April is a daughter of the sixties. As a young woman during that tumultuous decade, she made “sex, drugs, and rock ’n’ roll” a motto for her life. Actually, although she experimented with some of the psychedelia popular at the time, she was much more into the music and free love. She proudly attended at least one concert on every Rolling Stones tour beginning in 1968. She even partied with the Grateful Dead’s Jerry Garcia near Haight and Ashbury Streets in San Francisco.
After a few years of drifting in and out of college, April realized that she lacked the financial means to continue supporting her lifestyle. She had to find work. But she could not imagine being stuck in the suffocating confines of an office. Instead, she took a position that would satisfy her wanderlust: She became a flight attendant. She always wanted to explore the world; now she had the opportunity.
Other than the piggish behavior of an occasional drunk passenger, April loved her job. And like the sailors of times past, she had a lover in every port—Hong Kong, Greece, Nairobi, Ecuador, and Marrakech.
Through her many years of travel, April developed two hobbies. Despite never wanting to settle down and raise a family of her own, she was fascinated with fertility symbols. She collected dozens of them: statues from Africa, amulets from Asia, necklaces from South America. Her second hobby, which she put to more personal use, was finding the perfect aphrodisiac.
Over the years, April tried dozens of herbal teas, powders, and creams—all promising to enhance her already strong libido and sexual response. Some of them were stimulating, others did next to nothing, and still others caused nausea, vomiting, and diarrhea. To this day, she hasn’t given up her search for the ideal “love potion.”
Every culture—civilized or primitive, rich or poor, modern or ancient—has searched for the perfect aphrodisiac. The word aphrodisiac comes from Aphrodite, who happened to be the Greek goddess of love. Aphrodisiacs are substances that stimulate sexual desire, heighten sexual awareness, or improve sexual function.
Through the centuries of their existence, aphrodisiacs have gone from being the stuff of folklore to the subject of medical research. Thanks to technological advances, scientists can test whether certain substances have any real effect on human sexuality. Guess what? Some of these “love potions” really work.
Until relatively recently, the vast majority of aphrodisiacs came straight from nature, as herbs were the sexual elixirs of choice. Now pharmaceutical labs are attempting to isolate the compounds in herbs that can enhance our sexual experiences or fix our sexual problems. A company could make millions, if not billions, if it successfully synthesizes these compounds into pill form—an aphrodisiac in a bottle.
In this chapter, we’ll take a closer look at a selection of sexual “remedies” from conventional and herbal medicine. All promise to reinvigorate your libido—and improve your sex life in general. But as you’ll see, some support this claim better than others do.
To be honest, most women who come to see us at the Sexual Wellness Center are hoping for a pill to solve their sexual problems. As we explain to them, and as we stress throughout this book, low libido is much more complex than that. Though medication may help, it seldom is a cure-all. Until any underlying emotional, intellectual, or spiritual issues are addressed, libido most likely won’t bounce back.
With this in mind, let’s explore the aphrodisiac offerings from the pharmaceutical front. We’ll start with the medication that helped launch a sexual revolution all its own: Viagra (sildenafil).
It was Friday afternoon, and Mindy was looking forward to the weekend. Her 16-year-old daughter, Samantha, had just left for a school band trip and wouldn’t be back until Sunday night. With dinner already made, Mindy relaxed with a glass of chardonnay.
To pass the time until her husband, Steve, came home from work, she decided to tidy up their bedroom closet. Hidden under a pile of old T-shirts, she found Steve’s prescription bottle filled with Viagra. About a year before, he had developed a problem maintaining an erection—a side effect of the Paxil that his doctor had prescribed in the aftermath of his father’s death. He stayed on Paxil for almost 6 months. But once his doctor said that he could discontinue treatment, he did. His erections returned to normal soon after.
Mindy was feeling playful. “What’s good for the gander may be good for the goose,” she thought as she held the bottle. “Wouldn’t this make for an interesting evening when Steve gets here?”
You may be wondering why we haven’t mentioned the infamous drug Viagra before this. When we first began planning our book, we were following at least a dozen clinical trials involving pharmaceuticals that we hoped would solve many of the problems that women routinely encounter in their sex lives. Unfortunately, the results of these studies have largely been disappointing. This is especially true in the case of Viagra.
Viagra was the first in a class of drugs called phosphodiesterace 5 (PDE5) inhibitors. The PDE5 inhibitors increase blood flow to the vagina and clitoris by raising the concentration of nitric oxide, a very potent chemical that causes relaxation and dilatation of blood vessels. In fact, nitric oxide is so important that in 1998 the Nobel Prize was awarded to the three American pharmacologists who discovered the chemical’s role in regulating blood flow.
