This document summarizes information about various nutraceuticals that may help treat female sexual dysfunction. It discusses resveratrol, ashwagandha, tribulus, L-arginine, black cohosh, evening primrose oil, and shilajit. For each, it provides the scientific name, active components, proposed mechanisms of action, and clinical evidence of benefits related to female sexuality and sexual dysfunction. Relationship factors, physiological factors, and psychological factors are all discussed as contributors to low sexual desire and other issues.

1. Dr Raouf Roshdy
Dr. Rafik Raouf
A Novel Compilation

2. Female sexual dysfunction (FSD),
Female sexual arousal disorder (FSAD),
Female orgasmic disorder (FOD),
Hypoactive sexual desire disorder (HSDD).

3. Female sexual dysfunction is a multi-causal and
multidimensional medical problem that has
biologic and psychosocial components. It is age
related, progressive, and highly prevalent,
affecting 30% to 50% of women.
Based on the National Health and Social Life
Survey of 1749 women, 43% had complaints of
sexual dysfunction
Jaafarpour M, Khani A, Khajavikhan J, Suhrabi Z. Female sexual dysfunction: prevalence and risk factors. J Clin Diagn Res. 2013 Dec;7(12):2877-80.doi:
10.7860/JCDR/2013/6813.3822. Epub 2013 Dec 15. PMID: 24551663; PMCID: PMC3919309.

4. Desire problem (39.3%),
Arousal problem (25.8%),
Lubrication problem (21.5%),
Orgasm problem (16.6%),
Satisfaction problem (21.5%)
Pain problems (16.6%).
Ishak, I. H., Low, W.-Y., & Othman, S. (2015, December 16). Prevalence, risk factors, and predictors of female sexual dysfunction in a primary care
setting: A survey finding. The Journal of Sexual Medicine. Retrieved October 28, 2022, from https://doi.org/10.1111/j.1743-6109.2010.01848.x

5. Age
Husband's age
Duration of marriage
Medical problems
Menopausal status
Frequency of sexual intercourse
FMG in Meddle east
Kılıç M. (2019). Prevalence and risk factors of sexual dysfunction in healthy women in Turkey. African health sciences, 19(3), 2623–2633.
https://doi.org/10.4314/ahs.v19i3.38

6. Relationship factors were more important to
low desire than age or menopause, whereas
physiological and psychological factors were
more important to low genital arousal and low
orgasmic function than relationship factors.
Sexual distress was associated with both
psychological and relationship factors.
Hayes, R. D., Dennerstein, L., Bennett, C. M., Sidat, M., Gurrin, L. C., & Fairley, C. K. (2008). Risk factors for female sexual dysfunction in the
general population: exploring factors associated with low sexual function and sexual distress. The journal of sexual medicine, 5(7), 1681–1693.
https://doi.org/10.1111/j.1743-6109.2008.00838.x

7. Dr Stephen DeFelice coined the term
“Nutraceutical” from “Nutrition” and
“Pharmaceutical” in 1989. The term
nutraceutical is being commonly used
in marketing but has no regulatory
definition. An attempt to redefine
nutraceuticals and functional foods is
made in this article. The proposed
definitions can help distinguish
between functional foods,
nutraceuticals, and dietary
supplements.
Kalra, E.K. Nutraceutical-definition and introduction. AAPS PharmSci 5, 27–28 (2003).

8. Nutraceuticals can be effective in modulating
the perimenopausal symptoms in women.
The progressive reduction of the vasomotor
symptoms reported by women over the
nutraceutical usage could contribute to
improve their QoL and sexual life.
Caruso, S., Cianci, S., Cariola, M., Fava, V., Rapisarda, A. M., & Cianci, A. (2017). Effects of nutraceuticals on quality of life and sexual function
of perimenopausal women. Journal of endocrinological investigation, 40(1), 27–32. https://doi.org/10.1007/s40618-016-0500-2

9. 1. Resveratrol
2. Ashwagandha
3. Tribulus
4. L-arginine
5. Black Cohosh
6. Primrose
7. Shilajit

