Subscribe to RSS
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/s-0040-1712123
Tribulus Terrestris for Female Sexual Dysfunction: A Systematic Review
Tribulus terrestris para disfunção sexual feminina: Uma Revisão SistemáticaPublication History
24 September 2019
16 March 2020
Publication Date:
31 July 2020 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00030576/202007/lookinside/thumbnails/10-1055-s-0040-1712123_190269-1.jpg)
Abstract
Objective We performed a systematic review to assess the effectiveness and safety of Tribulus terrestris to treat female sexual dysfunction (FSD).
Data sources We performed unrestricted electronic searches in the MEDLINE, CENTRAL, EMBASE, LILACS, CINAHL, PsycINFO, WHO-ICTR, Clinicaltrials.gov and OpenGrey databases.
Selection of studies We included any randomized controlled trials (RCTs) that compared T. terrestris versus inactive/active interventions. After the selection process, conducted by two reviewers, 5 RCTs (n = 279 participants) were included.
Data collection Data extraction was performed by two reviewers with a preestablished data collection formulary.
Data synthesis Due to lack of data and clinical heterogeneity, we could not perform meta-analyses. The risk of bias was assessed by the Cochrane Risk of Bias (RoB) tool, and the certainty of evidence was assessed with Grading of Recommendations, Assessment, Development and Evaluations (GRADE).
Results After 1 to 3 months of treatment, premenopausal and postmenopausal women randomized to T. terrestris had a significant increase in sexual function scores. Three months of treatment with T. terrestris showed a significant increase in the serum testosterone levels of premenopausal women. There was no report of serious adverse events, and none of the studies assessed health-related quality of life. The certainty of the evidence was very low, which means that we have very little confidence in the effect estimates, and future studies are likely to change these estimates.
Conclusion More RCTs are needed to support or refute the use of T. terrestris. The decision to use this intervention should be shared with the patients, and the uncertainties around its effects should be discussed in the clinical decision-making process.
Number of Protocol registration in PROSPERO database: CRD42019121130
Resumo
Objetivo Nós realizamos uma revisão sistemática para avaliar a efetividade e a segurança do Tribulus terrestris no tratamento da disfunção sexual feminina (DSF).
Fontes de dados Nós realizados uma busca eletrônica irrestrita nas seguintes bases de dados: MEDLINE, CENTRAL, EMBASE, LILACS, CINAHL, PsycINFO, WHO-ICTR, Clinicaltrials.gov, e OpenGrey.
Seleção dos estudos Nós incluímos todos os ensaios clínico randomizados (ECR) que comparou T. terrestris com controles ativos/inativos. Após o processo de seleção, conduzido por 2 revisores, 5 ECRs (n = 279 participantes) foram incluídos.
Extração de dados O processo de extração de dados foi realizado por dois revisores, utilizando-se um formulário de extração de dados pré-estabelecido.
Síntese de dados Devido à falta de dados disponíveis e à heterogeneidade clínica entre os estudos incluídos, nós não realizamos meta-análises. O risco de viés foi avaliado pela tabela de risco de viés da Cochrane e, a certeza do corpo da evidência foi avaliada pelo Grading of Recommendations, Assessment, Development and Evaluations (GRADE).
Resultados Após 1 a três 3 meses de tratamento, mulheres na pré e pós-menopausa randomizadas ao T. terrestris tiveram um aumento significante nos escores de função sexual. O grupo com 3 meses de tratamento com T. terrestris exibiu um aumento significante dos níveis séricos de testosterona em mulheres pré-menopausa. Não houve relato de eventos adversos graves, e nenhum estudo avaliou qualidade de vida das participantes. A certeza da evidência foi considerada muito baixa, o que significa que existe pouca certeza na estimativa dos efeitos e que é provável que futuros estudos mudem estas estimativas.
Conclusão Mais ECRs são importantes para apoiar ou refutar o uso do T. terrestris. A decisão de usar essa intervenção deve ser compartilhada com pacientes, e as incertezas sobre seus efeitos devem ser discutidas durante o processo de decisão clínica.
Contributions
Drafting the study protocol (all authors); development of the search strategy (COCL and RR); selection of studies and data extraction (RLP, ALCM and RR); assessment of risk of bias of the included studies (RLP and ALCM); statistical analyses (all authors); interpretation of the results (all authors); drafting the review manuscript (all authors). Revision of the content (RR). All authors read and approved the final manuscript.