We fully expected Viagra to help treat the most common sexual complaint among women (and the focus of this book): low libido. Unfortunately, the drug—which has become extraordinarily important for treating male sexual dysfunction (specifically erectile dysfunction)—does not improve a woman’s sex drive. It does, however, play a limited role in treating two other “female” sexual complaints.
One of these conditions, called female sexual arousal disorder (FSAD), is analogous to male erectile dysfunction. Doctors define FSAD as a persistent or recurring inability to attain, or maintain, sufficient sexual excitement. It is associated with the same health problems that can cause male erectile dysfunction: diabetes, hypertension (high blood pressure), and high cholesterol. It also can occur after pelvic surgery. All these result in decreased blood flow to the vagina and clitoris. This leads to reduced vaginal lubrication, diminished vaginal and clitoral sensitivity, difficulty climaxing or inability to achieve orgasm, and less intense orgasms.
In studies, Viagra has improved the quantity and quality of orgasms in women with FSAD. It also can significantly improve the quality of their sexual response. And although scientists have not studied Viagra in women with “normal” sex lives, many women like Mindy have experienced more-intense orgasms after trying their partners’ pills. (For your own safety, you should never take any kind of prescription pharmaceutical—especially someone else’s—without first consulting your doctor.)
Viagra also has proven effective in helping women with impaired sexual response, a common side effect of SSRI antidepressants. As we mentioned in chapter 8, more than one-third of women who take SSRIs either cannot climax or have trouble doing so. For the vast majority of these women, Viagra—or either of the two new PDE5 inhibitors, Levitra (vardenafil) and Cialis (tadalafil)—can restore orgasm. Unfortunately, it does not enhance the desire for sex.
We want to mention a few other medications that one day may be prescribed for low libido in women. By far, the most exciting drug currently being studied is called flibanserin. Flibanserin has a complex interaction with several different types of serotonin receptors in the brain. However, in contrast to the SSRI antidepressants that increase serotonin and lower libido, flibanserin decreases the inhibitory effects of serotonin, thereby increasing dopamine levels and increasing libido. Flibanserin has minimal side effects, with the most common being sleepiness, which decreases over time and is minimized by nighttime dosing. In addition, while Intrinsa, the testosterone patch, has been studied only in menopausal women who have had their ovaries removed, Boehringer Ingelheim, the manufacturers of flibanserin, has focused its studies on a much larger group of women—premenopausal women with decreased libido. Lastly, as flibanserin is nonhormonal, there isn’t the concern of increased cancer risk that is associated with hormonal treatments. It is possible that flibanserin will be approved by the FDA in 2009.
For completeness’ sake, we must mention bremelanotide (PT-141), a medication that was being studied by Palatin Technologies for decreased libido and arousal in women. Bremelanotide is a melanocortin, a group of pituitary hormones that interact with hormone receptors in the hypothalamus to affect behavior. For example, some melanocortins affect feeding behavior and are being studied as drugs to treat obesity. Bremelanotide was shown in a clinical trial published in 2008 in the Journal of Sexual Medicine to improve arousal and sexual satisfaction in women. Unfortunately, further studies have been halted because some trial participants developed elevated blood pressure. It has been rumored that Palatin is studying another melanocortin without this worrisome side effect.
Two different drug companies are investigating alprostadil, a powerful blood vessel dilator, as a treatment for FSAD. Clinical trials have shown that when women apply alprostadil to the clitoris and vagina, the majority report increased vaginal warmth, tingling, and lubrication.
The oral medications phentolamine and Melanotan also may help in cases of FSAD. The injectable form of phentolamine already has earned FDA approval as a treatment for erectile dysfunction in men. It works by dilating blood vessels, just like alprostadil. Melanotan was intended tobe a sunless tanning agent, until researchers discovered that it causes spontaneous erection as a side effect. Now it is being tested as a treatment for erectile dysfunction. It may work for FSAD as well.
Kelly was surfing the Internet when, for what seemed like the millionth time, a pop-up ad came on the screen. Usually, Kelly would close the ads without giving them a thought. This one, however, grabbed her attention. It was for a product called Viacreme. The ad promised better orgasms and a stronger libido.
“What the heck,” Kelly thought to herself. “I spend a ton of money at Victoria’s Secret to turn Jed on. Why not get something to turn me on?” A few mouse clicks later, Kelly hoped she was on her way to a whole new world of sexual pleasure.
You probably have noticed the recent explosion in both topical and oral over-the-counter products that promise to fire up sexual response in women. Almost everyone who gets e-mail has seen the ads for products such as Viacreme, Dr. K’s Dream Cream, Please Her V-Gel, and ArginMax. All have one thing in common: Their active ingredient is L-arginine, a naturally occurring amino acid that is a precursor to nitric oxide.
