Archives of Sexual Behavior

, Volume 37, Issue 4, pp 530–547 | Cite as

Short- and Long-term Effects of Ginkgo Biloba Extract on Sexual Dysfunction in Women

  • Cindy M. MestonEmail author
  • Alessandra H. Rellini
  • Michael J. Telch
Original Paper


Ginkgo biloba extract (GBE) facilitates blood flow, influences nitric oxide systems, and has a relaxant effect on smooth muscle tissue. These processes are important to the sexual response in women and, hence, it is feasible that GBE may have a therapeutic effect. The present study was the first to provide an empirical examination of the effects of both short- and long-term GBE administration on subjective and physiological (vaginal photoplethysmography) measures of sexual function in women with Sexual Arousal Disorder. A single dose of 300 mg GBE had a small but significant facilitatory effect on physiological, but not subjective, sexual arousal compared to placebo in 99 sexually dysfunctional women. The long-term effects of GBE on sexual function were assessed in 68 sexually dysfunctional women who were randomly assigned to 8 weeks treatment of either (1) GBE (300 mg/daily), (2) placebo, (3) sex therapy which focused on training women to attend to genital sensations, or (4) sex therapy plus GBE. When combined with sex therapy, but not alone, long-term GBE treatment significantly increased sexual desire and contentment beyond placebo. Sex therapy alone significantly enhanced orgasm function compared with placebo. Long-term GBE administration did not significantly enhance arousal responses beyond placebo. It was concluded that (1) neither short- or long-term administration of GBE alone substantially impacts sexual function in women, (2) a substantial placebo effect on sexual function exists in women with sexual concerns, and (3) teaching women to focus on genital sensations during sex enhances certain aspects of women’s sexual functioning.


Ginkgo biloba Female sexual dysfunction Sex therapy Vaginal photoplethysmography 



This publication was made possible by Grant Number 5 RO1 AT00224-02 from the National Center for Complementary and Alternative Medicine to Cindy Meston. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Center for Complementary and Alternative Medicine. The authors wish to thank Jessica Davis for her assistance in all phases of this investigation.


