Background
Research suggests that sexual dysfunction is common, occurring in 43% of women and 31% of men. Sexual dysfunction refers to a problem occurring during any phase of the sexual response cycle that prevents the individual or couple from experiencing satisfaction from the sexual activity. The sexual response cycle traditionally includes excitement, plateau, orgasm, and resolution. Desire and arousal are both part of the excitement phase of the sexual response.
Sexual dysfunction is a complex issue, often involving hormone imbalance. Because the etiologies can be varied, having a tool that can address several aspects of dysfunction is valuable. Tribulus is one of those tools.
Tribulus terrestris (commonly referred to as Tribulus) is an herb also known as “puncture vine” that grows in South Africa, China, India, Australia, and the Mediterranean. This herb, particularly the leaf, has a long tradition of use in Ayurvedic medicine. Tribulus terrestris has numerous uses in botanical medicine and has been studied in the treatment of sexual health for both men and women.
Women’s Health
Tribulus has been shown to improve sexual dysfunction in women by enhancing desire and lubrication. Recent research has found that Tribulus can affect the testosterone and DHEA levels in women and can improve the Female Sexual Function Index (FSFI) better than placebo.
In a small 2014 study, 2 groups of 30 women with sexual dysfunction were either given 7.5mg per day of Tribulus or placebo. At 4 weeks, the treatment group had significantly improved desire, arousal, lubrication, satisfaction and pain1.
A more recent longer term study involved 36 postmenopausal women who were given either 750mg per day of Tribulus or placebo for 120 days. The treatment group reported improved desire, arousal/lubrication, pain, and anorgasmia, while no improvement was seen in the placebo group. Serum free testosterone levels showed significant increase in the Tribulus group and few side effects were reported2.
A 2014 qualitative, quantitative study reviewed the medical records of 120 women of reproductive age experiencing sexual dysfunction. The subjects were given tablets containing 250mg of Tribulus in three divided doses per day. 88% of these women showed significantly improved FSFI scores. There was a statistically significant rise in DHEA and decrease in serum testosterone and free testosterone3.
All three of these studies were relatively small and one did not involve a placebo group. Keeping in mind that the body of evidence is still growing, Tribulus can be considered as a part of a comprehensive treatment approach to help women experiencing sexual dysfunction.
Men’s Health
Tribulus can also be used to help treat men with erectile dysfunction (ED). Both animal and human studies have supported the use of Tribulus for erectile dysfunction. The mechanisms studied involve raising testosterone and other hormones as well as supporting the nitric oxide pathway.
30 males with partial androgen deficiency and ED were given 250mg of Tribulus three times daily for three months in a pilot study. This treatment resulted in statistically significant improvement in free and total testosterone and in International Index of Erectile Dysfunction (IIEF-5)4.
Similar results have been seen in animal studies. Primates showed significant increases in testosterone, DHT and DHEAs when given 7.5mg/kg of Tribulus during a study to investigate the hormonal effects when used for erectile dysfunction treatment5.
The mechanism of action of tribulus on erectile function involves the nitric oxide/nitric oxide synthase pathway and effects the corpus cavernosum endothelium. When rabbits were fed a preparation of Tribulus for one month, intracavernous pressure and cAMP levels were higher in the treatment group versus the control group6.
Based on the current research, Tribulus can help improve erectile dysfunction in men likely because it can raise testosterone levels and potentially increase intracavernous pressure and cAMP.
Summary
Consider running a Labrix salivary hormone panel to determine if your patients have hormonal imbalances that could be affecting sexual function. In addition to appropriate bioidentical hormone therapy, Tribulus terrestris can be considered in a comprehensive treatment approach when addressing sexual dysfunction for both male and female patients.
