Sexual Health and Healing
By Nick Delgado PhD, CHT
Overview of Female sexual health, orgasmic response, Testosterone
Therapy, Estrogen clearance, Male Erectile Dysfunction, STD-
Mind, Fitness, Diet, and biochemistry Physiologic balancing
1.Sexual dysfunction is highly prevalent in both sexes. Considerable progress
has been made in the development of new pharmacological treatments since the
approval of sildenafil in 1998. A variety of oral erectogenic agents are available
or are in late-phase development, including centrally active dopamine agonists
(e.g., sublingual apomorphine), peripheral nonselective alpha-blockers (e.g., oral
phentolamine), and other phosphodiesterase type-5 inhibitors (e.g., vardenafil).
2.FEMALES: Despite the importance of sexuality for both men and women of
all ages, only in the last few years’ extensive research has been carried out into
female sexual problems. It has been discovered that sexual problems affect a
considerable number of women each year, and this indicates the validity and
necessity of further medical studies. Estimates of the number of women who
have sexual dysfunction range from 19% to 50% in "normal" outpatient
populations67-69 and increase to 68% to 75% when sexual dissatisfaction or
problems (not dysfunctional in nature) are included.68-70 Currently, there are six
major pharmaceutical therapeutic paths being pursued for treatment of female
sexual disorders and/or postmenopausal symptoms. These include dopaminergic
agonists and related substances, melanocortin-stimulating hormones, adrenoceptor
antagonists, nitric oxide delivery systems, prostaglandins, and androgens. These
drugs have recently been evaluated for the treatment of female sexual arousal
disorder, although results to date have been inconclusive. We know that female
genital sexual response is a combination of vasocongestive and neuromuscular
events in the genital tract and pelvic floor, which are controlled in part by specific
neurotransmitters. Other pelvi-perineal genital structures undergo vasculogenic
changes, namely the labia, periurethral glands, urethra and the Halban's fascia, but
much less attention has been paid to the role of these tissues in sexual response
compared to the clitoris and the vagina. The most common etiologies of female
sexual dysfunction are vasculogenic, neurogenic, hormonal/endocrine and
muscologenic. The increasing various problems of female sexual dysfunction and
the interest in the matter and the subsequent research are factors that keep the
scientific community involved constantly active.
Device Assists Women to Reach Orgasm
The FDA has approved the Eros Clitoral Therapy Device, a mechanical pump that draws blood to the clitoris to cause
engorgement. Trials of the device in women with female sexual-arousal disorder resulted with 80% of the subjects able to achieve
sexual satisfaction, with 55% of the subjects reporting they were able to reach orgasm more easily.
SOURCE/REFERENCE: reported by Time 5/15/00
Vibrators –Hitachi, etc
Help For Female Impotence
The U.S. Food and Drug Administration has approved a device for treating female sexual arousal disorder, a condition
characterized by the inability to reach orgasm, vaginal dryness, lack of clitoral sensation or diminished interest in sex. Previously,
estrogen therapy and vaginal lubricants to relieve dryness were the main treatments available, but now UroMetrics Inc.'s Eros is
the first FDA-approved product to address clitoral dysfunction. The device consists of a soft suction cup that is placed over the
clitoris. The cup is attached via a tube to a handheld battery-operated vacuum. Women can turn the vacuum suction up or down
as needed until the clitoris feels engorged, and then remove the device. In a study of 15 women with female sexual arousal
disorder, 80 percent reported increased sexual satisfaction or orgasms after using Eros. However, the FDA cautions that the
device will not work for every woman. It is approved to be sold by prescription only.
SOURCE/REFERENCE: www.intelihealth.com 5/6/00
Viagra Effective For Women With Sexual Dysfunction
Related to Antidepressant Therapy
Results of a study conducted by Detroit psychiatrist Dr. Albert Bayer, M.D., show unequivocally that the drug Viagra (sildenafil) is
effective in treating women with sexual dysfunction related to antidepressant therapy. Although Viagra is commonly prescribed for
erectile dysfunction in males, scientific evidence supporting its use for the management of antidepressant-induced sexual
dysfunction in women has been relatively non-existent. In this unique study, 21 adult female patients with major depression were
given ten 50 mg samples of Viagra and instructed to take one tablet sixty to ninety minutes prior to initiating sexual activity. After
90 days, the women demonstrated statistically improvement of both sexual dysfunction and depressive symptoms. Many of the
women who participated reported sexual functioning in terms of arousal and intensity of orgasm as far greater than they had
experienced at any prior time in their lives. Besides two women experiencing mild facial flushing and a third woman reported mild
nasal congestion, no other adverse events were described. Furthermore, none of the subjects wished to discontinue Viagra due to
SOURCE/REFERENCE: reported by www.pslgroup.com , 5/9/00
Menopause Makes Women Eat More
Results of a recent study may help to explain why many women put on weight after the menopause. Judy Cameron and
colleagues at Oregon Health & Science University induced menopause in monkeys by removing the ovaries, and thus cutting off
the animals' supply of the female hormone estrogen. Results showed that removing the ovaries made the animals' food intake
increase by 67% and caused them to gain 5% of their body weight within weeks. The researchers say that the findings suggest
that estrogen may affect the metabolism, or play a role in appetite control.
SOURCE/REFERENCE: Reported by www.reutershealth.com on the 13th November 2003.
3.MALES. Pharmacological therapies have also been proposed for the treatment
of premature ejaculation and hypoactive sexual desire disorder. Strong evidence
exists for the value of serotonergic drugs (e.g., selective serotonin reuptake
inhibitors) in the treatment of premature ejaculation. Further research is needed,
particularly on the effects of these drugs on female sexual dysfunction.
