Supplements to increase libido

Libido supplements aka aphrodisiac supplements is defined as any food or drug that arouses the sexual instinct, induces veneral desire and increases pleasure and performance ¹. Libido is the sexual instinct or erotic desire and pleasure. Your libido is otherwise known your ‘sex drive’. Libido varies from person to person and can be influenced by a range of different factors.

Loss or reduction of libido can be experienced at any age and may result in:

• reduced desire to have sex
• sexual experiences that are no longer satisfying or pleasurable

Low libido can be a sign of other problems, such as mood or relationship issues, but it may also be due to something quite straightforward and symptomatic.

Vaginal dryness can be safely and effectively treated with an oestrogen cream or pessary.

Help is available – find a clinician who specialises in sexual counselling.

Talking with your partner about your concerns can strengthen your relationship. Getting older and chronic health problems like heart disease or diabetes can affect your sexual health and how you feel about sex. Some possible topics to discuss include:

• What feels good and what doesn’t
• Times that you may feel more relaxed
• Which positions are more comfortable
• Whether you need more time to get aroused than before
• Concerns you have about the way your appearance may be changing
• Ways to enjoy physical connection other than vaginal intercourse, such as oral sex or massage

You may want to also consider meeting with a therapist or sex counselor for individual or couples therapy if changes in your sex life bother you.

Aphrodisiacs can be classified by their mode of action into 3 types: those that increase (1) libido, (2) potency, or (3) sexual pleasure. There are two main types of aphrodisiacs, psychophysiological stimuli (visual, tactile, olfactory and aural) preparations and internal preparations (food, alcoholic drinks and love portion) ². A lot of natural substances have historically been known as aphrodisiacs in Africa and Europe, like yohimbine and the mandrake plant, as well as ground rhinoceros horn in the Chinese culture and “Spanish fly” which is actually toxic ³, ⁴. Even in today’s culture, there are certain foods that are used as aphrodisiacs, including strawberries and raw oysters. Chocolate, coffee, and honey are also believed to have aphrodisiac potential. Although these natural items are claimed as aphrodisiacs, there is no or little scientific confirmation supporting those assertions. For example, there is very little research in people on the effects of yohimbe as a dietary supplement and there are no human clinical studies of Pausinystalia yohimbe extract for low libido or erectile dysfunction ⁵. As a leading Pausinystalia yohimbe expert has succinctly summarized, “Any discussion of the use of the Pausinystalia yohimbe bark for sexual enhancement begins and ends with folklore” ⁵.

The hunt for an effective aphrodisiac has been a constant pursuit throughout history. The role of various dopaminergic, adrenergic, and serotonergic agents has been intensively examined in both human and animal studies. Some of these drugs have been considered for their potential role for the treatment of sexual dysfunction, while some others have contributed to the basic neurophysiological processes in sexual arousal ⁶.

Various substances of animal and plant origin have been used in folk medicines of different cultures; some have been identified pharmacologically, allowing for understanding of their mechanisms of action. For increasing libido, ambrein, a major constituent of Ambra grisea, is used in Arab countries ⁷. This tricyclic triterpene alcohol increases the concentration of several anterior pituitary hormones and serum testosterone. Bufo toad skin and glands contain bufotenine (and other bufadienolides), a putative hallucinogenic congener of serotonin. It is the active ingredient in West Indian “love stone” and the Chinese medication chan su ⁷. The aphrodisiac properties are likely of central origin, as are the other effects of the drug. For increasing potency, Panax ginseng used in traditional Chinese medicine, works as an antioxidant by enhancing nitric oxide synthesis in the endothelium of many organs, including the corpora cavernosa; ginsenosides also enhance acetylcholine-induced and transmural nerve stimulation-activated relaxation associated with increased tissue cyclic guanosine monophosphate, hence the aphrodisiac properties ⁷. For increasing sexual pleasure, cantharidin (“Spanish fly”) is a chemical with vesicant properties derived from blister beetles, which have been used for millennia as a sexual stimulant ⁷. Its mode of action is by inhibition of phosphodiesterase and protein phosphatase activity and stimulation of beta-receptors, inducing vascular congestion and inflammation. Morbidity from its abuse is significant. The ingestion of live beetles (Palembus dermestoides) in Southeast Asia and triatomids in Mexico may have a basis similar to cantharidin ⁷.

Sexual dysfunction is a serious medical and social symptom that occurs in 10-52% of men and 25-63% of women. There has been a worldwide increase in the incidence of erectile dysfunction in men, probably due to aging populations and other risk factors such as the presence of chronic illnesses (e.g. heart disease, hypertension, diabetes mellitus), smoking, stress, alcohol, drug abuse and sedentary lifestyles. Erectile dysfunction is defined as the consistent inability to achieve an erection sufficient for the purpose of satisfactory sexual intercourse, or the inability to ejaculate, or both ⁸. Management therapies include the use of psychotherapy, vacuum devices, surgery, penile implants and drugs ⁸. Some of these are too expensive and not easily affordable.

Table 1. List of plants having aphrodisiac potential

[Source ⁹]

Male libido supplements

Erectile dysfunction, the main reason of male impotence, is considered as one of the most important public health problems, since it affects a great percentage of men. Erectile dysfunction is defined as the consistent inability to obtain or maintain an erection for satisfactory sexual relations. Male impotence or erectile dysfunction is a significant problem that may contribute to infertility ¹⁰. An estimated 20-30 million men suffer from some degree of sexual dysfunction ¹¹. Erectile dysfunction occurs commonly in middle-aged and older men. Impotence occurs in 50% of men with diabetes mellitus. Atherosclerosis is the cause of approximately 40% of erectile dysfunction in men older than 50 years ¹². Among the most commonly recognized conditions associated are high blood pressure, lipid problems (cholesterol, triglycerides), diabetes, and cigarette smoking ¹². Endocrine disorders like low testosterone and thyroid problems also contributes to erectile dysfunction. Pelvic trauma, pelvic surgery (major prostate, bladder, and bowel operations) and pelvic radiation therapies are also connected with erectile dysfunction. Direct trauma to the perineum can cause vascular problems in the penis and lead to erectile dysfunction that may be treatable by penile artery bypass surgery. Sexual dysfunction is also caused by various factors such as psychological disorders like anxiety, depression, stress, fear of sex, neurological disorders, stroke, cerebral trauma and Parkinson’s disease, penile diseases like phinosis, peyroniesetc. Other organic causes include chronic renal failure, hepatic failure, multiple sclerosis, Alzheimer’s disease, sleep apnea and chronic obstructive pulmonary disease. Chronic alcohol abuse and cigarette smoking also adversely affect sexual potency. Decrease in hormone level with age, systemic diseases like cancer also influences sexual ability. erectile dysfunction is also associated with some therapeutic agents like antihypertensives, antipsychotics, antidepressants, and drugs for diabetes mellitus ¹³.

