Ashwagandha, Ginseng, and Maca Root for Female Sexual Dysfunction

DHEA supplements don’t seem to help with female sexual dysfunction, but what about other dietary supplements, such as the three roots: ginseng, maca, and ashwagandha? Ginseng has been suggested, given its demonstrated efficacy for male erectile dysfunction and the fact it causes a relaxation response in vitro to isolated strips of rabbit vaginal tissue. But when put to the test in human studies, a meta-analysis found no statistically significant effect of ginseng on female sexual dysfunction.

Maca root has been advertised as Peruvian Viagra. It’s an important dietary staple of the indigenous people of Peru but appears to have been overly hyped as a libido enhancer based largely on studies of male rodents. Yes, maca seems to enhance the sexual function of male mice and rats, but of the two trials on sexual desire in male humans, only one showed a significant benefit, but it took eight weeks to show an effect, which may explain the negative results of the second study, which only lasted two weeks. A pilot study without a placebo control on the management of sexual dysfunction induced by SSRIs (due to drugs like Prozac or Zoloft) on mostly women suggested maca may be useful, but when properly put to the test in a randomized, double-blind, placebo-controlled trial, it failed to have a significant effect.  The necessity of placebos is illustrated by a maca trial for infertility. Maca increased sperm concentration by 40%! Yeah, but the placebo in the study improved sperm concentration by 76%, so maca didn’t work after all.

Having placebo controls is particularly important for female sexual dysfunction, since based on studies of almost 4,000 women, the placebo effect accounts for more than two-thirds of the treatment effect, similar to the placebo efficacy of antidepressants. In contrast, improvement rates for erectile dysfunction in men given placebos are on the order of 15% or less. The thought is that just the act of consistent self-monitoring in female sexual dysfunction trials, for example by being asked to keep a symptom diary, may improve symptoms by heightening the participant’s attention and awareness of her own responses and behaviors even in lieu of an active treatment.

There was one small randomized double-blind placebo-controlled trial of maca for sexual dysfunction in postmenopausal women. Fourteen women were randomized to about ¾ of a teaspoon of maca powder or a placebo powder every day for six weeks, after which point they switched, for another six weeks. While on the real maca they reported significantly fewer symptoms of sexual dysfunction.

Ashwagandha is a revered herb of the traditional Indian Ayurvedic system of medicine. Its name comes from ashwa which means “horse” and gandha which means “smell,” because the roots evidently possess the “distinctive smell of a wet horse.” Ashwagandha is used as a household remedy in India where it’s been considered a rasayana—“rejuvenator” or “tonic”—for thousands of years, earning it the nickname of Indian ginseng.

After being fed the root, rodents thrown into the deep end swim twice as long before sinking (12 hours versus 6 hours). Benefits for physical performance (including an increase in aerobic fitness) have been found in people too. One study demonstrated evidence of cognitive benefit as well. Its Latin name, Withania somnifera points to another use (somnifera means “sleep-inducer”). A meta-analysis of five randomized controlled trials of ashwagandha extracts found a small but significant effect on overall sleep.

What about ashwagandha and female sexual function? Women ages 21 thorough 50 were randomized to two months of the estimated equivalent of three grams of ashwagandha root powder and did not have an increase in sexual desire, but they did show improvements over placebo in arousal, lubrication, orgasm, and satisfaction, translating into an additional quote-unquote “successful sexual encounter” by the end of the study. What are the downsides?

Ashwagandha belongs to the nightshade family, which includes some shady characters like tobacco and, well, deadly nightshade. There have been rare cases of ashwagandha-linked liver toxicity reported, though commercial herbal supplements are often mislabeled, so it’s hard to definitively attribute certain cases. However, there have been several liver injury cases in which the supplements have been tested and found to be contaminant-free, suggesting that ashwagandha-induced liver toxicity is a real phenomenon, however rare. What should we expect from a plant known by its other nickname, poison gooseberry.