4.Erection is basically a spinal reflex that can be initiated by recruitment of
penile afferents, but also by visual, olfactory, and imaginary stimuli. The reflex
involves both autonomic and somatic efferent and is modulated by supraspinal
influences. Several central transmitters involved in the erectile control have been
identified. Dopamine, acetylcholine, nitric oxide (NO) and peptides, such as
oxytocin and adrenocorticotropic/alpha-melanocyte-stimulating hormone, seem to
have a facilitatory role. Whereas, serotonin may be either facilitatory or
inhibitory, and enkephalins are inhibitory. Peripherally, the balance between
contractant and relaxant factors controls the degree of contraction of the smooth
muscle of the corpora cavernosa and determines the functional state of the penis.
Noradrenaline contracts both corpus cavernosum and penile vessels via
stimulation of alpha(1)-adrenoceptors. Neurogenic NO is considered the most
important factor for relaxation of penile vessels and corpus cavernosum. The role
of other mediators released from nerves or endothelium has not been definitely
established. ED may be due to inability of penile smooth muscles to relax. This
inability can have multiple causes. However, patients with ED respond well to
the pharmacological treatments that are currently available. The drugs used are
able to substitute, partially or completely, the malfunctioning endogenous
mechanisms that control penile erection. Most drugs have a direct action on
penile tissue facilitating penile smooth muscle relaxation, including prostaglandin
E (1), NO donors, phosphodiesterase inhibitors, and alpha-adrenoceptor
antagonists. Dopamine receptors in central nervous centers participating in the
initiation of erection have been targeted for the treatment of ED. Apomorphine,
administered sublingually, is the first of such drugs.
Uprima: a New Drug Treatment for Male Impotence
A Food and Drug Administration advisory panel this week recommended approval of a new drug, Uprima, for male impotence.
The drug, however, can have some serious side effects. Uprima takes a neurological approach to treating erectile dysfunction
(ED); it works by raising levels of the neurochemical dopamine in a part of the brain that is believed to be important for male
erections, and for this reason, it might not be effective for all forms of ED. The drug is supposed to be taken about half an hour
before sex. It is placed under the tongue and allowed to dissolve into the mouth tissue. In month-long studies of 3,000 men, a 4-
mg dose was effective 56 percent of the time, according to TAP Pharmaceuticals, manufacturers of prima. The 4-mg dose caused
seriously low blood pressure and even fainting in one of every 30 men who took it. Five percent of the men also experienced
nausea, vomiting, dizziness, sweating or sleepiness, and in some cases these side effects led to injuries from falling or, in one
case, a car wreck involving a man who was driving when he became dizzy from the drug. The FDA panel is concerned because of
the potential for cardiac patients and people with low blood pressure to be prescribed the medication.
SOURCE/REFERENCE: Reported by www.intellihealth.com 4/15/00
Although the decline in testosterone production as men age ("andropause") is not as dramatic as
the drop in women’s estrogen production with the onset of menopause, testosterone decline is a
serious issue for many older men. Among other problems, declining testosterone production is
strongly associated with impotency and libido problems.
ROLE FOR ANTI-AGING:
Anti-aging benefits that have been associated with testosterone replacement therapy may include
increased libido and sexual potency; improved erectile function; improved mood and
increased feelings of well-being; decreased fatigue; increased red blood cell count;
reduction of LDL cholesterol and overall cholesterol levels and strengthening of the
bones. Results of research published in 2002 revealed that men who have higher levels of
"bioavailable" testosterone - testosterone that is not bound to protein - appear to perform better
on tests of mental performance than men with lower levels of the hormone.
Symptoms of testosterone deficiency include: reduced libido, fatigue or a decrease in physical
stamina, difficulty in maintaining erections, memory impairment, weight gain, depression and
anxiety, increased risk of heart disease, and decreased muscle mass
THERAPEUTIC DAILY AMOUNT:
Testosterone replacement needs to be managed by a physician to ensure that a patient receives
only enough of the hormone to replenish lost levels. Many forms of administering testosterone
have been developed, including intramuscular injections, suppositories, transdermal patches,
attached to the midriff, thigh, or arm, as well as to the scrotum, oral micronized capsules, and
sublingual lozenges. Oral administrations seem to be the least effective method.
MAXIMUM SAFE LEVEL:
Testosterone should only be supplemented under medical guidance.
If testosterone replacement is administered to men with normal or near-normal levels of the
hormone, any number of dangerous side effects may occur. Most notably, excess doses of
testosterone may inhibit the body’s ability to produce testosterone. Testosterone replacement
carries with it the risk of stimulating both benign and malignant prostate tumor growth. In addition,
because it can reduce HDL cholesterol levels, testosterone replacement may be associated with
an increased risk of coronary artery disease.
Bright Light May Help to Boost
Bright light could help men to boost their testosterone levels, a new study has found. Dr Daniel F Kripke, of the University of
California at San Diego and colleagues found that exposing men to an hour of bright light before dawn led to increases in levels of
luteinizing hormone (LH), which in turn boosts testosterone levels. For the study, Kripke studied 11 healthy men aged between 19
and 30. For the first part of the study all participants were woken at five am and exposed to either a bright light, or a low-wattage
red light. For the second part, the groups were switched, so that the men who were exposed to bright light in the first part were
then exposed to low light, and vice versa. Results showed that exposure to the bright light for just one hour led to a staggering
69% increase in LH levels. The researchers believe that the light treatment could be of benefit to men suffering from depression,
and those with sexual dysfunctions caused by depression.
SOURCE/REFERENCE: Neuroscience Letters 2003;341:25-28.
Male Sex Hormone Levels Show
New research has revealed that sex hormone levels in men rise and fall with the seasons. Dr Anna-Maria Andersson and
colleagues at Copenhagen University Hospital in Denmark, found that the levels of testosterone and luteinizing hormone (LH), the
hormone that stimulates production of testosterone, peak in the heat of June and July and fall along with the temperature during
winter and early spring. Whether or not seasonal changes in testosterone affect fertility or men's behavior remains unclear,
however previous research has shown that people are more likely to conceive in June and August, and least likely to do so from
January through March.