Men’s herbal libido supplements

Chlorophytum borivilianum

Tuberous roots of Chlorophytum borivilianum (commonly known as safed musli) (family Liliaceae) possess immunomodulatory and adaptogenic properties and are used to cure impotency, sterility, and enhance male potency. Mayank et al. ¹⁴ studied the effect of lyophilized aqueous extracts obtained from the roots of Chlorophytum borivilianum, on sexual behavior in male albino rats and compared with untreated control group animals. They observed a significant variation in the sexual behavior of animals as reflected by reduction of mount latency, ejaculation latency, post-ejaculatory latency, intromission latency, and an increase of mounting frequency. Improvement in sexual behavior of extract treated animals achieved by enhanced penile erection and reduced hesitation time. The observed effects appear to be attributable to the testosterone like effects of the extracts. Nitric oxide based intervention may also be involved as observable from the improved penile erection. The present results, therefore, support the folklore claim for the usefulness of these herbs and provide a scientific basis for their purported traditional usage ¹⁴.

Kenjale et al. ¹⁵ designed a study to evaluate the aphrodisiac and spermatogenic potential of the aqueous extract of dried roots of Chlorophytum borivilianum in rats, and it observed a marked aphrodisiac action, increased libido, sexual vigor and sexual arousal. Similarly, at the higher dose, all the parameters of sexual behavior were enhanced, but showed a saturation effect after day 14. On day 60 the sperm count increased significantly in both the Chlorophytum borivilianum groups, 125 mg/kg and 250 mg/kg, in a dose dependent manner. They concluded that the roots of Chlorophytum borivilianum can be useful for the treatment of certain forms of sexual inadequacies, such as premature ejaculation and oligospermia ¹⁵.

Mondia whitei

Mondia whitei is from the Periplocaceae family has been used by many traditional medicine practitioners for the management of ED. It is used to increase libido and also for the management of low sperm count. Lampiao et al. ¹⁶ investigated motility parameters on aqueous administration to human spermatozoa in vitro. Results showed significantly enhanced total motility as well as progressive motility in a time-dependent manner. These support the use of M. whitei especially in men affected with asthenozoospermia. According to Suresh-Kumar et al. ¹⁷ the aqueous and hexane extract of Mondia whitei showed sexual enhancement in sexually inexperienced male rats. This is due to the reduction of the hesitation time of the sexually inexperienced males towards receptive females as indicated by the significant decrease in the mount latency. This suggest that the aqueous and hexane extract of Mondia whitei may act by inducing changes in levels of neurotransmitters, modulating the action of these neurotransmitters on their target cells or by increasing androgen levels. It confirms the demonstration of adrenergic effect of aqueous and hexane extracts of Mondia whitei on chronic administration in vivo in rats ¹⁸.

Tribulus terrestris

Tribulus terrestris is a flowering plant belongs to the family Zygophyllaceae, native to warm temperate and tropical regions. Administration of Tribulus terrestris to humans and animals improves libido and spermatogenesis. Neychev et al. ¹⁹ investigated the influence of Tribulus terrestris extract on androgen metabolism in young males. The findings of study predict that Tribulus terrestris steroid saponins possess neither direct nor indirect androgen-increasing properties.

It is also found to increase the levels of testosterone, leutinizing hormone, dehydroepiandrosterone, dihydrotestosterone, and dehydroepiandrosterone sulfate ²⁰. The corpus cavernosal tissues obtained from New Zealand White rabbits following treatment with Tribulus terrestris were tested in vitro with various pharmacological agents and electrical field stimulation and was found to have a proerectile effect. A study by Gauthaman et al. ²¹ showed the androgen releasing property of the Tribulus terrestris extract and its relation to sexual behavior and intracavernous pressure using castrated rats.

Crocus sativus

Crocus sativus L., commonly known as saffron, is a perennial stem less herb belongs to the family Iridaceae and is widely cultivated in Iran and other countries, including India and Greece. In traditional medicine, saffron is recommended as an aphrodisiac agent. Madan et al. ²² studied the effects of saffron stigma extract and two active constituents, crocin and safranal, on sexual behaviors in male rats.

Hosseinzadeh et al. ²³ studied the aphrodisiac activities of Crocus sativus stigma aqueous extract and its constituents, safranal and crocin, in male rats. The aqueous extract crocin, safranal, sildenafil as a positive control and saline were administered intraperitoneally to male rats. Mounting frequency, intromission frequency, erection frequency, mount latency, intromission latency, and ejaculation latency were the factors evaluated during the sexual behavior study. It was found that Crocin, at all doses, increased mounting frequency, intromission frequency and erection frequency behaviors and reduced ejaculation latency, intromission latency and mount latency parameters. Safranal did not show aphrodisiac effects. The present study revealed the aphrodisiac activity of Crocus sativus aqueous extract and its constituent crocin.

Safarinejad et al. ²⁴ conducted an open label, randomized, fixed-dose, crossover study comparing efficacy and safety of sildenafil citrate and saffron for treating erectile dysfunction in men naïve to treatment. The findings do not support a beneficial effect of saffron administration in men with erectile dysfunction ²⁴.

Myristica fragrans

The dried kernel of broadly ovoid seeds of Myristica fragrans Houtt. (Nutmeg) of the family Myristicaceae has been mentioned in Unani medicine to be of value in the management of male sexual disorders. In a study by Tajuddin et al. ²⁵, it was found that administration of 50% ethanolic extract of a single dose of Nutmeg and Clove, and Penegra resulted in the increase in the mating performance of the mice. It was found that out of 6 control animals only 2 males mated (inseminated) 2 females and the remaining 4 males mated 1 female each during the overnight experimental period. Whereas, Nutmeg treated male animals mated 3 females each except 2 which mated 5 females each. In the Clove treated male animals 3 mated 2 females each, 2 mated 4 females each and remaining 1 mated 3 females each. In the Penegra treated animals 4 mated 5 females each and 2 mated 3 females each ²⁵.

Phoenix dactylifera

Phoenix dactylifera (date palm) of the family Palmae is a native to North Africa has been extensively cultivated in Arabia and Persian Gulf. The date palm pollen is used in the traditional medicine for male infertility. In an experimental study by Bahmanpour et al. ²⁶ investigated the effect of P. dactylifera, pollen, on sperm parameters and reproductive system of adult male rats. They observed that the consumption of date palm pollen suspensions improved the sperm count, motility, morphology, and DNA quality with a concomitant increase in the weights of testis and epididymis. The date palm contains estradiol and flavonoid components that have positive effects on the sperm quality. The comparative evaluation between control and experimental groups revealed that consumption of date palm pollen suspensions improved the sperm count, motility, morphology, and DNA quality with a concomitant increase in the weights of testis and epididymis. It did not significantly affect the weight of the prostate and the seminal vesicle or the histology of the reproductive tissues. From the study, it was concluded that date palm pollen seems to cure male infertility by improving the quality of sperm parameters ²⁶.

