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Comparison of Elaeagnus Angustifolia Extract and Sildenafil Citrate on Female Orgasmic Disorders: a Randomized Clinical Trial

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Comparison of Elaeagnus Angustifolia Extract and Sildenafil Citrate on Female Orgasmic Disorders: a Randomized Clinical Trial Original Article Comparison of Elaeagnus angustifolia Extract and Sildenafil Citrate on Female Orgasmic Disorders: A Randomized Clinical Trial Marzieh Akbarzadeh 1∗, Sanaz Zeinalzadeh 2, Jaleh Zolghadri 3, Abdolali Mohagheghzadeh 4, Pouya Faridi 4, Mehrab Sayadi 5 1. Community Based Psychiatric Care Research Center, Department of Midwifery, Fatemeh (P.B.U.H) School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran, 2. Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran 3. Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran 4. Department of Traditional Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran 5. Department of Bio-statistics, Shiraz University of Medical Sciences, Shiraz, Iran Abstract Background: Orgasmic disorder can create a feeling of deprivation and failure and provide mental problems, incompatibility and marital discord. This study aimed to compare the ef- fects of Elaeagnus angustifolia flower extract and sildenafil citrate on female orgasmic dis- order in women in 2013. Methods: In this randomized clinical trial, 125 women between 18-40 years old who suffered from orgasmic disorder were divided into three E. angustifolia, sildenafil citrate and control groups. The data were gathered using Female Sexual Function In- dex and through measurement of TSH and prolactin. The first intervention group had Downloaded from http://www.jri.ir to consume 4.5 gr E. angustifolia extract in two divided doses for 35 days and the second one had to use 50 mg sildenafil citrate tablets for 4 weeks one hour before their sexual relationship. However, the control group had to consume the placebo. The data were analyzed using paired t-test, one-way ANOVA, and Bonferroni post- * Corresponding Author: hoc test and p<0.05 was considered significant. Marzieh Akbarzadeh, Results: The frequency of orgasmic disorder before the intervention was 41.5%, Hazrat-e-Fatemeh Nursing and Midwifery College, 40.5%, and 57.1% in E. angustifolia, sildenafil citrate, and control groups, respec- Namazi Hospital, Shiraz, tively (p=0.23). However, these measures were respectively 29.3%, 16.7%, and 50% Iran after the intervention (p=0.004). A significant difference between the two groups re- E-mail: garding sexual satisfaction after the intervention (p=0.003) compared to the begin- [email protected] ning of the study (p=0.356). Besides, the highest reduction of changes after the in- tervention (58.82%) was observed in the sildenafil citrate group. Received: May 21, 2014 Conclusion: Both E. angustifolia extract and sildenafil citrate were effective in re- Accepted: Jul. 15, 2014 duction of the frequency of orgasmic disorder in women. Keywords: Elaeagnus angustifolia, Orgasmic disorder, Sildenafil citrate. To cite this article: Akbarzadeh M, Zeinalzadeh S, Zolghadri J, Mohagheghzadeh A, Faridi P, Sayadi M. Comparison of Elaeagnus angustifolia Extract and Sildenafil Citrate on Female Orgasmic Disorders: A Randomized Clinical Trial. J Reprod Infertil. 2014;15(4):190-198. Introduction emale sexual dysfunction is a serious, com- lack of sufficient skills for having a healthy emo- mon, multifactorial general health problem tional relationship, inability to flourish in the soci- which is usually neglected in the general ety, infanticide and even death (2). In one study population while affecting the women’s quality of conducted in Hong Kong in 2007, Zhang inter- life to a great extent (1). Lack of sexual health and viewed 1510 Chinese women who were between security will result in anger, excessive rage, de- 19 and 49 years old and showed that 37.9% of the pression, drug abuse, lack of physical and psycho- participants suffered from at least one sexual dis- logical capability for parenting and child care, order (3). One other study in Egypt showed the J Reprod Infertil. 2014;15(4):190-198 Akbarzadeh M, et al. JRI prevalence of sexual dysfunction to be 76.9% naceae) is a Mediterranean medicine representa- among the studied women, with low sexual desire tive of the family Elaeagnaceae, commonly named being the most prevalent one (66.4%). Besides, as oleaster, which is cultivated in north American, the women’s age increased, the prevalence of sex- Eurasia as far southwards as Malaysia, Australia, ual disorders increased, as well (4). One study on northern regions of Asia to the Himalayas and Kurdish women in Iran indicated that 77% of the Europe and for centuries in the desert and sub de- studied participants had one sexual disorder (5). sert regions of western Asia including Iran (32- Another study in Iran also revealed that 10.5% of 35). women had never experienced orgasm (6). In the A previous study showed that E. angustifolia study that Safarinejad (2006) conducted on 20-60 flower and its derivatives had antibacterial and year old women in Iran, the prevalence of low antifungal properties. It also led to cutaneous sexual desire, lack of sexual arousal, lack of or- wound healing by increasing re-epithelialization gasm, and pain during intercourse was reported as and collagen deposition (31). 