  1. Auguet, M., & Clostre, F. (1983). Effects of an extract of ginkgo biloba and diverse substances on the phasic and tonic components of the contraction of an isolated rabbit aorta. General Pharmacology, 14, 277–280.PubMedGoogle Scholar
  2. Auguet, M., DeFeudis, F. V., & Clostre, F. (1982). Effects of ginkgo biloba on arterial smooth muscle responses to vasoactive stimuli. General Pharmacology, 13, 169–171.PubMedGoogle Scholar
  3. Azadzoi, K. M., Kim, N., Brown, M. L., Goldstein, I., Cohen, R. A., & Saenz de Tejada, I. (1992). Endothelium-derived nitric oxide and cyclooxygenase products modulate corpus cavernosum smooth muscle tone. Journal of Urology, 147, 220–225.PubMedGoogle Scholar
  4. Basson, R., & Brotto, L. A. (2003). Sexual psychophysiology and effects of sildenafil citrate in oestrogenised women with acquired genital arousal disorder and impaired orgasm: A randomized controlled trial. British Journal of Obstetrics and Gynecology, 100, 1014–1024.Google Scholar
  5. Basson, R., McInnes, R., Smith, M. D., Hodgson, G., & Kippiker, N. (2002). Efficacy and safety of sildenafil citrate in women with sexual dysfunction associated with Female Sexual Arousal Disorder. Journal of Women’s Health & Gender-Based Medicine, 11, 367–377.CrossRefGoogle Scholar
  6. Boolell, M., Allen, M. J., Ballard, S. A., Gepi-Attee, S., Muirhead, G. J., Naylor, A. M., et al. (1996). Sildenafil: An orally active type 5 cyclic GMP-specific phosphodiesterase inhibitor for the treatment of penile erectile dysfunction. International Journal of Impotence Research, 8, 47–52.PubMedGoogle Scholar
  7. Bryk, A. S., Raudenbush, S. W., & Congdon, R. T. (1996). Hierarchical linear and nonlinear modeling with the HLM/2L and HLM/3L programs (2nd ed.). Chicago: Scientific Software International Inc.Google Scholar
  8. Burnett, A. L. (1997). Nitric oxide in the penis: Physiology and pathology. Journal of Urology, 157, 320–324.PubMedCrossRefGoogle Scholar
  9. Caruso, S., Intelisano, G., Lupo, L., & Agnello, C. (2001). Premenopausal women affected by sexual arousal disorder treated with sildenafil: A double-blind, cross-over, placebo-controlled study. British Journal of Obstetrics and Gynaecology, 108, 623–628.PubMedCrossRefGoogle Scholar
  10. Chivers, M. L., Seto, M. C., Lalumiere, M. L., Laan, E., & Grimbos, T. (2005, July). The agreement of genital and subjective measures of sexual arousal: A meta-analysis. Poster presentation to the annual meeting of the International Academy of Sex Research, Ottawa, Canada.Google Scholar
  11. Christen, Y., Courtois, Y., & Droy-Lefaix, M. T. (1995). Effects of ginkgo biloba extract (EGB 761) on aging and age-related disorders. Paris, France: Elsevier.Google Scholar
  12. Cohen, A. J., & Bartlik, B. (1998). Ginkgo biloba for antidepressant-induced sexual dysfunction. Journal of Sex and Marital Therapy, 24, 139–143.PubMedCrossRefGoogle Scholar
  13. DeFeudis, F. V. (1991). Ginkgo biloba extract (GBE 761): Pharmacological activities and clinical applications. Paris, France: Elsevier.Google Scholar
  14. Dinsmore, W. W., Hodges, M., Hargreaves, C., Osterloh, I. H., Smith, M. D., & Rosen, R. C. (1999). Sildenafil citrate (Viagra) in erectile dysfunction: Near normalization in men with broad-spectrum erectile dysfunction compared with age-matched healthy control subjects. Urology, 53, 800–805. [Erratum in: Urology, 1999, 53, 1072].PubMedCrossRefGoogle Scholar
  15. Dunlop, W. P., Cortina, J. M., Vaslow, J. B., & Burke, M. J. (1996). Meta-analysis of experiments with matched groups or repeated measures designs. Psychological Methods, 1, 170–177.CrossRefGoogle Scholar
  16. Ellison, J. M., & DeLuca, P. (1998). Fluoxetine-induced genital anesthesia relieved by ginkgo biloba extract. Journal of Clinical Psychiatry, 59, 199–200.PubMedGoogle Scholar
  17. FDA Guidance document. (2000). Guidance for industry: Female sexual dysfunction: Clinical development of drug products for treatment.
  18. Foa, E. B., Hembree, E. A., Cahill, S. P., Rauch, S. A. M., Riggs, D. S., Feeny, N. C., et al. (2005). Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: Outcome at academic and community clinics. Journal of Consulting and Clinical Psychology, 73, 953–964.PubMedCrossRefGoogle Scholar