SOURCE/REFERENCE: The Journal of Clinical Endocrinology & Metabolism 2003;88:932-937
High Levels of "Free" Testosterone Linked to
Better Cognitive Performance
Elderly men with higher levels of "free" or bioavailable testosterone in their blood score higher at tests of verbal and visual recall,
and perform spatial tasks better than men with lower levels of the male hormone, according to researchers from the National
Institute of Aging. Study co-author, Susan Resnick, Ph.D, concluded: "Based on our results, testosterone levels are associated
with selective and very specific effects on some aspects of cognition, including memory." The findings suggest that "free"
testosterone could be used to protect men with deficient levels of the hormone against cognitive decline later on in life. Data
suggests that as many as 68% of men aged 70 and over have low levels of "free" testosterone. SOURCE/REFERENCE:
Reported by the National Institute on Aging on the 4th November 2002
II.Overview of drugs currently available in the U.S.
1. Sildenafil – Viagra The most distributed oral agent worldwide. Shows a high
efficacy safety profile with success rates for all etiologies between 50% to 80%.
a. Advantages: First drug in this category as a PDE5 inhibitor with the
longest track record of safety.
b. Side Effects include headaches, flushing, dyspepsia (stomach indigestion),
rhinitis (runny nose) and visual disturbances (seeing blue-green aura,
changes in brightness and inability to discriminate color). It may also
lower blood pressure too much if combined with other nitrate heart
Viagra Found to be Safe for Many
A new, small study funded by the maker of Viagra, the blockbuster anti-impotence pill, has found the drug appears to be safe in
men with existing heart disease. Dr. Howard C. Herrmann and colleagues at the University of Pennsylvania Medical Center in
Philadelphia studied the heart rate, blood flow, blood pressure and other vital signs in 14 men, average age 61, before and after
they ingested Viagra. All study participants had heart disease, showed severe narrowing of the arteries, and were referred to the
hospital for angioplasty. The team reports that Viagra is safe for men with heart disease who are not taking medications
containing nitrates (which have been linked to Viagra-related deaths). However, Dr. Herrmann points out this study did not look at
whether Viagra and sexual activity are safe for men with unstable angina, who have had a heart attack, or have congestive heart
SOURCE/REFERENCE: The New England Journal of Medicine, June 1, 2000
2. Vardenafil – Another selective PDE-5 inhibitor with potentially higher selectivity
and efficacy compared to sildenafil. Data from clinical trials show the same
adverse events and success rates as sildenafil.
a. Advantages: The percentage of successful intercourses was between
71% and 75% for the three-vardenafil doses. For the 20 mg dose,
80% of the patients experienced improved erections (GAQ) compared
to 30% for placebo.
b. Side Effects: headache (7-15%), flushing (10-11%) and up to 7% for
dyspepsia or rhinitis.
3. Tadalafil – “Cialis” Amplifies erectile function for up to 24 hours, allowing
patients to engage in sexual activity for this period. Adverse events and success
rates resemble those of the other two substances. Eli Lilly. Now approved by
FDA in USA.
a. Advantages: Faster action, last longer (up to 36 hours) without food or
alcohol restriction and more selective to sex and vision, etc. than Viagra.
b. Side effects: Headaches were the main complaint in those using tadalafil,
affecting 5% to 11% of 149 patients. Other side effects included back
pain (4%), nasal congestion (4%), myalgia/body pain (4%), flushing (4%)
and dyspepsia or indigestion (7%).
4. Comparison of PDE-5 Inhibitors – Since the introduction of the PDE-5
inhibitor sildenafil four years ago, there has been a fundamental change in
the treatment of ED. Intracavernosal or intraurethral injections of vasoactive
substances or penile implants as mechanical aids now play hardly any part in
it. The development of the PDE-5 inhibitors vardenafil and tadalafil prompts
the question of whether and how these three substances differ in terms of
their efficacy and adverse effects. Sildenafil has proven to be a very effective
medicinal product. Studies with a follow-up period of up to 6 years have been
conducted. The success rate of sildenafil varies in the group of ED patients
with an organic underlying disease from 43% in patients who have undergone
radical prostatectomy to 85% in patients with a neurological underlying
disease, and amounts to an average 82% (range 43-85%, 100mg). In an
evaluation of spontaneous reports of deaths associated with sildenafil, the
FDA concluded that there was no deducible evidence of an increase in the
mortality rate among sildenafil users compared to the general population. In
fact, fewer deaths associated in time with the ingestion of sildenafil were
reported than might have been expected purely statistically on the basis of
the normal mortality rate for men in this age group. According to the initial
studies conducted, vardenafil and tadalafil demonstrate efficacy data
approximately comparable to those of sildenafil. As of yet, insufficient data
are available to evaluate the adverse effects of vardenafil and tadalafil,
particularly their long-term use and use in high-risk groups. Sildenafil has
already been used by over 20 million men in over 110 countries and is one of
the best-studied pharmacological substances available. This advantage in
terms of knowledge and safety data makes sildenafil a safe and reliable
treatment for patients with ED.
5. Penile Self-Injection
Vasoactive drugs such as alprostadil (PGE1) are injected directly into the
side of the penis or inserted by suppository directly into the urethral opening
just prior to sex to achieve an erection. Some people may experience painful
erections, hematoma (bruising) and local fibrotic complications do occur in
4% to 12% of the patients. The use of a mixture of papverine and
phentolamine or moxisylyte reduces the likelihood of painful erections.
However, the incidence of fibrotic complications is higher than alprostadil at
nearly 30% of patients. This type of therapy has a very high drop out rate of
between 55% to 78% after 2 to 5 years. Nearly 10% of these people stopped
injections because of the partner’s lack of satisfaction associated with having
to plan sexual encounters and feeling that injecting was unnatural.
