An aphrodisiac is a substance that, when consumed, increases sexual desire. Aphrodisiacs are distinct from substances that address fertility issues such as impotence or secondary sexual (dys)function such as ED.
Assessment of aphrodisiac qualities
Throughout history, many foods, drinks, and behaviors have had a reputation for making sex more attainable and/or pleasurable. However, from a historical and scientific standpoint, the alleged results may have been mainly due to mere belief by their users that they would be effective (placebo effect). Likewise it is noteworthy that many medicines are reported to affect libido in an inconsistent or idiopathic ways: enhancing or diminishing overall sexual desire depending on the situation of subject. This further complicates the assessment process. For example: wellbutrin is known as an antidepressent that can counteract other co-prescribed antidepressants' libido-diminishing effects. However, because wellbutrin only increases the libido in the special case that it is already impaired by related medications, it is not generally classed as an aphrodisiac.
Classically, to be considered an aphrodisiac, a substance should:
- Be administered orally
- Reliably increase libido or sexual desire (no placebo effect, no diminishment of libido)
- Take effect in a relatively immediate time frame (minutes or hours, not days or weeks)
Libido is clearly linked to levels of sex hormones, particularly testosterone. When a reduced sex drive occurs in individuals with relatively low levels of testosterone (e.g., post-menopausal women or men over age 60), testosterone supplements will often increase libido. Approaches using a number of precursors intended to raise testosterone levels have been effective in older males, but have not fared well when tested on other groups.
Some compounds that activate the melanocortin receptors MC3-R and MC4-R in the brain are effective aphrodisiacs. One compound from this class, bremelanotide, formerly known as PT-141, is undergoing clinical trials for the treatment of sexual arousal disorder and erectile dysfunction. It is intended for both men and women. Preliminary results have proven the efficacy of this drug, however development was suspended due to a side effect of increased blood pressure observed in a small number of trial subjects who administered the drug intra-nasally. On 12 August 2009, Palatin, the company developing the drug, announced positive results (none of the previous heightened blood pressure effects were observed) of a phase I clinical study where trial subjects were instead administered the drug subcutaneously. Palatin is concurrently developing a related compound they call PL-6983.
Phenylethylamine (PEA) present in many food compounds as well as the human body is an aphrodisiac;[medical citation needed] however, this compound is quickly degraded by the enzyme MAO-B and so it is unlikely that any significant concentrations would reach the brain without a monoamine oxidase inhibitor. Amphetamine and methamphetamine, both phenethylamines, at high doses have been associated with hyperarousal, hypersexuality, and frequent or prolonged erections, although libido is reduced for some. Methamphetamine markedly enhances sexual desire in some individuals, and an entire sub-culture known as party and play is based around sex and methamphetamine use.
Drugs that act on the mesolimbic dopamine pathway, which includes psychostimulants like cocaine and methylphenidate, have libido-modifying (usually enhancing) effects which are mediated through increased receptor signaling in the nucleus accumbens. Pramipexole is the only dopamine agonist used in medicine as an aphrodisiac, and is sometimes prescribed to counteract the decrease in libido associated with SSRI antidepressant drugs. The older dopamine agonist apomorphine has been used for the treatment of erectile dysfunction, but is of poor efficacy and has a tendency to cause nausea. Other dopamine agonists such as bromocriptine and cabergoline may also be associated with increased libido, as can the dopamine precursor L-Dopa, but this is often part of a spectrum of side effects which can include mood swings and problem gambling and so these drugs are not prescribed for this purpose.
The libido-enhancing effects of dopamine agonists prescribed for other purposes has led to the development of a number of more selective compounds such as flibanserin, ABT-670 and PF-219,061, which have been developed specifically for the treatment of sexual dysfunction disorders, although none of them have yet passed clinical trials.
Some psychoactive substances such as alcohol, cannabis,[not in citation given] methaqualone, GHB and MDMA can increase libido and sexual desire. However these drugs are not aphrodisiacs in the strict sense of the definition, as they do not consistently produce aphrodisiac effects as their main action and often actually impair function (hence, Shakespeare's famed statement that alcohol "provokes the desire, but it takes away the performance"). Nonetheless, these drugs are sometimes used to increase sexual pleasure and to reduce sexual inhibition. Anti-erectile dysfunction drugs, such as Viagra and Levitra, are not considered aphrodisiacs because they do not have any direct effect on the libido, although increased ability to attain an erection may be interpreted as increased sexual arousal by users of these drugs.
Aphrodisiac foods and herbs
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Foods and herbs which have been claimed to be aphrodisiacs include:
- Tiger penis
- Deer penis and antlers (in Taiwan and China)
- Epimedium grandiflorum (Horny Goat Weed)
- Eurycoma longifolia
- Ginkgo biloba
- Mucuna pruriens
- Salamander Brandy 
- Socratea exorrhiza
- Spanish fly (cantharidin)
- Tribulus terrestris
- Turnera diffusa
- Watermelon Citrulline is a weak nitric oxide stimulator.
In popular culture
The invention of an Aphrodisiac is the basis of a number of films including Perfume: The Story of a Murderer, Spanish Fly, She'll Follow You Anywhere and Love Potion No. 9. The first segment of Woody Allen's Everything You Always Wanted to Know About Sex* (*But Were Afraid to Ask) is called "Do Aphrodisiacs Work?", and casts Allen as a court jester trying to seduce the queen. The novel Aphrodesia: A Novel of Suspense centers on an aphrodisiac perfume so powerful that it drives some people to kill their lovers in a fit of insatiable lust.
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ADVERSE REACTIONS ... changes in libido; frequent or prolonged erections. [emphasis added]
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Cross-sensitization is also bidirectional, as a history of amphetamine administration facilitates sexual behavior and enhances the associated increase in NAc DA ...In some people, there is a transition from “normal” to compulsive engagement in natural rewards (such as food or sex), a condition that some have termed behavioral or non-drug addictions (Holden, 2001; Grant et al., 2006a). ... In humans, the role of dopamine signaling in incentive-sensitization processes has recently been highlighted by the observation of a dopamine dysregulation syndrome in some patients taking dopaminergic drugs. This syndrome is characterized by a medication-induced increase in (or compulsive) engagement in non-drug rewards such as gambling, shopping, or sex (Evans et al, 2006; Aiken, 2007; Lader, 2008).
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