaptation in the Andes.
... One such popular herbal medicine that is used to improve semen quality and treat infertility in general is the maca plant, and most of the experimental data in the literature mainly report the effects of the red, yellow and black hypocotyl types (Gonzales et al., 2004;Gonzales et al., 2006a). Notably, this plant from Peru has long been utilized to enhance sexual functions (Shin et al., 2010;Lee et al., 2011). According to numerous in vivo studies, maca is replete with spermatogenic features, which, in turn, positively affect sexual behavior and sperm parameters (Gonzales et al., 2001;Gonzales et al., 2004;Chung et al., 2005;Bogani et al., 2006;Lentz et al., 2006;Rubio et al., 2006;Clément et al., 2010;Clement et al., 2012). ...
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Background: This study aimed to examine the evidence for the effect of Lepidium meyenii Walp. [Brassicaceae] ( L. meyenii W.), known as maca, on improving semen quality. Methods: Nine databases were searched for randomized controlled trials (RCTs) that examined the parameters for improvements in semen quality, regardless of the type of L. meyenii W. The risk of bias (ROB) among the studies was evaluated according to the Cochrane ROB tool. Results: Five RCTs met all of the inclusion criteria. Three RCTs showed mixed efficacy of maca in improving semen quality parameters, including sperm concentration and sperm motility, in men experiencing infertility. The meta-analysis also failed to show the efficacy of maca in increasing the sperm concentration compared to the placebo (weighted mean difference, 2.22, 95% confidence interval −2.94 to 7.37, p = 0.4). Two other RCTs also showed mixed effects of maca on several semen quality parameters in healthy men. Conclusion: The evidence from the included studies suggests unclear effects of maca on semen quality parameters in both men experiencing infertility and healthy men. However, the total number of RCTs and the total sample size were too small to draw firm conclusions.
... Although plant-derived compounds such as yohimbine, Panax ginseng, Butea superba, Epimedium herbs (icariin), Tribulus terrestris, Piper guineense and Lepidium meyenii (Maca) have been extensively used for their prosexual effects, [18][19][20][21][22][23][24][25][26] they have been frequently studied on animals with human studies being scarce having insubstantial methodology and outcomes [1]. The same has been the case with Spilanthes with no registered clinical trials as yet. ...
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Introduction Spilanthes acmella has been used as an aphrodisiac in India and other countries. However, studies concerning humans have been limited. This randomized controlled trial was carried out to evaluate the effect of SA3X capsules containing 500 mg of S. acmella on sexual function domain scores in sexually active men with symptoms of erectile dysfunction (ED) using the Men’s Sexual Health Questionnaire (MSHQ). Materials and methods This triple-blind, placebo-controlled, parallel-group was conducted at two centres in Hyderabad and Secunderabad from May to December 2021. Patients were randomized 1:1 to SA3X therapy or placebo for one month along with an observational cohort. The change of MSHQ score and its subdomains from baseline to month 1 (primary endpoint) and one-month post-treatment (secondary outcome) was assessed using a mixed model repeated measures analysis. Additional secondary outcomes measured were the change in the International Index of Erectile Function (IIEF) and duration of penile erection. Safety was evaluated. Results The intention-to-treat population included 448 patients (152 - SA3X therapy; 146 - placebo; 150 - observational cohort). A significant increase was observed with SA3X therapy versus placebo on the total MSHQ score (17.24 vs 4.72; SE: 2.11, 1.98; P<0.001) along with the sub-domains at the end of one month of therapy. At one-month post-treatment, the increase in MSHQ score with SA3X therapy was significant (18.48 vs 3.78; SE 2.81, 1.39; P<0.001). The IIEF scores and duration of penile erection also increased significantly in the SA3X therapy group. Dysgeusia (3.94%) was the most common drug-related adverse effect. No serious adverse effects were noted. Conclusion SA3X was concluded to be safe and effective as a potential treatment for ED.