Lepidium meyenii

Lepidium meyenii (Maca) belongs to the family Cruciferae is a Peruvian hypocotyl that grows exclusively between 4000 m and 4500 m in the central Andes. Maca is traditionally employed in the Andean region for its supposed aphrodisiac and/or fertility enhancing properties. Bo Lin et al. ²⁷ determined the effect of oral administration of a purified lipidic extract from L. meyenii on the number of complete intromissions and mating in normal mice, and on the latent period of erection in rats with erectile dysfunction. Oral administration enhanced the sexual function of the mice and rats, as evidenced by an increase in the number of complete intromissions and the number of sperm-positive females in normal mice, and a decrease in the latent period of erection in male rats with erectile dysfunction. The study revealed for the first time an aphrodisiac activity of Lepidium meyenii (Maca) ²⁷.

Gonzales et al. ²⁸ conducted a 12-week double-blind, placebo-controlled, randomized, parallel trial in which active treatment with different doses of Maca Gelatinizada was compared with a placebo. The study aimed to test the hypothesis that Maca has no effect on serum reproductive hormone levels in apparently healthy men when administered in doses used for aphrodisiac and/or fertility-enhancing properties. Data revealed that when compared with placebo Maca had no effect on any of the hormones studied nor did the hormones show any changes over time. Multiple regression analysis showed that serum testosterone levels were not affected by treatment with Maca at any of the times studied (P, not significant). In conclusion, treatment with Maca does not affect serum reproductive hormone levels ²⁸.

Gonzales et al. ²⁸ conducted a 12-week double blind placebo-controlled, randomized, parallel trial in which active treatment with different doses of Maca Gelatinizada was compared with placebo to demonstrate if effect of Maca on subjective report of sexual desire was because of effect on mood or serum testosterone levels. An improvement in sexual desire was observed with Maca since 8 weeks of treatment. Serum testosterone and estradiol levels were not different in men treated with Maca and in those treated with placebo. Logistic regression analysis showed that Maca has an independent effect on sexual desire at 8 and 12 weeks of treatment.

Cicero et al. ²⁹ evaluated the effect of Maca after oral administration on rat sexual behavior. The following sexual performance parameters were acutely decreased, 1st mount, 1st intromission, ejaculation, intercopulatory interval and copulatory efficacy. Moreover, chronic Maca treatment induced an apparently not dose-related increase in rat locomotion, during the second 10-min period of observation in the activity cage. Thus, they concluded that both acute and chronic Maca oral administration significantly improve sexual performance parameters in male rats.

Kaempferia parviflora

Kaempferia parviflora belongs to the family Zingiberaceae is a native plant of Southeast Asia, is traditionally used to enhance male sexual function. However, only few scientific data in support of this anecdote have been reported. The results showed that all extracts had virtually no effect on the reproductive organ weights even after 5 weeks. However, administration of the alcohol extract significantly decreased mount and ejaculatory latencies when compared with the control. By contrast, hexane and water extracts had no influence on any sexual behavior parameters. It has no effect on fertility or sperm motility. On the other hand, alcohol extract produced a significant increase in blood flow to the testis without affecting the heart rate and mean arterial blood pressure. In a separate study, an acute effect of alcohol extract of K. parviflora on blood flow to the testis was also investigated. The results indicated that alcohol extract had an aphrodisiac activity probably via a marked increase in blood flow to the testis ³⁰.

Eurycoma longifolia

Eurycoma longifolia (commonly called tongkat ali or pasak bumi) is a flowering plant in the family Simaroubaceae, native to Indonesia, Malaysia, and to a lesser extent, Thailand, Vietnam, and Laos. It has gained notoriety as a symbol of man’s ego and strength by the Malaysian men because it increases male virility and sexual prowess during sexual activities. The butanol, methanol, water, and chloroform extracts of the roots of Eurycoma longifolia Jack were studied by Ang et al. ³¹ using various tests of potency of treated male rats. The results showed that Eurycoma longifolia produced a dose-dependent, recurrent and significant increase in the episodes of penile reflexes as evidenced by increases in quick flips, long flips and erections of the treated male rats during the 30 min observation period. These results provide further evidence that Eurycoma longifolia increases the aphrodisiac potency activity in treated animals.

In another study by Ang et al. ³², the aphrodisiac effect of Eurycoma longifolia Jack (0.5 g/kg) was evaluated in noncopulator male rats using an electrical cage. Fractions of Eurycoma longifolia Jack decreased the hesitation time of noncopulator male rats, throughout the investigation period. Furthermore, it possessed a transient increase in the percentage of the male rats responding to the right choice, more than 50% of the male rats scored “right choice” after 3 weeks post-treatment and the effect became more prominent after 8 weeks post-treatment using the electrical copulation cage. Hence, this study lends further support to the use of the plant by indigenous populations as a traditional medicine for its aphrodisiac property ³².

Ang et al. ³³ again evaluated the effects of butanol, methanol, water, and chloroform fractions of Eurycoma longifolia Jack on the laevator ani muscle in both uncastrated and testosterone stimulated castrated intact male rats after dosing them for 12 consecutive weeks. Results showed that all the fractions increased the leavator ani muscle, when compared with the control (untreated) in the uncastrated intact male rats and testosterone-stimulated castrated intact male rats. Hence, the proandrogenic effect as shown by this study further supported the traditional use of this plant as an aphrodisiac ³³.

Satureja khuzestanica

Satureja khuzestanica Jamzad belongs to the family Lamiaceae is an endemic plant that is widely distributed in the Southern part of Iran. Sulmaz et al. ³⁴ studied the effect of Satureja khuzestanica essential oil (SKEO) in male rat fertility. Satureja khuzestanica essential oil (SKEO) was administered orally at doses of 75, 150, and 225 mg/kg/day for 45 days through drinking water. Treated and control rats were mated with female on day 45 of treatment. Satureja khuzestanica essential oil (SKEO) significantly improved all the parameters evaluated such as potency, fecundity, fertility index, and litter size ³⁴.

According to Rezvanfar et al. ³⁵ coadministration of satureja khuzestanica essential oil (SKEO) significantly improved cyclo phosphamide (CP)-induced changes in plasma testosterone, sperm quality, spermatogenesis and fertility, toxic stress, and DNA damage. It is concluded that cyclo phosphamide-induced toxic effects on androgenesis and spermatogenesis is mediated by free radicals. Satureja khuzestanica essential oil (SKEO) protects reproductive system from toxicity of cyclo phosphamide through its antioxidant potential and androgenic activity. Moreover, concentrations of FSH and testosterone were significantly increased in satureja khuzestanica essential oil (SKEO)-treated groups. Also the weights of testes, seminal vesicles, and ventral prostate weights were increased by SKEO. Histopathological analysis showed that in male rats treated with satureja khuzestanica essential oil (SKEO) the number of spermatogonium, spermatid cords, Leydig cells, and spermatozoids was increased. Furthermore, in these groups, the Sertoli cells were hypertrophic ³⁵.