  19. Goldstein, I., Lue, T. F., Padma-Nathan, H., Rosen, R. C., Steers, W. D., & Wicker, P. A. (1998) Oral sildenafil in the treatment of erectile dysfunction. New England Journal of Medicine, 338, 1397–1404.PubMedCrossRefGoogle Scholar
  20. Janssen, E. (2001). Psychophysiological measurement of sexual arousal. In M. W. Wiederman & B. E. Whitley (Eds.), Handbook for conducting research on human sexuality (pp. 139–171). Mahwah, NJ: Erlbaum.Google Scholar
  21. Jung, F., Morowietz, C., Kiesewetter, H., & Wenzel, E. (1990). Effect of ginkgo-biloba on fluidity of blood an peripheral microcirculation in volunteers. Drug Research, 40, 589–593.PubMedGoogle Scholar
  22. Kang, B., Lee, S., Kim, M., & Cho, M. (2002). A placebo-controlled, double-blind trial of ginkgo biloba for antidepressant-induced sexual dysfunction. Human Psychopharmacology, 17, 279–284.PubMedCrossRefGoogle Scholar
  23. Kirsch, I. (1997). Specifying nonspecifics: Psychological mechanisms of placebo effects. In A. Harrington (Ed.), The placebo effect: An interdisciplinary exploration (pp. 166–186). Cambridge, MA: Harvard University Press.Google Scholar
  24. Kleijnen, J., & Knipschild, P. (1992). Ginkgo biloba. Lancet, 340, 1136–1139.PubMedCrossRefGoogle Scholar
  25. Koltringer, P., Eber, O., Lind, P., Langsteger, W., & Wakonig, P. (1989). Mikrozirkulation und Viskoelastizitat des Vollblutes unter Ginkgo-biloba-extrakt. Eine plazebokontrollierte, randomisierte Doppelblind-Studie. Perfusion, 1, 28–30.Google Scholar
  26. Maitra, I., Marcocci, L., Droy-Lefaix, M. T., & Packer, L. (1995). Peroxyl radical scavenging activity of ginkgo biloba extract EGB 761. Biochemical Pharmacology, 49, 1649–1655.PubMedCrossRefGoogle Scholar
  27. Marcocci, L., Maguire, J. J., Droy-Lefaix, M. T., & Paker, L. (1994). The nitric oxide-scavenging properties of ginkgo biloba extract Egb 761. Biochemical and Biophysical Research Communications, 201, 748–755.PubMedCrossRefGoogle Scholar
  28. Marks, L. S., Duda, C., Dorey, F. J., Macairan, M. L., & Santos, P. B. (1999). Treatment of erectile dysfunction with Sildenafil. Urology, 53, 19–24.PubMedCrossRefGoogle Scholar
  29. Meston, C. M. (2003). Validation of the Female Sexual Function Index (FSFI) in women with female orgasmic disorder and in women with hypoactive sexual desire disorder. Journal of Sex & Marital Therapy, 29, 39–46.CrossRefGoogle Scholar
  30. Meston, C. M., & Gorzalka, B. B. (1992). Psychoactive drugs and human sexual behavior: The role of serotonergic activity. Journal of Psychoactive Drugs, 24, 1–40.PubMedGoogle Scholar
  31. Meston, C. M., & Heiman, J. R. (1998). Ephedrine-activated physiological sexual arousal in women. Archives of General Psychiatry, 55, 652–656.PubMedCrossRefGoogle Scholar
  32. Meston, C. M., Rellini, A. H., & McCall, K. M. (2005, October). The sensitivity of continuous laboratory measures of physiological and subjective sexual arousal for diagnosing women’s sexual dysfunction. Poster presentation to the annual meeting of the International Society for the Study of Women’s Sexual Health, Las Vegas, NV.Google Scholar
  33. Meston, C. M., & Trapnell, P. D. (2005). Development and validation of a five factor` sexual satisfaction and distress scale: The Sexual Satisfaction Scale for Women (SSS-W). Journal of Sexual Medicine, 2, 66–81.PubMedCrossRefGoogle Scholar
  34. Montorsi, F., McDermott, T. E., Morgan, R., Olsson, A., Schultz, A., Kirkeby, H. J., et al. (1999). Efficacy and safety of fixed-dose oral sildenafil in the treatment of erectile dysfunction of various etiologies. Urology, 53, 1011–1018.PubMedCrossRefGoogle Scholar
  35. Paick, J. S., & Lee, J. H. (1996). An experimental study of the effect of ginkgo biloba extract on the human and rabbit corpus cavernosum tissue. Journal of Urology, 156, 1876–1880.PubMedCrossRefGoogle Scholar
  36. Park, K., Goldstein, I., Andry, C., Siroky, M., Krane, R. J., & Azadzoi, K. (1997). Vasculogenic female sexual dysfunction: The hemodynamic basis for vaginal engorgement insufficiency and clitoral erectile insufficiency. International Journal of Impotence Research, 9, 27–37.PubMedCrossRefGoogle Scholar
