Libido: A Natural Whole-Person Approach
Sexual health is incredibly important to human health and often left out of the discussion when speaking to patients. As practitioners who focus on the whole-person, consider sexual health part of a holistic view.
Studies have revealed that most practitioners do not broach the topic of sexual health with patients, especially in general practice. One poll suggested that only 35% of general practitioners asked patients about sexual health and that was only 75% of the time. By not offering a discussion about sexual health with patients, it perpetuates the idea that the topic is not appropriate, too private or considered shameful, which is simply untrue. When you offer a safe, non-judgmental space for patients to discuss sexuality, it may strengthen the doctor-patient relationship and also uncover aspects of their health you may not have otherwise discussed in your visit.
For men, the inability to have or maintain an erection may not just be due to low hormones, but can be related to cardiovascular disease, diabetes or other chronic disease states.
For women who state they are having decreased sexual desire or function, you may want to look into further signs of depression or adrenal imbalance.
For all patients, decreased sexual function may be a result of concurrent medication use. They may not be aware that their medication is causing this side effect and remain silently embarrassed by it. If they do understand it is caused by their medication, they may feel there is nothing else they can do about it and there are no alternatives. By approaching this topic, you can counsel them and perhaps offer a natural alternative to help resolve the issue.
Asking all patients about sexual health can uncover potentially high-risk sexual practices for which counseling (non-judgmentally) is appropriate to reduce their risk of STIs or unwanted pregnancies. If you determine a patient is at risk of STIs, after offering counseling on barrier methods and safe practices, you may want to consider adding immune support to their treatment plan.
Many practitioners feel that they are unprepared for this type of questioning or they underestimate its importance. As a result, patients generally feel discomfort in bringing up sexuality for fear of judgment. The first step to this conversation is to ask permission from the patient to discuss their sexual health, allowing the patient to bring up the topic then or in the future.
Here are some simple, brief ways to incorporate the questioning into your visit:
Are you sexually active? (Don’t assume they are. Also ask if they have been in the last six months.)
Are your partners men, women or both? (Avoid using the phrase “married” or “monogamous”.)
Are you using barrier methods: sometimes, 100% or never? (Depending on the answer, this could provide an opportunity to discuss safe sexual practices or offer referrals.)
What sexual concerns do you have? (This leaves it open to the patient to discuss what is their concern, whether it is a physical symptom, a lack of desire or something more serious such as not feeling safe with their partner(s). It also implies that many people have sexual concerns and it is not unusual for them to have some as well.)
Be sensitive and mindful that the topics you address and how you approach a respectful discussion about sexual health will need to differ depending on the age and gender of the patient.
It is estimated that decreased sexual function, or low libido, affects over 50% of both men and women.1 Luckily, there are a number of botanicals for this issue. Here is a brief review of two of the best studied:
Tribulus is an herb of the Zygophyllaceae family. The main constituent, considered to be the active ingredient, is alpha amyrin.
The mechanism by which it can affect libido is unclear at this time. However, studies show that it can influence FSH and LH in women and testosterone in men.
Traditionally, it has been used for centuries for improving overall health, particularly in the realm of sexual desire and libido.
Overall, results of studies on Tribulus improving sexual function are mixed, but there have been multiple positive outcome studies involving Tribulus with women. One study in Iran showed that women taking 7.5 mg/day of Tribulus extract had improvement in desire, arousal, lubrication, satisfaction and pain2 with sex. It also has been shown in vivo and in vitro to have an erectogenic effect in males3.
Tongkat ali (Eurycoma longifolia)
This is an herb from the Malaysian rainforest. The mechanism of action comes from its “eurypeptides,” which have shown to help increase free testosterone from sex hormone binding globulin (SHBG). It has been used for centuries to enhance libido and reduce effects of stress.
There are many safety studies in both rodents and humans which show safety at the recommended dose of 50-200 mg/day.4
One small study looked at physically active seniors who took 400 mg of tongkat ali daily for five weeks and found that there was significant increase in total and free testosterone and muscular force in both men and women. The theory behind the increase in testosterone in women is that the tongkat ali causes a decline in SHBG.5
Another study showed that 200 mg/day for four weeks improved salivary cortisol and testosterone in stressed individuals.4 This may be helpful to those with sexual dysfunction as a result of stress.
Overall, discussing the topic of sexual health with patients as a part of a holistic approach to wellness can improve their health, well-being and longevity.
Meredith Murray, ND
Dr. Meredith Murray is a practicing naturopathic doctor and the newest member of the Medical Education team at Emerson Ecologics. She sees patients in New Hampshire, focusing on digestive disorders.
- Nusbaum M, Hamilton C. The Proactive Sexual Health History. American Family Physician. 2002;66(9):1705–1712.
- Akhtari E, Raisi F, Keshavarz M, et al. Tribulus terrestris for treatment of sexual dysfunction in women: Randomized double-blind placebo – controlled study. DARU Journal of Pharmaceutical Sciences. 2014;22(1):40. doi:10.1186/2008-2231-22-40.
- Do J, Choi S, Choi J, Hyun JS. Effects and mechanism of action of a Tribulus terrestris Extract on Penile erection. Korean Journal of Urology. 2013;54(3):183. doi:10.4111/kju.2013.54.3.183.
- Talbott SM, Talbott JA, George A, Pugh M. Effect of Tongkat Ali on stress hormones and psychological mood state in moderately stressed subjects. Journal of the International Society of Sports Nutrition. 2013;10(1):28. doi:10.1186/1550-2783-10-28.
- Henkel RR, Wang R, Bassett SH, et al. Tongkat Ali as a potential herbal supplement for physically active male and female seniors-a pilot study. Phytotherapy Research. 2013;28(4):544–550. doi:10.1002/ptr.5017.