Is there a difference between the effects of phytoestrogens and non-phytoestrogens medicinal plants on sexual health? A systematic review and meta-analysis

Abstract Background: The quality of life of a person and her sexual partner is impacted by sexual function. Sexual function disorders have a significant prevalence in society. There are different treatments for sexual disorders, including herbal therapies. Objective: This study aimed to do a comparison of phytoestrogens and non-phytoestrogens medicinal plant's effects on sexual health in pre- and postmenopausal women. Materials and Methods: This systematic review and meta-analysis was performed to identify relevant articles in electronic databases such as Web of Science, Scopus, PubMed, Cochrane Library, Google Scholar, and SID for English- and Persian-language articles published up to December 2021. The Cochrane collaboration tool was used to assess the risk of bias. Heterogeneity was assessed using I2 statistics. Results: Of 5428 records retrieved by searching the databases, after removing duplicate and irrelevant articles, 39 articles were included based on the inclusion criteria in the study. Finally, 18 articles with 1299 participants were included in the meta-analysis. 18 randomized clinical trial studies of phytoestrogens (n = 13) and non-phytoestrogens (n = 5) plants that used the female sexual function index questionnaire and reported the mean difference (MD) and standard deviation were included in the meta-analysis. The effects of phytoestrogens and non-phytoestrogens plants on the sexual health of postmenopausal women appear to differ significantly from one another, according to the meta-analysis (MD = 7.59; 95% CI = 4.56-10.60 and MD = 3.19; 95% CI = 1.25-5.13, respectively) but this difference was not observed in premenopausal women. Conclusion: The effect of phytoestrogens plants is more in menopausal women, and they can be advised to use these herbs.


Introduction
The inability to have healthy emotional relationships, the inability for society to flourish, infanticide, and even death will result from a lack of sexual health and security.These emotions include anger and frustration, depression, drug abuse, and parents' diminished physical and mental capacity for parenting and child care (1).
Sexual health, according to the definition of the World Health Organization, is the state of physical, mental and social health of a person in a sexual relationship (2,3).Humans have always focused their attention, curiosity, and interest on sexual function, which is the body's response to various stages of the sexual response cycle (4).One of the crucial aspects of a woman's health is her sexual function, which impacts her sense of well-being, welfare, and quality of life.Thus, any issues with sexual function may severely impact her quality of life (5).
Based on the 10 th revision of the International Statistical Classification of Diseases and Related Health Problems, sexual dysfunction is the inability to engage in desirable intercourse.Sexual arousal, desire, orgasm, and genital pelvic pain/penetration disorder are just a few examples of the various stages of the sexual cycle in which women might have sexual dysfunction (6).According to the latest edition of the Diagnostic and Statistical Manual 5, sexual disorders are "a heterogeneous group of disorders that are usually characterized by a clinically significant impairment in a person's ability to respond sexually or experience sexual pleasure".Thus, "female sexual dysfunction" is a collective term for 4 different disorders identified in the diagnostic and statistical manual 5: female orgasmic disorder, genito-pelvic pain/penetration disorder, drug-induced sexual dysfunction and female sexual interest/arousal disorder (7).Due to the taboo nature of this issue, the prevalence of sexual function abnormalities are underreported between 30 and 50% (8).
38% of married women, aged between 19 and 49 yr, who participated in a poll of the local population in Hong Kong reported having some form of sexual dysfunction.Age-related increases in the disorder's prevalence have been recorded (9).
As per the female sexual function index (FSFI), the prevalence of diminished libido, lack of sexual excitement, and absence of orgasm in Iranian women aged between 20 and 60 yr were 35, 30, 37, and 26%, respectively (10).Several techniques have been developed to assess women's sexual function.The FSFI measure has been the one most widely employed, a 19-item scale with 6 domains: desire, arousal, lubrication, orgasm, pain, and pleasure (7).
Many treatments have been investigated to improve this disorder.Despite the increase in access to effective modern medical treatments, the prevalence of side effects associated with these drugs has led to the emergence of complementary medicine.Medicinal herbs, acupuncture, and massage are some of these treatments (11).
The comparison of phytoestrogens and non-phytoestrogen plants' effects on sexual function in women was the goal of this systematic review and meta-analysis study.

