"Not tonight, honey. I have a headache." Such phrases are uttered nightly behind bedroom doors across America, where, according to recent studies, 43 percent of women and 31 percent of men suffer sexual dysfunction, and as many as 20 million couples live in sexless relationships.
The good news: Thirteen years after Pfizer unveiled ads for Viagra, its "little blue pill," men and women are more comfortable than ever seeking out solutions for subpar sex lives, experts say. And many are turning to natural alternatives, with sales of libido-boosting supplements soaring from $140 million in 1999 to more than $480 million in 2009, according to Nutrition Business Journal.
"Viagra commercials changed the conversation around this subject," says Genie James, coauthor of In the Mood Again (Simon and Schuster, 2010). "People realize there is nothing to be ashamed of and are eager to do something about it."
Eric Yarnell, ND, an associate professor at Seattle-based Bastyr University, notes that although prescription erectile-dysfunction drugs can help boost blood flow to genitals (thus heightening performance), they do little to address the hormonal and neurological factors that can often dull our appetite for love. "If there is no desire to begin with, they won't do you any good," he says.
For women, drug companies have yet to come up with a libido booster other than prescription testosterone, which can cause the unwanted side effects of acne and hair growth. But as positive studies on herbs and supplements for sexual health proliferate, women's health practitioners are becoming more comfortable recommending natural remedies, says Marianne Marchese, ND, a professor of gynecology at Tempe, Ariz.-based Southwest College of Naturopathic Medicine.
To help consumers find the right solution on your store shelves, here's what sexual-health experts are recommending.
Maca (Lepidium meyenii). Aside from combination formulas, which make up 60 percent of the sexual/virility category, Peruvian maca is the top-selling libido-boosting herb, with $68 million in sales in 2009, NBJ reports.
The root has been used as an aphrodisiac for men and women in the Andes for centuries, leading some researchers to theorize that it bolsters levels of reproductive hormones such as testosterone. But a 2003 study found it had no impact on hormone levels.
Instead, Marchese says maca works as an adaptogen, counteracting the physiological impact of stress and increasing stamina. "Think of the stressed-out, overworked woman who isn't sleeping because of hormonal changes. She's not going to have a lot of desire. Maca can help boost her [sexual] endurance," Marchese says.
In a 2010 meta-analysis published in the journal BMC Complementary and Alternative Medicine, three out of four randomized controlled trials showed maca to have "significant positive effects" on menopausal women with low sex drive and on men suffering from erectile dysfunction. Retailers should take note, however, that the Food and Drug Administration considers any supplement claiming to treat ED to be an unapproved drug.
Damiana (Turnera aphrodisiaca). Although sales figures aren't available for damiana, this shrub has traditionally been used as an herbal aphrodisiac. Western research is slim, but some industry-sponsored studies suggest damiana contains compounds that bind to progesterone receptors in the brain, mimicking this "feel-good" sex hormone. Progesterone is also a precursor to estrogen, which helps keep vaginal tissue moist. Because progesterone tends to diminish during perimenopause, women may need a boost.
A 2006 University of Hawaii study of 108 women age 22 to 73 found that among those who took a proprietary blend containing damiana for four weeks, 72 percent reported increased sex drive (compared to 37 percent in the placebo group). The damiana group also reported less vaginal dryness and increased frequency of intercourse.
- Yohimbe (Pausinystalia yohimbe). Sales of products made from this West African tree bark totalled $14 million in 2009, according to NBJ. Yohimbe contains a well-researched alkaloid called yohimbine that's believed to impact the production of brain chemicals, such as dopamine, that boost sexual desire and increase blood flow to the genitals. Yohimbe has been shown to treat libido problems in men. An FDA-approved form of yohimbine is available via prescription.High-quality over-the-counter varieties of yohimbe from a reputable, brand-name company, which contain lower amounts of yohimbine than the drug, can be effective if taken daily over a few months, Yarnell says. However, yohimbe can cause anxiety attacks when taken in excess, he warns.
- Tribulus (Tribulus terrestris). Research shows that this plant, which is used in Russia and India and had $16 million in sales in 2009, according to NBJ, works as an aphrodisiac and fertility booster by increasing natural levels of testosterone in men and estrogen in women. Although most recent studies have been on animals, an older study of 363 Bulgarian men treated with 750 mg daily of Tribulus terrestris for several months showed increased sperm mobility and libido.
- Ginkgo (Ginkgo biloba). Best known for its ability to boost memory, ginkgo also contains compounds that can increase blood flow and relax muscle tissue in the genitals, Marchese reports. Overall ginkgo sales (not specifically for sexual health) were $95 million in 2009, according to NBJ. The herb is often featured alongside circulation-boosting compounds such as ginseng, L-arginine or niacin in topical products applied before intercourse.