All of these products promise a more satisfying sexual experience because they contain L-arginine. But with the exception of ArginMax, such claims have not been substantiated by controlled medical studies.
As pharmaceutical companies continue their quest for the perfect synthetic aphrodisiac, more and more people are experimenting with natural alternatives to enhance their sexual experiences. Much of their interest has focused on herbs, though some cultures prize animal parts for their suspected aphrodisiac powers. (Tragically, this pursuit has contributed to the near extinction of several animal species—including the black rhinoceros, whose horn is believed to enhance sexual prowess.)
Plants in general are a rich source of compounds that can alter our physiological and psychological states. In fact, an estimated 60 percent of conventional medications come from plants. And that’s after scientific study of just a relative fraction of the world’s plant population. Realistically, then, many more herbs than the ones presented here may possess potent aphrodisiac powers. They just haven’t been discovered yet.
A number of our clients at the Sexual Wellness Center have tried herbs to improve their libidos, with excellent results. But as we always remind them, herbs are medicines. Like conventional pharmaceuticals, they can cause serious side effects if they are not used according to directions or if they’re taken with preexisting medical conditions such as hypertension.
In addition, the herbal industry—like the supplement industry—isn’t subject to FDA regulation. This means the quality, safety, and effectiveness of herbal products is not guaranteed. As we mentioned in our discussion of DHEA in chapter 7, what is on the label is not necessarily what is in the bottle. And DHEA, which is synthesized, is much easier to control than herbal preparations, which are grown.
The potency and quality of an herbal preparation depends on the same variables that affect all crops, such as rain, sun, temperature, and soil conditions. As an analogy, consider wine. Some years, the weather cooperates and the grapes grow well, so the wine is full-bodied and robust. Other years, too much rain, or not enough, takes a toll on the grape crop, producing a thin and not especially tasty vintage. Herbs are just as vulnerable to environmental factors, if not more so.
Keep in mind, too, that we do not intend for this section to be an authoritative text on herbal aphrodisiacs. Dozens, if not hundreds, of herbs can claim prosexual properties. We have chosen to recommend only a handful at the Sexual Wellness Center, because they have been scientifically studied, their side effects are well-known, and they are widely available.
As you’ll see, we’ve not included specific dosage information here. Your best bet is to consult a qualified herbalist or a physician who specializes in herbal medicine, who can recommend an appropriate dosage for you.
Manzambi and her husband, Remmy, moved from their native Zaire to the United States 7 years ago. At first, they lived with Remmy’s brother and his family in a cramped, dark Brooklyn apartment. Remmy worked 12 hours a day, 6 days a week driving a cab. It certainly was not paradise, but it was a much safer place to raise their daughter than in their war-torn country.
Like generations of immigrants before them, Manzambi and Remmy stayed in New York for a few years to get acclimated to the wonders and fast-paced life of their new country. Then they moved to Cleveland, where another relative had settled some years before. There Manzambi made many friends, who openly admired the relationship between Manzambi and her husband. While their husbands often went out to bars after work, Remmy headed straight home and showered affection on his wife.
Her new friends wanted the same type of relationship with their husbands that Manzambi had with Remmy. So they asked her advice. “The secret,” she told them, “is to keep your man happy in bed.” She continued: “Every night we drink a tea that we have sent from back home in Africa. The tea causes a pleasant fire in my vagina, and Remmy can make love like a man 15 years younger. Good sex keeps my husband home.”
A traditional herbal remedy in West Africa, yohimbe has a centuries-old reputation for its libido-enhancing properties. The herb, which comes from the bark of the corynanthe yohimbe tree, plays a role in tribal fertility celebrations, marriage ceremonies, and mating rituals. Spurred by yohimbe’s effects, some of these ceremonies involve sexual activity that may go on for days, or even weeks.
Since the late 1930s, researchers have been studying yohimbe to substantiate the prosexual claims for the herb. No less than 30 scientific articles have shown that the active ingredient in yohimbe, the alkaloid yohimbine, increases blood flow to the genitals and stimulates the central nervous system as well as the nerves of the genitals. Together, these physical changes set the stage for sexual arousal.
Researchers at Valparaiso University in Indiana confirmed that yohimbine increases the frequency of sexual activity and heightens sexual arousal. In fact, the FDA already has approved the compound as a treatment for erectile dysfunction in men. Further studies have shown that yohimbine can counteract the negative sexual side effects of the widely prescribed SSRI antidepressants.