10. Resveratrol is part of a group of compounds called
polyphenols. The are very strong antioxidants with
anti-aging properties, it also has anti-viral, anti-
inflammatory effects especially in tissues rich in
estrogen receptors.
It binds to β and α receptors with a comparable
affinity.
Koushki, M., Amiri-Dashatan, N., Ahmadi, N., Abbaszadeh, H. A., & Rezaei-Tavirani, M. (2018). Resveratrol: A miraculous
natural compound for diseases treatment. Food science & nutrition, 6(8), 2473–2490. https://doi.org/10.1002/fsn3.855

11. Kingdom: Plantae
Clade: Tracheophytes
Clade: Angiosperms
Clade: Eudicots
Order: Caryophyllales
Family: Polygonaceae
Genus: Reynoutria
Species: R. japonica

12. 1- Inhibition of NF-κB
2- Inhibition of the PI-3K/Akt
signaling pathway
3 - Inhibition of cyclooxygenase
(COX) Effect on nitric oxide
metabolism Mevalonate pathway

14. Polygonum cuspidatum root that is a plant extract,
so the origin is vegetal.
Excreted through hepatic system

15. For hundreds of years, people have used the roots and orange-red
fruit of ashwagandha for medicinal purposes. The herb is also known
as Indian ginseng or winter cherry.
The name “ashwagandha” describes the smell of its root, meaning
“like a horse.” By definition, ashwa means horse.
Considering these facts many scientific studies were carried out and
its adaptogenic / anti-stress activities were studied in detail. In
experimental models it increases the stamina of rats during
swimming endurance test and prevented adrenal gland changes of
ascorbic acid and cortisol content produce by swimming stress
Singh, N., Bhalla, M., de Jager, P., & Gilca, M. (2011). An overview on ashwagandha: a Rasayana (rejuvenator) of Ayurveda. African
journal of traditional, complementary, and alternative medicines : AJTCAM, 8(5 Suppl), 208–213.
https://doi.org/10.4314/ajtcam.v8i5S.9

16. Kingdom: Plantae
Clade: Tracheophytes
Clade: Angiosperms
Clade: Eudicots
Clade: Asterids
Order: Solanales
Family: Solanaceae
Genus: Withania
Species: W. somnifera

17. Active principles of Ashwagandha, for instance
the sitoindosides VII-X and Withaferin-A, have
been shown to have significant anti-stress activity
against acute models of experimental stress
The aerial parts of Withania
somnifera yielded 5-dehydroxy
withanolide-R and withasomniferin-A
Singh, N., Bhalla, M., de Jager, P., & Gilca, M. (2011). An overview on ashwagandha: a Rasayana (rejuvenator) of Ayurveda. African
journal of traditional, complementary, and alternative medicines : AJTCAM, 8(5 Suppl), 208–213.
https://doi.org/10.4314/ajtcam.v8i5S.9

19. Withania somnifera also known as “Indian Winter
cherry” or “Indian Ginseng,” is an evergreen shrub
that’s found in India, Africa and parts of the
Middle East

20. Tribulus terrestris (family Zygophyllaceae),
commonly known as Gokshur or Gokharu or
puncture vine, has been used for a long time in
both the Indian and Chinese systems of
medicine for treatment of various kinds of
diseases. Its various parts contain a variety of
chemical constituents which are medicinally
important, such as flavonoids, flavonol
glycosides, steroidal saponins, and alkaloids.
Chhatre, S., Nesari, T., Somani, G., Kanchan, D., & Sathaye, S. (2014). Phytopharmacological overview of Tribulus
terrestris. Pharmacognosy reviews, 8(15), 45–51. https://doi.org/10.4103/0973-7847.125530

21. Kingdom: Plantae
Division: Phanerogams
Subdivision: Angiospermae
Class: Dicotyledonae
Subclass: Polypetalae
Series: Disciflorae
Order: Giraniales
Family: Zygophyllaceae
Genus: Tribulus
Species: terrestris Linn.