-
References
- 1 Faubion SS, Rullo JE. Sexual dysfunction in women: a practical approach. Am Fam Physician 2015; 92 (04) 281-288
- 2 Mazaro-Costa R, Andersen ML, Hachul H, Tufik S. Medicinal plants as alternative treatments for female sexual dysfunction: utopian vision or possible treatment in climacteric women?. J Sex Med 2010; 7 (11) 3695-3714 . Doi: 10.1111/j.1743-6109.2010.01987.x
- 3 Weinberger JM, Houman J, Caron AT, Anger J. Female sexual dysfunction: a systematic review of outcomes across various treatment modalities. Sex Med Rev 2019; 7 (02) 223-250 . Doi: 10.1016/j.sxmr.2017.12.004
- 4 Parish SJ, Meston CM, Althof SE, Clayton AH, Goldstein I, Goldstein SW. , et al. Toward a more evidence-based nosology and nomenclature for female sexual dysfunctions-part III. J Sex Med 2019; 16 (03) 452-462 . Doi: 10.1016/j.jsxm.2019.01.010
- 5 Shifren JL, Monz BU, Russo PA, Segreti A, Johannes CB. Sexual problems and distress in United States women: prevalence and correlates. Obstet Gynecol 2008; 112 (05) 970-978 . Doi: 10.1097/AOG.0b013e3181898cdb
- 6 Aslan E, Fynes M. Female sexual dysfunction. Int Urogynecol J Pelvic Floor Dysfunct 2008; 19 (02) 293-305 . Doi: 10.1007/s00192-007-0436-3
- 7 Frühauf S, Gerger H, Schmidt HM, Munder T, Barth J. Efficacy of psychological interventions for sexual dysfunction: a systematic review and meta-analysis. Arch Sex Behav 2013; 42 (06) 915-933 . Doi: 10.1007/s10508-012-0062-0
- 8 Su L, Chen G, Feng SG, Wang W, Li ZF, Chen H. , et al. Steroidal saponins from Tribulus terrestris. Steroids 2009; 74 (4-5): 399-403 . Doi: 10.1016/j.steroids.2008.12.008
- 9 Basson R, Leiblum S, Brotto L, Derogatis L, Fourcroy J, Fugl-Meyer K. , et al. Definitions of women's sexual dysfunction reconsidered: advocating expansion and revision. J Psychosom Obstet Gynaecol 2003; 24 (04) 221-229 . Doi: 10.3109/01674820309074686
- 10 Vale FBC, Zanolla Dias de Souza K, Rezende CR, Geber S. Efficacy of Tribulus Terrestris for the treatment of premenopausal women with hypoactive sexual desire disorder: a randomized double-blinded, placebo-controlled trial. Gynecol Endocrinol 2018; 34 (05) 442-445 . Doi: 10.1080/09513590.2017.1409711
- 11 de Souza KZ, Vale FBC, Geber S. Efficacy of Tribulus terrestris for the treatment of hypoactive sexual desire disorder in postmenopausal women: a randomized, double-blinded, placebo-controlled trial. Menopause 2016; 23 (11) 1252-1256 . Doi: 10.1097/GME.0000000000000766
- 12 Postigo S, Lima SMRR, Yamada SS, dos Reis BF, da Silva GM, Aoki T. Assessment of the effects of tribulus terrestris on sexual function of menopausal women. Rev Bras Ginecol Obstet 2016; 38 (03) 140-146 . Doi: 10.1055/s-0036-1571472
- 13 Guazzelli RM, Lima SMRR, Postigo S, Martins CPB, Yamada SS. Estudo dos efeitos do Tribulus terrestris e da tibolona em mulheres com disfunção do desejo sexual após a menopausa. Arq Med Hosp Fac Cienc Med Santa Casa São Paulo. 2014; 59 (01) 20-26
- 14 Akhtari E, Raisi F, Keshavarz M, Hosseini H, Sohrabvand F, Bioos S. , et al. Tribulus terrestris for treatment of sexual dysfunction in women: randomized double-blind placebo - controlled study. Daru 2014; 22 (01) 40 . Doi: 10.1186/2008-2231-22-40
- 15 Higgins J, Green S. , Eds. Cochrane handbook for systematic reviews of interventions [Internet]. Version 5.1.0. London: The Cochrane Collaboration; 2011. [cited 2019 Aug 10]. Available from: https://handbook-5-1.cochrane.org/
- 16 Moher D, Liberati A, Tetzlaff J, Altman DG. ; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009; 339: b2535 . Doi: 10.1136/bmj.b2535
- 17 Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R. , et al. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 2000; 26 (02) 191-208 . Doi: 10.1080/009262300278597
- 18 Abdo CHN. Development and validation of female sexual quotient: a questionnaire to assess female sexual function. RBM Rev Bras Med. 2006; 63 (09) 477-482
- 19 Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev 2016; 5 (01) 210 . Doi: 10.1186/s13643-016-0384-4
- 20 Review Manager (RevMan). Version 5.3 [Computer program]. Copenhagen: The Nordic Cochrane Centre/The Cochrane Collaboration; 2014
- 21 Guyatt GH, Oxman AD, Schünemann HJ, Tugwell P, Knottnerus A. GRADE guidelines: a new series of articles in the Journal of Clinical Epidemiology. J Clin Epidemiol 2011; 64 (04) 380-382 . Doi: 10.1016/j.jclinepi.2010.09.011
- 22 McMaster University. GRADEpro GDT: GRADEpro Guideline Development Tool [Computer program]. Hamilton: Evidence Prime; 2015