  37. Park, K., Moreland, R. B., Goldstein, I., Atala, A., & Traish, A. (1998). Sildenafil inhibits phosphodiesterase type 5 in human clitoral corpus cavernosum smooth muscle. Biochemical and Biophysical Research Communications, 249, 612–617.PubMedCrossRefGoogle Scholar
  38. Porsolt, R. D., Martin, P., Lenegere, A., Fromage, S., & Drieu, K. (1990). Effects of an extract of ginkgo biloba (GBE 761) on “learned helplessness” and other models of stress in rodents. Pharmacology, Biochemistry and Behavior, 36, 963–971.CrossRefGoogle Scholar
  39. Prause, N., & Janssen, E. (2005). Blood flow: Vaginal photoplethysmography. In I. Goldstein, C. M. Meston, S. R. Davis, & A. M. Traish (Eds.), Women’s sexual function and dysfunction: Study, diagnosis, and treatment (pp. 368–382). London: Taylor & Francis.Google Scholar
  40. Rapin, J. R., Lamproglou, I., Drieu, K., & DeFeudis, F. V. (1994). Demonstration of the “anti-stress” activity of an extract of ginkgo biloba (GBE 761) using a discrimination learning task. General Pharmacology, 25, 1009–1016.PubMedGoogle Scholar
  41. Rellini, A. H., McCall, K. M., Randall, P. K., & Meston, C. M. (2005). The relationship between self-reported and physiological measures of female sexual arousal. Psychophysiology, 42, 116–124.PubMedCrossRefGoogle Scholar
  42. Rellini, A. H., & Meston, C. M. (2006). The sensitivity of events logs, self-administered questionnaires and photoplethysmography to detect treatment-induced changes in female sexual arousal disorder (FSAD) diagnosis. Journal of Sexual Medicine, 3, 283–291.PubMedCrossRefGoogle Scholar
  43. Rosen, R., D’Agostino, R., Brown, C., Heiman, J., Leiblum, S., Meston, C. M., et al. (2000). The Female Sexual Function Index (FSFI): A multidimensional self-report instrument for the assessment of female sexual function. Journal of Sex and Marital Therapy, 26, 191–208.PubMedCrossRefGoogle Scholar
  44. Rosen, R., Lane, R., & Menza, M. (1999). Effects of SSRIs on sexual function: A critical review. Journal of Clinical Pharmacology, 19, 67–85.Google Scholar
  45. Sintchak, G., & Geer, J. H. (1975). A vaginal plethysmograph system. Psychophysiology, 12, 113–115.PubMedCrossRefGoogle Scholar
  46. Smith, P. F., Maclennan, K., & Darlington, C. L. (1996). The neuroprotective properties of the ginkgo biloba leaf: A review of the possible relationship to platelet-activating factor (PAF). Journal of Ethnopharmacology, 50, 131–139.PubMedCrossRefGoogle Scholar
  47. Stimmel, G. L., Dopheide, J. A., & Stahl, S. M. (1997). Mirtazapine: An antidepressant with noradrenergic and specific serotonergic effects. Pharmacotherapy, 17, 10–21.PubMedGoogle Scholar
  48. Straus, J., & von Ammon, C. (1996). Placebo effects: Issues for clinical practice in psychiatry and medicine. Psychosomatics, 37, 315–326.PubMedGoogle Scholar
  49. Toesca, A., Stolfi, V. M., & Cocchia, D. (1996). Immunohistochemical study of the corpora cavernosa of the human clitoris. Journal of Anatomy, 188, 513–520.PubMedGoogle Scholar
  50. Tyler, V. E. (1993). Ginkgo. In V. E. Tyler (Ed.), The honest herbal (pp. 149–151). New York: Pharmaceutical Products Press.Google Scholar
  51. van Beek, T. A., van Scheeren, H. A., Rantio, T., Melger, W. Ch., & Lelyveld, G. P. (1991). Determination of ginkgolides and bilobalide in ginkgo biloba leaves and phytopharmaceuticals. Journal of Chromatography, 543, 375–387.CrossRefGoogle Scholar
  52. Wiegel, M., Meston, C. M., & Rosen, R. C. (2005). The Female Sexual Function Index (FSFI): Cross-validation and development of clinical cutoff scores. Journal of Sex and Marital Therapy, 31, 1–20.PubMedCrossRefGoogle Scholar
  53. Wiegel, M., Scepkowski, L. A., & Barlow, D. H. (2006). Cognitive and affective processes in female sexual dysfunction. In I. Goldstein, C. M. Meston, S. R. Davis, & A. M. Traish (Eds.), Women’s sexual function and dysfunction: Study, diagnosis, and treatment (pp. 85–92). London: Taylor & Francis.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Cindy M. Meston
    • 1
    Email author
  • Alessandra H. Rellini
    • 1
  • Michael J. Telch
    • 1
  1. 1.Department of PsychologyUniversity of Texas at AustinAustinUSA

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