Alternatives to Viagra.
June 12, 2000 -- A recent American visitor to the market stalls of a Turkish spice bazaar met aphrodisiac vendors at every turn. Catching his eye, they held up their fingers, counting off how many women the traveler could make love to in a single night. On closer inspection, these supposed "love potions" turned out to be mixes of common household spices -- cloves, coriander, cumin. But when confronted, the salesmen barely missed a beat. "It's the combination!" they insisted.
For thousands of years, people in every culture have sought a magical substance that could stir the embers of an ebbing libido. Scientists have generally pooh-poohed such notions. Now the arrival of the clinically proven impotence drug Viagra (sildenafil citrate) may have increased the allure of herbal aphrodisiacs. Many people, it seems, believe herbal remedies are safer than the drug. "Some people who are afraid of Viagra take these things," says William Catalona, MD, a urologist with Washington University School of Medicine in St. Louis. Others want to avoid the embarrassment of asking for a prescription.
Yohimbé, an herb used almost entirely for sexual problems, rang up $13.7 million in sales for 1999, according to the Hartman Group market research firm.
Just how effective are these supposed aphrodisiacs? Most vendors can't cite much evidence to back up their claims. And some products touted for sexual problems can cause serious side effects. Still, a few supplements have shown tantalizing promise in preliminary studies. Here's what you need to know to make an informed choice.
Ginseng: Boosting Quality of Life?
This medicinal root has a street reputation as an ancient aphrodisiac. That's probably because it has been used for thousands of years in Chinese medicine as part of a general tonic for "old man's disease," which includes a slipping libido, says Mark Blumenthal, executive director of the American Botanical Council.
Tissue and animal studies of one form of ginseng, called panax, give some credence to the root's sexy reputation. A study published in the May 1995 issue of the journal British Pharmacology, for instance, concluded that substances in ginseng extract known as ginsenosides may work in a similar way to Viagra. Viagra enhances the effects of nitric oxide, which helps relax artery walls, allowing more blood flow into the penis. Ginsenosides may encourage the release of more nitric oxide.
Human studies have mainly found increased "quality of life" among those taking ginseng, says Varro Tyler, PhD, ScD, professor emeritus of pharmacognosy at Purdue University. But for some people that might be all that's needed. "If you're an elderly person and if you feel better," says Tyler, "you may be more interested sexually."
Because panax ginseng has a stimulating effect, some experts caution against using it for longer than three weeks at a time, or using it at all if you have high blood pressure or consume a lot of caffeine.
Yohimbine: Ask Your Doctor
Yohimb´ bark, taken from a towering evergreen tree, was traditionally used in its native Africa to stimulate erections. A century before Viagra, yohimbine, a substance derived from the bark, was prescribed in Europe for male sexual dysfunction. While yohimb? is available over the counter, it's yohimbine -- still available only with a doctor's prescription -- that's been the subject of clinical studies.
A combined analysis of more than a dozen studies involving hundreds of subjects, published in the journal Archives of Sexual Behavior in August 1996, concluded that yohimbine can help many men who have problems getting an erection. It appears to work in part by increasing blood flow to the penis and may affect brain chemistry as well.
Research results on yohimbine in women, on the other hand, are mixed. And there's not much evidence that it will charge up the appetite of an already healthy man.
That bark may have a bite, too: Serious side effects of yohimbine can include everything from insomnia and increased blood pressure, to increasing the effects of blood pressure medications and MAO (monoamine oxidase) inhibitors.
As for the yohimb´ available over the counter, a 1995 analysis of 19 such products found that most products examined contained almost no measurable yohimbine. Things may have changed since then, but if you're going this route, your best bet is to ask your doctor whether a prescription is right for you.
Ginkgo Biloba: Choose the Right Extract
While best known for supposedly aiding mental processes, the modern leaf extract of this 200-million-year-old species of tree has also been studied for its effects on male erections. Both effects could be caused by ginkgo's encouragement of increased peripheral blood flow, says Blumenthal.
After a geriatric patient taking the extract for memory protection reported improved erections, researchers at the University of California at San Francisco put it to the test. They gave about 200 milligrams per day to 63 men and women with a variety of sexual problems caused by antidepressant drugs. The study found the gingko 84% effective overall in helping with these problems. Men reported more erections; women reported more desire and better orgasms. But there was no control group to compare placebo effects.
If you want to give ginkgo a shot, Tyler and Blumenthal both stress you'll want the extracts labeled "EGB 761" or "LI 1370" as they have been clinically tested. A recent analysis of 30 leading brands found nearly a quarter did not have adequate levels of these extracts. (To see the brand analysis go to http://www.ConsumerLab.com.)
Also, because ginkgo's improvements to blood flow may further reduce clotting, Tyler cautions those on any kind of blood-thinning regimen to check with their doctors.
L-Arginine: Mixed Results
L-arginine is an essential amino acid present in many foods; supplement makers are now offering it in concentrated form to improve sexual performance. The vendors argue that L-arginine might work something like Viagra because the amino acid is necessary for the formation of nitric oxide, the substance central to erections.
Studies of L-arginine supplements have also shown mixed results. A 1999 study of 30 impotent men found that 1,500 milligrams of oral L-arginine worked no better than a placebo. But a study of 21 men with "mild to moderate" impotence taking a supplement called ArginMax (3,000 milligrams per day) found big improvements in erection and sexual satisfaction. (The study was published in the December 1998 issue of the Hawaii Medical Journal.) ArginMax also contains ginseng and ginkgo biloba.
Even if these supplements do stand the test of further research, it's well worth talking to a doctor or therapist who can help you find the safest and most effective way to recharge your sex drive.
After all, sexual desire in men and women is much more complicated than the mere hydraulics of erections, says Harvey Rosenstock, MD, a psychiatrist who treats sexual dysfunction in his Houston clinic. Problems with desire, he says, are often related to the fact that a relationship is suffering.
It's the oldest lesson in aphrodisiacs: the chemistry between partners is as important as "the combination" in any herb or pill.
David Jacobson is a San Francisco-based writer and satirist. His work has appeared in Health, Men's Health, Salon, Maxim, and Details magazines.