Panax ginseng

For many years, Panax ginseng belonging to family Aralaceae has enjoyed a reputation as one of the finest aphrodisiacs in the world. The word Panax, in fact, means “all-healing” in Greek and is thus a reference to the roots supposed revitalizing properties for the whole human-body. As the neurotransmitter inducing penile erection, nitric oxide release was shown to be enhanced by ginsenosides in rabbit corpus cavernosum in vitro. Ginsenosides enhanced both acetylcholine-induced and transmural nerve stimulation-activated relaxation associated with increased tissue cGMP. The latter effect was eliminated by tetrodotoxin and was associated with decreased tissue cGMP. Ginsenoside-enhanced corpora cavernosa relaxation was attenuated by nitro-l-arginine and oxyhemoglobin, and enhanced by superoxide dismutase. It is postulated that cardiovascular protection by ginsenosides may be partly mediated by the release of nitric oxide, a potent antioxidant, and that the ginsenosides-enhanced release of nitric oxide from endothelial cells, especially from perivascular nitric oxidergic nerves in the corpora cavernosa, may partly account for the aphrodisiac effect of P. ginseng used in traditional Chinese medicine ³⁶.

Pausinystalia yohimbe

Pausinystalia yohimbe of the family Rubiaceae is an evergreen tree native to West Africa, also present in Asia. Yohimbe has been widely used for more than 75 years as an accepted treatment for male erectile dysfuntion. The US FDA approved yohimbe as the first plant-derived drug for treating impotency in late 1980s and was dubbed the “herbal viagra” in the February 1999 edition of Environmental Nutrition In Europe. Yohimbine hydrochloride, a standardized form of yohimbine, is available in the United States as a prescription drug for erectile dysfunction. This is a different product than dietary supplements made from the bark of the tree. The amount of yohimbine in dietary supplements may vary; some yohimbe products contain very little yohimbine. Yohimbe sold as a dietary supplement may not work like the prescription medication that contains yohimbine.

• Yohimbe has been associated with heart attacks and seizures.
• Yohimbe caused stomach problems, tachycardia (a rapid heartbeat), anxiety, and high blood pressure, according to a study comparing calls about yohimbe and other substances made to the California Poison Control System between 2000 and 2006. People calling about yohimbe were generally more likely to need medical care than other callers.
• Most yohimbe products don’t say how much yohimbine they contain. The amount may vary a lot among products, according to a recent analysis of 49 brands of supplements labeled as containing yohimbe or yohimbine for sale in the United States. Some of the yohimbine was either synthetic or from highly processed plant extract.

Yohimbe is believed to be effective in dealing with erectile dysfuntion, mainly due to its ability to stimulate blood flow by dilating blood vessels. The increase in the flow of blood to the penis helps in bringing about erections. Another manner in which Yohimbe relates to impotence is that it increases the body’s production of norepinephrone; which is essential in the formation of erections. Studies have shown that this herb can restore potency even to diabetic and heart patients that were suffering from impotency due mainly to their diseases. Yohimbe is also believed to act as a stimulant for the pelvic nerve ganglia and also to boost adrenaline supply to nerve endings. That leads to an increase in sexual sensation and stamina. In men without erectile dysfuntion, Yohimbe in some cases appears to increase sexual vigor and prolong erections.

Adeniyi et al. ³⁷ conducted a study to know the effect of yohimbine in the treatment of men with orgasmic dysfunction. A 20-mg dose of yohimbine was first given to 29 men with orgasmic dysfunction of different etiology in the clinic. Patients were then allowed to increase the dose at home (titration) under more favorable circumstances. Of the 29 patients who completed the treatment, 16 managed to reach orgasm and were able to ejaculate either during masturbation or sexual intercourse. A further three achieved orgasm, but only with the additional stimulation of a vibrator. A history of preceding nocturnal emissions was present in 69% of the men in whom orgasm was induced but only 50% who failed treatment. Of the patients, two have subsequently fathered children (one set of twins) and another three men were also cured. Side effects were not sufficient to cause the men to cease treatment. It was concluded that yohimbine is a useful treatment option in orgasmic dysfunction ³⁷.

Fadogia agrestis

Fadogia agrestis belongs to the family, Rubiaceae possess significant aphrodisiac potential. Yakubu et al. ³⁸ evaluated the aphrodisiac potential of the aqueous extract of Fadogia agrestis in Male rats. Their sexual behavior parameters and serum testosterone concentration were evaluated. The results showed a significant increase in mounting frequency, intromission frequency and significantly prolonged the ejaculatory latency and reduced mount and intromission latency. There was also a significant increase in serum testosterone concentrations in all the groups in a manner suggestive of dose-dependence. The aqueous extract of Fadogia agrestis stem increased the blood testosterone concentrations and this may be the mechanism responsible for its aphrodisiac effects and various masculine behaviors. It may be used to modify impaired sexual functions in animals, especially those arising from hypotestosteronemia.

Yakubu et al. ³⁸ studied the effects of administration of aqueous extract of Fadogia agrestis stem on some testicular function indices of male rats. Compared with the control, extract administration for 28 days at all the doses resulted in a significant increase in the percentage testes–body weight ratio, testicular cholesterol, sialic acid, glycogen, acid phosphatase and g-glutamyl transferase activities while there was a significant decrease in the activities of testicular alkaline phosphatase, acid phosphatase, glutamate dehydrogenase and concentrations of protein ³⁸.

Montanoa tomentosa

Montanoa tomentosa of the family Asteraceae has an extensive ethnomedical history of use as a traditional remedy for sexual impairment. Carro-Juárez et al. ³⁹ studied the copulatory behavior of sexually active male rats after oral administration of the aqueous crude extract of M. tomentosa. They also evaluated the effect extract on males with anesthetization of the genital area and on sexual behavior of sexually inactive male rats (noncopulators). Results showed that acute oral administration of crude extracts of M. tomentosa facilitates expression of sexual behavior in sexually active male rats, significantly increases mounting behavior in genitally anesthetized animals and induces the expression of sexual behavior in noncopulating males. Altogether, these data revealed a facilitatory action of this extract on sexual activity and particularly on sexual arousal. Present findings provided experimental evidence that the crude extract preparation of Montanoa tomentosa, used as a traditional remedy, possesses aphrodisiac properties ³⁹.

Carro-Juárez et al. ⁴⁰ again investigated the pro-sexual effect Montanoa tomentosa and its possible pro-ejaculatory properties in spinal male rats. The data showed that the extract acts directly at the spinal system in charge of the expression of the ejaculatory motor patterns and suggest that the aqueous crude extract exerts its aphrodisiacs properties by increasing sexual potency acting as an oxytocic agent ⁴⁰.