Despite the lack of guidance available for practitioners, extensive polypharmacy has become the primary method of treating patients with severe and chronic mood, anxiety, psychotic or behavioral disorders. This ground-breaking new book provides an overview of psychopharmacology knowledge and decision-making strategies, integrating findings from evidence-based trials with real-world clinical presentations. It adopts the approach and mind-set of a clinical investigator and reveals how prescribers can practice 'bespoke psychopharmacology', tailoring care to the individualized needs of patients. Practitioners at all levels of expertise will enhance their ability to devise rationale-based treatments, targeting manifestations of dysfunctional neural circuitry and dimensions of psychopathology that cut across conventional psychiatric diagnoses. Presented in a user-friendly, practical, full-colour layout and incorporating summary tables, bullet points, and illustrative case vignettes, it is an invaluable guide for all healthcare professionals prescribing psychotropic medications, including psychiatry specialists, primary care physicians, and advanced practice registered nurses.
BACKGROUND The Lepidium meyenii plant also known as Peruvian Maca, originates from high altitudes in the Andes, it has a high nutritional content and is extensively used as an herbal supplement for conditions such as sexual dysfunction, semen quality and menopausal symptoms. OBJECTIVE This systematic review was conducted to assess the effects of Maca on variety of conditions and not limited to sexual dysfunction, semen quality and menopausal symptoms. METHODS An extensive systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2015. Three databases (PubMed, Science Direct and Google Scholar) in addition to patents were searched up to March 2021. The key criteria for inclusion were; (1) in vivo study (2) randomized controlled clinical trial; (3) subjects were given Maca regardless of the type, preparation and/or administration route; and (4) measurable clinical data on a physiological and/or psychological aspect were reported. Studies were categorised into human and animal model studies and were further grouped by the type and preparation of Maca, dose, duration and condition assessed. The studies were also assessed for risk of bias according to the Cochrane Collaborations tool. Studies were compared to ascertain whether a meta-analysis was feasible. RESULTS A total of 57 studies, 14 clinical and 43 pre-clinical trials met the pre-defined criteria; although patent applications were searched none met the criteria. Nine different extraction methods of Maca were used with various coloured roots namely black, yellow and red roots or a mixture of all three. Different colour variations showed different effects thought to be due to the presence and/or concentration of secondary metabolites. Maca was reported to have an effect on conditions such as memory impairment, depression, bone structure, UV irradiations amongst others. Placebo and dose-dependent effects were observed in some studies. The overall quality of risk of bias was unclear due to insufficient information being published in addition to a high risk of reporting bias. Doses and durations varied, and an insufficient number of studies had further analysed whether these factors had an effect on the outcome made a meta-analysis unfeasible. Therefore, recommendations for future studies were discussed. CONCLUSION Evidence to date suggests that Maca root could be an effective treatment for a range of conditions with 55 out of 57 studies reporting an effect. Clinical trials with rigorous reporting and methods are warranted.
Introduction: Sexual dysfunction (SD) is a symptom of depression in ≈70% of patients presenting with major depressive disorder (MDD). Antidepressant medications (AD) and adjunctive treatments may further contribute to SD and complicate evaluation and management. Areas covered: A systematic literature search of PubMed, Ovid MEDLINE and Cochrane databases for MDD, SD, classes of antidepressants, etc. was performed with a focus on 2014 to June 2021. SSRIs are associated with 70% treatment-emergent sexual dysfunction (TESD), SNRIs and tricyclics have rates of TESD of 40 - 45%, and antidepressant medications without SRI effects or with additional unique mechanisms of action have rates similar to placebo (<10%). Appropriate assessment at baseline and throughout treatment, consideration of patient preferences in prescribing, addressing modifiable factors (comorbid medical/psychiatric conditions, substances, relationship difficulties), and utilizing management strategies of switching to an AD with less SD, adding an antidote/adjunctive therapy or lowering the dose are discussed. Expert opinion: MDD and antidepressant treatment contribute to SD in a high percentage of patients. Treating to remission reduces SD as a symptom of depression. Frequent assessment and targeted management strategies may be effective in preventing or addressing SD. Secondary outcomes like impact on adherence, relationships and self-image should also be considered.
