Improving your sex lifeLow sex drive is common. Surveys suggest it affects 20 per cent of the population at any one time, and up to 60 per cent of stressed executives and postmenopausal women. It's especially common when you're tense, anxious or tired - even though you may otherwise be in good health and eat a normal diet.

Several herbs and supplements have a reputation as prosexual agents. These may reduce sexual inhibition or boost desire and performance. Unfortunately, few clinical trials have been carried out to investigate their efficacy, but if your lovelife is in need of a boost, try the following three-step program:

Step one Take a multivitamin and mineral supplement, providing around 100 per cent of the recommended daily amount (RDA) of as many micronutrients as possible, as well as important trace elements such as boron, chromium, copper and molybdenum. This will help to correct any nutrient deficiencies that may be linked with reduced physical or sexual energy.

Step two Take evening primrose oil (500-1000mg per day) to provide essential fatty acids (EFAs) needed for synthesis and balance of sex hormones. Low sex drive is often linked with physical exhaustion, and EFA supplements showed significant beneficial effects (within three months) in 90 per cent of people suffering from chronic fatigue. EFAs may therefore prove helpful where low sex drive is associated with lack of energy.

Step three Take one or more of the following supplements which have a reputation for enhancing sexual function.

Korean ginseng

Damiana

Muira puama

Hypericum

Oats

Ashwagandha

Fo-ti

Gingko

Schisandra

Chicken egg extracts

Tribulus terrestris

Korean ginseng (Panax ginseng)

Korean Ginseng has been used in China as a sexual balancer and revitalising tonic for over 7,000 years. It is also praised as an aphrodisiac in India.

What it is Dried root containing ginsenosides, saponins, steroidal glycosides, sterols.

Actions In China, ginseng is widely used as an aphrodisiac and life-enhancing tonic. It is stimulating and restorative, improving physical and mental energy, stamina, strength, alertness and concentration. Clinical trials have confirmed its ability to help the body adapt to physical or emotional stress and fatigue. It has a normalising effect on hormone imbalances and boosts metabolic rate and improves peripheral circulation, including blood flow to the genitals.

Analysis has identified steroidal compounds similar to human sex hormones, and ginseng has been shown to boost sexual activity in rabbits, bulls and rats, and to stimulate ovulation in hens.

Who would benefit? Those whose low sex drive is linked with stress, over-work, fatigue, convalescence or hormone imbalances.

Dose: Depends on grade of root. Choose a standardised product. Start with a low dose and work up from 200-1000mg a day. Optimum dose usually around 600mg daily. It should not be taken for more than six weeks without a break. In the East, ginseng is taken in a two-weeks-on, two-weeks-off cycle.

Cautions: Not advised if you have high blood pressure (may make hypertension worse), glaucoma or have an oestrogen dependent condition (eg pregnancy, breast cancer) as it contains oestrogenic compounds.

Damiana (Turnera diffusa aphrodisiaca)

Damiana is a traditional aphrodisiac used by the Maya of Central America. It is one of the few herbs that may truly deserve its reputation as an aphrodisiac.

What it is: dried leaves and flowers of a plant native to Mexico and the US Southwest, which contains arbutin, volatile oils, alkaloids, glycosides, resins and gums.

Actions: Damiana contains volatile oils that gently irritate the urogenital tract to produce a local, stimulant effect. Its alkaloids may also boost circulation to the genital area and increase sensitivity of nerve-endings in the clitoris and penis. These combined effects are said to increase sexual desire, enhance sexual pleasure and stimulate sexual performance. Some herbalists claim the pharmacology of the alkaloids could have a testosterone-like effect, but so far, no clinical studies have been performed to support its traditional use. It also acts as a tonic, mild laxative and urinary antiseptic.

Who would benefit? Those whose loss of sex drive is linked with decreased sensitivity, difficulty achieving arousal, physical weakness, nervous exhaustion, painful periods, menstrual headaches, recurrent cystitis or constipation.

Dose: One to two 400mg capsules or one dropper of tincture. It's usually taken on an occasional basis when needed rather than regularly, and is often combined with other pro-sexual herbs such as ginseng, sarsaparilla, oats or muira puama.

Cautions: None

Muira puama (Ptychopetalum olacoides)

Muira puama is another herb that may deserve its reputation as a true aphrodisiac (Ref 1). It is widely used by natives of the Amazon and Orinoco river basins to enhance sexual desire and combat impotence, and is popularly known as potency wood.

What it is Dried root, bark and wood of a Brazilian shrubs containing resins, lupeol, campestrol and beta-sitosterol.