Terminalia catappa

Terminalia catappa is a large tropical tree belongs to the family, Combretaceae a significant aphrodisiac potential. Ratnasooriya et al. ⁴¹ observed that T. catappa seeds at dose of 1500 mg/kg or 3000 mg/kg, per oral for 7 days in rats had a marked improvement of aphrodisiac action, sexual vigor. In contrast, the higher dose (3 000 mg/kg, oral) reversibly inhibited all the parameters of sexual behavior other than mounting ⁴².

Casimiroa edulis

The seed extract of Casimiroa edulis belongs to the family Rutaceae is consumed in many parts of the world, including Central America and Asia as an aphrodisiac. Ali et al. ⁴³ studied the aphrodisiac actions of the aqueous extract of the seeds of on the sexual behavior of normal male rats. In this investigation, healthy male albino rats were fed with Casimiroa edulis extract (test reference) and sildenafil citrate (standard reference). Both the groups exhibited a significant increase in mounting frequency, intromission frequency, and first sand second ejaculatory latencies. Although a similar pattern of mating behavior was observed among the test and the standard groups, however, in all the cases as expected, sildenafil produced greater activity than the Casimiroa edulis extract. These results suggest the possibility of a similar mode of action of Casimiroa edulis and sildenafil citrate on mating behavior in these animals. This research, thus provide preliminary evidence that the aqueous seed extract of Casimiroa edulis possesses alphrodisiac activity and may be used as an alternative drug therapy to restore sexual functions probably via a neurogenic mode of action ⁴³.

Turnera diffusa

In folk medicine, Turnera diffusa or Damiana of the family Turneraceae is considered as an aphrodisiac. Estrada et al. conducted a study to determine whether Turnera diffusa recovers sexual behavior in sexually exhausted male rats and to identify the main components in an aqueous extract. Turnera diffusa (80 mg/kg) significantly increased the percentage of males achieving one ejaculatory series and resuming a second one ⁴⁴. In addition, T. diffusa significantly reduced the post-ejaculatory interval. The HPLC – ESI-MS analysis showed the presence of caffeine, arbutine, and flavonoids as the main compounds in the active extract. The results supported the use of T. diffusa as an aphrodisiac in traditional medicine and suggest possible therapeutic properties of T. diffusa on sexual dysfunction. The flavonoids present in active extract may participate in its pro-sexual effect, which is analogous to those produced by yohimbine, suggesting a shared mechanism of action ⁴⁴.

Butea superba

Butea superba Roxb (Leguminosae) is commonly found in Thai deciduous forests and has the domestic name of “Red Kwao Krua.” The plant tubers have long been consumed as a traditional medicine for the promotion of male sexual vigor. B. superba alcoholic extract (0.01, 0.1 or 1.0 mg/kg body weight/day) for 6 months treatment significantly increased the sperm concentration and delayed the decreased motility with time. None of signs of sperm anomalies and testicular damages were observed ⁴⁵. Subchronic treatment of B. superba tuberous powder suspension at high doses (200 mg/kg) in male rats exhibited adverse effects to blood chemistry, haematology, and blood testosterone level. Powdered crude drug at the doses of 2, 25, 250, and 1250 mg/kg body weight was administered for 8 weeks; there was an increased testis weight and sperm counts in rat. Hematology as well as the liver and kidney function of all treated groups showed no difference from the control ⁴⁶. A dose-dependent decrease of only blood testosterone, but not LH, was significantly different from the control in the rats treated with high doses of plant powder. This present study suggests that testosterone disruption is significant, at least after 90 days of consumption of high doses of B. superba powder ⁴⁷. The ethanol extract of Butea superba is effective in enhancing penile erection. The ethanol extract increased intracavernous pressure (ICP) in vivo. It also significantly enhanced the effects of cGMP and isobutylmethylxanthine. This suggests that B. superba may act through cAMP/cGMP pathways ⁴⁸. The plant powder showed potential activity in a human clinical trial for treatment of erectile dysfunction in male rats ⁴⁹.

Curculigo orchioides

Curculigo orchioides Gaertn (Amaryllidaceae), also known as Kali Musli or Syah (black) Musli, is considered as aphrodisiac and Rasayan or rejuvenator ⁵⁰. The ethanolic extract of rhizome improved sexual behaviour in male rats. The sexual performance as assessed by determining parameters such as penile erection, mating performance, and sexual and orientation behavior was significantly improved. Moreover a pronounced anabolic and spermatogenic effect was evidenced by weight gains of reproductive organs. The treatment also markedly affected sexual behavior of animals as reflected in reduction of mount latency, an increase in mount frequency and enhanced attractability towards female. Penile erection index was also incremented in treated group ⁵¹. The lyophilized aqueous extracts of Curculigo orchioides significantly improved the pendiculatory activity in male rats after 14 days of treatment. Similarly, the extract could also preserve the in vitro sperm count when compared to control group after 30 min. of incubation ⁵². The aqueous extract of the plant showed prominent activity at a dose level of 200 mg/kg. In general, a pronounced anabolic effect in treated animals was evidenced by weight gains in the body and reproductive organs. There was a significant variation in the sexual behavior of animals as reflected by reduction of mount latency, ejaculation latency, postejaculatory latency, intromission latency, and an increase of mount frequency. Penile erection was also considerably enhanced. Reduced hesitation time (an indicator of attraction towards female in treated rats) also indicated an improvement in sexual behavior of extract treated animals ⁵³. In case of physically induced sexual dysfunction, that is, heat induced damaged to the testicular function, the plant was useful in ameliorating the reduced spermatogenesis and the treated animals could effectively overcome the heat shock protein; this exemplified the role of C. orchioides in overcoming physically induced sexual dysfunction due to testicular damage ⁵⁴.

Cynomorium coccineum

Cynomorium coccineum Linn. (Cynomoraceae) is known as Som-El-Ferakh in Saudi Arabia, which is a black leafless parasitic plant devoid of chlorophyll. The natives in Qatar use it (mainly with honey) as a tonic and aphrodisiac ⁵⁵. Aqueous extract of Cynomorium coccineum induced significant increase in the sperm count, improved the percentage of live sperm and their motility, and decreased the number of abnormal sperm. Testicular histology showed increased spermatogenesis and seminiferous tubules full of sperm in the treated group compared to the untreated controls ⁵⁶. Aqueous extract of the plant elicited notable spermatogenesis in immature rats. Serum testosterone and FSH levels were lower in animals treated with extracts than controls, whereas interstial cell stimulating hormone levels was higher in treated animals ⁵⁷.

