Unexcited about Valentine’s Day? It Could Be HSDD.

By Amanda Rao

Valentine’s Day celebrates romantic love and playful passion. But for many women-even those in loving, happy relationships-it’s just another ho-hum day that (yawn) frankly leaves a lot to be desired. Why? It could be HSDD.

Hypoactive sexual desire disorder (HSDD, or loss of libido) is widely prevalent among females. Researchers estimate HSDD’s rates among females range from 13%¹ to 46%². HSDD has real and sometimes devastating effects, including depression, anxiety, and stress.

Women with HSDD experience many negative emotions, including feeling less feminine, less confident, and less able to be a good partner. Compared to women with normal levels of desire, women with HSDD often feel frustrated, hopeless, bitter, and depressed^{1, 3, 4}.

HSDD can also be costly to society, as it contributes to fatigue, anxiety, and stress. Clearly, the personal and societal effects are significant.

Despite HSDD’s prevalence and negative effects, clinical research on solutions is sparse. Some herbal remedies, such as Chinese ginseng and maca, are popular, but there is still limited scientific evidence available⁵. Hormone replacement therapy (HRT) is often useful in menopausal women, and testosterone therapy is also an option, but these may not be suitable for everyone.

Seeking solutions to HSDD, some researchers have turned to fenugreek (Trigonella foenum-graecum), which is a traditional but relatively unknown herbal remedy for sexual dysfunction. Prior to 2010, there were no studies on fenugreek for libido and sexual function, but more studies are emerging. For instance, the authors of a 2010 literature review⁶ suggested that because fenugreek has traditionally been used for its effect on stimulating milk production in lactating women, fenugreek’s mechanism of action may be hormonal.

A 2010 animal study⁷ showed that an extract of fenugreek, standardized to furostanol saponins, displaced a small fraction of bound testosterone, thus increasing free, active testosterone levels. The researchers pointed out that, while a number of factors contribute to HSDD, HSDD is often linked to low testosterone levels.

Follow-up research in 2011⁸ by Elizabeth Steels and myself on 60 human males expanded upon this finding. We found that this same fenugreek extract, standardized to furostanol saponins, had a positive effect on physiological aspects of libido, and, in particular, caused a significant increase in the subdomains of sexual desire and orgasm.

Recently, in a new and parallel study⁹ on women, my team conducted an eight-week, randomized, placebo-controlled, double-blind clinical trial in Australia in conjunction with the University of Queensland. The goal was to evaluate the effects of this fenugreek extract on women’s libido. The subjects were healthy, menstruating women in stable sexual relationships. All participants reported a low sexual desire and furthermore stated that they were in stable and happy relationships with their partners.

The study found that sexual functioning, as measured by the Derogatis Interview for Sexual Functioning (DISF-SR- Female) scale, significantly increased (p<0.001) over two months. A sub-analysis found significant increases in the five following domains: Sexual Cognition/Fantasy, Sexual Arousal, Sexual Behavior/Experience, Orgasm, and Sexual Drive/Relationship. Study participants also maintained consistent, healthy metabolic activity, as measured by red blood cell and electrolyte counts, as well as liver and kidney function. We concluded that Trigonella foenum-graecum seed extract had a positive effect in enhancing libido in the trial subjects. Positive changes were also observed for physiological aspects and psychosocial aspects of libido, accompanied by increases in relationship quality and general quality of life. Additionally, the product was well tolerated.

There is a growing need for scientifically substantiated ingredients for sexual health; these are some examples of ongoing research. Perhaps, more importantly, the arrival of well-researched ingredients for female HSDD will bring the issue of HSDD into the open, where therapeutic options can be readily explored. In a world in which the topic of male libido is frequently displayed in catchy TV ads, likewise, clinical substantiation for the promotion of women’s healthy sexual functioning may help thousands of women overcome HSDD and libido limbo-not just on Valentine’s Day, but always.

Amanda Rao is a director at Integrated Health Group in Australia and lectures at Australian and international universities. She has over 20 years of experience in the natural medicine industry, including in product development, regulatory affairs, clinical research, and education. Funding and study medication for her clinical trials mentioned above^9,10 came from the trial sponsor and ingredients supplier Gencor (Irvine, CA), which commercially supplies the standardized fenugreek extract as the branded ingredient Libifem.

References

1. Dennerstein L et al., “Hypoactive sexual desire disorder in menopausal women: a survey of western European women,” J Sex Med. (March 2006) vol. 3, no. 2: 212–222.
2. Chiechi LM et al., “Sexuality in the climacterium,” Clin. Exp. Obstet. Gynecol. (1997) vol. 24, no. 3: 158–159.
3. Leiblum S et al., “Hypoactive sexual desire disorder in postmenopausal women: US results from the Women’s International Study of Health and Sexuality (WISHeS),” Menopause. (January-February 2006) vol. 13, no. 1: 46–56. 
4. Rosen RC et al., “Correlates of sexually related personal distress in women with low sexual desire. J Sex Med. (June 2009) vol. 6, no. 6: 1549–1560.
5. Rowland DL et al. “A review of plant-derived and herbal approaches to the treatment of sexual dysfunctions,” J Sex Marital Ther. (May-June 2003) vol. 29, no. 3: 185-205.
6. Zuppa AA et al., “Safety and efficacy of galactogogues: substances that induce, maintain and increase breast milk production,” J Pharm Sci. (2010), vol. 13, no. 2: 162-174.
7. Aswar U et al., “Effect of furostanol glycosides from Trigonella foenum-graecum on the reproductive system of male albino rats,” Phytother Res. (October 2010) vol. 24, no. 10: 1482-1488.
8. Steels E et al., “Physiological aspects of male libido enhanced by standardized Trigonella foenum-graecum extract and mineral formulation,” Phytother Res. (February 10, 2011) Epub ahead of print.
9. Rao A at al., “Physiological aspects of female libido enhanced by standardized Trigonella foenum-graecum extract and mineral formulation.” In press.