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Learn More. The use of und food and herbal supplements to enhance sexual functions is drastically increasing. This phenomenon, combined with the availability of these products over the Internet, represents a challenge from a clinical and a public health perspective.

A comprehensive multilingual assessment of websites, drug fora, and other online resources was carried out between February and July with exploratory qualitative searches including websites.

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Once the active constitutes of the products were identified, a comprehensive literature search was carried out using PsycInfo and PubMed. The most common sexual enhancement products available on the Internet were identified. Their active ingredients included yohimbine, maca, horny goat weed and Ginkgo biloba.

These four substances were reported with the occurrence of adverse events and the induction of psychological Mexico horny women, such as mood changes, anxiety, and hallucinations as well as addictive behaviours. Uncontrolled availability of sexual enhancement products that contain potentially harmful substances is a major public health concern. The possible impact on population health, particularly among subjects with psychiatric disorders, usually at risk for sexual dysfunction, may be ificant. This new trend needs to be extensively studied and monitored. The use of food and herbal supplements to enhance erectile function as well as sexual arousal and desire has become increasingly popular in the recent years [ 12 ].

However, they often contain potent active constituents [ 3 — 5 ], which remain undeclared on the packaging [ Mexico horny women7 ]. The effects of the aforementioned products, thus, remain unknown until reports on harms expose the problem and accurate clinical evaluation takes place. However, several case reports of side effects to herbs and herbal products have been reported [ 89 ], such as on- and off-target effects from biologically active ingredients, side effects caused by contaminants, and herb-drug interactions.

It is difficult to determine the true frequency of side effects from herbs and herbal products, since surveillance systems are much less extensive than those in place for pharmaceutical drugs. Some of the side effects and adverse events due to ingestion of herbs and herbal products are related to their action on central nervous system and can present as mood alterations, anxiety, mania, depression, hallucinations, and addictive behaviour; one example of such herbal product is ephedra, which was banned in the USA in [ 11 ].

However, psychological safety profiles of sexual enhancement products have not been characterised. This review, therefore, aimed Mexico horny women identifying the sexual enhancement products advertised and sold on the Internet while collecting information about their characteristics i.

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We then focused on four substances, which are common in these products: yohimbine, maca, horny goat weed, and Ginkgo bilobaas these were reported to induce psychological side effects. We also described, less in detail, other components of sexual enhancer products that may have both somatic and psychological side effects. A multilingual qualitative assessment of a range of websites, drug fora, and other online resources i.

Exploratory qualitative searches of websites in English and Italian took Mexico horny women using brand names through Google search engine. The remaining 97 websites were considered not to bear any interest for the present study and thus were no longer monitored. While a series of algorithms were used and adjusted to capture relevant information, analysis of relevant data since was also carried out manually by a multidisciplinary and multilingual team of analysts.

Finally, once the active constituents of these products were identified, a comprehensive literature search was carried out using PsycInfo and Pubmed databases. During the website assessment stage where websites were monitored for 6 months, we have identified 15 sexual enhancement products Mexico horny women and sold on the Internet. The characteristics of these products are summarized in Table 1.

Yohimbe, ginseng, Ginkgo bilobamaca, horny goat weed, and L-arginine were claimed to be the most common ingredients in those products.

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Among all the substances identified in these products, we have found psychological safety concerns for only four: yohimbine, maca, horny goat weed, and Ginkgo biloba. Biological, pharmacological, and safety profiles of these four substances are presented below.

1. introduction

Yohimbine is a natural tryptamine alkaloid, which can be extracted from the bark of a variety of plants mostly of African and Asian origin such as Pausinystalia yohimbe also known as yohimbe tree and the root of Rauvolfia serpentina. Yohimbe bark extract is traditionally used in Africa as an aphrodisiac: it has to be underlined, though, that tree bark does contain a large of alkaloids, and yohimbine level in Mexico horny women natural source may be low.

Yohimbine concentration has been suggested to increase in older branches [ 13 ].

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A study by Betz et al. Currently, yohimbine-containing products are advertised on the Internet not only for treating erectile dysfunction and enhancing sexual performance, but also as a fast weight-loss and body-building supplement [ 15 — 17 ]. Yohimbine has high affinity to human alpha-2 adrenoceptors, moderate affinity to alpha-1 adrenoceptors, and low affinity to some of the serotonin and dopamine receptors in the central and peripheral nervous systems [ 19 ].

Alpha-2 adrenoceptors mediate erection-inhibiting impulses in the central nervous system. Yohimbine is generally believed to enhance central sexual impulse by blocking the alpha-2 adrenoceptors in the locus coeruleus in the brain [ 20 ]. In the periphery, yohimbine has been suggested to inhibit alpha-1 and alpha-2 adrenoceptors as well Mexico horny women enhancing the release of nitric oxide NO from cavernosal endothelial cells [ 2122 ].

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In conclusion, the mechanism of action of yohimbine in enhancing sexual function is currently unclear. Yohimbine hydrochloride is rapidly absorbed and the maximum plasma concentration is generally achieved in less than one hour after oral administration [ 2324 ]. The mean bioavailability is low and is subject to very high variation Mexico horny women one individual to another [ 25 ]. The plasma concentration of yohimbine does not appear to correlate with the dose of the compound administered [ 26 ].