Literature and search strategy
This systematic review and meta-analysis was performed based on reporting items  "sexual dysfunction of women" OR "sexual dysfunction of reproductive age women" OR "sexual dysfunction of menopausal women" OR "sexual health" OR "orgasmic disorder" OR "sexual satisfaction" OR "female sexual dysfunction" OR "sexual dysfunction" Block 3 "Randomized control trial" OR "RCT" OR "randomized trial"

Inclusion criteria
The patient, intervention, comparison, and O-The outcome included improved sexual health.

The criteria for selecting herbs
Phytoestrogens and non-phytoestrogens medicinal plants that are effective on sexual health, and eligible articles that researched the effects of these herbs on women's sexual health.

Screening and data collection
All search results for title page, abstract and full text were imported into EndnoteX7.The overall agreement between the reviewers was 95%, and all disagreements were discussed and analyzed by examining the inclusion or exclusion criteria and achieving consensus.
Finally, another staff member (FN) verified the entire process.
International Journal of Reproductive BioMedicine Sayahi et al.

Quality assessment and risk of bias
The

Data analysis and description of findings
All effect sizes for sexual health were calculated using mean differences and standard deviations.Heterogeneity was evaluated using the I 2 statistic to determine the presence of real or random differences in the study results.I 2 is the degree of variance change for the calculated effect size, which results from heterogeneity in studies.I 2 values include 0%, 25%, 50%, and 75%, indicating no, low, medium, and high heterogeneity, respectively (3).P ≥ 0.05 was considered significant to evaluate heterogeneity.Heterogeneity was considered statistically significant (p < 0.05 or I 2 > 50%) and the random effects model was used.Based on the obtained results, a meta-analysis was performed.And International Journal of Reproductive BioMedicine Medicinal plants and women's sexual health articles were included in the meta-analysis in which sexual health was measured based on the FSFI questionnaire and the reason for that was increased accuracy.The calculations were performed using the Review Manager 5.1 software.

Study selection and characteristics
According to the above search term (Table I

Phytoestrogens plants
Flavonoids, coumestans, and lignans, which have the potential to hold the estrogen receptors alpha and beta together, are the 3 prominent families of phytoestrogens (12).

Vitex-agnus castus
The Vitex plant belongs to the category of phytoestrogens.The chemical compounds of the Vitex plant are flavonoids, glycosides, saponins, and fatty acids such as linoleic acid.The impact of the Vitex plant on the sexual dysfunction of women of reproductive age was examined.Once daily, tablets of 3.2-4.8mg of dried Vitex fruit extract were utilized.
Women's sexual function did not differ between the intervention's beginning and end for 4 wk (p > 0.05) (6).

Red clover (Trifolium pratense)
Trifolium pratense, is a plant containing phytoestrogens.Use of red clover as a 2% vaginal cream once a day for 8 wk was studied to see how it affects the postmenopausal women's sexual dysfunction.Postmenopausal women who took red clover experienced improved sexual function (p = 0.001) (13).Red clover has been shown to improve performance and sexual health in menopausal women as well.Compared to the control group, menopausal women who took 2 red clover 40 mg capsules daily for 90 days had these benefits, and a reduction of vaginal dryness (47% vs. 83%), dyspareunia (34% vs. 69%), and decreased libido (52% vs. 73%), were observed (14).

G. biloba
Flavonol glycosides account for 24% of the phytoestrogen-rich G. biloba plant extract.G. biloba improves blood flow, modifies nitric oxide systems, and relaxes soft muscular tissues, which can impact the sexual response cycle (15).The effect of G. biloba extract capsules on postmenopausal women, aged between 50-60, who were sexually active were examined.After taking 2-4 tablets daily for one month, or 120-240 mg (each containing 60 mg of G. biloba extract), postmenopausal women did not experience any statistically significant differences in their sexual activity compared to the placebo group.The intervention, however, increased sexual desire (p = 0.02) (16).The effect of G. biloba capsules on postmenopausal women's sexual satisfaction was not observed in another study (15).The impact of G. biloba pills and aromatherapy inhalation components on the sexual function of postmenopausal women was examined.In the G. biloba group, 40 mg pills were taken 3 times per day.In contrast, in the aromatherapy group, 2-3 drops of an aromatherapy solution (lavender, fennel, rose, and geranium) were recommended each day for 6 wk.Sexual function in postmenopausal women was enhanced by aromatherapy and G. biloba supplements (p < 0.001) (17).