As yohimbine works to stimulate the nervous system, it can enhance blood flow, metabolism, and alertness. On the downside, it can raise blood pressure and heart rate and cause heart palpitations, restlessness, and insomnia. For these reasons, we do not recommend yohimbe or yohimbine for anyone with a history of coronary artery disease, stroke, heart arrhythmias, high blood pressure, migraines, panic attacks, schizophrenia, or bipolar disorder. Even if you don’t have one of these conditions, we advise trying yohimbe only after a thorough physical exam.
You have several options for using yohimbe. You can brew yohimbe bark to make a tea—we suggest adding honey to mellow the slightly bitter taste—or buy the powdered form in capsules. Yohimbine also is available as a concentrated tincture.
Damiana is a wild shrub that grows in parts of Mexico, Central and South America, and the West Indies. Recently, it has been cultivated in Texas and California. Its botanical name, Turnera diffusa aphrodisiaca, hints at its reputation as a libido-enhancing plant. The ancient Mayans used damiana for its prosexual properties. And for centuries, Mexican women have been brewing tea from the plant’s leaves to improve their sexual satisfaction.
Though much less studied than yohimbe, damiana has been the subject of some research that’s worth discussing here. In one trial, researchers gave a damiana extract to impotent or sexually sluggish male rats, which showed marked improvement in their sexual activity. In another, an herbal preparation called ArginMax for Women—which combines damiana with other reputed sex-enhancing herbs—boosted sexual desire, reduced vaginal dryness, increased the frequency of sexual intercourse and the frequency and intensity of orgasm, and improved clitoral sensation in women who took it.
In fact, almost three-quarters of the women in the study showed positive changes in these sexual variables, compared with only slightly more than one-third of the women who took a placebo. The results are all the more significant because they come from adouble-blind placebo-controlled study, considered the gold standard in clinical research.
Damiana leaves can be brewed as a tea or taken in powdered form in capsules. You also can buy Damiana Liqueur, a light herbal-based liqueur that is made from damiana grown in Baja California. It comes in a bottle with the shape of a pregnant woman, modeled after the Incan goddess of fertility. According to Mexican folklore, the very first margarita was made with Damiana Liqueur. The Damiana Margarita remains popular in the Los Cabos area of Mexico.
Chinese culture is rich in the study and use of aphrodisiacs and sex-enhancing herbs. For centuries, the Chinese people have relied on the nuts and leaves of the ginkgo tree to help improve their sexual vigor, as well as their mental acuity.
Though limited, recent scientific research suggests that ginkgo may benefit sexual function by increasing blood flow. Two separate studies involving men with erectile dysfunction found that the herb helps to restore erections without side effects. In a study involving women, a preparation of ginkgo mixed with other herbs improved orgasms and overall sexual satisfaction.
Most herbalists agree that the effects of ginkgo are gradual. A woman who’s taking ginkgo may notice increased genital sensation and more vivid orgasms, along with sharper memory, over a period of several months. Ginkgo can be found in most health food stores in extract form or as a powder in capsules.
Perhaps the best known of the Chinese herbs is ginseng. It has been used in Asia for more than 5,000 years to boost energy and alertness. It also is known for improving sexual response, increasing sexual energy, and reviving libido.
There are three different types of ginseng: Asian, or “red,” ginseng (Panax ginseng); American, or “white,” ginseng (Panax quinquefolius); and Siberian ginseng (Eleutherococcus senticosus). The herb is considered an adaptogen. In other words, it helps restore normal function to the human body by increasing all-around resistance to stress.
Ginseng contains ginsenosides, compounds that stimulate the hypothalamus to invigorate sex drive. It also acts locally on the vagina and clitoris to increase genital blood flow, which enhances lubrication, sensation, and arousal.
In randomized placebo-controlled trials, Asian ginseng has improved sexual response in men with erectile dysfunction. And in combination with ginkgo and damiana, ginseng appears to boost sexual arousal and overall sexual satisfaction.
Look for ginseng in tincture, capsule, or tablet form. Some health food stores even carry soft drinks made with the herb.
Before concluding our discussion of herbal aphrodisiacs, we must mention Avlimil, an herbal formula that was aggressively marketed on radio and TV. The ads cleverly compared Avlimil with Viagra by saying that women now had their own “little blue pill,” just as men did. They also urged potential customers to ask their doctors about Avlimil, which implied that the supplement was available only by prescription and, therefore, had been approved by the FDA. Unfortunately, neither was the case. In 2006, the Federal Trade Commission filed charges against Steve Warshak, the owner of Berkeley Premium Nutraceuticals, the manufacturer of Avlimil. The FTC charged that Warshak made false and unsubstantiated claims about the effectiveness of Avlimil.
As an herbal supplement, Avlimil is not regulated by the FDA. And if it has been studied, the research has yet to appear in any peer-reviewed medical journal.