What nutrients can be used for enhancing sexual health and sexual performance?

Dr. John Lewis Ph. D.

03 March 2017

Sexual health is highly important to all of us.  In Abraham Maslow’s hierarchy of needs, sex appears in two of the five levels:  (1) in the foundation of physiological needs, which comes before everything else and (2) to a lesser extent in the third level as part of love and belonging.  Thus, sexuality is a highly important part of being healthy and having a positive outlook in life.  Without a positive orientation toward and enjoyment of at least somewhat frequent sex, many people would argue that life would be unfulfilled and less than satisfactory based on the work of people like Maslow and others.  Unfortunately, poor sexual health appears to be quite common today and has seemingly risen in incidence along with many other chronic diseases and disorders, such as cardiovascular disease, diabetes, cancer, and depression.  Physical (physiological) and psychological etiologies affect sexual health.  Physical causes could be related to atherosclerosis, obesity, inflammation, and hormonal changes associated with aging, and psychological causes might be depression, anxiety, other mood disorders, and psychoses.  Regardless of the cause of sexual dysfunction, all of these secondary co-morbid complications are ripe for being addressed by health promoting behaviors, such as dietary supplementation, diet, and exercise.

In the case of dietary supplementation, several nutrients, extracts, and whole-food concentrations are marketed to improve sexual health.  Products are targeted to enhance particular areas of sexual health, such as:  (a) libido, or desire to have sex or express sexuality; (b) sexual performance, particularly for men as the ability to achieve and sustain an erection; (c) hormonal function, such as for women who are approaching or are beyond the menopause stage of life; and (d) sperm quality and motility in men.  Thus, products that have effects related to:  (a) increasing vasodilation, or blood flow, throughout the vascular system; (b) improving the endocrine system or the regulation of the delicate balance of our hormones; and (c) elevating mood would likely be ones that might provide help for people who currently have some of level of sexual dysfunction or inability to feel sexually satisfied.

Some of the most commonly sold products today to alleviate some or all of the aforementioned concerns, thereby enhancing sexual health, include maca, tribulus, Gingko biloba, horny goat weed, yohimbine, L-arginine, blue lotus, soy natto, beetroot juice, and deer antler, among many others.  Let us look at some of the findings in the literature for a few of these products.

Yohimbine is an alkaloid that is extracted from the bark of several African and Asian plants.  It is not entirely certain how yohimbine affects sexual health, but it is thought to interact with various receptors in the central and peripheral nervous systems, which may not only impact the male’s erection, but may enhance the central sexual impulse in the brain and increase the release of nitric oxide (NO) from cavernosal endothelial cells, which would improve blood flow (vasodilation).  In a few human trials, yohimbine has shown to be more effective than placebo in treating erectile dysfunction.  If you decide to try yohimbine, you should check with your physician, particularly if you are taking a monoamine oxidase inhibitor, hypertension medication, tricyclic antidepressant, or phenothiazine (medicines used mostly for mental health conditions such as schizophrenia) or if you have a kidney disorder.  The United States National Institutes of Health have issued statements about the possible interaction of yohimbine with these medications and/or its potential side effects particularly related to blood pressure and mood changes.  You also want to make sure you are taking a pure source of yohimbine and not a chemical or synthetic analogue or derivative.

Horny goat weed (Epimedium) is part of the genus of plants of the Berberidaceae family, and the active ingredient is apparently icariin, a flavonol glycoside.  Among other actions, icariin increases NO synthesis in the penis, mimics androgen or hormonal activity, and is anti-inflammatory.  To my knowledge, no clinical trials have been conducted in humans, but it has shown effectiveness in treating erectile dysfunction in animals.  It also has a very minimal adverse effect profile; thus it appears to be generally safe to take.

