Sexual Dysfunction

Elham Akhtari et al. (2014) · Daru : journal of Faculty of Pharmacy, Tehran University of Medical Sciences

This randomized, double-blind, placebo-controlled trial of 67 randomized women (60 analyzed) explored whether an extract of Tribulus terrestris, a low-growing plant also called puncture vine or bindii, affects sexual desire in women of childbearing age. The condition studied, hypoactive sexual desire disorder (HSDD), is a persistent lack of sexual thoughts and desire that causes personal distress, and the authors cite a prevalence of about 1 in 10 adult women in the USA and 30% in Iran. No drug is approved by the US Food and Drug Administration for it. In Iranian Traditional Medicine, texts including Avicenna's Canon of Medicine describe Tribulus as a remedy that boosts libido. The women, all married and living with a partner, were recruited at two medical centers in Tehran Province, Iran, between June 2012 and July 2013, with an average age of 36 years. After random assignment in a 1:1 ratio, one group took a syrup made from an ethanol extract of Tribulus leaves, 7.5 ml twice a day for four weeks, and the other took a look-alike sucrose syrup. Sexual function was scored with the Female Sexual Function Index (FSFI), a 19-item questionnaire covering desire, arousal, lubrication, orgasm, satisfaction and pain, completed at baseline and four weeks after treatment ended. Desire, the primary outcome, rose from 3.06 to 3.90 points in the Tribulus group but only from 2.66 to 2.86 with placebo, an adjusted difference of 0.71 points (95% CI 0.41 to 1.01, p < 0.001, meaning the gain was unlikely to be chance). Several other domains also favored Tribulus: satisfaction by 1.10 points, orgasm by 0.85, arousal by 0.75, lubrication by 0.50 and pain by 0.37 (p-values between < 0.001 and 0.041). The total FSFI score improved from 21.25 to 26.80 with Tribulus versus 20.89 to 22.41 with placebo (p = 0.040 in the results text, although the abstract gives p < 0.001). Only one participant reported a side effect, a mild (grade 1) abdominal cramp. Dropouts cited the very sweet taste and anxiety about taking an investigational drug. The authors interpret the results as supporting the traditional libido-boosting reputation of Tribulus and call for larger studies. Limitations include the small sample, only four weeks of treatment with a single follow-up, one country, and a cultural setting in which women may be reserved about reporting sexual matters. The dose is stated inconsistently between the abstract and the methods, and menopausal women were excluded, so the findings do not extend to them. The mechanism was not tested; the authors only propose a possible link to follicle-stimulating and luteinizing hormones.

Ana Luiza Cabrera Martimbianco et al. (2020) · Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia

This systematic review of five randomized controlled trials (279 women) examined whether Tribulus terrestris, a creeping herb used as a natural sexual stimulant, improves female sexual dysfunction (FSD) and what safety data exist. All participants had hypoactive sexual desire disorder (HSDD, persistently low sexual desire that causes distress) or loss of libido. Tribulus extracts contain protodioscin, a steroidal saponin (plant compound with hormone-like structure) proposed to increase luteinizing hormone, the pituitary hormone that stimulates androgen production. The review cites estimates that 30 to 50% of women experience FSD during their lifetime, and notes that the effects of Tribulus had not been established. Reviewers searched six databases and trial registries up to February 2019 for trials comparing Tribulus with placebo or another treatment. The trials took place in Brazil (four) and Iran (one) and enrolled 172 postmenopausal women (43 to 65) and 107 premenopausal women (18 to 44). Four trials gave 250 mg by mouth three times daily for 90 to 120 days; one gave a syrup twice daily for 30 days. Sexual function was measured with the Female Sexual Function Index (FSFI, scored 2 to 36) and the Sexual Quotient Female Version (SQ-F, scored 0 to 100); higher scores mean better function. Differences between trials prevented pooling results. One trial in 67 premenopausal women found a higher FSFI total score after one month on Tribulus (mean difference 4.39 points; 95% CI 2.90 to 5.88, a statistically reliable gain), driven by arousal, lubrication, orgasm and satisfaction rather than desire or pain. Two other FSFI trials at three months found no significant difference (p = 0.19 and p = 0.44). In 60 postmenopausal women, SQ-F scores rose by 16.40 points (95% CI 7.67 to 25.13) at three months. Testosterone rose in premenopausal women (mean difference 6.60; 95% CI 0.27 to 12.93) but not in postmenopausal women (2.50; 95% CI -1.79 to 6.79, a range that includes no effect). Only one trial reported adverse events: none serious, and one case of abdominal cramps. No trial measured quality of life. The authors rate the certainty of the evidence as very low, meaning future studies are likely to change the estimates. Trials were small, selection methods were unclear, and two trials lost 20% and 37.5% of participants. The authors state that current evidence does not support routine clinical use and call for more well-designed randomized trials in pre- and postmenopausal women. They note the main limitation was that only one of the contacted trial authors supplied additional data, and that this is the first systematic review of Tribulus for FSD.

Milou L V Covers et al. (2021) · European journal of psychotraumatology

This randomized controlled trial with 57 recent rape victims explored whether early eye movement desensitization and reprocessing (EMDR) therapy reduces post-traumatic stress more effectively than watchful waiting, the standard wait-and-monitor approach used at Dutch sexual assault centres. EMDR is a trauma-focused psychotherapy in which a therapist guides bilateral eye movements while the person recalls a distressing memory, aiming to reduce the memory's vividness and emotional charge. Watchful waiting, by contrast, involves brief check-ins, psychoeducation, and emotional support without active trauma processing. About 40% of rape victims develop post-traumatic stress disorder (PTSD) within three months, making the timing and content of early support clinically significant. Fifty-seven participants (56 women, one man; average age about 26) were randomly assigned, between two and four weeks after a rape, to either two sessions of EMDR therapy (3.5 hours total, using a protocol adapted for very recent trauma) or two brief supportive phone calls with a case manager. Symptoms were measured before treatment, right after treatment, and again at 8 and 12 weeks using clinician-rated and self-report scales covering post-traumatic stress (CAPS-5, PCL-5), anxiety and depression (HADS), dissociation (DTS), general psychological symptoms (BSI), and sexual functioning (FSFI, AOPFS). Both groups improved substantially over the 12 weeks (large effect sizes, Cohen's d around 1.5, meaning both approaches were followed by a large drop in symptoms), but EMDR was not more effective than watchful waiting for post-traumatic stress symptoms at any time point (no statistically significant difference, p > .05 throughout). EMDR did show a short-lived edge over watchful waiting on anxiety (a 2.25-point lower score on the Hospital Anxiety and Depression Scale immediately after treatment, p = .023) and on dissociative symptoms (p = .013), but both advantages faded by the 12-week follow-up. No meaningful differences emerged between the two approaches for depression, general psychological symptoms, sexual functioning, or feelings of guilt and shame. By 12 weeks, fewer EMDR participants still met PTSD diagnostic criteria than watchful-waiting participants (16% versus 35%), though this difference was not formally tested for significance. One EMDR participant left the study after an increase in suicidal thoughts and received care; the treatment was otherwise well tolerated. The authors conclude that two sessions of early EMDR conferred no lasting advantage over watchful waiting for recent rape victims and, given its lower cost, state that the findings support existing guidance favoring watchful waiting as the default early response. The comparison involved an active watchful-waiting condition rather than no treatment, so the trial cannot show whether either approach outperforms natural recovery. The sample was small, mostly female, and experienced considerable dropout (21 of 57 participants), limiting how far the results generalize to other populations. The authors call for further research into watchful waiting's own effectiveness as an early intervention.