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Herb Power:
Are there any useful supplements when it comes to treating sexual dysfunctions?

Martin S. Mach

Immense industries have sprung up around correcting sexual dysfunctions such as impotence and infertility. Remember Viagra or fertility clinics? Admittedly, the range of new brews and potions under the term of “herbal supplements” is bewildering when it comes to curing impotence or infertility, but there is little evidence (and often it is contradictory) that they have any benefit to public health. Traditional herbal and mineral supplements such as ginseng, yohimbe, ginkgo biloba, zinc, and newer trendy herbal products have been extensively used throughout the world for many symptoms, not just sexual dysfunctions. However, questions persist regarding the scientific evidence and efficacy of these products, as they remain unproven.

While Americans use supplements on a regular basis and supplements are main components in their health regimens, it might come as a surprise that in the age of Viagra and in vitro fertilization that Americans still use herbal treatments for sexual dysfunctions such as impotence or infertility. Reasons for using these products range from improving the chances of pregnancy to enhancing sexual arousal. However, many of the problems related to sexual dysfunctions may be more serious such as psychological or physiological difficulties--beyond the remedy of mere herbs. Other times a change in diet or the introduction of an exercise regimen is sufficient to bring about the desired outcome. Unfortunately, even with well-documented and practiced procedures such as in vitro fertilization the success rates are low. Frankly, the claim that herbs and other supplements are unnecessary and a waste of money may be true. Supplements listed in detail in this article are those that are most often recommended for sexual dysfunctions, are commonly listed in the ingredients of herbal supplements, and/or there have been attempts to scientifically prove the claims of these substances. Nonetheless, many substances have been suggested or tried as treatments for sexual dysfunctions but they have not been scientifically proven effective at this time. The bottom line is that there are no well-established natural treatments for these sexual dysfunctions.

Impotence, or erectile dysfunction (ED), is the inability of a male to attain or sustain an erection sufficient for intercourse. It can be a persistent condition; however, almost half of all men experience impotence occasionally. Common non-herbal treatment options include the drug Viagra, mechanical devices that use a vacuum to produce an erection, drugs for self-injection, and implantation of penile prostheses. Impotence can have either physical or psychological (or both) causes. Although some doctors used to believe differently, most researchers and doctors now believe that a majority of men suffering from impotence have physical causes. Psychological counseling can be helpful, however, if the impotence is related to emotional factors. There are several physical contributors to impotence, including atherosclerosis, diabetes, pituitary tumors, hormonal imbalances, hypothyroidism, multiple sclerosis, smoking, chronic alcohol use, or what doctors sometimes call “venous leakage” of blood. Certain medications can also be the culprit. Common supplements and herbs that claim to be helpful in the case of impotence are L-arginine, ginkgo biloba, ginseng, yohimbe, and zinc. Many other herbs and supplements are reputed to improve sexual function, including ashwaganda, DHEA (dehyrdoepiandrosterone) suma, damiana, pygeum, choline, pantothenic acid, L-phenylalanine, L-tyrosine, nicotinic acid, and muira puama. However, there is as yet no real evidence that they work.

Male infertility, as defined by doctors is the failure of a couple to achieve pregnancy after a year of unprotected intercourse. In men, infertility is usually associated with a decrease in the number or quality of sperm. Infertility in men can be caused by anatomical defects to hormonal imbalances. There are a multiple possible underlying causes for this including biochemical, psychological, environmental, and the exact cause may be unknown or a mixture of variables. In about half of all cases, however, the source of the problem is never discovered. Some of the causes of infertility are responsive to natural medicine, whereas others are not. Zinc, coenzyme Q10 (CoQ10), and L-arginine are natural treatments widely recommended for male infertility. Many other substances have been suggested as treatments for infertility, including the herbs ashwaganda, pygeum, as well as supplements PABA (para-aminobenzoic acid), L-carnitine, beta-carotene, Vitamin C, Vitamin E, Vitamin B12, SAMe (S-adenosyl-L-methionine) and selenium. However, the evidence that they really work is negligible. The good news is that without any treatment, approximately 25% of supposedly infertile men bring about pregnancy within a year of the time they first visit a doctor, this is symptomatic of low fertility rather than infertility.1