Ginkgo biloba is a living fossil tree, belonging to Ginkgoaceae family typically found in China.  Ginkgo biloba extracts contain flavonoid glycosides and terpenoids and have been used for hundreds of years in traditional Chinese medicine, particularly for memory and improved blood flow.  Thus, the improvement in blood flow along with enhanced NO to the genitals may ultimately have a positive impact on sexual performance.  Although Ginkgo biloba extracts have been suggested for counteracting female sexual arousal disorder, a common side effect of selective serotonin reuptake inhibitors (SSRI), only a few case reports have reported positive results with no clinical trials to my knowledge.  The side effect profile of Ginkgo biloba is not considered to be significant, other than for people on blood thinners or psychoactive medications acting on the central nervous system, where caution may be warranted.

Finally, maca (Lepidium meyenii) may be the most widely studied food or dietary supplement for its potential in enhancing sexual health and performance.  Maca is a Peruvian plant belonging to the Brassicaceae family that grows at more than 4,000 m in altitude.  Like Ginkgo biloba in China, it has been used for hundreds of years by Andeans as an aphrodisiac, energizer, and enhancer of fertility and sexual performance.  Maca contains glucosinolates and polyphenols, among other phytochemicals and nutrients, but its action on sexual performance still needs to be determined.  Maca has been widely studied in animals.  It has been shown to modulate hormone balance, particularly by enhancing follicle stimulating hormone, in ovariectomized rats.  Among female rats during the pro-oestrus stage, a 4+ times increase in luteinizing hormone and a 19 times increase in follicle-stimulating hormone were noted in those fed with maca compared to the control.  Maca extracts improved daily sperm production and sperm count in the epididymis and vas deferens in mice.  In another study in mice, maca was able to reverse the deleterious effect of chemical subfertility on sperm count and motility.  In humans, data are suggestive of positive effects of maca as well.  For example, one clinical trial showed positive effects of maca on sperm mobility in infertile men.  Another clinical trial found that sperm concentration and motility increased in response to maca consumption compared to placebo, although hormone levels did not change.  Two other clinical trials found beneficial effects of maca on several semen quality parameters in healthy men, and two observational studies also proposed encouraging effects of maca on semen quality.  In a sample of pre-menopausal women, maca enhanced the hypothalamus-pituitary-ovarian axis, stimulated production of estrogen, and improved symptoms of menopausal discomfort (primarily hot flashes and night sweats).  A study in postmenopausal women with SSRI-induced sexual dysfunction showed that maca improved self-reported sexual functioning compared to placebo.  Another study in postmenopausal women found that maca improved measures of sexual dysfunction, anxiety, and depression, despite having no effect on hormone levels, compared to placebo.  A sample of early postmenopausal had a decrease in follicle-stimulating hormone, proliferation of both estrogen and progesterone, and lower menopausal discomfort in response to taking maca compared to placebo.  In perimenopausal women, maca balanced multiple hormones and improved menopause symptoms compared to a placebo.  Maca has also been shown to boost overall mood and energy in women and men, which could indirectly have a beneficial effect on libido and sexual performance.  Maca has generally been found to be well-tolerated and safe in most studies, and the side effect profile is largely insignificant.

In summary, many dietary supplements are available that tout improvements in sexual health and sexual functioning.  Unfortunately, the research in humans in many of these nutrients, foods, or products is limited.  Nonetheless, what research exists to date suggests that certain products, such as maca, may provide positive benefits on sperm quality, fertility, sexual function, modulation and enhancement of hormones, and improved energy and mood, thereby not only enhancing sexual health, but indirectly affecting overall health and well-being.  As with the purchase of any dietary supplement, please do your homework on the dosage, purity, and ingredients of these products and check with your physician or other trusted health care practitioner to discuss the possibility of any side effects that I mentioned above.  With a continued demand for high-quality nutraceuticals for sexual health and performance, hopefully more randomized clinical trials will be performed to determine which products can truly be classified in the category of aphrodisiac and responsible for improving your sexual health.  Meanwhile, continue reading my articles to help you make informed decisions about buying good quality dietary supplements to help you achieve your health goals!

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