Sexual disorders remain an important but often under-addressed component of clinical care. In men, erectile dysfunction (ED) is the most common sexual disorder, affecting an estimated 1 in 2 men between 40 and 70 years of age. The prevalence increases from approximately 20% at 40 years of age to nearly 70% after 70 years of age. The condition may be psychogenic or organic, with either vascular or iatrogenic causes.

Sexual disorders are equally prevalent in both men and women. Between 2000 and 2019, the prevalence was estimated to be 51%, with disorders of sexual desire and arousal predominating. Menopausal transition is particularly associated with symptoms that impair sexual health, sometimes accompanied by vulvovaginal atrophy.

Interest in nutraceuticals and natural approaches has substantially increased in recent years. These dietary supplements and nonpharmacologic alternatives are increasingly considered complementary strategies for managing sexual disorders in both sexes. Clinical trials suggest that certain nutraceuticals have demonstrated statistically significant improvements in erectile function and female sexual function (FSF), although these approaches are generally positioned as adjunctive options rather than substitutes for established pharmacologic therapy.

ED

The standard medical management of ED relies primarily on phosphodiesterase type 5 inhibitors, including sildenafil, tadalafil, and vardenafil. Naturally derived compounds have attracted increasing attention in recent years. Their proposed mechanisms include improvement of endothelial function through vasodilatory effects, reduction of oxidative stress, and modulation of hormonal balance.

Several nutraceuticals have been supported by consistent clinical evidence. Panax ginseng has been shown in multiple randomized trials to improve the International Index of Erectile Function (IIEF) score, a validated questionnaire for assessing male sexual function, by approximately 3-5 points, likely through increased nitric oxide production. L-arginine, particularly when combined with pycnogenol, improves nitric oxide bioavailability and increases IIEF scores by 3-6 points, mainly in vascular ED. Tribulus terrestris, especially saponin-rich extracts, has shown effects on ED associated with hormonal imbalance, including a randomized placebo-controlled phase 4 trial involving 180 participants.

Combined approaches have also demonstrated benefits. Acetyl-L-carnitine, propionyl-L-carnitine combined with sildenafil, and L-arginine combined with tadalafil were associated with higher IIEF scores. Similar improvements were reported with Ginkgo biloba combined with alpha-lipoic acid and Vitis vinifera combined with avanafil (n = 123) compared with placebo (P < .01) and avanafil alone (P < .05). Most nutraceuticals are marketed as dietary supplements in France.

However, these findings contrast sharply with the highly variable quality of commercially available supplements. An analysis of nutraceutical products marketed in Italy revealed that 80% of the products were unlikely to provide meaningful efficacy, 12% showed low efficacy, and only 8% demonstrated a higher potential efficacy. The analysis highlighted that complex formulations often contain more than five ingredients per product, with L-arginine being the most frequently used, followed by Tribulus terrestris and Panax ginseng. The major limitations of this study include the use of ingredients without clinical evidence and underdosing of compounds with demonstrated benefits.

Female Sexual Disorders

Evidence is emerging for the use of nutraceuticals in female sexual disorders, including primary conditions and drug-induced dysfunctions. Randomized clinical trials (RCTs) primarily rely on outcomes measured using the FSFI.

Several products have shown benefits in primary sexual disorders, particularly in hypoactive sexual desire disorder. Tribulus terrestris 750 mg/d for 4 weeks improved desire and FSF index (FSFI) scores (n = 67; P < .001). The local application of visnadine derived from Ammi Visnaga, delivered as a spray or oil, was associated with improved FSFI scores (n = 38; P < .001). ArginMax, a formulation combining L-arginine, ginseng, ginkgo, damiana, vitamins, and minerals, demonstrated superiority over placebo in postmenopausal women (n = 108; P = .008). Red clover obtained from Trifolium pratense improved dyspareunia, vaginal dryness, and libido in women older than 40 years (n = 60; P < .05). Libifem, derived from Trigonella foenum-graecum, improved sexual desire and arousal in women aged 20-49 years (n = 80; P < .05).

For drug-induced sexual dysfunction, ginkgo biloba improved sexual desire when combined with sexual therapy in women treated with antidepressants (n = 63; P < .05). Saffron (Crocus sativus) improved overall FSFI scores (P < .001), as well as arousal, lubrication, and pain, in women receiving fluoxetine (n = 38).

Additional studies have reported significant improvements in arousal (P = .014) and sexual desire (P < .001) with Panax ginseng. In women with depressive disorders treated with selective serotonin reuptake inhibitors, positive effects on sexual dysfunction were observed with a combination of ginger, saffron, cinnamon, thistle, and Tribulus terrestris (n = 32; P < .05) and with L-arginine supplementation at 2 g/d (n = 40; P = .001).

Clinical Perspective

In clinical practice, nutraceuticals may represent a complementary option for the management of ED, particularly in mild-to-moderate forms. Large-scale RCTs are necessary to clarify efficacy, optimal dosing, and patient selection criteria before these approaches can be broadly recommended.

For female sexual disorders, although the overall level of evidence remains limited, interventions based on natural products appear to improve disorders of sexual desire, including both primary conditions and those induced by pharmacologic treatments.

This story was translated from Univadis France, part of the Medscape Professional Network.