III. Other medical treatments available (nonpharmacologic options)
a. Penile implants – completely imitate the physiologic erection.
b. Vacuum constriction device – safe and effective option for well-selected
patients, however, 58% to 81% of people discontinued using the vacuum
because of pain or discomfort from the constriction ring. Another reason
for stopping was that women disliked the feel of a cold penis in the vagina
due to hypoxemic (entrapped blood). Nearly 50% of the men had
difficulty using the device.
c. Infection rates and mechanical failures have been minimized due to recent
d. Well accepted by the patients and their partners.
IV. HERBS in the Treatment of Sexual Performance
Despite the increasing availability of effective conventional
medical treatments, plant-derived and herbal remedies continue to
provide a popular alternative for men and women seeking to improve
their sex life. Nevertheless, the efficacy of most herbal agents
in treating sexual problems remains uncertain. Therapists and
consumers alike would benefit from an increased understanding of
commonly used herbal agents on the market, their purported or
supported effects, and their potential side effects. To this end,
we cataloged the major prosexual herbal agents currently sold in
several representative health food stores. We also specify the
sexual problem purported ameliorated by each herbal agent.
Finally, we evaluate eight herbal agents commonly promoted for the
treatment of sexual problems. This evaluation includes a review of
the research supporting the use, efficacy, dose, adverse effects,
contraindications, and possible mechanism of action of each. We
conclude by commenting on the quality of current research,
pointing out gaps in our knowledge, and noting the need for
rigorous research and product control to adequately address
questions regarding the efficacy of these agents.
1. Over-the-Counter Products: Updated herbal studies (transdermal and oral)
2. Herbal remedies that are most desired-combine capsules of multiple herbs,
transdermal cream for hormone therapy (Strength Energy liposome cream)
and a PDE5 inhibitor. The herbs found to be most effective undergo multi-
fractionation, which makes them more potent than any other herbal enhancer. The
Kudzu herb increases NO-Nitric Oxide for the filling of blood to the male or
female sex organs. The Epimedium increase libido, drive and interest in sex.
The herbs are not denatured as typically occurs from traditional processing. The
bio-identical hormones (DHEA, Pregnenolone, Androstendiol added liposome
Cream, Strength Energy combined will raise free testosterone (aphrodisiac like
effect increasing libido). It is suggested to take a low dose PDE5 inhibitor that
clears enzymes to prevent the loss of erection.
3. Why they work: Transdermal cream Strength Energy with DHEA,
Pregnenolone and prohormones from the Scottish Pine-Androstendiol and
phytochemicals (DIM, Chrysin) increase testosterone and remove estrogen
binding and blocking of receptor sites. See 3-26 reference below.
4. Multiple hormones, peptides and neurotransmitters that enhance the sexual
experience. DHEA, Pregnenolone from Wild Yam Root, Androstendiol from
Scottish Pine build the experience. Other factors such as Serotonin, Dopamine
also play a role in response. See reference 38 thru 51 below.
5. Why most herbal products don’t work (denatured processing methods). The
process of extraction is a sophisticated science perfected by Ultimate Medical
researchers. Most extraction companies use outdated methods that literally
destroy the key active ingredients.
6. Legal issues, high incidence of drug doping of herb products in Europe sold
over $6 million, several million sold in the USA, were found to have Cialis (Eli
Lilly Tadalafil- the equivalent of Viagra). One lab found 8 out of 10 herbal
products tested and sold over the internet were found to have Sildenafil – Viagra.
Some of these companies official line is that others tampered with their product.
FDA Public Health Advisory:
FDA Warns Consumers Against Taking the Following Dietary
Today, the Food and Drug Administration (FDA) is warning consumers not to purchase or
consume the following products: SIGRA, STAMINA Rx and STAMINA Rx for Women, Y-Y,
Spontane ES and Uroprin, manufactured by NVE, Inc., in Newton, N.J. and distributed by Hi-Tech
in Norcross, Ga. These products, which are being marketed as dietary supplements, actually
contain a prescription drug ingredient that poses possible health risks. The products are being
sold over-the-counter and are claiming to increase stamina, confidence and performance.
FDA has determined that the products actually contain the prescription-strength drug ingredient,
tadalafil. Tadalafil is the active ingredient in Cialis, an Eli Lilly product approved in Europe to treat
male erectile dysfunction. An interaction between certain prescription drugs containing nitrates
(such as nitroglycerin) and tadalafil may cause a drastic lowering of blood pressure. There is real
danger that this product may be taken by patients taking nitrates since erectile dysfunction is
often a common problem in people with diabetes, hypertension (high blood pressure),
hyperlipidemia (high cholesterol), ischemic heart disease and in people who smoke.
FDA's Office of Criminal Investigations, with assistance from FDA’s New Jersey and Atlanta
Districts, executed concurrent federal search warrants in Georgia and New Jersey after finding
these dietary supplements.
Consumers who have used these products and have medical concerns should consult with their
health care providers.
All consumers should be aware of the risks associated with these products.
V. Physiology of Arousal
1. Masters & Johnson-correct stimulus response techniques
2. Touch receptors
3. Possibilities and how they can be achieved/enhanced. See references 67 to 70.
VI. The psychology of sex
The psychology of sex is not to be overlooked since the power of the mind does influence
several biochemical pathways in men and woman. Timeline therapy which is a form of
biofeedback with guided imagery has proven to free on of excessive feelings of guilt and
or trauma form past experiences. This freeing effect allows for future positive encounters
and a greater degree of satisfaction.
VII. STD- prevention Herpes, warts, Aids, Tests etc. Condoms, oral sex
Section I and II
1. Delgado, Nick PhD, # 1 Way to Fitness "Grow Young and Slim" Lake Forest CA, Health Wellness Studios, 2003.
2. Collins, Joe ND, What’s Your Menopause Type? Roseville, CA, Prima Health, 1999.
3 Muti, Paola, et al., Estrogen metabolism and risk of breast cancer: A prospective study of the 2OHE: 16-alpha-
Hydroxyestrone ratio in premenopausal and postmenopausal women. Epidemiology, Nov., 2000, Vol. 11 No. 6, 635-664.
