Natural Approaches for Sexual Dysfunction in Women
While sexual dysfunction in men may be a difficult topic of conversation, sexual dysfunction in women is even more neglected. Research into female sexual dysfunction is not nearly as comprehensive as research into erectile dysfunction. Still, sexual dysfunction can be devastating for both women and men.
Keep in mind that the majority of these treatments need additional evidence to document benefits. In addition, research shows that female sexual function has a strong placebo response which may affect clinical trial results (Weinberger 2018).
Some of the potential treatments include:
Gokshura (Tribulus terrestris)
Gokshura is an herb used in traditional Ayurvedic medicine from India. The herb has a long history of use as an aphrodisiac and urinary/kidney tonic.
Of all the potential treatments for female sexual dysfunction, gokshura is one of the best studied with five clinical trials all showing benefits. A trial in premenopausal women with low desire showed improvements in desire, arousal, lubrication, orgasm, satisfaction and decreased pain with intercourse (Vale 2018). Part of the benefit may have come from increased testosterone levels documented with its use.
Another trial studied gokshura in postmenopausal women. Again they saw improvements in all domains of sexual function including desire, arousal, lubrication, orgasm and decreased pain with intercouse (de Souza 2016). In addition, they also documented increased testosterone with gokshura. A second study in postmenopausal women found similar results (Postigo 2016).
In women of reproductive age, gokshura showed statistically significant improvement in sexual function for 88% of the women on the herb. Interestingly, in younger women, DHEA hormone levels went up but testosterone went down (Gama 2014). A second study in women of reproductive age also showed significant improvements in desire, arousal, lubrication, satisfaction and decreased pain (Akhtari 2014).
Gokshura is typically safe with minimal side effects, although gastrointestinal side effects were reported in some studies. However, there are a couple of case reports of kidney toxicity with gokshura (Brown 2017). Gokshura is often sold for sexual performance enhancement, a category of supplements that is commonly adulterated with dangerous and/or illegal additives (FDA 2010). In animals, studies appear to mostly document protective effects on the kidneys with gokshura (Yaday 2019, Jiang 2018). In addition, researchers have refuted at least one of the kidney failure case reports (Schmidt 2011).
Like men, women may also benefit from improved blood flow for sexual response. Arginine is an amino acid and precursor to nitric oxide, a signalling molecule that opens up blood vessels. Studies in women for sexual dysfunction mostly focused on arginine in combination with other ingredients. However, these products were primarily composed of arginine with or without citrulline which functions similarly.
ArginMax is a product containing arginine, combined with small amounts of ginkgo, ginseng and damiana along with a multivitamin formula. In younger women, the product significantly improved sexual desire, satisfaction and frequency of intercourse. Perimenopausal women primarily improved in frequency of intercourse, satisfaction and vaginal dryness. Postmenopausal women improved significantly in just level of sexual desire (Ito 2006). The second study on ArginMax by the same research group also showed similar benefits in women’s sexual function (Ito 2001).
Another combination product called Prelox that combines arginine, citrulline, pycnogenol and rose hips showed benefits for women’s sexual function as well. One study showed more than doubling of the Female Sexual Function Index in women of reproductive age (Bottari 2013). In postmenopausal women, the Female Sexual Function Index increased by a factor of 1.6 (Bottari 2012).
Overall, I would be cautious interpreting these results on arginine containing products. All of the studies above were on commercially branded products and were likely industry sponsored. Unfortunately, from the studies that I could access, conflicts of interest were not disclosed.
Ginseng (Panax ginseng)
Like in men, ginseng has been studied in women to see if it can improve sexual functioning. Unfortunately, in women, results are mixed.
In postmenopausal women, ginseng was shown to significantly improve sexual functioning over placebo (Ghorbani 2019). A separate study on postmenopausal women showed sexual arousal was modestly improved with ginseng (Oh 2010). In a study on premenopausal women, sexual function improved but improvement was not statistically significant over placebo (Chung 2015).
Maca (Lepidium meyenii)
The research on maca is also preliminary but potentially promising. An earlier study on maca showed improved sexual function in postmenopausal women (Brooks 2008). A more recent trial showed improvements in sexual dysfunction caused by antidepressant medication with maca (Dording 2015). Overall, more evidence is needed to fully evaluate the effects of maca for improving sexual function in women.
While we need more research, there is some promise that natural therapies may have benefits for female sexual dysfunction. To date, the strongest evidence that I could find suggests gokshura may help alleviate symptoms.