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Dr. Tori Hudson, Portland, Oregon, Blog Healthline Blog

Female sexual dysfunction (FSD) is a well-recognized clinical condition characterized by lack of sexual desire, arousal, orgasm, and/or pelvic pain/penetration, or a combination of these symptoms. Low desire is called hypoactive sexual desire disorder (HSDD), low arousal is called female arousal disorder (FAD), female orgasmic disorder (FOD)  is delayed, infrequent or absent orgasms, or significantly less-intense orgasms after sexual arousal and adequate sexual stimulation and pelvic pain with penetration is called dyspareunia.

Conventional medicine approaches include:

  • Estrogen therapy.Localized estrogen therapy comes in the form of a vaginal ring, vaginal cream, vaginal ovule or vaginal tablet. This therapy benefits sexual function by improving vaginal tone and elasticity, increasing vaginal blood flow and enhancing lubrication.
  • Ospemifene (Osphena).This medication is a selective estrogen receptor modulator. It helps reduce pain during sex for women with vulvovaginal atrophy.
  • Androgen therapy.Androgens include testosterone. Testosterone plays a role in healthy sexual function in women as well as men, although women have much lower levels of testosterone.

Androgen therapy for sexual dysfunction is controversial. Some studies show a benefit for women who have low testosterone levels and develop sexual dysfunction; other studies show little or no benefit.

  • Flibanserin (Addyi).Originally developed as an antidepressant, flibanserin is approved by the Food and Drug Administration (FDA) as a treatment for low sexual desire in premenopausal women.

Addyi is a daily pill. It may boost sex drive in women who experience low sexual desire and find it distressing. Potentially serious side effects include low blood pressure, sleepiness, nausea, fatigue, dizziness and fainting, particularly if the drug is mixed with alcohol. Experts recommend that you stop taking the drug if you don’t notice an improvement in your sex drive after eight weeks.

  • Bremelanotide (Vyleesi).Bremelanotide is another FDA-approved treatment for low sexual desire in premenopausal women. This medication is an injection you give yourself just under the skin in the belly or thigh before anticipated sexual activity.

 

Vitex flower, also known as Chaste tree berryBotanical medicines have a long historical tradition in the area of low libido with a small amount of modern research. Chasteberry (Vitex agnus-castus, Verbenaceae) has been used in traditional medicine to treat premenstrual syndrome (PMS), dysphoric mood disorders, dysmenorrhea, hyperprolactinemia, anovulation, irregular menses, lactation problems, and infertility. This is the first and only study I’ve seen on chaste tree berry and sexual dysfunction in premenopausal (or postmenopausal) women and it showed a positive effect. The purpose of this randomized, double-blind, placebo-controlled trial was to evaluate the effects of chasteberry consumption over a four-month period on sexual function in women of reproductive age experiencing FSD.  The primary study outcome measures included determining changes in the mean score of sexual function. The secondary outcome measures included determining the number of intercourses in heterosexual women and satisfaction with the intervention.

The study was conducted between February 2018 and December 2019 in heterosexual Iranian women in Iran. Women referred to the gynecological clinic at the hospital were invited to participate if they had a sexual problem and wanted to improve their sexual function. The women who participated were those who wanted to improve their sexual function, were between the ages of 15 and 44 and did not have depression or PMS.  Additional criteria for inclusion in the study were those who did not have alcohol or drug addiction of the wife or husband, or separation based on participant’s statement, the ability of the husband to have normal intercourse during the study period, and no consumption of hormonal contraception during the study period.

Women were asked to compete the female sexual function index (FSFI), gynecology, and demographic questionnaires prior to commencement of the study. Participants received education on the natural sexual response.

After evaluation for inclusion/exclusion criteria, 112 participants remained and were randomized to the chasteberry (n = 55) or placebo (n = 57) group. The chasteberry group received a proprietary chaste tree product that contained 3.2 to 4.8 mg dried chasteberry extract. Participants were asked to take one tablet daily of chaste tree or placebo for 16 weeks and return to clinic every four weeks to complete the FSFI questionnaire.

Both treatment group and placebo group had similar scores before starting treatment.  At the end of the 16 weeks, results showed that mean scores for all variables assessed in the chasteberry group changed significantly over time as well as the overall FSFI.  The only mean score that changed in the placebo group was for vulvovaginal pain with intercourse.

Commentary:  Iranian culture is different for women than in the Western world in many ways, including the freedom and comfort of talking about sexual issues.  I think this would be a limitation of this study.  There is no previous study that I am aware of utilizing chaste tree for libido.  In fact, it is paradoxical to think of a plant called chaste tree to be indicated for libido, and there are reports of lowered libido with its use.  On the other hand, chaste tree is used due to the effect it has on the hypothalamic-pituitary axis and having an effect to promote ovulation  (thus enhancing fertility).  More paradox.  In addition, lack of similar studies make it difficult to determine the actual best dose for this purpose of sexual function.

Also of note is that this study was in women of reproductive age, not in peri or postmenopausal women where sexual function decline is a common experience.  If chaste tree does work, might it only work in reproductive aged women???

Additionally, of late, there is some concern about studies coming out of Iran (and select other countries) in terms of authenticity.  For this study, some concerns would be:  The researchers started recruiting in Feb 2018, but the  Iranian Registry of Clinical Trials (IRCT) document says they were approved by the ethics committee on November 5, 2018.  Also, the IRCT document says the expected recruitment start date was December 22, 2018. The document was registered on December 9, 2018, at which time they would have known if they had really started recruiting in Feb 2018.  In addition, the study was part of a Masters’ thesis. It is possible but questionable that a graduate student could do such a study.

None the less, the authors of this study have concluded that chasteberry supplementation over a period of four months increased all domains of sexual desire, arousal, lubrication, orgasm, satisfaction, and pain as well as the overall score of female sexual function.

Reference: Heirati SFD, Ozgoli G, Mehri RK, Mojab F, Sahranavard S, Nasiri M. The 4-month effect of Vitex agnus-castus plant on sexual function of women of reproductive age: A clinical trial. J Educ Health Promot. August 31, 2021;10:294

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