December 2004
By Ellen Kamhi PhD RN

Ellen Kamhi, Ph.D.,R.N. , The Natural Nurse®, is the author of several books, including The Natural Guide to Great Sex . She is an appointed clinical instructor in the Department of Family Medicine at Stony Brook University, a professional herbalist for Nature’s Answer in Hauppauge, N.Y., and lectures to pharmacists and consumers nationally.

An aphrodisiac arouses or intensifies sexual desire. The word probably originated in the early 18th century, gleaned from the Greek, Aphrodisiakos- arousing sexual desire, and Aphrodite-the goddess of sexual love.

A variety of nutritional supplements are safe and effective libido boosters. Some of these have undergone scientific scrutiny to investigate their pharmacological mechanisms of action. Others have stood the test of time afforded by long time traditional use.

Humankind’s quest for substances that increase both the pleasure and potency of sexual encounters spans the ages. In civilizations past and present high honors and awards have been given to ‘healers’ (or drug companies) who have been able to produce effective sexual stimulants.

Aphrodisiacs work in several ways. They may directly increase the physical desire to have sex, stimulate the strength and endurance of an erection in men, and increase lubrication and genital sensitivity in women. There are very few substances that are scientifically proven to do this on a consistent basis. Most supposed aphrodisiacs act as tonics, increasing virility over time, usually by supplying nutrients which feed the glands and organs. Others may relate more to psychological and mind/body interactions.
Following, is a discussion of several natural substances that both ancient shamans and modern scientists credit with the ability to enhance sexuality.

Arginine

Arginine is an amino acid found in meat, nuts, eggs, coconut milk and cheese. It has many important functions in the body, including the formation of nitric oxide, which increases blood flow to the genitals. Arginine is touted as an ‘anti-aging’ factor due to its ability to increase strength and lean muscle mass. It has been shown to increase sperm motility and male fertility, and may be useful for erectile dysfunction. In women, Arginine, combined with other supplements, has been found to enhance sexual desire, reduce vaginal dryness, increase the frequency of intercourse and orgasm, and improve clitoral sensation and sexual arousal. 4 , 5 The dosage of arginine can vary from 500-3000 mg twice per day. There are occasional reports of gastrointestinal upset and diarrhea. With higher doses, Arginine is suspected of causing herpes outbreaks in infected individuals.
Damiana (Turnera aphrodisiaca)
Damiana has a long history of use as an herbal medicine in Mexico, dating back to the ancient Aztec and Mayan civilizations. Damiana extract contains several chemical constituents, such as flavone glycosides and p-arbutin 6, as well as the phytosterol, beta-sitosterol. Damiana extract binds to progesterone receptors, 7 which may have some connection to its use as a sexual enhancer. Damiana has been hailed as a helpful tonic for the digestive system, 8 as well as for its ability to tone the mucous membranes of reproductive organs. The species name “aphrodisiaca”, refers to the most renown, although not scientifically proven, use of this herb; as a sexual stimulant for both sexes. Damiana was listed in the National Formulary (1888-1947) for menstrual difficulties including headache, acne, insufficient flow, delayed menstruation in adolescent girls, irritability and lack of sexual desire. In Jamaican folk medicine, it is called “Ram Goat Dash Along”, because when male goats eat it, their libido appears to increase dramatically! The dose of a liquid Tincture/Extract is 10- 20 drops 3 times/day, or 300- 500 mg capsules 2 to 3 times per day. No cautions have been noted for the use of this herb, except an occasional slight laxative effect.

Deer Antler Velvet
Deer Antler Velvet has been prized in Chinese medicine for its use as a sexual stimulant, as well as a tonic. A 2000 year old silk scroll describes the use of deer antler as a remedy for over 50 illnesses. It is considered one of the strongest ‘yang’, or ‘male energy’ tonics. Yang energy is an important aspect of sexuality and libido in both men and women, as well as a primary indicator of overall health, strength and vitality. While deer antler velvet does not act as an immediate sexual stimulant it has been shown to have adaptogenic effects, enhancing overall strength and endurance, and decreasing muscle fatigue. 9 Deer Antlers are high in IGF-1 (insulin growth factor). 10 Maintenance of sufficient IGF-1 is linked to “anti-aging” factors in humans, including enhanced physical activity, muscle function, and testosterone and DHEA levels. 11 Deer Antler is high in amino acids, including arginine and the branched chain amino acids valine, leucine and isoleucine, needed for growth of muscle fibers. Scientific studies show that deer antler is useful for anemia, by increasing hemoglobin, as well as the number of red blood cells, 12 which supports energy and vitality. Deer antlers regenerate yearly 13, and undergo extremely active mitotic growth. One hypothesis of deer antler’s sexual enhancing effects, is that these quickly regenerating cells may act in a similar manner to stem cells, and provide ‘young and rejuvenating’ cellular substance to the body. Measurement of the proliferating cell nuclear antigen (PCNA) found that the entire antler is in a state of growth and renewal, especially the keratinocytes that make up the basal cell layer of the epidermis that forms the deer antler velvet. 14 Deer antler velvet contains several components that support the growth of healthy joint tissue, including several glycosaminoglycans such as chondroitin sulfate, keratin sulfate, hyaluronic acid, and dermatan sulfate. 15 The dosage is 500mg-1000 mg/ day. The only known caution is the possibility of mild stomach upset with larger than usual doses of this supplement.