Fennel
Foeniculum vulgare, a carrot family member, is a native of the Mediterranean Sea coast.Iran is one of the nations where this plant is produced.The primary chemical constituents of fennel are transand dianethole, which have estrogenic actions.The impact of fennel vaginal cream on postmenopausal women's dyspareunia and sexual function were examined.An 8 wk prescription for a vaginal lotion containing 30 mg of 5% fennel, boosted sexual satisfaction and decreased dyspareunia (p < 0.001) (18).The impact of fennel vaginal cream on postmenopausal women's sexual function was researched.A fennel vaginal cream dose of 5 mg every night was utilized for this purpose for 8 wk.

International Journal of Reproductive BioMedicine
Medicinal plants and women's sexual health Women's sexual function was enhanced by the intervention (p < 0.001) (19).

Squill
The squill bulb, ranging from 3-15 cm in diameter, has a pear-like shape and is found worldwide.The sea onion is also referred to by its scientific name, Drimia maritima.In squill extract, flavonoids have been found such as quercetin, which has phytoestrogen properties such as boosting libido and stimulating sexual desire (20).The effects of squill oil were investigated in postmenopausal women.During the 4 th wk, they applied squill oil on the clitoris in a dose of 3 ml 2-3 times each week, 5 min before sexual intercourse.When compared to the control group, the intervention group's levels of dyspareunia and sexual satisfaction were significantly higher (p < 0.001) (21).
The impact of topical squill oil on the sexual function of reproductive-age women was examined.Squill oil was applied topically to the clitoris 1-3 times per week, 5-10 min before sexual intercourse for one month, squill oil enhances female sexual performance (p < 0.001) (20).

Ginseng
According to C.A. Meyer, Korean red ginseng (KRG), also known as P. ginseng root, has been utilized as a traditional herbal remedy in Asian nations for a very long time.Ginseng is a potent phytoestrogen with excellent antioxidant effects (22).Red ginseng's impact on 41 reproductive-age women was studied by double-blind, cross-over clinical trial; the intervention group received 1 gr of ginseng capsules 3 times per day for 8 wk.In the group receiving ginseng, the intervention increased sexual desire, arousal, orgasm, and sexual satisfaction.
However, no significant difference was observed in sexual function between the intervention and control groups (p = 0.07) (23).The impact of P. ginseng on postmenopausal women's sexual function was examined in another study, 500 mg of P. ginseng was administered twice a day for 4 wk, which improved women's sexual performance in comparison to the control group (p < 0.001) (24).The impact of KRG on the sexual arousal of 32 postmenopausal women was examined.Taking 1 mg ginseng in the form of pills 3 times per day for 8 wk increased sexual arousal (p = 0.006) (25).

T. foenum-graecum or Fenugreek
This plant, which belongs to the family of legumes, contains phytoestrogens.The progesterone-like actions of the sapogenin are found in T. foenum extract.Diosgenin, a substance with estrogenic and steroid hormone-like properties, is also present in this extract.The effect of T. foenum-graecum seed extract (Libifem) on testosterone, estradiol and sexual function in healthy menstruating women was examined, this clinical trial's findings showed that healthy menstrual women who self-reported impaired sexual function responded well to 600 mg/day of a specialized extract of T. foenum-graecum seed extract (Libifem).Significant improvements were seen in both arousal and sexual desires (p < 0.001) (26).Fenugreek vaginal cream's impact on postmenopausal women's dyspareunia and sexual satisfaction was studied (27).
International Journal of Reproductive BioMedicine Sayahi et al.

Apium graveolens L. fruit (celery seed)
The plant known as "celery" is Apium graveolens

Carrot seed (Daucus carota)
The carrot is one of the plants emphasized in traditional Iranian medicine.Carrot seeds have been described as a contraceptive, aphrodisiac, emmenagogue, and antifertility agent in some European literature (29).
The impact of carrot seeds on lowering libido in women of reproductive age was examined.In this study, 500 mg carrot seeds were given 3 times per day for 12 wk.The intervention enhanced sexual performance (p < 0.001) (30).
The impact of the Jazar supplement on postmenopausal women's quality of life and sexual performance was investigated, 4 Jazar capsules (500 mg each capsule) which contains Vitex, fennel, and carrot seeds, were recommended daily.Postmenopausal women's sexual function was enhanced by the intervention (p < 0.001) (29).