Female infertility is defined by doctors the same way as male infertility, the failure to become pregnant after a year of unprotected intercourse. Common techniques designed to correct female infertility range from hormone therapy to in vitro (test-tube) babies. Although these methods have occasional successes, there is considerable controversy about the high cost and low rate of effectiveness of fertility treatments in general. Infertility in females can be caused by a variety of problems such as sex-hormone abnormalities, low thyroid function, endometriosis, scarring of the tubes connecting the ovaries with the uterus, or a host of other causes. Smoking, drinking alcohol, and even caffeine have been found to cause female infertility. Tubal disease and endometriosis (a condition in which uterine tissue begins to grow where it shouldn’t) account for 50% of female infertility; failure of ovulation is the cause of about 30%; and cervical factors cause another 10%.2 L-arginine has been studied for its effects on women’s infertility and libido. Gross deficiencies of many nutrients including iron, B vitamins, Vitamin E, and beta-carotene reduce female fertility, but not much is known about the specific role most nutrients play. PABA, Vitex, Chasteberry, and ashwaganda are more exotic treatments recommended. As with infertile males, infertile women often eventually become pregnant with no medical intervention at all. There is no good published evidence that any dietary supplement can improve libido or sexual function in women.

Arginine (L-arginine)

An amino acid found in many foods; it is needed to produce sperm. Also, it can raise levels of nitric oxide in the blood and body tissues that can increase blood flow, which is necessary for arousal. The best dietary sources of arginine are meat, nuts, eggs, milk and cheese.

There is some evidence that arginine helps some men. Most research shows that several months of arginine supplementation increase sperm count and quality3,4 and also fertility.5,6 Notwithstanding, some studies have reported that arginine helps few,7 if any, infertile men.8 Only two small studies have looked at whether arginine has any effect on sexual performance in humans. In both studies, the results were less than impressive. In one study the results looked positive, however, the results in a subsequent study couldn’t be duplicated.9 In the second published study, researchers at Tel Aviv University in Israel gave 46 men with erectile dysfunction either 5,000 mg of arginine or a placebo every day for six weeks. Arginine made no difference in erectile function or sexual activity, performance, or satisfaction, according to questionnaires filled out by the men. What’s more, the researchers could detect no increased engorgement of the arginine-takers’ genitals.10 Two unpublished studies have looked at ArginMax, a popular product that contains a combination of arginine, gingko, ginseng, a handful of vitamins, and (in the women’s formula) damiana. In one study, 21 of 24 men with erectile dysfunction who took ArginMax for four weeks reported improvement in their ability to maintain erection during intercourse, compared to five of 24 men who were given a placebo. In the other study, 25 of 34 women who took ArginMax for four weeks reported that their sex lives were more satisfying, compared to 16 of 43 women who were given a placebo.11 Until the studies are peer-reviewed and published, there is no way to validate the results.

Though there are conflicting, insufficient, or only preliminary studies suggesting a health benefit from arginine, nonetheless, many physicians of natural medicine advise 4 grams of arginine per day for several months to see if it will help infertile men. However, in research the amount varies considerably (2-30 grams per day).

Arginine appears to be free of obvious side effects, so far. Although, some doctors are concerned that increases in growth hormone triggered by arginine could overwork the pancreas. Occasional side effects reported with large doses of this dietary supplement include diarrhea. Those with kidney disease or liver disease should talk to their physician about taking this supplement. Those with herpes (either cold sore or genital herpes) should not use arginine supplements, because arginine can stimulate replication of the virus. Some preliminary research has shown high usage (30+ grams per day) of arginine can both promote and interfere with cancer growth.12-14 No known drug interactions exist with arginine.

Coenzyme Q10 (CoQ10 or ubiquinone)

Coenzyme Q10 is a vitamin-like compound that is present throughout the body. Coenzyme Q10 is primarily found in fish and meat. Coenzyme Q10 is a powerful antioxidant that protects the body from free radicals.15 As a coenzyme, this nutrient aids metabolic reactions, such as the complex process of transforming food into ATP, the energy on which the body runs. Synthesis of sperm requires considerable energy. Due to its role in energy production, coenzyme Q10 has been studied in infertile men.16 Preliminary research reports that supplementation of coenzyme Q7 a related molecule, increased sperm counts in a group of infertile men. However, this supplement has little scientific support and/or minimal proven health benefit.