Fenugreek ( Trigonella Foenum-Graceum)

Fenugreek has been recognized as a medicinal plant for centuries. The Egyptians, Greeks and Romans used the aromatic seeds extensively. It was a stable included in the diet of Harem woman to increase the size and roundness of their breasts, and is currently being promoted in several herbal ‘bust enhancing’ products. 16 Studies support the practice of modern midwives, as they continue the ancient tradition of recommending fenugreek to improve the milk supply of nursing mothers. 17 ,18 Traditional Chinese herbalists used fenugreek for male reproductive issues and kidney problems. 19 It is interesting to note that in Chinese medicine the kidneys are considered to be the area where sexual energy is stored. Fenugreek lowers blood sugar, 20 ,21 probably by increasing tissue insulin sensitivity. 22 The rich combination of nutrients in Fenugreek include the steroidal saponin diosgenin, 23 choline , trimethylamine (a sex hormone in frogs), Vitamins A, B 2, B 6, B 12, D, and essential oils. Diosgenin is an important precursor for the synthesis of a number of sex hormones, and also exhibits estrogenic effects.24 The aromatic compounds in the fenugreek seeds have a maple-syrup like odor, which freshens the breath; an added advantage in sexual encounters. The dosage of fenugreek in tea is 1 tsp. seed in 1 cup hot water, steeped for five minutes, 1-3 cups/day. In a liquid tincture or extract, the dose is 10-15 drops two times per day, or one 500 mg capsule two times per day. Although no adverse effects are known, if too much is used during nursing, the urine of mother and child may start to have a maple syrup odor, and could potentially lead to a misdiagnosis of ‘maple syrup urine disease.’ Fenugreek contains coumarin-like substances, and should be used with caution along with heparin, warfarin and other anti-coagulants.25 Due to its blood sugar lowering effects, using fenugreek may require a dose adjustment with glipizide and insulin.
Ginseng (Panax ginseng)
The name ‘ginseng’ refers to several plant species. The two most common are Panax Ginseng- called Chinese or Korean Ginseng and Panax quinquefolius- American Ginseng. Chinese and Korean ginseng are actually the same plant species, but differ in the preparation of the root. Korean ginseng is cooked, which turns the root a deep red. It is considered ‘hot ginseng’ and is the most stimulating form. “Panax” is derived from the Greek word ‘panacea’ due to the wide range of healing effects attributed to this root. Ginseng confers a youthful vigor to men and women alike. The human-shaped root was called ‘man with thighs spread apart’ by Native Americans. The ancient use of ginseng as a sexual stimulant is collaborated by recent studies. The jJournal of Urology reports that the “Mean International Index of Erectile Function scores were significantly higher in patients treated with Korean red ginseng than in those who received placebo.” 26 While ginseng ingestion appears to have no immediate effect on testosterone levels, 27 other possible mechanisms of action include the pharmacologically active component, ginsenoside-Rb1, which increases the secretion of luteinizing hormone(LH) by acting directly on the anterior pituitary gland. 28 The LH receptor plays an important role in both male and female fertility, and in male sexual development. 29 In addition, nitric oxide may be involved in the mechanism of action of ginsenosides on both the central nervous system and gonadal tissues, leading to increased copulatory performance and libido in animal studies. 30 Overall, there is abundant anecdotal and scientific support for the use of ginseng as a sexual enhancer. The usual dose of ginseng is 500-1000 mg/day. Cautions include “Ginseng Over Use Syndrome” which may produce symptoms of insomnia, irritability, anxiety, and heart palpitations. This effect is rare, and most often seen in young men using higher than recommended levels of ginseng. Ginseng use should be monitored by a physician in patients using warfarin, ticlopidine and other blood thinning medications, because it may enhance the blood thinning effects of these medications. 31