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Context While recent pharmacological advances have generated increased public interest and demand for clinical services regarding erectile dysfunction, epidemiologic data on sexual dysfunction are relatively scant for both women and men. Objective To assess the prevalence and risk of experiencing sexual dysfunction across various social groups and examine the determinants and health consequences of these disorders. Design Analysis of data from the National Health and Social Life Survey, a probability sample study of sexual behavior in a demographically representative, 1992 cohort of US adults. Participants A national probability sample of 1749 women and 1410 men aged 18 to 59 years at the time of the survey. Main Outcome Measures Risk of experiencing sexual dysfunction as well as negative concomitant outcomes. Results Sexual dysfunction is more prevalent for women (43%) than men (31%) and is associated with various demographic characteristics, including age and educational attainment. Women of different racial groups demonstrate different patterns of sexual dysfunction. Differences among men are not as marked but generally consistent with women. Experience of sexual dysfunction is more likely among women and men with poor physical and emotional health. Moreover, sexual dysfunction is highly associated with negative experiences in sexual relationships and overall wellbeing. Conclusions The results indicate that sexual dysfunction is an important public health concern, and emotional problems likely contribute to the experience of these problems.
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Purpose: To discuss the incidence and prevalence of sexual dysfunction among women, some common etiologies, and patient-provider relationships that seem to inhibit successful resolution of female sexual dysfunction. Data sources: A selective review of the literature on female sexual dysfunction, and an overview of assessment tools that can be used to evaluate and monitor its treatment. Conclusion: Sexual dysfunction in women is a health issue often overlooked by medical personnel, but it is a topic of great importance to both the patient and her sexual partner(s). It has been well established that quality of sex, that is, satisfaction with one's sex life, is a major quality-of-life indicator. But specifically as concerns the female patient, the issue has been overlooked by much of the healthcare community, perhaps because the topic of female sexual dysfunction is multifaceted and complex in nature. Implications for practice: Clinicians have an obligation to develop self-awareness and clinical intuition to address the topic in the utmost professional manner.
The maca species Lepidium meyenii grows all over several South American countries, but, to date, only maca from Peru has been significantly researched and shown to have therapeutic benefit. This has resulted in many botanists referring to maca that grows in Peru as Lepidium peruvianum in order to specify the exact origin. Some botanists, in fact, believe L. peruvianum to be a different species than L meyenii. While there will continue to be dissension on maca's correct botanical nomenclature, the most important point to clarify is that the origin of the maca referred to in this article is Peru and, due to this fact, will be referred to as L peruvianum. Maca's high nutritional value makes it a Peruvian dietary staple. Traditionally, the herb is best known as an adaptogenic plant, ie, a plant that modulates the body's response by supporting it in dealing with physiological, biochemical, and psychological stressors. Traditional healing methods include using the herb to benefit the endocrine and reproductive systems by addressing such disorders as chronic fatigue, anemia, and infertility and to aid in enhanced stamina and hormonal balance. Maca research shows benefit in the production of sex hormones, enhanced sex drive, stimulation of body metabolism, control of body weight, and increased energy, stress reduction, antidepressant activity, and memory improvement. It has been suggested that maca's therapeutic actions rely on plant sterols stimulating the hypothalamus, pituitary, adrenal, and ovarian glands and, therefore, also affecting the thyroid and pineal glands and, thus, improving sleep, mood, fertility, energy, and hot flashes. As such, this herb has been found clinically useful in perimenopausal and menopausal women.
Publication bias is the tendency to decide to publish a study based on the results of the study, rather than on the basis of its theoretical or methodological quality. It can arise from selective publication of favorable results, or of statistically significant results. This threatens the validity of conclusions drawn from reviews of published scientific research. Meta-analysis is now used in numerous scientific disciplines, summarizing quantitative evidence from multiple studies. If the literature being synthesised has been affected by publication bias, this in turn biases the meta-analytic results, potentially producing overstated conclusions. Publication Bias in Meta-Analysis examines the different types of publication bias, and presents the methods for estimating and reducing publication bias, or eliminating it altogether. Written by leading experts, adopting a practical and multidisciplinary approach. Provides comprehensive coverage of the topic including: • Different types of publication bias, • Mechanisms that may induce them, • Empirical evidence for their existence, • Statistical methods to address them, • Ways in which they can be avoided. • Features worked examples and common data sets throughout. • Explains and compares all available software used for analysing and reducing publication bias. • Accompanied by a website featuring software, data sets and further material. Publication Bias in Meta-Analysis adopts an inter-disciplinary approach and will make an excellent reference volume for any researchers and graduate students who conduct systematic reviews or meta-analyses. University and medical libraries, as well as pharmaceutical companies and government regulatory agencies, will also find this invaluable.
