Flashback Friday: Are Apples the Best Food for a Better Sex Life in Women?

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

“The creation and promotion of ‘female sexual dysfunction'” as a mental disorder seems like “a textbook case of disease mongering by the pharmaceutical industry” harkening back to the first DSM, psychiatry’s diagnosis manual, which listed “frigidity” as a mental disorder, along, of course, with homosexuality. The latest manifestation is “hypoactive sexual desire disorder,” a disease invented by drug companies. It’s like when Prozac was about to go off patent, “the company sponsored the creation of” a new mental illness to market a drug called Sarafem, which was simply Prozac repacked into a pink capsule. “The condition previously known as shyness was…branded as ‘social anxiety disorder'” so they could get kids on Paxil.

“There are certainly women who are troubled by low libido, but there is no reliable scientific evidence that hypoactive sexual desire disorder is a real medical condition.” And, women can get diagnosed with it even with a normal libido. “A woman highly interested in sex, just not [for whatever reason] with her current partner, can still qualify for [the] diagnosis”—and the drug. Even a woman who is perfectly satisfied with her sex life “may still qualify if her partner [isn’t].”

Our story begins in 2009, when a drug company tried to get “a failed antidepressant” called flibanserin approved “to treat hypoactive sexual desire disorder.” Only problem? It didn’t work. It was resubmitted again after more study, and was still rejected, as was the appeal. But, in 2015, the FDA approved the drug. “What changed? Nothing about [its] efficacy.” It didn’t work any better. What changed is that the drug company that bought it “helped launch an [astroturf fake grassroots] advocacy group, “Even the Score,” which lobbied for approval under a feminist rubric.

“Men have their drugs.” Why don’t women get any sex drugs, which was exposed as kind of a bitter irony. But hey, “within 48 hours of FDA approval, [the drug] was sold for [a cool] billion in cash. Very satisfying for the drug company, “but what about the women who take” the drug (sold now as Addyi)? Not much. The drug just doesn’t work as advertised.

Yes, it may stimulate monkeys to groom each other more. But, when researchers dug up the unpublished data about the drug, any clinical benefit was found to be “marginal,” and the drug was found to have significant adverse side effects. “Besides being ineffective…, [it can be] dangerous.” “[C]ombining [it] with alcohol can cause dangerous hypotension and [fainting]—problems so serious that the FDA put a black box warning, its most serious safety alert, on the label [that, of course, no one reads].” “Even without alcohol, [it] can cause severe drops in blood pressure levels and [cause] sudden prolonged unconsciousness. Now, serious side effects “might be acceptable in [some kind of] cancer [wonder] drug or something, but “are entirely unacceptable in a drug given to healthy women for an invented condition.”

Are there any safe and natural solutions? Well, there’s lots of studies on diet and men’s sexual health, but what about women’s? I’ve previously explored the evidence about women with high cholesterol levels reporting diminished sexual function across a number of dimensions. This could explain why a more plant-based diet, rich in a variety of whole plant foods, “might be effective in ameliorating sexual function [issues] in women,” as it is in men. More whole grains, beans, vegetables, and fruit, and less meat, dairy, and sugar “associated with a reduced risk of [erectile dysfunction],” because the anatomy and physiology of sexual responses are actually quite similar between the two. You can measure clitoral engorgement with fancy MRI techniques within minutes of exposure to an erotic video.

And, we now know lubrication is all about blood flow, too. “Within the sexually-aroused vagina,” it’s the hydrostatic pressure from all the additional pelvic blood flow that forces fluid “to leak [out] onto the surface…as the vaginal lubrication.”

So, how can we improve blood flow? Well, the flavonoid phytonutrients in cocoa can help open up arteries, increasing pulse wave amplitude from this at baseline to this, after drinking cocoa for four days, peaking at about 90 minutes after consumption.

So, can that Valentine’s Day chocolate make a difference? Women who eat chocolate do tend to have higher female sexual function index scores, but the effect disappeared once age was taken into account. So: “Despite all the potential biological mechanisms supporting a role for chocolate as an aphrodisiac food,” the study failed to show a benefit. One would assume that chocolate could improve blood flow, but remember that was with cocoa powder. Maybe the fat and sugar in chocolate is counteracting the benefits. What are some whole-food sources of flavonoids? Well, onions have a lot. Indeed, “fresh onion juice enhanced copulatory behavior…in…rats,” but for those of us less interested in increasing “the percentage of ejaculating rats,” and looking for something other than onion juice for our hot date, how about that apple?

But, “there [wasn’t] a study addressing the potential correlation between daily apple consumption and women’s sexual function”… until, now. The title kind of gives it away, but women were split into regular daily apple consumers versus those consuming less than an apple a day, and the hundreds of apple eaters in the study scored “significantly higher” on the female sexual function index.