Pomegranate (P. granatum L.)
Several qualities of P. granatum L. ellagitannins which can be astringent or possess traits connected to protein molecules, are one of the principal and significant chemicals in pomegranate bark that ultimately induce muscles to stretch and contract.In addition, phytoestrogen is present in pomegranate bark, and its gel affects is found to affect orgasm and sexual satisfaction in women of reproductive age.3% pomegranate bark gel was applied 3 times weekly, 15 min before sexual contact for consecutive 8 wk.
Sexual satisfaction and orgasm were enhanced in the intervention group in comparison to the control group (p < 0.001) (31).

Maca
Maca is the root of the Lepidium meyenii plant, which grows exclusively at high altitudes in the Andes region of Peru where it is widely used for its putative fertility-enhancing and aphrodisiac properties.In a study, menopausal women who consumed 3.5 mg of mace powder daily for 6 wk had their sexual performance examined.Using Greene Climacteric Scale questionnaire, they discovered that sexual issues drastically diminished following intake (p = 0.05) (32).

M. officinalis (Lemon balm)
A tonic for the major organs, M. officinalis, often known as lemon balm (Labiate), is an aromatic and mildly peppery plant with a lemon flavor and aroma.
In a study, lemon balm affected sexual dysfunction in women between 18 and 50.500 mg capsules of lemon balm extract were given twice a day for 4 wk (p < 0.001) (33).

Aphrodite
The herbal supplement Aphrodite contains Zygophyllacea, ginger, saffron, and cinnamon, each with unique medicinal benefits.Aphrodite's impact on International Journal of Reproductive BioMedicine Medicinal plants and women's sexual health orgasm and sexual desire in postmenopausal women was examined in a study. 2 Aphrodite capsules daily for one month were given to the postmenopausal women in the intervention group, which increased libido and orgasm compared to the control group (p = 0.02).Aphrodite capsules contain 40 mg of Zygophyllaceae fruit, 27.12 mg of ginger, 3.3 mg of saffron, and 11 mg of cinnamon (34).Aphrodite intake increased menopausal women's sexual satisfaction, according to a different study (p = 0.01) (35).

Date palm pollen
A member of the Palmaceae family of plants, the palm tree (Phoenix dactylifera) has various medicinal uses.Date palm pollen contains fatty acids, antioxidants, vitamins A and E, as well as a wealth of minerals, according to phytochemical studies.Date pollen capsules' impact on postmenopausal women's vaginal dryness and dyspareunia was studied.Date pollen capsules containing 300 gr of the substance were recommended for 35 days.Vaginal wetness and dyspareunia significantly differed between the 2 groups (p = 0.001 and p = 0.048, respectively) (36).
The impact of date pollen capsules on orgasm and sexual satisfaction in postmenopausal women was examined.For 35 days, postmenopausal women took 300 mg of date pollen capsules, which increased orgasm in the intervention group compared to the control group (p = 0.004) but did not affect the women's sexual satisfaction (37).

Althaea Officinalis or Alcea
This plant is a type of medicinal plant that contains a lot of mucilage and moisturizing properties.
The impact of Alcea on postmenopausal women's sexual function was examined.5% Alcea vaginal suppository was administered each night for the first 2 wk and every other night for the following 6 wk.The intervention had a favorable impact on postmenopausal women's sexual function compared to the placebo group (p = 0.001) (38).

Tribulus terrestris L. (Zygophyllaceae)
Tribulus terrestris L. (Zygophyllaceae) is native to India.Protodioscin a steroidal saponin found in Tribulus preparations, influences hormonal activity and the generation of endogenous androgen by causing a rise in the release of luteinizing hormone (39).The effect of hydroalcoholic extract of Zygophyllaceae in the form of syrup taking 0.9 mg twice a day for 8 wk was investigated on 60 postmenopausal women compared to 60 people in the control group.This intervention increased sexual satisfaction (p < 0.005) (40).The impact of Zygophyllaceae extract on 40 women of reproductive age was examined.Compared to the control group, sexual function increased when the section was administered in the form of 250 mg tablets 3 times per day for 120 days (p < 0.001) (41).
The effect of Zygophyllaceae extract was investigated on postmenopausal sexual disorders.250 mg of extract was administered as treatment, 3 times daily for 120 days.Among the intervention group, sexual function had improved (p < 0.01) (42).The Zygophyllaceae was studied on 60 postmenopausal women as opposed to 30 individuals in the control group.For 90 days, the extract was recommended in 250 mg tablets to be taken thrice daily.The intervention enhanced sexual function (43).7.5 ml of Zygophyllaceae extract was administered twice daily for one month to women of reproductive age.In the intervention group, Zygophyllaceae extract increased sexual function (p = 0.04) (44).