35%, 30%, 37%, and 26%, respectively (7). E. angustifolia flower is one of the herbal medi- Up to now, most studies regarding the pharma- cations which, according to traditional medicine, cological treatments for sexual dysfunction have is hot and dry, aromatic, and can stimulate sexual been conducted on males and female sexual dys- activity especially in young girls and women (36). function has been less taken into account (8-10). It is also believed to have antioxidant effects (37). Recently, pharmacological treatments have been Due to its analgesic and anti-inflammatory effects, considered for female sexual dysfunction mainly E. angustifolia extract is used in oils for external focusing on improvement of androgen deficiency, application (38). Moreover, one study showed E. increase of blood flow to the genital area and angustifolia ointment to be effective in treatment stimulation of the central nervous system (11). of some skin disorders (39). Downloaded from http://www.jri.ir Estrogen, progesterone, and testosterone are the Other studies have also confirmed that the fruit main effective hormones in females’ sexual re- core and leaves of this plant had analgesic and sponse (12). In addition, androgen deficiency is anti-inflammatory effects (40-43). Furthermore, one of the main causes of female sexual dysfunc- one study evaluated the effect of aqueous and al- tion (13). Thus, these compounds have been used coholic extracts of E. angustifolia on intestinal for hormone therapy in some studies. Nonetheless, smooth muscle relaxation in mice. It indicated that testosterone has been less welcomed due to its the presence of flavonoids in the fruit was effec- side-effects, including hirsutism and acne (9, 14). tive in intestinal smooth muscle relaxation. There- According to some researches, sildenafil citrate fore, the researcher suggests that this plant is a is effective in treatment of orgasm as well as suitable candidate for treatment of muscle-skeletal arousal disorders and increase of females’ sexual disorders (40) due to its muscle relaxant effect. experiences (15-18). Sildenafil citrate is among On the other hand, E. angustifolia has been found the phosphodiesterase type 5 (PDE5) inhibitors to contain flavonoid components and some fla- which improve female sexual dysfunction through vones, such as chrysin, (5, 7-dihydroxyflavone) increasing blood flow to corpus cavernosum of which have a partial agonistic effect on benzodi- clitoris, vagina and labia minor (15-17,19-25). azepine receptors. Central benzodiazepine recep- However, in rare cases, its consumption might be tor (BDZ-R) agonists have been known to induce accompanied by complications, such as mild multiple effects including anxiolytic, myorelaxant, headache, urinary tract infection and nausea (14). anticovulsant, hypnotic and amnestic effects (44- Complementary and Alternative Medication 46). (CAM) is also used in treatment of sexual disor- These two folk indications, anti-rheumatoid, an- ders (26). Ginseng which is a Chinese traditional ti-tetanus activities (40), anxiolytic, myorelaxant medication is one of the effective herbal medi- effects acting on central benzodiazepine receptors cines in treatment of sexual disorders (27-28). of flavonoid found in E. angustifolia, may make Other common medications include Yohimibine this plant a suitable candidate for inducing muscle and Ginkgo biloba. However, Yohimibine has relaxant activity for sexual dysfunction. been shown to be more effective in treatment of Up to now, several studies have been conducted sexual dysfunction in males as compared to fe- on female sexual dysfunction in Iran. However, males (29-31). most of these studies have focused on the preva- In folk medicines, Elaeagnus angustifolia (Elaeag- lence and types of sexual disorders and have paid J Reprod Infertil, Vol 15, No 4, Oct-Dec 2014 191 JRI E. Angustifolia and Sildenafil Citrate in Orgasmic Disorder less attention to the treatment dimensions, includ- tion. Nevertheless, since assessment of pain (6 ing training, consultation and pharmacotherapy. points) was omitted from the present study, score Hence, the present study aimed to compare the of 22 was considered instead of 28. The reliability effects of E. angustifolia flower extract and and validity of the Persian version of FSFI were sildenafil citrate on female orgasmic
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