Chlorophytum borivilianum

Safed Musli (Chlorophytum borivilianum) belongs to the family Liliaceae with folkloric claims as aphrodisiac and sexual stimulant ⁵⁸. Ethanolic extract of roots as well as sapogenins isolated from the roots were studied for effect on sexual behavior and spermatogenesis in albino rats. Treatment had pronounced anabolic and spermatogenic effect in treated animals, evidenced by weight gains of body and reproductive organs. Administration of extracts markedly affected sexual behavior of animals reflected in reduction of mount ejaculation, postejaculatory, and intromission latency. An increase in mount frequency and attractability towards female was observed ⁵⁸. The aqueous extract of dried roots of Chlorophytum borivilianum enhances the sexual arousal, vigor, and libido in Wistar rats. The extract increases sperm count significantly ⁵⁹.

In case of streptozotocin and alloxan induced hyperglycemia, the aqueous extract from the plant resulted in amelioration of sexual dysfunction, resulted in improved sexual performance compared to diabetic control rats. The study thus provided evidence that herbal drugs may act on sexual dysfunction in normal as well as diabetic animals ⁶⁰.

Epimedium koreanum

The traditional Chinese medicinal herb, Epimedium L. (Berberidaceae), is a popular botanical supplement used as a health tonic. Most important Epimedium species used for medicinal purposes are E. koreanum Nakai, E. pubescens Maxim., E. brevicornum Maxim, E. sagittatum (Sieb. Et Zucc) Maxim, and E. wushanense T.S. Ying ⁶¹. Hydroalcholic extract of the plants are reputed to produce aphrodisiac effects and are commonly used in Chinese herbal medicine to enhance erectile function ⁶². It is thought that icariin is likely to be the primary active component of Epimedium extracts. Icariin is a flavonol, a type of flavonoid. It is the prenylacetylation of kaempferide 3,7-O-diglycoside, icariin on erectile dysfunction and established its dose-dependent selective inhibitory effect on phosphodiesterase-5 (PDE5). Oral treatment with icariin (>98.6% purity) for 4 weeks potentially improves erectile function. This effect is correlated with an increase in the percentage of smooth muscle and the expression of certain NO synthase isoforms in the corpus cavernosum of castrated rats. These results suggest that icariin may have a therapeutic effect on erectile dysfunction ⁶³. Icariin was inhibitory to all three PDE5 isoforms and with similar IC50 values, which were approximately three times greater than those for zaprinast. Icariin was able to enhance the levels of cyclic guanosine monophosphate in sodium nitroprusside-treated cavernous smooth muscle cells ⁶⁴ and to enhance the production of bioactive nitric oxide ⁶⁵ as well as mimicking the effects of testosterone ⁶⁵.

Mucuna pruriens

Mucuna pruriens Linn. Family Leguminosae is a popular Indian medicinal plant, which has long been used in traditional Ayurvedic Indian medicine. The total alkaloids from the seeds of M. pruriens were found to increase spermatogenesis and weight of the testes, seminal vesicles, and prostate in the albino rat ⁶⁶. M. pruriens stimulated sexual function in normal male rats which was observed by increase in mounting frequency, intromission frequency, and ejaculation latency ⁶⁷. M. pruriens seed powder improved significantly various sexual parameters copulatory behavior including mount frequency, mount latency, intromission frequency, and intromission latency of the male albino rats ⁶⁸. The ethanolic extracts of M. pruriens seed produced a significant and sustained increase in the sexual activity of normal male rats at a particular dose (200 mg/kg). There is significantly increased mounting frequency, intromission frequency, and ejaculation latency and decreased mounting latency, intromission latency, postejaculatory interval, and interintromission interval ⁶⁹. M. pruriens efficiently recovered the spermatogenic loss induced due to ethinyl estradiol administration to rats. The recovery is mediated by reduction in ROS level, restoration of MMP, regulation of apoptosis, and eventual increase in the number of germ cells and regulation of apoptosis. The major constituent L-DOPA of M. pruriens largely accounts for prospermatogenic properties ⁷⁰. Administered of seed extract of M. pruriens to diabetic rats showed significant improvement in sexual behavior, libido and potency, sperm parameters, DSP, and hormonal levels as compared to diabetic rat without extract treatment ⁷¹.

Withania somnifera

Ashwagandha (Withania somnifera (L.) Dunal, Family: Solanaceae) is also known as Indian ginseng commonly used in Ayurvedic medicine. It is best regarded as adaptogen, tonic with aphrodisiac properties. Some workers have reported the decrease mating behavior and antifertility effects of W. somnifera root on in mice ⁷². The root extract induced a marked impairment in libido, sexual performance, sexual vigour, and penile erectile dysfunction ⁷³. It also showed antifertility activity in male rat ⁷⁴. But some scientist shows that W. somnifera has the capability of combating stress-induced infertility. It also protects swimming-induced reproductive endocrine dysfunctions in male rat ⁷⁵. Aqueous extract improved spermatogenesis, which may be due to increased interstitial cell stimulating hormone and testosterone-like effects as well as the induction of nitric oxide synthase ⁷⁶.

Ashwagandha root extract administered to the oligospermic patients resulted in a significantly greater improvement in spermatogenic activity and serum hormone levels as compared to the placebo treated ⁷⁷. Treatment of infertile men with Withania somnifera inhibited lipid peroxidation and protein carbonyl content and improved sperm count and motility. It also recovered the seminal plasma levels of antioxidant enzymes W. somnifera root powder when administered in a dosage of 5 g/day for 3 months to normozoospermic infertile man resulted in a decrease in stress, improved the level of antioxidants, and improved overall semen and vitamins A, C, and E and corrected fructose. Significantly increased serum T and LH and reduced levels of FSH and PRL in infertile men were observed ⁷⁸.

Female libido supplements

Libido, otherwise known as your sexual ‘drive’ or ‘desire’ varies from woman to woman and there is no right or wrong level. It is normal for desire to fluctuate perhaps due to changes in hormone levels, medication, your health, lifestyle changes and what’s happening in your relationship and in your life. If your libido level worries you there are a number of things you can do to improve desire. Finding a solution to the problem involves determining what seems to affect your libido and trying strategies to deal with this.

Many women will experience low libido at some time in their lives. This may be over a long period of time or short-term such as after the birth of a baby, during a stressful life period or when a relationship is rocky.

Low libido can become an issue in relationships when one partner wants sex more often than the other. This is called ‘desire discrepancy’ and can cause conflict and unhappiness.

You can take steps to improve your sexual health during perimenopause and after menopause:

• Be active. Physical activity can boost your energy levels, lift your mood, and improve your body image. All of these can help increase your interest in sex.
• Don’t smoke. Cigarette smoking can reduce blood flow to the vagina and lower the effects of estrogen. This can make it more difficult to get aroused.
• Avoid drugs and alcohol. They can slow down how your body responds.
• Have sex more often. If you choose to have sex, it can increase blood flow to your vagina and help keep tissues healthy.
• Allow time to become aroused during sex. Moisture from being aroused protects tissues and makes sex more comfortable.
• Practice pelvic floor exercises. These can increase blood flow to the vagina and strengthen the muscles involved in orgasm. Learn more about pelvic floor exercises.
• Avoid products that irritate your vagina. Bubble bath and strong soaps might cause irritation. See your doctor or nurse if you have vaginal itching or irritation as it may be a sign of infection.
• Talk to your doctor or nurse about products to increase your sex drive if you are bothered by a low level of interest in sex. Some women try products like pills or creams with the male hormone testosterone or similar products. The Food and Drug Administration (FDA) has not approved these products for treating low female sex drive. But, the FDA has approved flibanserin, a medicine to treat low sexual desire. If you take flibanserin, you cannot drink alcohol because of its risks for serious low blood pressure problems and loss of consciousness. Flibanserin can increase the number of times you have a satisfying sexual experience by once a month or once every two months. Talk to your doctor about the benefits and other risks of taking any medicine.