4. Michnovicz JJ. Changes in levels of urinary estrogen metabolites after oral indole-3carbinol treatments in humans. J National
Cancer Inst.89 (10): 718-23, 1997.
5. Michnovicz JJ. Increased estrogen 2-hydroxyation in obese women using oral indole-3-carbinol. Int J Obese Relat Metab
Disorder 22(3): 227-9, 1998.
6. Kall MA, Effects of dietary broccoli on humans in vivo drug metabolizing enzymes: evaluation of caffeine, estrone.
Carcinogenesis 17(4):793-9, 1996.
7. Bradlow HL, Telang NT, Sepkovic DW, et al., "2-hydroxyestrone: The ‘good’ estrogen," Journal of Endocrinology 150 Suppl
8. Lemon HM, Reduced estriol excretion in patients with breast cancer prior to endocrine therapy. JAMA 196(no 3), 1966.
9. Ursin G, A pilot study of urinary estrogen metabolites 16 alpha hydroxyestrone (OHE1) and 2-OHE-1 in postmenopausal
women with and without breast cancer. Environ. Health Perspect 105(suppl 3): 601-5, 1997.
10. Brandi ML. Natural and synthetic isoflavones on the prevention and treatment of chronic diseases. Calicif Tissue Int 61
(suppl 1): S5-S8, 1997.
11. Ghanadian, R. and Puah, C.M., "The clinical significance of steroid hormone measurements in the management of patients
with prostatic cancer," World Journal of Urology, 1983; 1: 49-54.
12.Geller, J. et al., "DHT concentrations in human prostate cancer tissue," JCEM, 1978; 46:440-4
13. Gustafsson, O. et al., "Dihydrotestosterone and testosterone levels in men screened for prostate cancer: a study of a
randomized population," British Journal of Urology, 1996;77:133-140.
14. Suzuki, K. et al., "Endocrine environment of benign prostatic hyperplasia: prostate size and volume are correlated with
serum estrogen concentration," Scandinavian Journal of Urology and Nephrology, 1995; 29:65-68.
15. Gann, P.H. et al., "A prospective study of plasma hormone levels, nonhormonal factors, and development of benign prostate
hyperplasia," The prostate, 1995; 26:40-49.
16. Kaiser, F. et al., "Impotence and aging: clinical and hormonal factors," Journal of the American Geriatric Society, 1988; 36:
17 b. Feldman HA et al., Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study.
J Urology 1994; 151:54-61.
18 c. Davidson J et al., Hormonal changes and sexual function in aging men. J Clin Endocrinology Metab. 1983; 57:71-77.
19. Waynberg, Jacques MD. "Male Sexual Asthenia" The American Journal of Natural Medicine. November 1994.
20. Carruthers M. "Maximizing Manhood" London: Harper Collins Publishers; 1996
21. Mowrey, D. "Herbal Tonic Therapies" 2000.
22. Pugeat, Carve, Tourniaire, Forest MG. Clinical utility of sex hormone-binding globulin measurement. Hormone Res. 1996;
23. Van Goozen, Wiegant, Endert, Helmond, Van De Poll. Psychoendocrinological assessment of menstrual cycle: the
relationship between hormones, sexuality & mood. Arch Sexual Behav. 1997.
24. Shippen, Eugene MD, "The testosterone Syndrome" New York, NY, Evans and Co, 1998.
23. Wright, Jonathan MD., Maximize your Vitality & Potency for men over 40, Petaluma CA Smart Publication, 2000.
26. S. RafeeQ Ahmed, Alice Boucher, et. Al., Transdermal Testosterone Therapy in the Treatment of Male Hypogonadism.
JCEM vol. 66: 546, 1988.
27. Bergink, EW, et al., Metabolism and receptor binding of nandrolone and testosterone under in vitro and in vivo conditions.
Acta Endocrinologica (1985) 271 (suppl): 31-37.
28. Bhasin, S, et al., The effect of supraphysiological doses of testosterone on muscle size and strength in normal men. N Eng J
Med (1996) July 4; 335(1):1-7.
29. Svetec, David, et al., The effect of parenteral testosterone replacement on PSA in hypogonadal men with erectile
dysfunction. Journal of Urology, Nov., 1997, Vol 158, 1775-77
30. Strawford, Alson, et al., Resistance exercise and supraphysiologic androgen therapy in eugonadal men with HIV-related
weight loss. JAMA, April 14, 1999,
Vol 281, No 14, 1282-90.
31. Johnson SG, Joplin, Burrin. Direct assay for testosterone in saliva: relationship with a direct serum free testosterone assay.
Clin Chim Acta. 1987 Mar 30; 163(3):309-18.
32. Umehara T, Kumamoto, Mikuma, Itoh, Nanbu, Nitta. Salivary testosterone levels in normal boys at puberty. Nippon Naibunpi
Gakkai Zasshi. 1991 March 20; 67 (3):230-8. Japanese.
33. Mooney, M and Vergel, N, Built to Survive, Power, 1999.
34. Arver S, Dobs AS, Meikle AW, Allen RP, Sanders, Mazer. Improvement of sexual function in testosterone deficient men
treated for 1 year with permeation enhanced testosterone transdermal system. J Urology 1996 May; 155(5): 1604-8.
35. Tenover JS. Effects of testosterone supplementation in the aging male. J Clinical Endocrinology Metabolism 1992 Oct;
36b. Tenover JL. Testosterone and the aging male. J Androl. 1997; 18: 103-6.
37. Davidson JM. Camargo, Smith ER. Effects of androgen on sexual behavior in hypogonadal men. J Clin Endocrinol Metab
1979 June; 48(6): 955-8.
38. Warnock, JK. Female hypoactive sexual desire disorder due to androgen deficiency: clinical and androgen deficiency:
40. Ruutiainen K, Sannikka, Santti, Erkkola, Adlercreutz. Salivary testosterone in hirsutism: correlations with serum testosterone and
the degree of hair growth. J Clin Endocrinol Metab. 1987 May; 64(5):1015-20.