(Ho/He) Shou Wu (Polygonum multiflorum)
Ho Shou Wu is usually called Fo-Ti in the US. In China, it is revered for its mysterious properties of rejuvenation and anti-aging, and has been used for over 1000 years as a ‘royal tonic’ that nourishes the blood, cleanses the liver and kidneys and enhances sexuality and fertility in both women and men. According to legend, it has the unique ability to return grey hair to its natural color. The name He Shou Wu translates to ‘Mr. He’s Black Hair tonic’. While there are no studies on this cosmetic ability, Polygonum has been shown to improve cognitive function in mice, 32 protect heart tissue from oxidative damage, 33 and has been determined to have surprisingly high estrogen activity, which may account for its reported sexually rejuvenating effects. 34 The typical recommended dosage of Fo ti is 4-8 grams per day, which equals 4-8 ml of a (1:1) fluid extract. Fo ti may have a slight laxative effect, which can be reduced by lowering the dose. One case of possible liver toxicity has been reported. 35

Lychii Fruit (Lycium barbarum)

Lychii fruit, also called Wolfberry, and Go-Qi-Zi, has traditionally been used in China for thousands of years for its rejuvenating effects on sexuality and fertility. Lychii is a small red berry which is dried and prepared as a tea. Scientific studies have found that polysaccharides found in Lychii fruit protect both male and female sex organs from free radical damage. 36 ,37 In addition to protection of sexual tissue, Lycium barbarum polysaccharide-protein complex (LBP(3p)) has been shown to increase the expression of interleukin-2 and tumor necrosis factor-alpha in a dose-dependent manner in human mononuclear cells, 38, and eliminate fatigue, increase adaptability to an exercise load and enhance resistance. 39 All of this modern evidence supports the ancient chinese use of this tangy, delicious fruit for its sexually invigorating and anti-aging properties. The usual dosage is ¼- ½ cup of Lychii berries soaked in one cup warm water/ day. Although adverse reactions are rare, there is one reported case of a possible interaction between warfarin and Lycium barbarum L. 40 Lychii should be avoided during pregnancy and nursing, because it contains betaine, which may act as an abortifacient.
Maca (Lepidium meyenii)
Maca is a cruciferous vegetable like Kale and Broccoli, that grows in the Andes Mountains in Peru. Native people dig up the root-like tuber and brew it into a strong drink. Both men and women partake of this brew shortly before going off in couples for connubial enjoyment. Incan warriors used maca before battle to increase strength and endurance. Laboratory studies have shown a significant increase in sexual function in rodents. 41 Maca is high in essential fatty acids, minerals such as phosphorus, calcium, magnesium and zinc, along with vitamins B, C and E, various phytosterols, and other nutritional factors known for their importance to sexual function. The usual dosage is 300 mg- 500 mg per day. There are no reports of adverse effects.

Yohimbe (Pausinystalia yohimbe)

Yohimbe is derived from bark stripped from a tall evergreen West African tree. Yohimbine, the primary active constituent of yohimbe, is available as a prescription drug, yohimbine hydrochloride, used for erectile dysfunction in men. 42 ,43 Yohimbine’s mode of action includes blocking alpha-2 adrenergic receptors 44 and increasing dilation of blood vessels. Both of these processes are involved in achieving and maintaining an erection. The herbal form of yohimbe, has been used traditionally as a sexual stimulant, and has been shown to have similar mechanisms of action as the drug. 45 Dosage is important with this herb. A safe amount is 15-20 mg/ day. Follow label product directions carefully. Do not use with kidney or liver disease, high blood pressure, or heart arrhythmias. Possible side effects include anxiety, increased blood pressure, and heart palpitations. 46 These side effects are infrequent and reversible. It is interesting to note that some people who experience adverse effects with the herbal extract have no problem taking the prescription drug! Yohimbine can block the action of the drug brimonidine thus reducing its effectiveness in treating glaucoma. 47

Other supplements that are enjoying use as aphrodisiacs, although they have very little or no scientific documentation, include Horny Goat Weed (Epimedium grandiflorum), Muira Puama (Ptychopetalum olacoides), Oats (Avena sativa), Quebracho(Aspidosperma quebracho-blanco), Tribulus (Tribulus terrestes) and Zallouh (Ferulis harmonis).

