News & Perspectives

The Viagra Alternative

Walk into any health-food store and you'll find countless products that purport to enhance your sex life: Passion Blend, Man Power, Super Sex, the list goes on. But do these products work? And how do they compare with that hugely popular little blue pill, Viagra?

The drug Viagra has proved a best-seller for a good reason: For many people, it's effective. Despite side effects such as headaches and anecdotal reports of possible links to heart attacks, it has helped millions. And although it's prescribed for impotence, or erectile dysfunction, in men, some ongoing studies are aimed at women as well. One, at the Women’s Sexual Health Clinic at Boston University School of Medicine, suggests that Viagra does indeed improve female sexual response.

While there's no doubt that popping a pill is convenient, sexual dysfunction is a complex issue, with many causes and manifestations. And doctors caution against taking a quick-fix approach to symptoms that are often part of a bigger problem. "The critical thing is to address the underlying cause," says naturopathic physician Michael Murray, N.D., of Bastyr University in Seattle.

According to the 1994 Massachusetts Male Aging Study, age-associated impotence is frequently tied to chronic illnesses, such as arteriosclerosis ("hardening of the arteries"), hypertension, diabetes, and depression. And researchers at the Women’s Sexual Health Clinic say many of the same diseases affect female sexual function as well. Other causes include prostate enlargement (in men); endometriosis, fibroids, and PMS (in women); and age-related declines in hormone levels in both sexes. Sexual dysfunction is also a common side effect of many prescription and over-the-counter drugs, including those for depression, high blood pressure, insomnia, and allergies.

If you’re concerned about sexual problems, a good place to start is to review your overall health and current medications with your doctor. It's also essential to address any psychological or relationship issues through counseling or other forms of therapy. Exercise, a healthy diet, less stress, and a daily multivitamin can also go a long way toward preventing problems. "If you take good care of yourself by protecting your blood vessels and nervous system, the likelihood is sexual function can be preserved in both men and women," notes Steven Lamm, M.D., author of The Virility Solution.

Herbal jump-start
"Treating the primary cause should improve symptoms," says Dr. Lamm, "but it will do nothing in one night." While Viagra is often effective and fast acting--it typically boosts blood flow within 30 minutes to several hours--some people prefer non-drug alternatives. Several interesting supplements have recently come to light and may provide benefits within days to weeks, thereby improving outlook. Unfortunately, studies of their effects on sexual response are limited--especially in women.

The herb ginkgo biloba, commonly taken as a memory booster, may provide benefits. It presumably acts by enhancing blood flow and seems relatively free of side effects. In a pilot study at the University of California at San Francisco, ginkgo reversed sexual problems in 84% of men and women who were taking antidepressant drugs such as Prozac. A larger trial is under way.

Another promising supplement is the heart-healthy amino acid arginine, which also enhances blood flow. In a study of 50 men at Tel Aviv University, 31% of those with impotence improved after six weeks of taking arginine, versus only 9% with a placebo. (As with Viagra, you should avoid arginine if you are taking the heart medication nitroglycerin, because the combination may cause a dangerous drop in blood pressure. For the same reason, you should probably not take arginine with Viagra.)

The supplement DHEA may also provide benefits in men and women who have low levels of this hormone. DHEA helps our bodies make estrogen and testosterone, and a recent trial at the University of Vienna found it helped men with impotence.

Additional herbs that have shown some benefit in small studies include the stress reliever Panax ginseng and the hard-to-find Brazilian herb Muira puama. In a study at Yonsei University College of Medicine in Korea, 60% of men who took Panax ginseng were better able to achieve an erection, versus 30% in those who took a placebo; in animals, the herb appears to boost testosterone levels. And at the Institute of Sexology in Paris, more than half of men who took Muira puama responded positively within two weeks.

Finally, many potency formulas contain the African tree bark yohimbe, which some studies have shown may correct impotence and possibly heighten libido. However, this herb can cause a dangerous rise in blood pressure, as well as anxiety and other side effects. Many doctors prefer the purified form of the herb, the FDA-approved drug yohimbine, instead, because it has a guaranteed purity and potency.

Additional remedies
Other popular but unproved therapies that may provide a boost for sexual function include aromatherapy (vanilla for confidence; rose for mood), hypnosis, meditation, acupuncture, and homeopathy. In a recent study from the Netherlands, twice-weekly acupuncture relieved impotence in 39% of men after four weeks. Off-the-shelf homeopathic remedies such as Vigorex, an ultra-diluted solution of oats (Avena sativa) that is thought to free up testosterone, are also popular, though expert Dana Ullman, M.P.H., advises that people see a professional homeopath to get individually tailored remedies.

Passion potions
Can Super Sex, Biagra, or any of the countless other high-priced passion potions and aphrodisiacs sold at health-food stores or pharmacies restore your sex drive? Probably not. Many contain a long list of ingredients, some of dubious value. Check the label carefully to make sure the product delivers an adequate dose of natural compounds that have been shown to help (see chart below). "Unless it has a sufficient amount of the active ingredient, the product is not likely to be effective," says Dr. Murray.

Instead of a blend, you may be better off buying an individual ingredient tailored to your particular condition. Allow at least several weeks to see if it works for you.

In search of that lovin' feelin’

Who Might Benefit? Men or women who have circulatory disorders that may be contributing to sexual problems; boosts blood flow.
Suggested Dose 1 gram 3 times a day; sold as L-arginine.

Who Might Benefit? Men or women with low levels of this hormone, as determined by doctor; helps the body make estrogen and testosterone.
Suggested Dose 5 mg each morning for women; 10 mg for men; increase dose if doctor advises.

Ginkgo biloba
Who Might Benefit? Sometimes recommended for men or women on Prozac or other antidepressants; boosts blood flow.
Suggested Dose 80 mg 3 times a day, standardized to contain 24% flavone glycosides and 6% terpene lactones.

Ginseng (Panax)
Who Might Benefit? Men with impotence. May also benefit men or women with stress-induced loss of libido.
Suggested Dose 100 to 250 mg twice a day, standardized to contain at least 7% ginsenosides.

Muira puama
Who Might Benefit? Called potency wood in Brazil; only one small study in men has been conducted to date.
Suggested Dose As tea, 1 tsp. dried herb per cup of water each morning.

Who Might Benefit? May boost blood flow, but has serious side effects.
Suggested Dose Opt for the prescription drug yohimbine instead. See your doctor.

Additional herbs:
Avena sativa (oat extract, said to free up testosterone); damiana (Mayan herb that may boost blood flow); guarana (caffeine-rich soda imported from Brazil); maca (Peruvian herb used for menopause and impotence); tribulus (possible testosterone and libido booster). Little or no research has been done on these herbs. An appropriate dose cannot be determined at this time.

Further reading: Stephen Lamm, M.D., The Virility Solution (Fireside, 1999); Marc Bonnard, M.D., The Viagra Alternative (Healing Arts Press, 1999)

Date Published: 04/30/2002
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