So far in my lifetime, every drug that researchers thought would improve female sexual function has been rejected by the FDA. Why can’t we find a Viagra equivalent for women? For starters, the situation for women is a little more complicated than for men. The female sexual response usually involves neurovascular, hormonal, and psychological factors (it’s similar for men, but a major improvement is seen when enhancing just the neurovascular component with them).
Simply increasing bloodflow to the clitoris or vagina— the way Viagra does for the penis—does not improve desire, arousal, orgasm, or other aspects of female sexual dysfunction. And what works for menopausal women may not work for premenopausal women and vice versa (this is also a critical difference compared to men), making the picture even more complicated.
Let’s just say that female sexual dysfunction, or FSD, is a medical specialty that should have embraced lifestyle changes and dietary supplementation long ago because there are so few other options. (Of course, that means doctors will have to start asking their patients about it as well, which they’re not doing consistently now.)
What is Female Sexual Dysfunction?
Between 25 and 63 percent of women have some form of female sexual dysfunction, which involves problems with one or more of the following:
- Desire/libido (most common complaint)
- Arousal (second most common complaint)
- Pain (known as dyspareunia, usually due to lack of lubrication, vaginal atrophy, or thinning of the vaginal lining)
- Overall sexual satisfaction
FSD can be chronic or it can occur periodically or even situationally, and the underlying cause—physical, psychological, or both (see “Potential Causes of Sexual Dysfunction” for a list of these)—can be hard to pinpoint. Here are some eye-opening FSD facts.
- Fewer than 30 percent of women experience orgasm on a regular basis with a partner.
- At least 30 percent of women report having some issues with sexual desire, arousal, or orgasm.
- About 30 to 50 percent of women report having sexual complaints, but the actual number of women who are bothered enough to seek medical treatment is lower (research statistics conflict here a bit). That’s an important difference. Many experts and some professional medical organizations believe that unless a woman has “personal distress” about her sexual dysfunction, it should not necessarily be recognized as a problem that needs to be treated. Although this makes some sense, I believe part of the problem is that women, regardless of age, are not given the opportunity to have an open discussion about their sex lives—and any complaints or problems—with health care professionals. The typical checkup is so rushed that it’s just not conducive to a frank, thoughtful discussion.
Home Remedies For Female Sexual Dysfunction
1. Lubricant (oil-, silicone-, or water-based) as needed
Vaginal dryness or inadequate lubrication is a major issue for women of all ages and their partners, and it’s a relatively easy fix. (Granted, these aren’t technically “supplements.” I’m taking some liberties here because lubricants work better than supplements for many people, and lots of them contain supplement ingredients.) A few more stats: Fifteen percent of women between 18 and 64 report always or usually experiencing dryness during sexual activity. Lack of lubrication occurs “very often” in about 10 percent of women over the age of 50, and even younger women report problems with adequate lubrication.
Finally, as many as 24 to 48 percent of women have reported experiencing pain during intercourse, and lack of lubrication is a major cause (some studies are suggesting that dyspareunia is more common in younger women). Overall, research continues to show that lubricant use is associated with higher sexual pleasure and satisfaction for both individual and partnered sex. A Johnson & Johnson study showed it increased sexual well-being for healthy women (they felt more satisfied). Some studies suggest that lubricants work as well as locally (vaginally) applied estrogen to improve dryness in menopausal or postmenopausal women.
An over-the-counter massage oil for women known as Zestra—a blend of borage seed oil, evening primrose oil, angelica root extract, and coleus extract— has had some success in clinical trials. A study (with women ages 21 to 65) published in the Journal of Sex & Marital Therapy found that Zestra increased sensitivity and warmth and may improve female desire, arousal, and overall sexual pleasure when applied to the clitoris, labia, and vaginal opening. Borage and evening primrose oil contain large amounts of gamma-linolenic acid (GLA, an omega-6 fatty acid), which, after it’s metabolized through the skin, could increase blood-flow and enhance nerve communication.
The only side effect reported (by 10 to 15 percent of participants) was mild genital burning that lasted anywhere from 5 to 30 minutes. I would have liked Zestra to be tested against other over-the-counter products or even against a placebo in a very large study, but beggars cannot be choosers; this is an area of medicine that is woefully lacking in research. There are other massage oils out there, so don’t be afraid to try them out and see which one works best. The “don’t be afraid” part is key! One of the most-cited reasons for not using lubricant is being too embarrassed to purchase it.
One final note: I recommend looking for a product that contains a thickening or gelling agent, such as hydroxyethylcellulose, which improves the consistency of the lubricant, and a pH-balancing agent, such as citric acid, which wards off infection and maintains good bacteria. If you prefer more natural ingredients, look for a lubricant with organic compounds instead of silicone; they may help protect against infections (Some like beeswax have antimicrobial properties, but don’t use them to avoid sexually transmitted diseases!). Many of the best lubricant brands have multiple options to pick from, including Yes and Kama Sutra (my favorites), K-Y, and Astroglide.
2. Combination product (L-arginine and Panax ginseng) and/or L-citrulline dosage varies by form
L-arginine by itself (3,000 to 6,000 milligrams per day) has shown real promise for FSD because it can increase nitric oxide levels in the body, which improves blood-flow to the sexual organs. A related compound, L-citrulline, which I talk about extensively in the Erectile Dysfunction section, does an even better job of increasing nitric oxide and it’s metabolized more effectively by the body, so I usually recommend it over L-arginine. In fact, L-citrulline (the free form versus the malate form) is one of the supplements I recommend the most for female and male sexual health. Research has shown that 1,500 to 6,000 milligrams per day can increase nitric oxide levels in the body within 1 week. Most of the benefit appears to be in premenopausal women, but some post-menopausal women could also benefit.