1. Elam RP. Morphological changes in adult males from resistance exercise and amino acid supplementation. J Sports Med Phys Fitness 1988;28:35–9.
2. Scibona M, et al. L-arginine and Male Infertility. Minerva Urol Nefrol. Dec1994;46(4):251-53.
3. Stanislavov R, Nikolova V. Treatment of erectile dysfunction with pycnogenol and L-arginine. J Sex Marital Ther. 2003 May-Jun;29(3):207-13
4. Meston CM, Worcel M., The effects of yohimbine plus L-arginine glutamate on sexual arousal in postmenopausal women with sexual arousal disorder. Arch Sex Behav 2002 Aug;31(4):323-32
5. Ito TY, Trant AS, Polan ML. A double-blind placebo-controlled study of ArginMax, a nutritional supplement for enhancement of female sexual function. J Sex Marital Ther. 2001 Oct-Dec;27(5):541-9
6. Piacente S, Camargo EE, Zampelli A, et. al., Flavonoids and arbutin from Turnera diffusa., Z Naturforsch [C]. 2002 Nov-Dec;57(11-12):983-5.
7. Zava DT, Dollbaum CM, Blen M. Estrogen and progestin bioactivity of foods, herbs, and spices. Proc Soc Exp Biol Med 1998;217:369–78.

8. Gracioso Jde S, Vilegas W, Hiruma-Lima CA, et. al., Effects of tea from Turnera ulmifolia L. on mouse gastric mucosa support the Turneraceae as a new source of antiulcerogenic drugs., Biol Pharm Bull. 2002 Apr;25(4):487-91.

9. Gerrard DF, Clinical evaluation of New Zealand deer velvet antler on muscle strength and endurance in healthy male university athletes. Agsearch Invermay. New Zealand. 1989:31

10. Elliott JL, Oldham JM, Ambler GR, et. al., Receptors for insulin-like growth factor-II in the growing tip of the deer antler. J Endocrinol 1993 Aug;138(2):233-242

11. Bonnefoy M, Patricot MC, Lacour JR, et. al. Relation between physical activity, muscle function and IGF-1, testosterone and DHEAS concentrations in the elderly. Rev Med Interne. 2002 Oct;23(10):819-27

12. Kim, K. W. and S. W. Park. 1982. A study of the hemopoietic action of deer horn extract. Korean Biochem. J. 15: 151-157.

13. Allen SP, Maden M, Price JS. A role for retinoic acid in regulating the regeneration of deer antlers. Dev Biol. 2002 Nov 15;251(2):409-23.

14. Matich J, Basford Nicholson LF. Et. al. Mitotic activity in the growing red deer antler. Cell Biol Int. 2003;27(8):625-32.

15. Sunwoo, H. H., Nakano, T. and Sim, J. S. 1997. Effect of water soluble extract from antlers of wapiti (Cervus elaphus) on the growth of fibroblasts. Can. J. Anim. Sci. 77:343-345.

16. Fugh-Berman A., “Bust enhancing” herbal products. Obstet Gynecol. 2003 Jun;101(6):1345-9.

17. Tiran, D. The use of fenugreek for breast feeding women. Complement Ther Nurs Midwifery. 2003 Aug;9(3):155-6.

18. Gabay MP. Galactogogues: medications that induce lactation. J Hum Lact. 2002 Aug;18(3):274-9.

19. Basch E, Ulbricht C, Kuo G, et. al. Therapeutic applications of fenugreek. Altern Med Rev. 2003 Feb;8(1):20-7.

20. Thompson Coon JS, Ernst E. Herbs for serum cholesterol reduction: a systematic view. J Fam Pract. 2003 Jun;52(6):468-78

21. Devi BA, Kamalakkannan N, Prince PS. Supplementation of fenugreek leaves to diabetic rats. Effect on carbohydrate metabolic enzymes in diabetic liver and kidney. Phytother Res. 2003 Dec;17(10):1231-3.

22. Puri D, Prabhu KM, Murthy PS., Mechanism of action of a hypoglycemic principle isolated from fenugreek seeds. Indian J Physiol Pharmacol. 2002 Oct;46(4):457-62.

23. Taylor WG, Zulyniak HJ, Richards KW, et. al, Variation in diosgenin levels among 10 accessions of fenugreek seeds produced in western Canada. J Agric Food Chem. 2002 Oct 9;50(21):5994-7

24. Aradhana. Rao AR. Kale RK. (1992) Indian Journal of Experimental Biology, 30(5):367-70.

25. Miller LG, Murray WJ, eds. Herbal Medicinals: A Clinician’s Guide. New York: Pharmaceutical Products Press, 1999, 313–5.