Actions Researchers are unsure how it works, but it is thought to stimulate sexual desire through a direct action on the central nervous system, or boost production/function of sex hormones. A clinical study of 262 patients comparing muira puama with Yohimbine - an FDA-approved treatment for impotence - found that 62 per cent of subjects complaining of lack of sexual desire (and 51 per cent with difficulty maintaining an erection) said muira puama had a dynamic effect on their sex lives, while 51 per cent who had erectile dysfunction felt it was of benefit. The researchers

suggested that muira puama is one of the best herbs for treating erectile dysfunction and lack of libido.

Who would benefit? Those with low sex drive; males with temporary difficulty maintaining an erection.

Dose: 1-1.5g daily for two weeks, a cup of muira puama tea or a dropperful of tincture on an occasional basis when needed. Often combined with other pro-sexual herbs such as ginseng, sarsaparilla and damiana.

Cautions: None

Hypericum (Hypericum perforatum)

Hypericum has been used for 2,000 years to aid emotional well-being. It is said to have taken its common name, St John's wort, from the Knights of St John of Jerusalem, who used it as a salve during the Crusades.

What it is: Dried leaves and flowers containing hypericins, antioxidant bioflavonoids, tannins, resins and volatile oils.

Actions: An effective antidepressant that boosts low mood in at least 67 per cent of those with mild- to moderate depression. Low sex drive is an early feature of depression, and Hypericum can boost libido in these cases. Research in Germany involving 111 post-menopausal women with low sex drive as well as physical exhaustion found that Hypericum helped 60 per cent became interested in sex again, and to enjoy or even initiate sex with their partner. Eight two per cent also suffered less irritability, anxiety, low mood, hot flushes, sweating and disturbed sleep.

Who would benefit? Anyone whose loss of sex drive is linked with physical exhaustion, anxiety, stress, irritability, low mood or depression. Especially beneficial for women around the time of the menopause. May be used together with oestrogen replacement therapy.

Dose: 300mg three-times daily (0.3 per cent standardised extracts)

Cautions: Avoid strong sunlight as it may cause photosensitive dermatitis if your skin is exposed to the sun during systemic treatment.

Oats (Avena sativa)

Oat is a familiar, nutritious cereal used to make porridge

and muesli. Its reputation as a prosexual herb may account for the popular saying about sowing ones wild oats.

What it is: Extracts from the young, whole plant or unripe grain, also known as oat straw or wild oats. Contains saponins, flavonoids, alkaloids, steroidal compounds, vitamins and minerals.

Actions: An antidepressant, restorative nerve tonic used to treat nervous exhaustion and stress. Research in Australia found that athletes who followed an oat-based diet for three weeks showed a four per cent increase in stamina. A study involving 40 adults found that an oats and nettle supplement increased sexual desire and performance.

Who would benefit? Those whose low sex drive is associated with stress, exhaustion, convalescence, poor sleep or low mood.

Dose: One dropperful fluid-extract or tincture taken two or three times daily.

Cautions: For those sensitive to gluten (coeliac disease), take the tincture after allowing it to settle, and decanting off the clear liquid for use.

Ashwagandha (Withania somnifera)

Ashwagandha is a popular Indian herb used in Ayurvedic medicine as a restorative. It is also popularly known as winter cherry or Indian ginseng. Its Hindi name means 'horse smell'.

What it is Dried roots of a small Indian shrub containing alkaloids and withanolides.

Actions Traditionally used to soothe nerves and promote sleep in those suffering from overwork or nervous exhaustion. Research shows it increases haemoglobin levels, improves sexual performance, reduces premature greying of hair and has anti-inflammatory properties. It's sometimes used to treat impotence.

Who would benefit? Those whose low sex drive is associated with anaemia, stress, overwork, difficulty sleeping or exhaustion.

Dose: 1-2g powdered root daily, or 150-300mg capsules standardised to contain 2-5mg withanolides.

Cautions: None

Fo-ti (Polygonum multiflorum)

Fo-ti is one of the oldest Chinese tonic herbs, known traditionally as he shou wu. Chinese legend claims that over 1000 years ago, a childless, impotence male tried he shou wu and it restored his virility, allowing him to father numerous children and live to 130.

What it is Dried roots of a climbing perennial vine, containing chrysophanic acid, anthraquinones and lecithin.

Actions: Fo-ti Famous for its rejuvenating and revitalising properties. It is widely used as a general restorative and to promote fertility, sexual function and boost a low libido. Research shows it can reduce an abnormally raised cholesterol and may have some antibiotic effects against tuberculosis and malaria. Also used to reduce premature greying of hair.

