Natural aphrodisiacs: traditional use, mechanism of action, clinical efficacy, and safety

Since time immemorial, people have been trying to increase their sexuality. They seek ways to increase sexual activity or sexual desire in themselves and their partners. In addition to resorting to all sorts of mystical rituals, people were looking for various effects from the use of natural raw materials. Some plant, animal, or fungal products have been shown to affect libido, sexual arousal, erectile function, orgasm or erogenous zone sensitivity. Such substances have been called "aphrodisiacs" in honor of the ancient Greek goddess of love - Aphrodite. Most often, aphrodisiacs were taken orally, but some were smoked and others applied to the genitals. In modern clinical practice, phosphodiesterase type 5 inhibitors are used. These are substances, which enhance erection and prevent detumescence in the presence of sexual arousal. Another group of drugs is selective serotonin reuptake inhibitors, which reduce sexual arousal and sexual afferent from the genitals, thus preventing the premature onset of orgasm in men and prolonging sexual intercourse. However, drugs from other pharmacological groups have not found widespread clinical application. Another issue is a trend among young people taking drugs of natural origin, therefore, all kinds of traditional aphrodisiacs are actively used to the present day. Very little is known about almost all of them. Clinical trials are in most cases limited to a few, often not randomized, studies. In this regard, it is very difficult to evaluate the adequate therapeutic and toxic doses of remedies. The situation is complicated by the fact that those few clinical studies were based on questionnaires, that is, the indicators taken into statistical calculations were extremely subjective. Moreover, it was uncertain whether all patients could adequately assess their dynamics in terms of parameters such as sexual satisfaction, or clearly distinguish between libido and sexual arousal. Since the majority of the studies were not blinded, a psychogenic influence on the results of the investigations could not be eliminated, which in the sexual area may be huge. It is worth emphasizing the toxicity of many traditional aphrodisiacs. Of course, there is a serious deficit in the spectrum of pharmacotherapy for sexual disorders. Perhaps further large, randomized, placebo-controlled trials would add some of the traditional aphrodisiacs or their modifications to the arsenal of the clinical specialist.