26. Hong B, Ji YH, Hong JH et. al. A double-blind crossover study evaluating the efficacy of korean red ginseng in patients with erectile dysfunction: a preliminary report, Journal of Urology, 2002, Nov;168(5):2027-3

27. Youl Kang H, Hwan Kim S, Jun Lee W, et.al. Effects of ginseng ingestion on growth hormone, testosterone, cortisol, and insulin-like growth factor 1 responses to acute resistance exercise. J Strength Cond Res. 2002 May;16(2):179-83.

28. Tsai SC, Chiao YC, Lu CC, et. al., Stimulation of the secretion of luteinizing hormone by ginsenoside-Rb1 in male rats. Chin J Physiol. 2003 Mar 31;46(1):1-7

29. Laue L, Wu SM, Kudo M 1996 Heterogeneity of activating mutations of the human luteinizing hormone receptor in male-limited precocious puberty. Biochem Mol Med 58:192-198

30. Murphy LL, Lee TJ. Ginseng, sex behavior, and nitric oxide. Ann N Y Acad Sci. 2002 May;962:372-7.

31. Janetzky K, Morreale AP. Probable interaction between warfarin and ginseng. Am J Health Syst Pharm 1997;54:692

32. Chan YC, Wang MF, Chang HC. Polygonum multiflorum extracts improve cognitive performance in senescence accelerated mice. Am J Chin Med. 2003; 31(2): 171-9.

33. Yim TK, Wu WK, Pak WF, et. al., The radical scavenging effects of stilbene glucosides from Polygonum multiflorum. Arch Pharm Res. 2002 Oct; 25(5): 636-9.

34. Oerter Klein K, Janfaza M, Wong JA, et. al. Estrogen bioactivity in fo-ti and other herbs used for their estrogen-like effects as determined by a recombinant cell bioassay. J Clin Endocrinol Metab. 2003 Sep;88(9):4077-9

35. Park GJ, Mann SP, Ngu MC., Acute hepatitis induced by Shou-Wu-Pian, a herbal product derived from Polygonum multiflorum. J Gastroenterol Hepatol 2001 Jan;16(1):115-7

36. Wang Y, Zhao H, Sheng X , et al., Protective effect of Fructus Lycii polysaccharides against time and hyperthermia-induced damage in cultured seminiferous epithelium., J Ethnopharmacol 2002 Oct;82(2-3):169-75

37. Zhang B, Zhang X, Li W., The injury of Xenopus laevis oocytes membrane and its acetylcholine receptor by free radical and the protection of lycium barbarum polysaccharide, Zhongguo Ying Yong Sheng Li Xue Za Zhi 1997 Nov;13(4):322-5

38. Gan L, Zhang SH, Liu Q, Xu HB. A polysaccharide-protein complex from Lycium barbarum upregulates cytokine expression in human peripheral blood mononuclear cells. Eur J Pharmacol. 2003 Jun 27;471(3):217-22.

39. Luo Q, Yan J, Zhang S. Isolation and purification of Lycium barbarum polysaccharides and its anti-fatigue effect , Wei Sheng Yan Jiu. 2000 Mar 30;29(2):115-7.

40. Lam AY, Elmer GW, Mohutsky MA. Possible interaction between warfarin and Lycium barbarum L. Ann Pharmacother. 2001 Oct;35(10):1199-201.

41. Bo Lin Zheng, Kan He, Calvin Hyungchan Kim, et al., Effect of a lipidic extract from Lepidium meyenii on sexual behavior in mice and rats, Urology, April 2000, Vol 55: 4,598-602

42. Pushkar’ DIu, Segal AS, Bagaev AG, et. al. Yohimbine in the treatment of erectile dysfunction. Urologiia. 2002 Nov-Dec;(6):34-7

43. Ernst E, Pittler MH. Yohimbine for erectile dysfunction: A systematic review and meta-analysis of randomized clinical trials. J Urol 1998;159:433–6

44. Goldstein DS, Grossman E, Listwak S, et. al., Sympathetic reactivity during a yohimbine challenge test in essential hypertension. Hypertension. 1991 Nov;18(5 Suppl):III40-8

45. Ajayi AA, Newaz M, Hercule H, et. al., Endothelin-like action of Pausinystalia yohimbe aqueous extract on vascular and renal regional hemodynamics in Sprague Dawley rats. Methods Find Exp Clin Pharmacol. 2003 Dec;25(10):817-22

46. Blumenthal M, Busse WR, Goldberg A, et al. (eds). The Complete Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, MA: Integrative Medicine Communications, 1998, 382–3

47. Berlan M, LeVerge R, Galitzky J, LeCorre P. Alpha 2-adrenoceptor antagonist potencies of two hydroxylated metabolites of yohimbine. Br J Pharmacol 1993;108:927–32.