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A meta-analysis in of seven clinical trials with yohimbine has shown a superiority of the compound over placebo in treatment of erectile dysfunction [ 27 ]. Yohimbine has also been reported to be effective in treatment of orgasmic disorders such as delayed ejaculation [ 28 ]. There have been no clinical studies testing Yohimbe bark. The Clinical Guidelines Panel on Erectile Dysfunction of the American Urological Association AUA has concluded that the data available on Yohimbine do not allow it to be recommended as Mexico horny women treatment in erectile dysfunction particularly not in organic aetiology [ 29 ].

The side effects of yohimbine include high blood pressure, increased heart rate, manic reactions, bronchospasm, palpitations, insomnia, anxiety, irritability, shivering, sweating, nausea, flushing, and headaches which all can be attributed to its central adrenergic activity [ 2630 ]. Adverse events mostly due to self-administration of yohimbine have been reported since s.

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InSandler and Aronson have described the development of progressive renal failure, cutaneous eruption, and a lupus-like syndrome in a year-old Afro-American man following yohimbine use [ 31 ]. Myers has reported a case of refractory priapism in a year-old HIV infected and depressed man who self-administered a product containing yohimbine to treat his erectile dysfunction and was subsequently admitted to emergency department with a hour lasting erection which required insertion of a proximal corpus cavernosum to spongiosum shunt Quackles shunt [ 32 ].

According to California Poison Control System, cases of adverse reactions after yohimbine consumption have been identified within a 7-year period — : most commonly reported adverse events have been gastrointestinal distress, tachycardia, anxiety, agitation, and Mexico horny women [ 33 ]. US National Institute of Health also warns consumers about taking yohimbine supplements if they suffer from schizophrenia, anxiety, depression, or posttraumatic stress disorder [ 34 ]. Additional situation of emergency has been reported in Amman where the public corporation of the food and the medicine warned the citizens about the use of some und sexual stimulants, such as yohimbine, for its inclusion of poisonous substance strychnine that caused convulsions, hallucinations, and heart and kidney failure [ 35 ].

This caused the hospitalisation of two female patients aged 34 and 21 in Hong Kong for acute hepatitis symptoms. As a result, the Mexico horny women of Health opened an investigation and appealed to members of the public not to buy or consume the product [ 30 ].

As mentioned above, anxiety and agitation are among the most common side effects of yohimbine or yohimbine-containing products [ 33 ]. Yohimbe should be used with caution when taken with medicines for high blood pressure, tricyclic antidepressants, or phenothiazines a group of medicines used mostly for mental health conditions such as schizophrenia.

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InLinden et al. Acute neurotoxic effects related to the ingestion of yohimbine-containing products have been reported by Giampreti et al.

Maca Lepidium meyenii is a Peruvian plant, which belongs to the Brassicaceae Mexico horny women. Hypocotyl colour allows the distinction of three different varieties: white, yellow, and black maca. Naturally dried hypocotyls have been used for centuries by native Andean populations as aphrodisiac, energizer, and enhancers of fertility and sexual function [ 38 ].

With the advent of Internet, maca has become a common ingredient of sexual enhancer products available worldwide. The mechanism of action of maca in altering sexual behaviour is unknown. No information could be found related to the pharmacokinetics properties of Maca.

Zheng et al. Cicero et al. In a further study, the same group has demonstrated that the hexanic extract of maca had more effect on sexual behaviour of rats than the methanolic and chloroformic extracts [ 42 ].

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Lentz et al. They found that maca had only a small effect on sexual behaviour and locomotor activity but no effect on anxiety [ 43 ]. The studies with maca on human subjects were reviewed in [ 44 ].

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Four randomised clinical trials met the authors' inclusion criteria: two trials suggested a ificant positive effect of maca on sexual dysfunction or sexual desire in healthy postmenopausal women [ 45 ] or healthy adult men [ 46 ], while the other Mexico horny women failed to show any effects on healthy cyclists [ 47 ]. A further trial assessed the effects of maca in patients with erectile dysfunction using the International Index of Erectile Function Questionnaire and showed ificant effects [ 48 ]. Lee et al.

An overview of systematic reviews on various complementary medicine products for sexual dysfunction in elderly patients has found that the evidence for maca was insufficient [ 50 ]. Piacente et al. MTCA has been suggested to be an inhibitor of the monoamine oxidase MAO enzyme and is a comutagenic or a precursor to mutagenic compounds [ 51 ]. Because of these potential mutagenic properties of MTCA, the French Agency for Sanitary Security warned consumers of powdered maca Mexico horny women about possible health risks from its ingestion [ 52 ].

These findings have been disputed by others based on Mexico horny women assumption that MTCA is deactivated during the boiling process of the maca roots [ 53 ]. MTCA-like compounds have also been suggested to be associated with craving behaviour, which is common in addictions [ 51 ]. Side effects subjectively reported by fora users were altered menstrual cycles, moodiness, cramps, gastritis, and insomnia see Table 2.

Epimedium is a genus of plants of the Berberidaceae family, including more than 50 species. Among the most frequently used in sexual enhancer products are Epimedium grandiflorum and Epimedium sagittatum.