Who would benefit? Anyone neededing a general, restorative tonic, those whose low sex drive is associated with dizziness, weakness and numbness

Dose: 5g daily, or one dropperful tincture two or three times daily.

Cautions: Avoid if you're suffering from diarrhoea.

Ginkgo (Ginkgo biloba)

The ginkgo or maidenhair tree is one of the oldest known plants on earth. It seems to have remained unchanged during the last 200 million years and is often described as a living fossil.

What it is: Dried ginkgo leaves containing flavoglycosides, bioflavones and unique chemicals known as ginkgolides and bilobalides.

Actions: Relaxes blood vessels and boost circulation to the peripheries and the brain. Research suggests that it may improve blood flow to the male genitals to improve maintenance of an erection, even at a relatively low dose of 60mg daily for 12-18 months. Research involving males with erectile dysfunction showed a beneficial effect after six to eight weeks treatment, and after six months, half of patients had regained full potency.

Who would benefit? Those whose low sex drive is

linked with mental fatigue, poor memory, stress during times of intensive study (eg exams), peripheral vascular disease, cold extremities, chilblains or tinnitus. Would also benefit male smokers who tend to have problems with erection.

Dose: Standardised 40-60mg extracts up to three times a day (chose a preparation standardised for at least 24 per cent ginkolides). Stimulating effects last from three to six hours, but effects may not be noticed until ten days of treatment.

Cautions: None

Schisandra (Schisandra chinensis)

Schisandra is a popular Chinese tonic herb also known as wu wei zi.

What it is: Dried fruit (berries) of an aromatic woody vine containing lignans such as schizandrin, phytosterols (including beta-sitosterol and stigmasterol), a volatile oils plus antioxidants.

Actions: Like ginseng, Schisandra has been found to have powerful adaptogenic properties, helping the body to cope with stress. It is a well-known sexual tonic that reputedly increases secretion of sexual fluids in both men and women, and improves male sexual stamina. It has been found to increase oxygen uptake of cells and helps mental clarity and to allieve irritability and forgetfulness. Also boosts liver function.

Who would benefit? Those whose low sex drive is linked with nervous exhaustion, general fatigue, insomnia, anxiety, excess alcohol or liver problems.

Dose: 250mg-500mg once to three times daily. Traditionally taken for 100 days to boost sexual energy and vitality.

Cautions: None

Chicken egg extracts

Chicken egg extracts are one of the latest supplements promoted as prosexual agents.

What is it: Natural extracts derived from freeze-dried, fertilized, pre-embryonic and incubated chicken eggs. Cholesterol-free.

Actions: Extracts contain a high molecular weight substance thought to stimulate testosterone production. Norwegian research (randomised, placebo-controlled, double-blind, cross-over study) involving 31 volunteers with low sex drive showed that 58 per cent experienced a significant increase in sexual desire. Another trial with 24 patients whose low sex drive was related to antidepressant therapy showed a definite to very pronounced increase in sexual activity in 88 per cent of cases. These benefits were noted within two to three weeks. US trials have shown extracts increase frequency of desire, intensity of orgasm, general well-being, feelings of happiness and energy levels.

Who would benefit? Anyone with a low sex drive, especially if this is linked with antidepressant therapy.

Dose: No information

Cautions: Avoid if you are sensitive to hens' eggs.

Tribulus terrestris

Tribulus terrestris is a herbal extract used in Ayurvedic medicine. Also known as ci ji li.

What is it: Dried extracts from the fruit of an Indian plant, containing furostanol saponins.

Actions: Tribulus is traditionally used as a general tonic, and to treat genito-urinary problems (due to its diuretic action) erectile dysfunction, to reduce high blood pressure and as a liver stimulant. A trial involving 50 male patients with low sex drive due to lethargy, fatigue and lack of interest in daily activities showed a 45 per cent improvement in symptoms. Taking tribulus for five days has been shown to increase testosterone levels in some healthy men by around 30 per cent.

Who would benefit Males with low sex drive or erectile dysfunction.

Dose 250mg capsules standardised to contain 40 per cent furostanol saponins.

Cautions No information.

For more information, read Increase Your Sex Drive by Dr Sarah Brewer (Thorsons).

Take care

Do not take herbal supplements in pregnancy without seeking specialist advice from a medical herbalist.

About the author

Dr Sarah Brewer studied at Cambridge where she qualified as a doctor in 1983, and now specialises in genito-urinary problems. Sarah has written over 20 books, and is a regular columnist on the Daily Telegraph and a wide range of magazines such as Top Sante.