Adult levels of supplementation are usually 30-300mg per day, depending on the health of the individual. There are no known toxicities or significant side effects associated with coenzyme Q10. However, this supplement should not be used if you are pregnant or breast-feeding because the safety of coenzyme Q10 is unknown. Certain medications interact in a positive and/or negative way with coenzyme Q10. There have been reports that coenzyme Q10 may decrease the effectiveness of blood-thinning medications such as warfarin.17 Be aware that there are some interactions between coenzyme Q10 and pharmaceuticals. Per the book "A-Z Guide to Drug-Herb-Vitamin Interactions", coenzyme Q10 should not be taken in conjunction with the following: (generic or Trade names listed) Adriamycin, Amitriptyline, Apo-Gemfibrozil, Atorvastatin, Blocadren, Cosopt, Coumadin, Desipramine, Doxepin, Doxorubicin, Elavil, Fluvastatin, Gemfibrozil, Imipramine, Inderal, Inderide, Lescol, Lipitor, Lopid, Lovastatin, Mevacor, Norpramin, Novo-Gemfibrozil, Pravachol, Pravastatin, Propranolol, Simvastatin, Sinequan, Timolide, Timolol, Timoptic, Tofranil, Tricyclic Antidepressants, Warfarin, Zocor.18

 

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Ginkgo Biloba (GBE or Maidenhair tree)

Ginkgo has been extensively used worldwide; a popular prescribed medical herb in Europe with hundreds of studies performed on this substance. Ginkgo biloba works by increasing arterial blood flow by reducing the stickiness of blood. Ginkgo has been used to treat and help some impotent men.19,20 The combination of ginkgo and papaverine has reportedly been effective for treatment of erectile dysfunction.

Ginkgo may improve circulation, and several studies have shown that it can help with sexual function. But none of them compared the herb to a placebo, so there’s no way to tell whether the improvement would have occurred no matter what the subjects were given. One study involving 30 men who were experiencing erectile dysfunction as a result of medication use (such as selective serotonin reuptake inhibitors and other medications), found that approximately 200 mg per day of ginkgo had a positive effect on sexual function in 76% of the men.21 Unfortunately, this was not a blind study and we do not know how ginkgo would affect healthy men.

The average daily dose is 120 mg of dried extract in 2 or 3 doses orally (in clinical studies up to 240 mg were used as a daily dose or 40-80 mg 3 times a day). Ginkgo biloba is considered to be safe and side effects are rare. Ginkgo does not appear to alter heart rate and blood pressure or to change cholesterol and triglyceride levels. Mild gastrointestinal complaints could occur as side effects. Allergic skin reactions have been observed on rare occasions. Other hypersensitivity reactions are the occurrence of spasms and cramps, and in cases of acute toxicity, atonia and adynamia. Ginkgo has blood-thinning properties and therefore should not be used if you are taking anticoagulant (blood-thinning) medications or nonsteroidal anti-inflammatory medications (NSAID), such as aspirin, naproxen (Aleve) clopidogrel, dipyridamole, heparin, ticlopidine, or warfarin.22 High doses of Ginkgo biloba could decrease the effectiveness of anticonvulsant therapy in patients taking carbamazepine or valproic acid to control seizures. If you are taking these medications, you should not use gingko without consulting your health care provider. Because ginkgo decreases platelet aggregation (stickiness), there is some concern that ginkgo may increase risk of intracranial (brain) hemorrhage.23

Ginkgo biloba may be beneficial during treatment with cyclosporine because of its ability to protect cell membranes from damage. If you are currently taking cyclosporine, you should consult your doctor before adding any new herbs or supplements to your existing medication regimen. The combination of papaverine and ginkgo may be effective for the treatment of erectile dysfunction in patients who do not respond to papaverine alone. Consult with your doctor about whether this is an appropriate treatment option for you. Although there has been one literature report of increased blood pressure associated with the use of ginkgo during treatment with thiazide diuretics, this interaction has not been verified by clinical trials. Nevertheless, you should consult with your healthcare provider before using ginkgo if you are taking thiazide diuretics. Additionally, there has been a report of an adverse interaction between ginkgo and trazodone, an antidepressant medication, which resulted in an elderly patient going into a coma. Therefore, you should not take ginkgo if you are taking trazodone for depression without consulting with your doctor first.24,25

Ginseng (Panax ginseng, Panax quinquefolius, Eleutherococcus senticosus)

There are three different herbs commonly called ginseng: Asian, Chinese or Korean ginseng (Panax ginseng), American ginseng (Panax quinquefolius), and Siberian or Russian “ginseng” (Eleutherococcus senticosus). Siberian “ginseng” is actually not ginseng at all, but it is believed to function identically as ginseng. Dried, unprocessed ginseng root is called “white ginseng,” and steamed, heat-dried root is “red ginseng.” Amongst many claims for ginseng, the improvement of sexual performance is one, but there is as yet little direct evidence that it really works.26-28

Ginseng’s actions in the body are due to a multifaceted interplay of chemicals. The primary is composed of the ginsenosides, which are believed to increase energy, counter the effects of stress, and enhance intellectual and physical performance. Thirteen ginsenosides have been identified in Asian ginseng. Siberian ginseng contains eleutherosides. Other constituents include the panaxans, which help lower blood sugar, and the polysaccharides (complex sugar molecules), which support immune function.