Now, note they only included women eating unpeeled apples, because the phytonutrients are concentrated in the peel. So, we don’t know if there’s a link with peeled apples. And, this was just an observational study, so “further studies will be necessary to clarify…the relationship between apple intake
 and female sexuality.” “However, the present data can allow the development of future research for identifying new compounds and food supplements to use in female sexuality recovery.” Uh, or, you can just try eating an apple.

Please consider volunteering to help out on the site.

• Deliganis AV, Maravilla KR, Heiman JR, et al. Female genitalia: dynamic MR imaging with use of MS-325 initial experiences evaluating female sexual response. Radiology. 2002;225(3):791-9.
• Maravilla KR, Heiman JR, Garland PA, et al. Dynamic MR imaging of the sexual arousal response in women. J Sex Marital Ther. 2003;29 Suppl 1:71-6.
• Cai T, Gacci M, Mattivi F, et al. Apple consumption is related to better sexual quality of life in young women. Arch Gynecol Obstet. 2014;290(1):93 - 8.
• CAI T. Eve and the apple: the origin of original sin - Apple consumption and female sexual quality of life:an intriguing relationship. TKS Publisher. 2018.
• Fisher ND, Hughes M, Gerhard-herman M, Hollenberg NK. Flavanol-rich cocoa induces nitric-oxide-dependent vasodilation in healthy humans. J Hypertens. 2003;21(12):2281-6.
• Salonia A, Fabbri F, Zanni G, et al. Chocolate and women's sexual health: An intriguing correlation. J Sex Med. 2006;3(3):476-82.
• Salonia A, Giraldi A, Chivers ML, et al. Physiology of women's sexual function: basic knowledge and new findings. J Sex Med. 2010;7(8):2637-60.
• Angel K. The history of 'Female Sexual Dysfunction' as a mental disorder in the 20th century. Curr Opin Psychiatry. 2010;23(6):536-41.
• Tiefer L. Female sexual dysfunction: a case study of disease mongering and activist resistance. PLoS Med. 2006;3(4):e178.
• Parish SJ. From whence comes HSDD?. J Fam Pract. 2009;58(7 Suppl Hypoactive):S16-21.
• Jaspers L, Feys F, Bramer WM, Franco OH, Leusink P, Laan ET. Efficacy and Safety of Flibanserin for the Treatment of Hypoactive Sexual Desire Disorder in Women: A Systematic Review and Meta-analysis. JAMA Intern Med. 2016;176(4):453 - 62.
• Fugh-berman A. Advise Against Flibanserin. Am J Nurs. 2016;116(3):13.
• Meixel A, Yanchar E, Fugh-berman A. Hypoactive sexual desire disorder: inventing a disease to sell low libido. J Med Ethics. 2015;41(10):859-62.
• Mccartney M. Margaret McCartney: Flibanserin for low sexual desire is not feminism. BMJ. 2015;351:h5650.
• Shaughnessy AF. Flibanserin Ineffective for Hypoactive Sexual Desire Disorder in Women. Am Fam Physician. 2016;94(5):384-6.
• Converse AK, Aubert Y, Allers KA, Sommer B, Abbott DH. Flibanserin-Stimulated Partner Grooming Reflects Brain Metabolism Changes in Female Marmosets. J Sex Med. 2015;12(12):2256-66.
• Chańska W, Grunt-mejer K. The unethical use of ethical rhetoric: the case of flibanserin and pharmacologisation of female sexual desire. J Med Ethics. 2016;
• Woloshin S, Schwartz LM. US Food and Drug Administration Approval of Flibanserin: Even the Score Does Not Add Up. JAMA Intern Med. 2016;176(4):439-42.
• Maiorino MI, Bellastella G, Esposito K. Lifestyle modifications and erectile dysfunction: what can be expected?. Asian J Androl. 2015;17(1):5-10.
• Esposito K, Ciotola M, Giugliano F, et al. Mediterranean diet improves sexual function in women with the metabolic syndrome. Int J Impot Res. 2007;19(5):486-91.
• La J, Roberts NH, Yafi FA. Diet and Men's Sexual Health. Sex Med Rev. 2018;6(1):54-68.
• Esposito K, Ciotola M, Maiorino MI, et al. Hyperlipidemia and sexual function in premenopausal women. J Sex Med. 2009;6(6):1696-1703.
• Allouh MZ, Daradka HM, Al barbarawi MM, Mustafa AG. Fresh onion juice enhanced copulatory behavior in male rats with and without paroxetine-induced sexual dysfunction. Exp Biol Med (Maywood). 2014;239(2):177-82.
• Zanotti I, Dall'asta M, Mena P, et al. Atheroprotective effects of (poly)phenols: a focus on cell cholesterol metabolism. Food Funct. 2015;6(1):13 - 31.
• Kukull WA. An apple a day to prevent Parkinson disease: reduction of risk by flavonoids. Neurology. 2012;78(15):1112-3.

Image credit: Nietjuh via Pixabay. Image has been modified.

Motion graphics by Avocado Video.