An aphrodisiac is a substance that increases libido when consumed. Aphrodisiacs are distinct from substances that address fertility issues such as impotence or secondary sexual (dys)function such as erectile dysfunction (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, Bupropion (Wellbutrin) is known as an antidepressant 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.
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.
Phenethylamine (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 are phenethylamine derivatives which are known to increase libido and cause frequent or prolonged erections as potential side effects, particularly at high supratherapeutic doses where sexual hyperexcitability and hypersexuality can occur. 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 dopamine dysregulation syndrome which can include mood swings and problem gambling; hence, these drugs are not prescribed for improving libido.
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.
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 ,Love Potion No. 9 and A Serbian Film. 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. The graphic novel Click by Milo Manara is about a surgical implant which acts as an aphrodisiac, and can be turned off and on by remote control.
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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., 2006). ... 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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