There have been thousands of research papers published on ginseng. Unfortunately, nearly all involved aniceived injections of ginseng extracts directly into the abdomen. There are only a few good double-blind human studies of ginseng taken by mouth. In experiments with animals, ginseng generates the release of nitric oxide. So does the anti-impotency drug Viagra. In the only published human study, 30 Korean men with erectile dysfunction who took 300 mg a day of Korean red ginseng for three months reported significant improvements in their sexual performance.29 Thirty similar placebo-takers reported less improvement. However, one small study isn’t enough. Ginseng, especially American ginseng, is claimed to exhibit some estrogen-like activity and may improve vaginal lubrication in menopausal women.30

The typical recommended daily dosage of Asian ginseng is 1 to 2 grams of raw herb, or 200 mg daily of an extract standardized to contain 4-7% ginsenosides. Siberian ginseng is taken at a dosage of 2 to 3 grams whole herb or 300 to 400 mg of extract daily. Normally, a 2 to 3 week period of using ginseng is recommended, followed by a one to two week rest period. Finally, because Asian ginseng is so expensive, some products actually contain very little, often in an adulterated weaker form. Some products that claim to contain ginseng actually contain none.

Used in the recommended amounts, ginseng is generally safe and non-toxic. In certain instances, however, it may cause over-stimulation and possibly insomnia.31 Consuming caffeine or other stimulants with ginseng increases the risk of over-stimulation and gastrointestinal upset. Persons with uncontrolled high blood pressure should not use ginseng. Long-term use of ginseng may cause menstrual abnormalities and breast tenderness in some women. Ginseng is not recommended for pregnant or lactating women. Adverse affects include diarrhea, restlessness, nausea, vomiting, anxiety, tachycardia, hypertension and extreme nervousness. There is some evidence that ginseng can interfere with drug metabolism, specifically drugs processed by an enzyme called “CYP 3A4.”32 One study reported that ginseng might increase the effects of digoxin, a medication used to treat heart conditions. You should consult with your doctor before using ginseng with digoxin in order to assure that it is appropriate for you to combine the two. There have been reports of a possible interaction between ginseng and the antidepressant medication, phenelzine, resulting in symptoms ranging from manic-like episodes to headache and tremulousness. Therefore, you should not use ginseng with phenelzine. There have been reports that Asian ginseng may possibly decrease the effectiveness of the blood-thinning medication, warfarin. If you are currently on warfarin therapy, you should refrain from taking Asian ginseng. Ginseng may block the effects of analgesic medications such as morphine. You should not use ginseng with morphine except on the advice of your doctor. There has been a report that Siberian ginseng increased levels of digoxin in the blood but did not cause toxic effects. However, you should consult with your health care provider before using Siberian ginseng if you are currently taking digoxin.

Yohimbe (Pausinystalia Yohimbe)

Yohimbe is an over-the counter supplement made from the bark of a West African tree that has been traditionally used to treat fever,coughs, and leprosy.33 Additionally, yohimbe is often used for sexual disorders and as an aphrodisiac. It is marketed in a number of products for body building and "enhanced male performance." Yohimbe is a prescription drug approved by the Food and Drug Administration (FDA) to dilate (widen) the pupils of eyes. The major identified alkaloid in yohimbe is yohimbine, a chemical that causes vasodilation, thereby lowering blood pressure. Since yohimbe can cause blood vessels to dilate and blood flow to increase, some physicians prescribe it for erectile dysfunction.

Yohimbe has been shown in several double blind studies to help treat men with impotence;34,35 negative studies have also been reported.36,37 In a 1997 meta-analysis that pooled the results of seven studies, 15 to 43 mg of yohimbine (a compound extracted from the yohimbe bark) every day for four to ten weeks was more effective than a placebo in helping men who were suffering from one or more sexual dysfunctions. Problem is that the meta-analysis couldn’t determine which conditions were helped and which weren’t. And two later studies found no benefit from yohimbe.