41. Labrie F, et al. Physiological changes in DHEA are not reflected by serum levels of active androgens and estrogens but of their
metabolites: intracrinology. JCEM 82:2403-2409.
42. Casson Pr, et al. Delivery of DHEA to pre-menopausal women, effects of micronization and non-oral administration. Am J Ob
43. Yen, Samuel, et al. Effects of Replacement Dose of DHEA in Men and Women of Advancing Age. JCEM 78: 1360-1367,
44. Arlt, Wiebke, et al. Biotransformation of Oral DHEA in Elderly Men: Significant Increase in Circulating Estrogens. JCEM 84:
45. Morales AJ, et al. Effects of replacement dose of DHEA in men and women of advanced age. JCEM 78: 1360-67, 1994.
46. Artl, Wiebke, et al. Oral DHEA for adrenal androgen replacement for adrenal androgen replacement. JCEM 83: 1928-34,
47. Sunderland, Reduced plasma DHEA concentrations in Alzheimer’s disease. Lancet 2: 570, 1989.
48. Granger, Schwart, Booth, Curran, Zakaria, Assessing dehydroepiandrosterone -DHEA in saliva: a simple radioimmunoassay
for use in studies of children, adolescents and adults. Psychoneuroendocrinology. 1999.
49. Sahelian, Ray. Pregnenolone: Nature’s Feel Good Hormone. Garden City Park Ny: Avery Publishing Group, 1997:57-64.
50. McAuley JW. Oral administration of micronized progesterone: a review and more experience. Pharmacotherapy 16(3):453-7,
51.Lee, John R., MD, What your doctor may not tell you about Menopause, New York, New York: Time Warner Books 1999.
52. Goodyear, I, Cortisol hypersecretion in depressed school-aged children and adolescents. Psychiat Res 37: 237-44, 1991
53. Antonini, Jorge SM, Moreira. The emergence of salivary cortisol circadiam rhythm and its relationship to sleep activity in
preterm infants. Clin Endocrinol (Oxf). 2000 April 52 (4):423-6.
54. Opstad K. Circadian rhythm of hormones is extinguished during prolonged physical stress, sleep and energy deficiency in
young men. Eur J Endocrinol Metab 73: 1224-34, 1991.
55. Jefferies, W. Safe Uses of Cortisol, Charles C. Thomas Publication Ltd, Sept 1996
56. Wong, YF, Mao K, Panesar, Loong, Chang. Salivary estradiol and progesterone during the normal ovulatory menstrual cycle
in Chinese women. Eur J Obstet Gynecol Reprod Biol. 1990 Jan-Feb; 34 (1-2):129-35.
57. Overlie, Moen, Morkrid L, Skjaeraasen, Holte. The endocrine transition around menopause—a five year prospective study
with profiles of gonadotropines, estrogens, androgens and SHBG among healthy women. Acta Obstet Gynecol Scand 1999 Aug;
58. Lovejoy JC. The influence of sex hormones on obesity across the female life span. J Womens Health 1998 Dec; 7(10)1247-56.
59. Lonning, Dowsett, Jacobs, Scehm, Hardy, Powles. Lack of diurnal variation in plasma levels of androstenedione,
testosterone, estrone, and estradiol in postmenopausal women. J Steroid Biochem. 1989; 34(1-6):551-3.
60. Inaba, M. Can human hair grow again? J Dermatology Surg Oncol 12:672, 1986.
61. Conway, G. Hirsutism, Br Med J 301:619, 1990.
62. Journal of Steroid Biochemical Molecular Biology 1993; vol 46, No 3.
63. Monteleone P. Physical exercise at night blunts the nocturnal increase of plasma melatonin levels in healthy humans. Life Science
64. RJ. Reiter, The aging pineal gland and its Physiological Consequences, Bioessays 1992 March.
65. Bunevicius, R, et al., Effects of Thyroxine as compared with thyroxine plus triiodthyronine in patients with hypothyroidism. New
England Journal of Medicine vol 340, 6 424-429 Feb 11, 1999
66. Brind J, et al., "Obese men have elevated plasma levels of estrone sulfate," International Journal of Obesity 14(6) (June 1990):
67. Bachmann GA, Leiblum S, Grill J. Brief sexual inquiry in gynecologic practice. Obstet Gynecol 1989;73(3 pt 1):425-7.
68. Angst J. Sexual problems in healthy and depressed persons. Int Clin Psychopharmacol 1998;13(suppl 6): S1-4.
69. Read S, King M, Watson J. Sexual dysfunction in primary medical care: prevalence, characteristics and detection by the general
practitioner. J Public Health Med 1997;19:387-91.
70. Michael RT. Sex in America: a definitive survey. Boston: Little, Brown, 1994:111-31.
Schein M, Zyzanski SJ, Levine S, Medalie JH, Dickman RL, Alemagno SA. The frequency of sexual problems among family practice
patients. Fam Pract Res J 1988;7:122-34.
Section III HERBS Treatment
A review of plant-derived and herbal approaches to the treatment
of sexual dysfunctions
Rowland, David L; Tai, Wendi
Valparaiso U, Dept of Psychology, Valparaiso, IN, US [Rowland,
Rowland, David L, Dept of Psychology, Valparaiso U, Valparaiso,
IN, US, 46383,
Journal of Sex & Marital Therapy. Vol 29(3), May-Jun 2003, pp.
1. Adaikan, P. G., Gauthaman, K., Prasad, R. N., & Ng, S. C.
(2000). Proerectile pharmacological effects of Tribulus terrestris extract on
the rabbit corpus cavernosum. Annals of the Academy of Medicine,
2. Adimoelja, A. (2000). Phytochemicals and the breakthrough of
traditional herbs in the management of sexual dysfunctions. International
Journal of Andrology, 23, 77-84.
