Sexual Function in Women: Shatavari and Ashwagandha May Help

Women’s sexual function is determined by oh so many things.   There is something called the biopsychosocial (BPS) model which is the standard clinical framework for understanding female sexual function. It asserts that sexual well-being relies on a complex, dynamic interaction between biological, psychological, and sociocultural factors rather than just physical genital response.  I couldn’t agree more.   When I am in a discussion with a patient about their sexual function issues, it is essential to explore in conversation, physical exam of the genital area in particular and perhaps testing, what factors might be involved.

When it comes to straight up hormonal influences on sexual function or in particular libido, there are several herbs that have emerged as potential benefit.  However, this is not a strong area of research in botanical medicine, nor in conventional medicine either.

Two of those herbs that have a small amount of research, as well as long historical tradition, are Shatavari and Ashwagandha.  Shatavari (Asparagus racemosus, Asparagaceae) is used in Ayurvedic medicine to enhance reproductive health and overall well-being in women. Ashwagandha (Withania somnifera, Solanaceae) has a small amount of research on sexual function but  is often used with shatavari because of its role as an adaptogen and stress modulator.

The authors of the current study conducted a prospective, randomized, double-blind, three-armed, placebo-controlled trial to evaluate the efficacy of shatavari root extract either alone, or in combination with ashwagandha root extract.

The study was conducted in India, and at San Francisco Research Institute in San Francisco, California.  Both reproductive aged women and menopausal women aged 18-55 who agreed to engage in sexual activity at least four times per week were eligible.

Participants were randomly assigned to one of three groups, with 45 participants in each group.  They took one capsule daily for eight weeks. The shatavari group took 300 mg of shatavari powder; the shatavari-ashwagandha group took capsules with 300 mg of shatavari and 250 mg of ashwagandha; and the placebo group took 300 mg starch capsules. The shatavari herb-to-extract ratio was 13:1 standardized to  total shatavarin content.

Evaluations took place at baseline and at weeks 4 and 8. The primary outcome measure was change in the Female Sexual Function Index (FSFI) score, which measures Sexual Desire, Arousal, Lubrication, Orgasm, Satisfaction, and Pain.  Secondary outcomes measured number of satisfying sexual events, the Female Sexual Distress Scale-Revised (FSDS-R), the Profile of Mood States (POMS), the Oxford Happiness Questionnaire (OHQ), the Pittsburgh Sleep Quality Index (PSQI), and serum hormone and liver enzyme levels.

FSFI scores revealed significant improvement in the Sexual Desire component in the shatavari-ashwagandha compared with the placebo group at week 4. Arousal scores were significantly greater in the shatavari-ashwagandha group compared with the placebo at week 4 and week 8. The scores for lubrication and orgasm  were greater in the shatavari-ashwagandha group compared with the placebo group at week 8. The Satisfaction score was improved by week 8 in the shatavari group compared with placebo.  FSFI total scores at week 8 were significantly higher in both the shatavari-ashwagandha and shatavari groups compared with the placebo group. The scores between the shatavari-ashwagandha and shatavari alone groups were not significantly different.

The number of sexual encounter occurrences was significantly greater in the shatavari-ashwagandha group compared with the placebo group at week 8. The number of orgasms or satisfying sexual activities  was similar amongst the groups.  FSDS-R total scores significantly improved in the combination group of shatavari-ashwagandha at both weeks 4 and 8 and in the shatavari alone group at week 8 with no significant differences between the combo group and the shatavari alone group.

The OHQ total score improvement was greater in the shatavari-ashwagandha group compared with the shatavari and placebo group at weeks 4 and 8. The POMS total score was significantly improved in the shatavari-ashwagandha group compared with the placebo and shatavari alone.  The Sleep Efficiency score on the PSQI improved significantly in the shatavari-ashwagandha group compared with placebo at week 8.

There were no changes in liver enzymes in any of the groups and any hormone changes were no different amongst the groups.

Commentary:  I would be questioning whether a sexual function scale of only two months duration is accurate.   As I said, many variables affect sexual function, and in this study, we have reproductive aged menstruating women and postmenopausal women which have very different hormonal environments.  While there are differences in results amongst groups,  the statistical power of the study based on the number of participants in each group is small.  That said, it seems both shatavari and ashwagandha should rise in prominence on the list of herbs that may help women and their sexual function.  Again though, this area is complex and requires of the practitioner to know how to properly evaluate so that the cause or causes and specifics of her sexual function-dysfunction can be determined and addressed.  For example, if a woman has vulvar/vaginal dryness and discomfort/pain with sexual activity, the practitioner needs to know where the dryness is, where specifically the pain is, and that can likely be addressed with vaginal and/or vulvar estrogen cream.  Dryness/pain with sexual activity affects desire/libido… so if she has this condition, called genitourinary syndrome of menopause (GSM), that problem needs to be treated first before expecting her libido to improve.

Reference: Ademola J, Mahajan S, Srivathsan M, Langade D. Effects of shatavari (Asparagus racemosus) root extract on sexual wellness in women: findings from a prospective, randomized, double-blind, three-arm, parallel-group, placebo-controlled study. Int J Womens Health. February 10, 2026;18:561213.