There have been mainly two placebo-controlled studies of a combination dietary supplement known as ArginMax, which contains Panax ginseng and L-arginine, along with several other ingredients. The results showed improved arousal, desire, orgasm, sexual frequency, clitoral sensation, and sexual function scores, but these effects were mostly observed in premenopausal and perimenopausal women.
Post-menopausal women reported improved sexual desire, but that was it. A recent clinical study published in the Journal of Sex & Marital Therapy showed a benefit within 4 weeks. This supplement does not appear to have estrogenic enhancement properties, so it could be an appropriate option for women with breast cancer or who don’t want to use hormone replacement therapy. A study of this product in breast cancer patients (whose sexual health can be so greatly impacted by cancer treatment) found that it helped, but the impact was not statistically significant; still, the fact that it helped some of these women is a testament to the product.
You could take L-citrulline by itself, with the ArginMax (500 to 1,500 milligrams of L-citrulline, in this case), or with ginseng only. In other words, there are plenty of options here to experiment with. (Ginseng by itself has not worked for premenopausal FSD.)
These supplements need to be used for at least 4 weeks before judging if they work. It does not appear to matter if they’re taken with or without food, and there has been no good research in the area of drug interactions or the effect on pregnancy, so check with your doctor. (I’d like to see testing of lubricants containing these two amino acids. I think they could improve bloodflow to the vagina and may even improve arousal and lubrication.)
3. Panax ginseng up to 3,000 milligrams a day in divided doses
Ginsenosides are the active ingredient in ginseng, and they work in multiple ways. One way is that they improve the conversion of L-arginine to nitric oxide in the body, allowing for adequate bloodflow to the genitals. Another fascinating mechanism of action is their effect on the brain. They bind to areas that can promote relaxation, improve mood, and impact dopa-mine, all of which may stimulate sex drive. Ginseng also improves energy levels. The future of research in the area of ginseng and FSD involves isolating specific active ginsenosides and testing higher dosages.
For example, Panax ginseng contains high amounts of a ginsenoside known as Rg1, which has shown some ability to improve bloodflow, arousal, and libido in the laboratory (for women and men), but it needs to be tested more by itself.
A small, randomized trial published in the Journal of Sexual Medicine found that taking 3 grams of Panax ginseng (participants took a form called Korean red ginseng) daily for 8 weeks resulted in a significant improvement in arousal in postmenopausal women. The product contained about 8 percent ginsenosides. The reason I believe this trial should get more attention is 1) the Korean-based research team is one of the best in the business and 2) Panax ginseng has a long history of improving male erectile dysfunction and sex drive. You can also look for a product with 16 percent ginsenosides and just take half the dosage. (Always check the percentage of ginsenosides when browsing products at the store so you’re comparing apples to apples.)
Pharmacological reviews have found that the potential for drug-ginseng interactions is low; the concern over this supplement interacting with medications, such as blood thinners and antihypertensives, is mostly based on isolated case reports. I recommend taking it with a meal to avoid stomach upset.
What Supplements Are Useless For Treating Female Sexual Dysfunction?
General supplements for “women’s issues,” including depression, PMS, menopause, and more.
While FSD can be caused by or associated with some of these problems, the supplements or drugs that help treat them won’t necessarily improve FSD. And they could make it worse! For example, it’s well known that prescription antidepressants (drugs like venlafaxine or paroxetine) can reduce hot flashes in postmenopausal women, but they increase the risk of sexual dysfunction.
Calcium supplements can reduce PMS but have absolutely no ability to improve sexual function beyond the fact that women with less severe PMS might be able to be more sexually active. So until a PMS supplement, like vitex (which has serious quality control issues in the United States), shows some consistent impact on FSD, I cannot recommend them like other doctors do. I think the idea that what works for one thing must work for the other is a bit demeaning to women and the field of FSD research—so this is one bandwagon I won’t be jumping on!
I’m going to skip this bandwagon as well. The studies for ginkgo and FSD have been very weak and controversial. I realize that the dietary supplement ArginMax (see #2) has ginkgo in it, but I don’t believe it’s the active ingredient because gingko has shown minimal to no activity in past studies of sexual dysfunction.
These sound good because they can contain precursors or compounds that resemble human hormones that impact sexual health—such as DHEA (dehydroepiandrosterone), estrogen, or testosterone—but the body isn’t able to convert them into the actual hormones. The research with these products is very weak as a result.
Plant estrogens (a.k.a. phytoestrogens), such as soy, flaxseed, and red clover
Having low estrogen can result in a dramatic reduction in bloodflow to the clitoris, vagina, and even the urethra, and it can cause the tissue in these areas to thin. The problem with calling these products “plant estrogens” is that they are so weak. Most clinical trials with these compounds do not show any changes in estrogen.
If you are excited to take yohimbe, please look at the Erectile Dysfunction section to see why many of the yohimbe products are a scam and why they are not safe in general.
What Lifestyle Changes Can Help With Female Sexual Dysfunction?
Heart healthy = sexually healthy! The following heart-healthy habits can improve or prevent some forms of FSD.
- Exercise for at least 30 minutes or more every other day; try to break a sweat.
- Lose weight or maintain a healthy weight.
- Reduce your overall caloric intake by 100 to 200 calories per day if you need to drop pounds.
- Increase your intake of high-quality protein from lean, grass-fed beef; fish; eggs; or even whey, soy, and brown rice protein powders.
- Increase your intake of monounsatu-rated fats and omega-3s from plants (do this with flaxseed, chia seeds, or heart-healthy cooking oils, such as
- canola, olive, and safflower).
- Get 20 to 30 grams per day of fiber.
- Eat at least two servings of fatty, omega-3-rich fish daily.