3. American Psychiatric Association. (1994). Diagnostic and
statistical manual of mental disorders (4 th ed). Washington, DC: American
4. Ansari, M. S., & Prasad, S. (1970). Pharmacognostical studies on
roots of tribulus terrestris linn (gokhru mool). Journal of Research in
Indian Medicine, 4, 193-200.
5. Arletti, R., Benelli, A., Cavazzuti, E., Scarpetta, G., &
Bertolini, A. (1999). Stimulating properties of Turnera diffusa and Pfaffia
paniculata extracts on the sexual behavior of male rats.
Psychopharmacology, 1, 15-19.
6. Ashton, A. K., Ahrens, K., Gupta, S., & Masand, P. S. (2000).
Antidepressant-induced sexual dysfunction and ginkgo biloba. American
Journal of Psychiatry, 157, 836-837.
7. Athleticnutrition.com. (2000, October 17). Natural testosterone
support: Tribulus terrestris [online]. Available:
8. Balon, R. (1999). Ginkgo biloba for antidepressant-induced
sexual dysfunction?: Comment. Journal of Sex & Marital Therapy, 25, 1-2.
9. Bass, J. (2000). Maca. Natural Health, 47,.
10. Buck, A. C. (1996). Phytotherapy for the prostate. British
Journal of Urology, 78, 325-336.
11. Carey, M. P., & Johnson, B. T. (1996). Effectiveness of
yohimbine in the treatment of erectile disorder: Four meta-analytic
integrations. Archives of Sexual Behavior, 25, 341-360.
12. Chakraborty, B., & Chakraborty, K. (1977). Some central effects
of tribulus terrestris linn. Indian Journal of of Physiology and Allied
Sciences, 31, 189-192.
13. Chen, X., & Lee, T. J. (1995). Ginsenosides-induced nitric
oxide-mediated relaxation of the rabbit corpus cavernosum. British Journal
of Pharmacology, 115, 15-18.
14. Choi, Y. D., Xin, Z. C., & Choi, H. K. (1998). Effect of Korean
red ginseng on the rabbit corpus cavernosal smooth muscle.
International Journal of Impotence Research, 10, 37-43.
15. Cicero, A. F., Bandieri, E., & Arletti, R. (2001). Lepidium
meyenii Walp improves sexual behaviour in male rats independently from its
action on spontaneous locomotor activity. Journal of Ethnopharmacology,
16. Cohen, A. J. (2001, May 25). Long term safety and efficacy of
ginkgo biloba extract in the treatment of anti-depressant-induced sexual
dysfunction [online]. Available:
17. Cohen, A. J., & Bartlik, B. (1998). Ginkgo biloba for
antidepressant-induced sexual dysfunction. Journal of Sex & Marital Therapy, 24,
18. Cohen, A. J., Stachel, L. E., & Sanders, B. (2001). The use of
natural products in the treatment of female sexual dysfunction
[online]. Available: [URL:http://www.priory.com/psych/sexherb.htm.].
19. Crenshaw, T. L., & Goldberg, J. P. (1996). Sexual pharmacology:
Drugs that affect sexual functioning. New York: W. W. Norton.
20. DeSmet, P. A. (1997). The role of plant-derived drugs and
herbal medicines in healthcare. Drugs, 54, 801-840.
21. Elstein, M. (2001, May 25). Alternatives to Viagra [online].
22. Ernst, E., & Pittler, M. H. (1998). Yohimbine for erectile
dysfunction: A systematic review and meta-analysis of randomized clinical
trials. Journal of Urology, 159, 433-436.
23. Fahim, M. S., Fahim, Z., Harman, J. M., Clevenger, T. E.,
Mullins, W., & Hafez, E. S. (1982). Effect of Panax ginseng on testosterone
level and prostate in male rats. Archives of Andrology, 8, 261-263.
24. Huemer, R. P. (2000). Tribulus and pro-sexual herbs. Let's
Live, 68, 36-37.
25. Ito, T. Y., Kawahara, K., & Das, A. (1998). The effects of
ArginMax, a natural dietary supplement for enhancement of male sexual
function. Hawaii Medical Journal, 57, 741-744.
26. Ito, T. Y., Trant, A. S., & Polan, M. L. (2001). A double-blind
placebo-controlled study of ArginMax, a nutritional supplement for
enhancement of female sexual function. Journal of Sex & Marital Therapy,
27. Jellin, J. M., Batz, F., & Hitchens, K. (2000). Natural
medicines comprehensive database. Stockton, CA: Therapeutic Research Faculty.
28. Kaplan, H. S. (1974). The new sex therapy. New York:
29. Khalsa, K. P. (1999). Peruvian sex herb and more maca. Let's
Live, 67, 49-51.
30. Kilham, C. (2000). Maca. Total Health, 22, 48-49.
31. Kilham, C. (1999). Maca: Secret of the Incas. Better Nutrition,
32. Kleijnen, J., & Knipschild, P. (1992). Ginkgo biloba. Lancet,
33. LeBars, P. L., Katz, M. M., Bermann, N., Itil, T. M., Freedman,
A. M., & Schatzberg, A. M. (1997). A placebo-controlled, double-blind,
randomized trial of an extract of ginkgo biloba for dementia. The
Journal of the American Medical Association, 278, 1372-1382.
34. Lowry, T. P. (1984). Damiana. Journal of Psychoactive Drugs,
35. Marks, L. S., Partin, A. W., Epstein, J. I., Tyler, V. E.,
Simon, I., Macairan, M. L., Chan, T. L., Dorey, F. J., Garris, J. B.,
Veltri, R. W., Santos, P. B., Stonebrook, K. A., & deKernion, J. B. (2000).
Effects of a saw palmetto herbal blend in men with symptomatic benign
prostatic hyperplasia. Journal of Urology, 163, 1451-1456.