Saffron
Because it contains substances like crocin and safranal, saffron has a stimulating and arousing International Journal of Reproductive BioMedicine Sayahi et al.
influence on the senses.Saffron promotes sexual satisfaction and vaginal wetness in lab animals (45).Saffron's impact on sexual dysfunction in women between the ages of 18 and 39 was studied.In comparison to the control group, sexual function was improved by taking 15 mg saffron extract capsules twice daily for 8 wk (p < 0.001) (46).The sexual function of postmenopausal women was examined.The study aimed to investigate the effects of oral saffron in a daily capsule (containing 30 mg of dry saffron stigma powder) for 4 wk (p < 0.001) (45).Alcea improved menopausal women's sexual function.These results are probably brought on by this plant's moisturizing abilities (38).
Aphrodite was found to have a favorable impact on enhancing sexual function on orgasm, sexual desire, and sexual satisfaction in postmenopausal women (34).In studies examining the effect of saffron on sexual function before and after menopause, saffron was found to enhance sexual function (45,46). 2 studies investigated the impact of date pollen capsules in postmenopausal women's vaginal moisture, dyspareunia, orgasm, and sexual satisfaction.
The intervention increased vaginal moisture, dyspareunia, and orgasm but it had no effect on menopause women's sexual satisfaction, which can be influenced by some factors, including one's attitude toward aging, stress, anxiety, mental activity, and personal responsibility (36,37).A systematic review and meta-analysis investigated the effects of phytoestrogens on sexual function in postmenopausal women.
In this study, Soy had no effect on sexual function but it had improved the dyspareunia.
Red ginseng did not significantly increase sexual performance, while maca and fenugreek significantly improved it (51).The previous study only examined medicinal plants that contained phytoestrogens, as opposed to the current study, which examined both phytoestrogen-and non-phytoestrogen containing plants' effects on the sexual health of women.A systematic review of medicinal herbs that affect menopausal women's sexual function and enjoyment was conducted, the results showed that Aphrodite, bindii, fennel, ginseng, fenugreek, and red clover all improved dyspareunia, sexual enjoyment, and sexual function.But date palm pollen and G. biloba did not affect sexual satisfaction (52).The authors of "A systematic review of herbal medicines to improve the sexual function of menopausal women" hypothesized that red ginseng, fennel, bindii, red clover, and black cohosh had the most significant impact on enhancing the menopausal women's sexual function (8).However, the current study looked at the effects of both phytoestrogens and non-phytoestrogen plants on the sexual health of both pre-and postmenopausal women.The elimination of these symptoms with the synergistic effect of phytoestrogen in increasing vaginal moisture has improved sexual function in postmenopausal women, but this is not true in women of reproductive age (6).

Conclusion
There is no difference between the effects of phytoestrogens and non-phytoestrogens medicinal plants in improving the sexual health of premenopausal women.But the effect of phytoestrogens medicinal plants is more in menopausal women, so using phytoestrogens medicinal plants such as fennel, fenugreek, and red clover with precaution (avoid high dose consumption) is a suitable choice for improving the sexual health of menopausal women.
outcome framework was used to identify components of clinical evidence.Randomized controlled trial studies with the following characteristics for which full text was available were included in this systematic review and meta-analysis: P-The target population was women with sexual dysfunction (and do not have a chronic disease).I-The intervention was phytoestrogen or non-phytoestrogen medicinal plants.C-The comparison group was women with sexual dysfunction who received placebo.

6 areas
Cochrane Collaboration tool was used to assess the risk of bias for randomized controlled by Review Manager 5.1 software.Bias was assessed as a result for data (attrition bias), and selective reporting (reporting bias) (3).The results are shown in figure 1 as low, high, and unclear risks.The risk of bias for each study is shown in figure 2.

Figure 1 .
Figure 1.Risk of bias assessment of clinical trial articles used in the study.

Figure 2 .
Figure 2. Risk of bias for each study.The green color indicates low risk of bias, white indicates unclear risk of bias, and red indicates high risk of bias.
Chamomile is the most frequently employed in medicinal use as Compositae or Asteraceae family herb.According to pharmacological studies, chamomile extract consists of apigenin and chrysin flavonoids which have phytoestrogens effects and can bind both classical and non-classical estrogen receptors to produce estrogenic effects.Postmenopausal women who used chamomile vaginal gel reported less painful sexual intercourse and greater sexual satisfaction (p < 0.001)(12).

