A Meta-Analysis of the Efficacy of Panax Ginseng on Menopausal Women’s Sexual Function

Abstract

Objectives: An increase in life expectancy results in the aging population growth. This study was designed to evaluate the efficacy and adverse events of ginseng that could be used as a herbal medicine in women with sexual dysfunction. Materials and Methods: The authors of this study searched Cochrane Library, MEDLINE, Web of Science, Embase, Scopus, ProQuest, Google Scholar, and Persian databases without a time limitation until May 2018 and examined all the randomized clinical trials (RCTs) that compared the effect of different types of ginseng on sexual function of menopausal women as compared to the placebo controls. The Cochrane risk of bias tool was used to assess the methodological quality of the included studies. The heterogeneity was determined using the I2 index. In addition, standardized mean difference (SMD) was used instead of mean differences (MD) and a random effect was reported instead of fixed effect in meta-analysis. Results: The eligibility criteria were found in five RCTs. All the included studies were placebo-controlled. Two trials had a parallel design while three studies used a crossover design. Although four trials indicated that ginseng significantly improved sexual function, they didn’t report any treatment effect compared to the placebo group. Based on the results of meta-analysis obtained from five studies including 531 women, there was no statistically significant effect of ginseng on female sexual dysfunction (FSD) compared to the placebo control group (SMD: 0.26; 95% CI: -0.26 to 0.76). Nonetheless, there was a considerable heterogeneity among the studies (I2 = 81%; P < 0.0001). Moreover, all the included studies assessed adverse events, but in three of the RCTs, there was no significant difference between the placebo and ginseng groups. Conclusions: The evidence regarding ginseng as a therapeutic agent for sexual dysfunction is unjustifiable. Rigorous studies seem warranted in this respect.

Ginseng and health outcomes: an umbrella review

“…Subsequently, 719 records were excluded after reviewing the titles and abstracts. The full-texts of the remaining 81 records were evaluated, and 19 studies ( Jang et al, 2008 ; Seida et al, 2011 ; Bach et al, 2016 ; Duan et al, 2018 ; Ghorbani and Mirghafourvand, 2019 ; Mohammadi et al, 2019 ; Saboori et al, 2019 ; Antonelli et al, 2020 ; Ghavami et al, 2020 ; Miraghajani et al, 2020 ; Lee et al, 2021 ; Sha’ari et al, 2021 ; Zhu et al, 2021 ; Ikeuchi et al, 2022 ; Lee et al, 2022 ; Luo and Huang, 2022 ; Naseri et al, 2022 ; Park et al, 2022 ; Zhu et al, 2022 ) were involved in the final analysis. The flow chart for the study selection process is shown in Figure 1 .…”

“…All meta-analyses were published from 2008 to 2022. These studies were published in peer-reviewed journals in eight geographical regions, including five studies each from Korea ( Jang et al, 2008 ; Bach et al, 2016 ; Lee et al, 2021 ; Lee et al, 2022 ; Park et al, 2022 ) and Iran ( Ghorbani and Mirghafourvand, 2019 ; Mohammadi et al, 2019 ; Saboori et al, 2019 ; Ghavami et al, 2020 ; Miraghajani et al, 2020 ); four from China ( Duan et al, 2018 ; Zhu et al, 2021 ; Luo and Huang, 2022 ; Zhu et al, 2022 ); and one each from Italy ( Antonelli et al, 2020 ), Canada ( Seida et al, 2011 ), Japan ( Ikeuchi et al, 2022 ), Australia ( An et al, 2011 ), and Malaysia ( Sha’ari et al, 2021 ). Eight studies had registered their protocols prior to publication ( Antonelli et al, 2020 ; Lee et al, 2021 ; Sha’ari et al, 2021 ; Zhu et al, 2021 ; Ikeuchi et al, 2022 ; Lee et al, 2022 ; Luo and Huang, 2022 ; Park et al, 2022 ).…”