A tincture of yohimbe bark is often used in the amount of 5-10 drops three times per day. There are also standardized yohimbe products available for the treatment of impotence. A typical amount of yohimbe is 15-30 mg.38

Yohimbe is contraindicated in liver and kidney diseases. Side effects that can appear include, among other things, anxiety states, elevated blood pressure, exanthema, excitatory states, queasiness, sleeplessness, tachycardia, tremor, and vomiting. People with a history of heart disease, high blood pressure, or kidney diseases should be wary of yohimbe. Side effects are well recognized and may include central nervous system stimulation that causes anxiety attacks. At high doses, yohimbine is a monoamine oxidase (MAO) inhibitor. MAO inhibitors can cause serious adverse effects when taken concomitantly with tyramine-containing foods (e.g., liver, cheeses, red wine) or with over-the-counter (OTC) products containing phenylpropanolamine, such as nasal decongestants and diet aids. Individuals taking yohimbe should be warned to rigorously avoid these foods and OTC products because of the increased likelihood of adverse effects. Symptoms of over dosage include weakness and nervous stimulation followed by paralysis, fatigue, stomach disorders, and ultimately death. Serious adverse effects, including renal failure, seizures and death, have been reported to FDA with products containing yohimbe and are currently under investigation.

Zinc

Zinc is an essential trace mineral, which, next to iron, is the second most abundant trace mineral in the body. We absorb 20 to 40% of the zinc that is in our food. Zinc from animal foods like red meat, fish, and poultry is the most prevalent. Zinc in vegetables, dairy products, and eggs are less available to our bodies.Zinc is stored primarily in muscle but is also found in red and white blood cells, the retina of the eye, bones, skin, kidney, liver, and pancreas. In men, the prostate gland contains more zinc than any other organ.39 Zinc is essential for normal sexual development during male adolescence and for producing healthy sperm. Zinc is necessary for the maturation of sperm, ovulation and fertilization. A lack of zinc can reduce testosterone levels.40

For men with low testosterone levels, zinc supplementation raises testosterone and also increases fertility.41 For men with low semen zinc levels, zinc supplements may increase both sperm counts and fertility.42 Most studies have infertile men take zinc supplements for at least several months. Unfortunately, only two good studies have tested zinc supplements on sexual function, and both involved a total of 17 men on dialysis for kidney disease. The men in one of the studies reported improved potency when zinc was added to their dialysis fluid.43 The men in the other study reported no improvement.44 Whether zinc helps healthy men is unknown.

The most common dosage level is 25mg daily. The dosage range for zinc is 2-50mg daily. Zinc is relatively non-toxic. Ingestion of high levels of zinc can induce copper deficiency. High doses of zinc (150mg/day) can cause diarrhea, dizziness, drowsiness, vomiting, loss of muscle coordination, and lethargy. One known negative side effect of too much zinc is that it lowers HDL (good) cholesterol and raises LDL (bad) cholesterol. Zinc decreases the absorption of oral quinolones, a class of antibiotics that includes ciprofloxacin, norfloxacin, ofloxacin, and levofloxacin, as well as tetracycline antibiotics.45-48 Similarly, zinc interacts with nonsteroidal anti-inflammatory drugs (NSAIDs), and could reduce the absorption and effectiveness of these medications. If you take NSAIDs and are considering taking zinc supplements, talk with your healthcare provider first. Penicillamine, a medication used to treat Wilson's disease and rheumatoid arthritis, decreases zinc levels. Since zinc supports immune function, it should not be taken with corticosteroids, cyclosporine, or other medications intended to suppress the immune system. Hormone replacement therapy consisting of estrogen and progesterone derivatives may reduce loss of zinc in the urine, particularly in women with osteoporosis. There has been at least one report of an interaction between zinc and hydralazine, a medication used to treat high blood pressure, which resulted in a lupus-erythematosus-like syndrome (characterized by a facial butterfly rash, fever, leg and mouth ulcers, and abdominal distress). It would be wise to refrain from using zinc supplements with hydralazine.49

USEFUL RESOURCES

  • http://www.supplementinfo.org

  • Foster, S. and Tyler, V.E., (4th ed.). Tyler’s Honest Herbal: A Sensible Guide to the Use of Herbs and Related Remedies, New York, the Haworth Herbal Press. 2000.

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