Maca (Lepidium meyenii walp.), a biennial herbaceous plant of the family Brassicae, which is cultivated mainly in the central Andes of Peru, has been used as both a food and a traditional medicine in the region for over 2000 years. The subterranean parts of the plant have long been used as a staple foodstuff by indigenous peoples in the Andean region, but the plant is also valued for its medicinal role. As is usual with many traditional “folk” medicines, many claims have been made regarding the efficacy of maca in treating a wide range of illnesses and medical conditions. However, in the 20th century most scientific attention has been focused in the areas where the pharmacological actions of maca seem most strongly attested, these include, enhancement of sexual drive in humans, increasing overall vigour and energy levels, and increasing sexual fertility in humans and domestic livestock. Since the early days of the 20th century numerous scientific studies have been carried out into the basis of its pharmacological action in these areas. In this review, the composition and pharmacological function of maca are systematically discussed. Additionally, the current discussion surrounding its mode of action in the areas listed above is also presented.
The Cochrane Handbook for Systematic Reviews of Interventions (the Handbook) has undergone a substantial update, and Version 5 of the Handbook is now available online at and in RevMan 5. In addition, for the first time, the Handbook will soon be available as a printed volume, published by Wiley-Blackwell. We are anticipating release of this at the Colloquium in Freiburg. Version 5 of the Handbook describes the new methods available in RevMan 5, as well as containing extensive guidance on all aspects of Cochrane review methodology. It has a new structure, with 22 chapters divided into three parts. Part 1, relevant to all reviews, introduces Cochrane reviews, covering their planning and preparation, and their maintenance and updating, and ends with a guide to the contents of a Cochrane protocol and review. Part 2, relevant to all reviews, provides general methodological guidance on preparing reviews, covering question development, eligibility criteria, searching, collecting data, within-study bias (including completion of the Risk of Bias table), analysing data, reporting bias, presenting and interpreting results (including Summary of Findings tables). Part 3 addresses special topics that will be relevant to some, but not all, reviews, including particular considerations in addressing adverse effects, meta-analysis with non-standard study designs and using individual participant data. This part has new chapters on incorporating economic evaluations, non-randomized studies, qualitative research, patient-reported outcomes in reviews, prospective meta-analysis, reviews in health promotion and public health, and the new review type of overviews of reviews.
Accurate estimates of prevalence/incidence are important in understanding the true burden of male and female sexual dysfunction and in identifying risk factors for prevention efforts. This is the summary of the report by the International Consultation Committee for Sexual Medicine on Definitions/Epidemiology/Risk Factors for Sexual Dysfunction. The main aim of this article is to provide a general overview of the definitions of sexual dysfunction for men and women, the incidence and prevalence rates, and a description of the risk factors identified in large population-based studies. Literature regarding definitions, descriptive and analytical epidemiology of sexual dysfunction in men and women were selected using evidence-based criteria. For descriptive epidemiological studies, a Prins score of 10 or higher was utilized to identify population-based studies with adequately stringent criteria. This report represents the opinions of eight experts from five countries developed in a consensus process and encompassing a detailed literature review over a 2-year period. The study aims to provide state-of-the-art prevalence and incidence rates reported for each dysfunction and stratified by age and gender. Expert opinion was based on the grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate. A wealth of information is presented on erectile dysfunction, its development through time, and its correlates. The field is still in need of more epidemiological studies on the other men's sexual dysfunction and on all women's sexual dysfunctions. A review of the currently available evidence from epidemiological studies is provided.
Women's sexual dysfunction includes reduced interest/incentives for sexual engagement, difficulties with becoming subjectively and/or genitally aroused, difficulties in triggering desire during sexual engagement, orgasm disorder, and sexual pain. To update the recommendations published in 2004, from the 2nd International Consultation on Sexual Medicine (ICSM) pertaining to the diagnosis and treatment of women's sexual dysfunctions. A third international consultation in collaboration with the major sexual medicine associations assembled over 186 multidisciplinary experts from 33 countries into 25 committees. Twenty one experts from six countries contributed to the Recommendations on Sexual Dysfunctions in Women. Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate. A comprehensive assessment of medical, sexual, and psychosocial history is recommended for diagnosis and management. Indications for general and focused pelvic genital examination are identified. Evidence based recommendations for further revisions of definitions for sexual disorders are given. An evidence based approach to management is provided. Extensive references are provided in the full ICSM reports. There remains a need for more research and scientific reporting on the optimal management of women's sexual dysfunctions including multidisciplinary approaches.