“…The RCTs number involved in every meta-analysis varied between two and 28, and the total number of participants ranged between 123 and 2,503. Except for two studies conducted in healthy participants ( Seida et al, 2011 ; Ikeuchi et al, 2022 ) and four that included both healthy controls and patients ( Bach et al, 2016 ; Antonelli et al, 2020 ; Ghavami et al, 2020 ; Miraghajani et al, 2020 ), all remaining studies were conducted in patients with indications for ginseng use ( Jang et al, 2008 ; Duan et al, 2018 ; Ghorbani and Mirghafourvand, 2019 ; Mohammadi et al, 2019 ; Saboori et al, 2019 ; Lee et al, 2021 ; Sha’ari et al, 2021 ; Zhu et al, 2021 ; Lee et al, 2022 ; Luo and Huang, 2022 ; Naseri et al, 2022 ; Park et al, 2022 ; Zhu et al, 2022 ). Moreover, 17 meta-analyses focused on placebo-controlled trials ( Jang et al, 2008 ; Seida et al, 2011 ; Bach et al, 2016 ; Ghorbani and Mirghafourvand, 2019 ; Mohammadi et al, 2019 ; Saboori et al, 2019 ; Antonelli et al, 2020 ; Ghavami et al, 2020 ; Miraghajani et al, 2020 ; Lee et al, 2021 ; Sha’ari et al, 2021 ; Ikeuchi et al, 2022 ; Lee et al, 2022 ; Luo and Huang, 2022 ; Naseri et al, 2022 ; Park et al, 2022 ; Zhu et al, 2022 ), whereas two focused on eligible combinations (such as with usual medication) ( Duan et al, 2018 ; Zhu et al, 2021 ).…”

“…Except for two studies conducted in healthy participants ( Seida et al, 2011 ; Ikeuchi et al, 2022 ) and four that included both healthy controls and patients ( Bach et al, 2016 ; Antonelli et al, 2020 ; Ghavami et al, 2020 ; Miraghajani et al, 2020 ), all remaining studies were conducted in patients with indications for ginseng use ( Jang et al, 2008 ; Duan et al, 2018 ; Ghorbani and Mirghafourvand, 2019 ; Mohammadi et al, 2019 ; Saboori et al, 2019 ; Lee et al, 2021 ; Sha’ari et al, 2021 ; Zhu et al, 2021 ; Lee et al, 2022 ; Luo and Huang, 2022 ; Naseri et al, 2022 ; Park et al, 2022 ; Zhu et al, 2022 ). Moreover, 17 meta-analyses focused on placebo-controlled trials ( Jang et al, 2008 ; Seida et al, 2011 ; Bach et al, 2016 ; Ghorbani and Mirghafourvand, 2019 ; Mohammadi et al, 2019 ; Saboori et al, 2019 ; Antonelli et al, 2020 ; Ghavami et al, 2020 ; Miraghajani et al, 2020 ; Lee et al, 2021 ; Sha’ari et al, 2021 ; Ikeuchi et al, 2022 ; Lee et al, 2022 ; Luo and Huang, 2022 ; Naseri et al, 2022 ; Park et al, 2022 ; Zhu et al, 2022 ), whereas two focused on eligible combinations (such as with usual medication) ( Duan et al, 2018 ; Zhu et al, 2021 ). Most studies reported the type of ginseng, which mainly included Panax ginseng , Panax notoginseng , Panax quinquefolius , and red ginseng.…”

“…Among female patients with sexual dysfunction, ginseng failed to improve overall sexual function (GRADE level: very low), but had a positive effect in treating sexual arousal (GRADE level: very low) and sexual desire (GRADE level: very low) (Sha'ari et al, 2021). Similarly, ginseng failed to improve sexual function in menopausal women (GRADE level: very low) when compared with the placebo (Ghorbani and Mirghafourvand, 2019;Lee et al, 2022). However, ginseng could significantly reduce menopausal symptoms (GRADE level: low), hot flashes (GRADE level: low), and improve the QoL (GRADE level: moderate) in menopausal women (Lee et al, 2022).…”