22. It has diuretic, aphrodisiac, antiurolithic,
immunomodulatory, antidiabetic,
absorption enhancing, hypolipidemic,
cardiotonic, central nervous system,
hepatoprotective, anti-inflammatory,
analgesic, antispasmodic, anticancer,
antibacterial, anthelmintic, larvicidal,
and anticariogenic activities.
Chhatre, S., Nesari, T., Somani, G., Kanchan, D., & Sathaye, S. (2014). Phytopharmacological overview of Tribulus
terrestris. Pharmacognosy reviews, 8(15), 45–51. https://doi.org/10.4103/0973-7847.125530

23. Experimental studies using T. terrestris extracts have
demonstrated an increase in sexual function in rats
which has been attributed to an increase in
testosterone, dihydrotestosterone, and
dehydroepiandrosterone.
One clinical study has also demonstrated that T.
terrestris extract increases body's natural testosterone
levels and thereby improves female desire and helps
build muscle.
Singh, S., Nair, V., & Gupta, Y. K. (2012). Evaluation of the aphrodisiac activity of Tribulus terrestris Linn. in sexually sluggish male albino
rats. Journal of pharmacology & pharmacotherapeutics, 3(1), 43–47. https://doi.org/10.4103/0976-500X.92512

25. Tribulus terrestris is a fruit-producing
Mediterranean plant that's covered with spines. It
is also called puncture vine.

26. L-arginine is an amino acid that helps the
body build protein.
L-arginine is also found in most protein-
rich foods, including fish, red meat,
poultry, soy, whole grains, beans and
dairy products.
As a supplement, L-arginine can be used
orally and topically. It can also be
administered intravenously (IV).
https://www.mayoclinic.org/drugs-supplements-l-arginine/art-20364681

28. Five randomized controlled trials and two
nonrandomized studies met eligibility criteria.
Six of the seven studies reported either an increase in
the total mean Female Sexual Function Index score
or significant increases in multiple domains
therein. One study assessed vaginal pulse
amplitude and found a statistically significant
increase in a combination treatment group
compared to placebo. No significant side effects
were reported. Four of seven studies had potential
risk-of-bias concerns per Cochrane assessments.
Cieri-Hutcherson, N. E., Jaenecke, A., Bahia, A., Lucas, D., Oluloro, A., Stimmel, L., & Hutcherson, T. C. (2021). Systematic Review of l-Arginine for the
Treatment of Hypoactive Sexual Desire Disorder and Related Conditions in Women. Pharmacy (Basel, Switzerland), 9(2), 71.
https://doi.org/10.3390/pharmacy9020071

31.  Black cohosh, a member of the buttercup family, grows
in North America. Native Americans traditionally used
black cohosh for a variety of ailments and introduced it
to European colonists.
 Currently, black cohosh is promoted as a dietary
supplement for hot flashes and other menopausal
symptoms. It’s also been promoted for other conditions,
including menstrual cramps and premenstrual
syndrome, and to induce labor.
 The part of the black cohosh plant used in herbal
preparations is the root or rhizome (underground stem).
https://www.mayoclinic.org/drugs-supplements-l-arginine/art-20364681

32. Kingdom : Plantae
Clade : Tracheophytes
Clade : Angiosperms
Clade : Eudicots
Order : Ranunculales
Family : Ranunculaceae
Genus : Actaea
Species: A.racemosa

33. 1) As a selective estrogen receptor
modulator,
2) Through serotonergic pathways
3) As an antioxidant,
4) On inflammatory pathways.
We found that while the most
prominent triterpenein BCE, 23-
epi-26-deoxyactein, suppresses
cytokine-induced nitric oxide
production in brain microglial
cells, the whole BCE extract
actually enhanced this pathway
Ruhlen, R. L., Sun, G. Y., & Sauter, E. R. (2008). Black Cohosh: Insights into its Mechanism(s) of Action. Integrative medicine insights, 3, 21–32.