36. Masters, W. H., & Johnson, V. E. (1970). Human sexual
inadequacy. Boston: Little Brown.
37. McKinney, D. E. (1999). Saw palmetto for benign prostatic
hyperplasia: Letter to the editor. The Journal of the American Medical
Association, 281, 1699.
38. Medical Economics Company. (1998). PDR for herbal medicines.
Montvale, NJ: Medical Economics Company.
39. Morales, A. (2000). Yohimbine in erectile dysfunction: The
facts. International Journal of Impotence Research, 12, S70-S74.
40. Morales, A., Condra, M., Owen, J., Surridge, D., Fenemore, J.,
& Harris, C. (1987). Is yohimbine effective in the treatment of organic
impotence? Results of a controlled trial. Journal of Urology, 137,
41. Murphy, L. L., Cadena, R. S., Chavez, D., & Ferraro, J. S.
(1998). Effect of American ginseng (Panax quinquefolium) on male copulatory
behavior in the rat. Physiology & Behavior, 64, 445-450.
42. Numrich, P. D. (2001). Buddhist tradition: Religious beliefs
and health care decisions. Chicago: Park Ridge Center.
43. Pfaus, J. G. (1996). Homologies of animal and human sexual
behaviors. Hormones and Behavior, 30, 187-200.
44. Prevention's guide: Healing herbs. (2000, November). Emmaus,
45. Qiu, R. X., Gin, M. H., & Wu, G. Z. (1996). Diphasic regulatory
effect of lishen0 injection on sex hormones in senile female patients
with coronary heart disease of kidney deficiency type. Zhongguo Zhong Xi
Yi Jie He Ze Zhi, 16, 267-269.
46. Rand, M. (2000, October 27). Maca: Passion plant from Peru
47. Rowland, D. L., & Burnett, A. L. (2000). Pharmacotherapy in the
treatment of male sexual dysfunction. Journal of Sex Research, 37,
48. Rowland, D. L., Kallan, K. H., & Slob, A. K. (1997). Yohimbine,
erectile capacity, and sexual response in men. Archives of Sexual
Behavior, 26, 49-62.
49. Roybal, B. A., & Skowronski, G. (2000). Herbs for romance.
Better Nutrition, 62, 20.
50. Salvati, G., Genovesi, G., Marcellini, L., Paolini, P.,
DeNuccio, I., Pepe, M., & Re, M. (1996). Effects of Panax ginseng C. A. Meyer
saponins on male fertility. Panminerva Medica, 38, 249-254.
51. Sanderoff, B. T. (2000/2001). Herbal medicine: Use with caution
and respect. Generations, 24, 69-74.
52. Sandoval, A. (2000). Muira puama for sex drive. Natural Health,
53. Segraves, R. (1995). Yohimbine may alleviate sexual
dysfunction. Psychopharmacology Update, 6, 4.
54. Singh, R. C., & Sisodia, C. S. (1971). Effect of tribulus
terrestris fruit extracts on chloride and creatine renal clearances in dogs.
Indian Journal of Physiology and Pharmacology, 15, 93-96.
55. Smith, P. F., Maclennan, K., & Darlington, C. L. (1996). The
neuroprotective properties of the gingko biloba leaf: A review of the
possible relationship to platelet-activating factor (PAF). Journal of
Ethnopharmacology, 50, 131-139.
56. Tomowa, M. P., Botschewa, D. M., Zaikin, W. G., & Wulfson, N.
S. (1977). Steroid saponines and sapogenines: V. Hecogenin from tribulus
terrestris L. Planta Medica, 32, 223-224.
57. Turkoski, B. B. (2000). Common herbal remedies. Orthopaedic
Nursing, 19, 83-89.
58. Vimaca (2000, October 17). Maca herbs for erectile dysfunction
and impotence [online]. Available:
59. Virag, R., Frydman, D., Legman, M., & Virag, H. (1984).
Intracavernous injection of papaverine as a diagnostic and therapeutic method
in erectile failure. Angiology, 35, 79.
60. Waynberg, J. (1994). Yohimbine vs. muira puama in the treatment
of sexual dysfunction. American Journal of Natural Medicine, 1, 8-9.
61. Waynberg, J., & Brewer, S. (2000). Effects of Herbal vX on
libido and sexual activity in premenopausal and postmenopausal women.
Advances in Therapy, 17, 255-262.
62. WebFarm Shop. (2000, October 17). Natures paradise: Tribulus
terrestris [online]. Available:
63. Wheatley, D. (1999). Ginkgo biloba in the treatment of sexual
dysfunction due to antidepressant drugs. Human Psychopharmacology
Clinical & Experimental, 14, 512-513.
64. Wilt, T., Ishani, A., Stark, G., MacDonald, R., Lau, J., &
Mulrow, C. (1998). Saw palmetto extracts for treatment of benign prostatic
hyperplasia: A systemic review. The Journal of the American Medical
Association, 280, 1504-1509.
65. Wu, G., Jiang, S., Jiang, F., Zhu, D. Wu, H., & Jiang, S.
(1996). Steroidal glycosides from tribulus terrestris. Phytochemistry, 42,
66. Yen, T. T. (1990). Stimulation of sexual performance in male
rats with the root extract of dinh lang (Policias fructicosum L.). Acta
Physiologica Hungarica, 75, 61-67.
67. Zava, D. T., Dollbaum, C. M., & Blen, M. (1998). Estrogen and
progestin bioactivity of foods, herbs, and spices. Proceedings of the
Society of Experimental Biology and Medicine, 217, 369-378.
68. Zheng, B. L. He, K., Kim, C. H., Rogers, L., Shao, Y., Huang,
Z. Y. Lu, Y., Yan, S. J., Qien, L. C., & Zheng, Q. Y. (2000). Effect of
a lipidic extract from lepidium meyenii on sexual behavior in mice and
rats. Urology, 55, 598-602.