Jan. 30, 2003 -- For millions of women with sexual arousal problems, the mind is willing but the body just doesn't respond. Arousal disorder is one of the most common forms of female sexual dysfunction, and there are literally hundreds of over-the-counter products claiming to fix the problem. But there has been almost no scientific proof that any of them worked until now.
A small study, reported in the January issue of the Journal of Sex and Marital Therapy, found the botanical massage oil Zestra to be much more effective than a placebo oil for enhancing sexual arousal when applied to the genitalia. The manufacturer-funded research included just 20 women, but one of the nation's top sex therapists says she is impressed by it.
"The fact that this was found effective in comparison [with] a placebo sets it apart from the other herbal products out there," Laura Berman, PhD, tells WebMD. "These herbal products aren't regulated by the FDA, so they didn't have to do this study."
Berman, who runs the Berman Center in Chicago and makes frequent television appearances to talk about sexual problems in women, says many of her patients have used the product with mixed results.
"It does create a tingling and warmth sensation in the genital area," she says. "Many patients enjoyed that, but others told us they didn't like the tingling."
The study assessed Zestra's effectiveness in 10 women with female sexual arousal disorder (FSAD) and 10 women without the disorder by surveying them about their sexual satisfaction before and after its use. The researchers looked at changes perceived in the level of arousal, desire, satisfaction with arousal, genital sensation, and ability to have an orgasm. Each woman used Zestra five times and the placebo oil five times, but neither they nor the research team knew which oil they were using until the test was completed.
Women with FSAD reported satisfaction with sexual arousal less than one-third of the time while using the placebo oil, but 85% of the time with Zestra. Women without FSAD reported satisfaction with arousal 73% of the time with the placebo oil and 95% of the time while using Zestra.
"The magnitude of the change that we saw was every bit as dramatic as what was seen in the studies of Viagra for men," lead researcher David M. Ferguson, MD, PhD, tells WebMD. Ferguson works as an independent consultant helping manufacturers test their products.
Results from the small study offer early evidence that Zestra may be effective in one of the largest groups of women who commonly experience problems with arousal -- those taking selective serotonin reuptake inhibitor (SSRI) antidepressants. More than 40 million women take SSRIs and as many as 60% report some sexual side effects.
Seven of the women in the study took SSRIs, and their response to Zestra was similar to that of women not taking the antidepressant.
Pharmacist Martin Crosby developed Zestra and now runs QualiLife Pharmaceuticals, which manufactures it. He tells WebMD the botanical ingredients in the massage oil -- which includes borage seed oil, evening primrose oil, angelica extract, and coleus extract -- were chosen because they have properties similar to a pharmaceutical treatment for severe erectile dysfunction.
The New Jersey pharmaceutical company NexMed Inc. is taking a similar approach in its treatment for female sexual arousal problems. It has developed a topical cream based on the drug known as prostaglandin instead of herbal alternatives. The company has obtained a patent for the cream, but FDA approval is not expected for several years.
Both the oil and the cream are designed to help trigger the blood flow to women's sexual organs that is needed for arousal.
Psychologist Leonore Tiefer, PhD, says it is unlikely that an oil, cream, or even drug will be developed that will be as effective in women as Viagra has been in men, because sexual problems in women tend to be more complex. She is also critical of QualiLife for marketing its over-the-counter product directly to physicians. The company offers the product to medical professionals at a discount.
"It seems highly unethical for doctors to have a shared interest in the success of a particular product," she tells WebMD. "The whole thing strikes me as inappropriate commercialization of sexuality."
Tiefer says women with sexual problems are usually better off visiting their local bookstore than their doctor, because physicians currently have little to offer them.
"If you are experiencing pain, that is a different matter. That needs to be checked," she says. "But for women who are experiencing changes in their sexuality, it is a good time to recognize that they probably don't know enough about their sexuality. For most women, education is the key."
SOURCES: Journal of Sex and Marital Therapy, January, 2003 • David M. Ferguson, MD, PhD, consultant in clinical development research • Christopher P. Steidle, MD, Northeast Indiana Research, Fort Wayne, Indiana • Martin G. Crosby, PharmD, chairman, QualiLife Pharmaceuticals, Charleston, South Carolina • Laura Berman, PhD, director, Berman Center in Chicago • Leonore Tiefer, PhD, clinical associate professor of psychiatry, New York University School of Medicine.