What affects women’s libido?

It’s normal for women’s desire to fluctuate and there may be many reasons for this.

Influence		Impact on libido
Changes in hormone levels	An increase in prolactin stimulates milk production after childbirth.	This increase can result in reduced libido when breastfeeding.
	A reduction in the level of the female sex hormone oestrogen occurs with menopause.	The reduction can: cause symptoms that reduce your libido such as: hot flushes vaginal dryness loss of vaginal elasticity discomfort during intercourse influence your perception of touch decrease muscle tone and elasticity of the pelvic floor
	A reduction in the level of the female hormone testosterone occurs as women age.	For some women this causes symptoms such as: loss of libido lessened sexual responsiveness a reduced sense of wellbeing loss of energy
Menopause	Natural, surgical, induced, premature and early  menopause all have symptoms caused by changes in hormone levels.	Hot flushes and night sweats are symptoms of menopause that can impact sleep making you tired and lethargic and uninterested in sex Weight gain and body shape changes can make some women self-conscious about their body so they feel less like sex
Premenstrual syndrome (PMS)	PMS is a cluster of symptoms caused by changes in hormone levels.	Symptoms of PMS can make women feel less feel like sex including: bloating tiredness breast tenderness headaches mood swings
Medication	Medications such as: antidepressants some oral contraceptive pills affect hormone levels	The reduced hormone levels can decrease libido or your desire for sex.
Lifestyle	Rest, relaxation, recreation and suitable exercise.	Can all have positive effects on your libido.
Psychological influences	Stress Depression and anxiety Poor body image Feelings of resentment, shame or guilt about sex Past experiences of sex including abuse and trauma	Can each affect libido by making you feel less confident, more negative and hesitant about having sex.
Your relationship	End of the ‘honeymoon’ period of the relationship Being time poor or feeling too tired/fatigued for sex Poor sexual compatibility or partner sexual problems Experiencing problems other than sexual such as financial issues	Relationships can have the biggest influences on libido. If your relationship is unhappy and/or the sex you are having is disappointing, it is difficult to feel sexually inclined towards your partner and your willingness to engage in sex will be reduced.
Medical conditions	Medical conditions such as: endometriosis pelvic inflammatory disease a prolapse haemorrhoids anaemia kidney failure infections (such as thrush or urinary tract) hypothyroidism (underactive thyroid gland) chronic pain	These conditions can lead to painful sex (dyspareunia) or involuntary spasms of the pelvic floor muscles (‘vaginismus’) that reduce the desire for sex.

So what causes female libido to decline around midlife?

Menopause

Women entering menopause experience physical symptoms from the associated drop in their oestrogen levels; a common symptom is vaginal dryness, which can lead to uncomfortable or painful sex. 21% of women in a study reported pain during or after intercourse, which can also affect libido.

Menopause may cause changes in your sex life, or you may not notice any changes at all. Here are some possible changes:

• Lower hormone levels can make your vaginal tissue drier and thinner. This condition, called vaginal atrophy, can make sex uncomfortable or painful.
• Lower hormones may lower your sex drive. It may take you longer to get aroused.
• Night sweats can disturb your sleep and make you tired.
• Emotional changes can make you feel stressed or irritable.

Being less interested in sex as you get older is not a medical condition that requires treatment. But if changes in your sexual health bother you, talk to your doctor or nurse about ways to help, such as treatments to relieve vaginal dryness.

Antidepressants

Australians are the second-highest users of antidepressants in the developed world. One in five women aged 40 to 65 years take antidepressant medication. It’s a clear sign of just how much stress women are under. Unfortunately, a lot of these medications can affect sexual function and it’s one of the main reasons people choose to come off them, or not start them at all.

However, women who stop taking antidepressants without the supervision of their doctor can create a new set of problems for themselves; coming off such medication suddenly or too quickly can cause a woman’s mood to plunge dramatically. Talking to your doctor to find out your options, as there are some medications that have less impact on libido.

Alcohol

Alcohol may also affect a woman’s libido. A study found that binge drinking is an issue for many midlife women, particularly in women with depression. 11% of women aged 40-65 were having four or more drinks at least once per week –and women who were depressed are more likely to binge drink.

Background

When it comes to a woman’s educational background, low libido does not discriminate. However, socio-economic stability definitely plays a part. Financial worries can affect women’s mental and emotional wellbeing, causing their desire for sex to wane.

Managing and treating low libido in women

Don’t be concerned about when or how often others have sex. There is no ‘normal’ when it comes to the frequency of sex. What’s important is whether you and your partner are happy with your level of sexual activity.

Some women may not be worried about having low libido; they may be very happy to have infrequent sex, or none at all. For others, the impact of low libido on their wellbeing is comparable to that of chronic back pain or urinary incontinence. If low libido is an issue for you, identify the possible causes and seek the appropriate help. Start by talking to your doctor about how to improve your overall wellbeing.

If your libido level worries you or is very different from your partner’s and this causes you distress, there are a number of things you can do to improve the situation. Finding a solution to the problem involves determining what seems to affect your libido and then trying strategies to deal with this. The most important thing to remember is that just because one person in the relationship has a lower level of libido than the other, this doesn’t mean there is something wrong with either person. It is when the difference in libido is causing problems that you may need to seek help to manage the issue. It does not mean that one person is good or bad, but just that you are different.

Chronic or long-term, low libido can create differences in sexual desire in couples. Sometimes, your partner can fear hurting you (physically and emotionally) and this starts a negative cycle in your sexual relationship.