L.
One of the plants rich in flavonoids including apigenin, is celery.Celery seed includes phytoestrogens components that may assist in the lubrication and vasocongestion of the clitoral and vaginal canals, which enhance the sexual function of females.Celery seed's impact on female sexual dysfunction was studied, the administration of celery seed for 6 wk could considerably enhance female sexual function by improving sexual desire, arousal, lubrication, and pain relief during intercourse.Those receiving celery seed had significantly higher, overall, FSFI scores as compared to those receiving a placebo (p < 0.001) (28).
Randomized clinical trial (RCT) studies of phytoestrogens plants (5 RCTs studies in the reproductive period and 8 RCTs studies in the menopause period) and 5 RCTs studies of non-phytoestrogens plants (3 RCTs studies in the reproductive period and 2 RCTs studies in menopause period) that used the FSFI questionnaire and reported the mean and standard deviation were included in meta-analysis.No discernible difference was observed between phytoestrogens and non-phytoestrogens plants' effects on premenopausal women's sexual health, according to the meta-analysis (MD = 7.01; 95% CI = 0.39-13.64and MD = 8.28; 95% CI = 2.05-14.5,respectively) (Figures 4, 5).The effects of phytoestrogen and non-phytoestrogen plants on the sexual health of postmenopausal women appear to differ significantly from one another (MD = 7.59; 95% CI = 4.56-10.60,and MD = 3.19; 95% CI = 1.25-5.13,respectively) (Figures 6, 7).

Figure 4 .
Figure 4. Forest plot of the phytoestrogens plants and sexual health of premenopausal women.

Figure 5 .
Figure 5. Forest plot of the non-phytoestrogens plants and sexual health of premenopausal women.

Figure 6 .
Figure 6.Forest plot of the phytoestrogens plants and sexual health of postmenopausal women.

Figure 7 .
Figure 7. Forest plot of the non-phytoestrogens plants and sexual health of postmenopausal women.

FSFI
All articles were done in Iran except a: Brazil, b: Australia c: Korea, and d: Santiago.All control groups received placebo.FSFI: Female sexual function index, SQ-F: Sexual quotient-female, FIEI: Female intervention efficacy index, GCS: Greene climacteric scale International Journal of Reproductive BioMedicine Sayahi et al.The active ingredients of T. terrestris can be metabolically transformed into weak androgens like dehydroepiandrosterone, which can then be transformed into stronger androgens like testosterone in the gonads and peripheral tissues, which are positively connected with sexual desire and sexual behavior (43).
These investigations looked at the effects of phytoestrogens and non-phytoestrogen plants on the sexual function of menopausal women.We discovered that these herbs benefit sexual function, although several medicinal plants, such as vitex, G. biloba, and ginseng, cannot be conclusively proven to have any effects.Therefore, further research with a larger sample size and a more focused technique is needed.Other findings of the present study are that there is no difference between phytoestrogens and non-phytoestrogens medicinal plants on the sexual health of premenopausal women, till, it seems that phytoestrogens medicinal plants are more effective in improving the sexual function of postmenopausal women than non-phytoestrogens medicinal plants.The reason phytoestrogens are more effective than non-phytoestrogens in postmenopausal women is due to the low estrogen level in International Journal of Reproductive BioMedicine Medicinal plants and women's sexual health postmenopausal women compared to women of reproductive age.Phytoestrogens, weak estrogen agonists, can provide more substantial estrogenic effects when the amount of estrogen in the environment is low.Therefore, maybe this prediction is correct that they provide more estrogenic properties in postmenopausal women(53).On the other hand, the vasomotor symptoms of menopause, which hurt sexual function, are resolved by taking phytoestrogen.

Table I .
Search term

Table II .
Clinical trials conducted on herbal medicines effective on sexual health of premenopausal women

Table II .
Continued All articles were done in Iran except a: Brazil, b: India, c: Korea, d: Australia.All control groups received placebo.FSFI: Female sexual function index, KRG: Korean red ginseng, DISF-SR: Derogatis sexual function interview

Table III .
Clinical trials conducted on herbal medicines effective on sexual health of postmenopausal women

Table III .
Continued

Table III .
Continued