THE use of herbal products and supplements has dramatically increased in recent years. Various sexual enhancement products, labelled as ‘herbal’ or ‘all natural’, have claimed to improve sexual stamina or even enlarge the size of the penis. Further, they have penetrated several markets through varied, but effective marketing strategies.

Psychoactive effects

New research, however, has shown that some products that are advertised or sold for sexual enhancement are associated with several serious psychoactive effects. The most common of these were products that contained yohimbine, maca, ginkgo biloba, and horny goat weed.

The researchers from the Department of Neuroscience and Imaging at the G D’Annunzio University in Italy, found that these substances were linked to the induction of anxiety, panic, mood changes, hallucinations, and addictive behaviours.

Yohimbine, which can be extracted from a variety of plants, was advertised as a treatment for erectile dysfunction, as a sexual performance enhancer, and as a weight loss and body-building supplement. However, it was also associated with the adverse effects of anxiety and agitation, as well as gastrointestinal distress, hypertension and increased heart rate.

Maca is a Peruvian plant that has been used as an energiser, and to treat infertility and sexual dysfunction. However, it also contained a chemical that may play a role in increasing craving and addictions.

Horny goat weed has been associated with hypomanic symptoms, which includes being extremely talkative, with flight of ideas and sometimes risky behaviours, as well as an increased heart rate and skin rash.

Ginkgo biloba, which has been used especially for memory enhancement and improved blood flow, may cause bleeding even in healthy adults. It may also trigger hypomanic episodes when taken with other medications such as St John’s wort, fluoxetine (Paxil) and melatonin.

Manic episodes

The researchers found that while these compounds have sexual enhancement properties, they also had psychiatric effects, such as acting as a stimulant and/or predisposing someone toward a manic episode.

A manic episode is characterised by an elevated, expansive or unusually irritable mood lasting for at least one week, during which there is a purposeful, goal-oriented activity by the individual. The mood disturbance associated with manic symptoms is noticeable to others, and is uncharacteristic of the person’s usual behaviour.

The feelings produced by a manic episode are sufficiently severe to cause some difficulty or impairment in occupational, social, educational, or other important functioning. Symptoms include an inflated self-esteem or grandiosity, a decreased need for sleep where the person feels rested after only three hours of sleep, more talkative than usual, and have a flight of ideas or the subjective feeling that their thoughts are racing. These persons’ attention may be fixed on unimportant or irrelevant items or events, and they may be excessively involved in pleasurable activities that have a high potential for painful consequences, such as engaging in unrestrained buying sprees, sexual indiscretions or foolish business investments.

Pharmacological agents

Many in our Jamaican population do not regard them as pharmacological agents, but they are. Therefore, doctors should ask their patients specifically if they are taking ‘natural’ or unprescribed products, particularly if they complain about the aforementioned symptoms or if they are on psychiatric medication, since additional adverse effects may occur if prescribed medication are mixed with these sexually enhancing products.

When people buy what they think are just simple herbs or supplements, they may be unwittingly getting products that contain sildenafil, the active chemical present in Viagra, or similar compounds. So taking these compounds when you also happen to be taking, for example, nitrates for your heart, can drop your blood pressure and cause severe problems.

Further, some of the companies that produce these products are not as reputable as others. They are all unregulated businesses in various countries, and some may insert ingredients like synthetic hormones.

Potential risks vs potential benefits

In the end, you should know all of what you are getting, not some of it. One should always balance the potential risks and the potential benefits. One may have less concern about Ginkgo biloba, but more concern about yohimbine, which does in fact enhance sexual desire in some instances, but comes at a bigger price – it is a panic inducer. It may make you have a panic attack while seeking to provide you with sexual benefits.

We therefore need to raise public awareness about the adverse effects of these drugs, most of which are not regulated. The uncontrolled availability and use of many of these products represent a serious issue from both a clinical as well as public health perspective. The possible impact on public health, particularly among persons with psychiatric disorders who are usually more at risk for sexual dysfunction, may be very consequential.

Derrick Aarons MD, PhD is a consultant bioethicist/family physician, a specialist in ethical issues in medicine, the life sciences and research, and is the ethicist at the Caribbean Public Health Agency (CARPHA). (The bioethical views expressed here are not written on behalf of CARPHA).