35. Black cohosh, Cimicifuga racemosa (L.) Nutt., is a
member of the buttercup family
(Ranunculaceae) native to deciduous forests of
eastern North America

36. Primrose's pale yellow flowers can be a
common sight across the UK. The name
derives from the Latin prima rosa meaning
'first rose' of the year, despite not being a
member of the rose family. In different
counties of England it is also referred to as
butter rose, early rose, Easter rose, golden
rose and lent rose

37. Kingdom : Plantae
Clade : Tracheophytes
Clade : Angiosperms
Clade : Eudicots
Clade : Asterids
Order : Ericales
Family : Primulaceae
Genus : Primula
Species : P. vulgaris

38. Evening primrose oil (EPO) is extremely high in linoleic acid (LA)
(70–74%) and γ-linolenic acid (GLA) (8–10%), which may
contribute to the proper functioning of human tissues because they
are precursors of anti-inflammatory
EPO supplementation results in an increase in plasma levels of γ-
linolenic acid and its metabolite dihomo-γ-linolenic acid (DGLA).
This compound is oxidized by lipoxygenase (15-LOX) to 15-
hydroxyeicosatrienoic acid (15-HETrE) or, under the influence of
cyclooxygenase (COX),
DGLA is metabolized to series 1 prostaglandins. These compounds
have anti-inflammatory and anti-proliferative properties.
Furthermore, 15-HETrE blocks the conversion of arachidonic acid
(AA) to leukotriene A4 (LTA4) by direct inhibition of 5-LOX. In
addition, γ-linolenic acid suppresses inflammation mediators such
as interleukin 1β (IL-1β), interleukin 6 (IL-6), and cytokine - tumor
necrosis factor α (TNF-α).
Timoszuk, M., Bielawska, K., & Skrzydlewska, E. (2018). Evening Primrose (Oenothera biennis) Biological Activity Dependent on Chemical
Composition. Antioxidants (Basel, Switzerland), 7(8), 108. https://doi.org/10.3390/antiox7080108

40. Evening primrose oil is
extracted from the seeds of
the evening primrose plant,
a wildflower native to North
America and introduced to
Europe in the early 1600s. The
seed oil has been studied for
medicinal effects for decades
because it is a rich source of
linoleic acid E

41. Shilajit is an astonishing sticky tar-like resinous
substance that is neither completely plant nor
of animal origin. In nature, Shilajit is a type of
mineral pitch that is made up of humus and
decomposed plant remains, exuded from the
rocks present in the Himalayas at an altitude of
1000 to 5000 metres above sea level.
Carrasco-Gallardo, C., Guzmán, L., & Maccioni, R. B. (2012). Shilajit: a natural phytocomplex with potential procognitive activity. International journal of
Alzheimer's disease, 2012, 674142. https://doi.org/10.1155/2012/674142

42. This black tar-like rock has been produced for
millions of years from plants and organic matter
trapped in the layers of the Himalayan
Mountains above 8,000 feet in elevation. Shilajit
contains a high concentration of trace minerals
including fulvic and humic acids, iron, zinc,
magnesium, copper, nickel, potassium,
manganese, silicon, silver, sodium, sulfur,
iodine, and more.

44. Carrasco-Gallardo, C., Guzmán, L., & Maccioni, R. B. (2012). Shilajit: a natural phytocomplex with potential procognitive activity. International journal
of Alzheimer's disease, 2012, 674142. https://doi.org/10.1155/2012/674142

46. It is a natural substance found mainly in the
Himalayas, formed for centuries by the gradual
decomposition of certain plants by the action of
microorganisms. It is a potent and very safe dietary
supplement, restoring the energetic balance and
potentially able to prevent several diseases

47. The use of Nutraceuticals can be
effective in modulating the Female
Sexual dysfunction and peri-
menopausal symptoms in women.
The proper usage could contribute to
improve their QoL and sexual life.

48. To
Prof. Dr. Ashraf Farag Elbaz
‫استاذ‬
‫الصناعية‬ ‫البيوتكنولوجيا‬ ‫قسم‬ ‫ورئيس‬
–
‫الوراثية‬ ‫الهندسة‬ ‫بحوث‬ ‫معهد‬
‫الحيوية‬ ‫والتكنولوجيا‬
–
‫السادات‬ ‫مدينة‬ ‫جامعة‬
For his great professional knowledge to inspire
This lecture

49. Dr. Raouf Roshdy