While you should never feel you have to have sex with someone you are not attracted to or don’t like, nor do you have to have sex that doesn’t please you, the following strategies may help you:

Health	Maintain a healthy lifestyle by being physically active, eating a healthy diet, reducing your alcohol intake Find ways to reduce stress and take time out to relax regularly
Opportunity	Create goodwill and some intimacy between you and your partner, by talking, listening and touching and holding each other, so you are more likely to feel sexual towards each other Don’t wait for sex to happen spontaneously – allocate time for sex Create a physical environment for sensuality and intimacy
Communication	Let your partner know what makes you feel loved and encourage them to do these things and do the same for them in return Work with your partner as a team to deal with libido issues – if there is desire discrepancy try to find a compromise agreeable to both of you Communicate what works best for you during sex – your partner may not know what you like
Options	If you have low desire but still enjoy sex, try: ‘decision-driven’ sex rather than waiting to have ‘desire-driven’ sex – you make some decisions by saying to yourself: “Sex is good for our relationship, so even though I can’t be bothered, I will suggest making love tonight” sex for affection or intimacy or because sex is good for your relationship or because you enjoy sex manual or oral stimulation rather than intercourse Realise that sex is not only penetrative intercourse but includes touching, kissing, holding, trusting and/or oral stimulation. Talk about this with your partner. Take it in turns to make love to the other with no expectations.
Exploration	Rather than automatically saying no to sex when the opportunity arises, ask yourself “why not?” – if no good reason presents itself, give sex a try Optimise the quality of sex you are having with your partner – the better the sex, the more likely you are to want it Explore your own sexuality – get to know your sexual anatomy, learn how things work and what gives you pleasure Where do you like to be touched, what sort of pressure, can you bring yourself to orgasm? If you don’t know, how can your partner know? Nothing gives most men more pleasure than seeing their partner enjoy sex When together, focus on your own pleasure – stay present and enjoy

Seek advice

It is better for your relationship and future sexual experiences to discuss your feelings of low libido. You may want to seek advice from your doctor, with your partner if appropriate. Some of the following may help:

• Treatment for any underlying illness or medical condition
• Lifestyle changes and stress management
• Herbal remedies (see an accredited naturopath)
• Hormone therapy (if appropriate)
• Medication changes
• Antidepressants (certain antidepressants may be more suitable, others can reduce libido)
• Stress management
• Couples counselling
• Counselling with a therapist who specialised in sexual concerns.

Your doctor may prescribe an estrogen cream or pessary for vaginal dryness, individual/relationship counselling or sexual therapy and in some cases a testosterone cream maybe helpful.

For vaginal dryness that causes mild discomfort during sex:

• Use an over-the-counter, water-based vaginal lubricant when you have sex.
• Try an over-the-counter vaginal moisturizer to help increase moisture. You may need to use it every few days.

For more severe vaginal dryness, your doctor might prescribe medicines that you put into your vagina to increase moisture and sensation. These may include ⁷⁹:

• Vaginal estrogen creams
• Estrogen tablets or rings for insertion into the vagina
• A non-hormonal medicine called ospemifene ⁸⁰

Discuss your symptoms and personal health issues with your doctor or nurse to decide whether one or more treatment options are right for you.

Overview of available therapies for sexual problems*

Problem	Possible therapies or actions to consider
Low libido/ low sexual desire	First and foremost, examine your relationship and situation: What are the turnoffs? How can they be addressed? Identify medications that may curb desire (such as certain antidepressants or blood pressure drugs) and talk with your provider about lowering the dose or switching to alternatives Sex therapy/counseling Certain testosterone-containing products (not government-approved for treating low desire in women) Bupropion (not government-approved for treating low desire) Yoga
Vaginal dryness/ atrophy	Regular sexual activity or stimulation (promotes vaginal health and blood flow) Vaginal lubricants (for temporary relief of dryness before and during sex) Vaginal moisturizers (for longer-term relief from dryness) Low-dose vaginal estrogen therapy in cream, ring, or vaginal tablet form (reverses underlying atrophy and dryness) Higher-dose hormone therapy throughout the body via pills, patches, and other preparations (reverses underlying atrophy and dryness, but generally reserved for women with bothersome hot flashes)
Arousal difficulties	Topical treatments for vaginal dryness/atrophy (see above) Vibrator or other mechanical devices (eg, clitoral therapy device) Sex therapy/counseling Bupropion (not government-approved for treating arousal difficulties) Viagra-like drugs (PDE-5 inhibitors) to increase blood flow to the clitoris (not government-approved for treating female arousal difficulties) Yoga
Orgasm difficulties	Sex therapy/counseling Yoga
Pain during sex	A variety of therapies are available depending on the source of the pain: Vaginal moisturizers, lubricants.  If pain doesn’t improve, see your provider. Vaginal estrogen Sex therapy/counseling Vaginal dilators Pelvic floor physical therapy Kegel exercises Symptom-specific medications (eg, steroid creams for vaginal inflammation, antibiotic creams or pills for vaginal infections) Yoga

Footnotes: *In addition to the listed therapies and actions, all sexual problems are likely to benefit from good health habits (including exercise, eating right, and adequate sleep) and open communication with your partner.

Testosterone therapy

Whether testosterone can help women with loss of libido continues to be debated. Testosterone treatment in women aims to replace the reduced testosterone production by the ovaries that occurs as you age and after menopause.

Some studies have shown women who experience a loss of sexual interest at menopause may benefit from testosterone therapy when it is used in high doses ⁸¹. Due to potential complications of testosterone therapy, using high doses may not be the right thing to do however.

While some women seeking help from health professionals because they are concerned about their decreased sexual function do have low testosterone levels, researchers have concluded that the relationship between testosterone and libido is likely to be complex and you need to take into account age, mood, general wellbeing, sexual function and the risks of testosterone therapy also ⁸².

What are the risks of testosterone therapy?

This therapy is an area of ongoing research to better identify a safe and effective dose of testosterone for women.

Testosterone treatment in women has been associated with an increased risk of developing:

• oily skin
• acne
• excess facial and body hair growth
• scalp hair loss
• irritability
• aggression

Serious potential side effects include lowering of the voice and enlargement of the clitoris, both of which are irreversible.

One study of testosterone only treatment in postmenopausal women reported an increased risk of breast cancer compared to women who had received a placebo, or dummy treatment.

If you are considering testosterone therapy, talk to your doctor to gain a clear understanding of what is currently known about this therapy. It is essential for women undergoing testosterone treatment to be supervised by doctors who are experts in this area. And if you are of childbearing age and considering testosterone use, use reliable contraception, as serious adverse effects on a developing foetus may result if you become whilst using testosterone treatment.

Herbal remedies for low female libido

Data on the use of natural aphrodisiacs in women is limited. Many cultures use herbs that traditionally have had a reputation for increasing libido. It’s not clear whether these herbs actually stimulate a sexual urge or act as a placebo. The mind is a powerful sexual organ! For more information on libido and natural therapies visit our webpages

There are many factors that can influence a woman’s libido and the general advice is to address the lifestyle, nutrition and relationship factors that may be playing a role in low libido and not just rely upon medications.

The importance of a healthy diet not only for general health and wellbeing but for increased sexual health as well. Eat more strawberries, honey, fresh figs, pomegranate, chocolate and, of course, oysters.

Natural therapies and dietary changes can be effective in treating some causes of low libido. If vaginal dryness is the issue, for example, research suggests eating two dessert spoons of linseeds daily can ‘plump up’ the cells of the vagina and improve vaginal lubrication.

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