Heydarpour S, Sharifipour F, Heydarpour F. Effect of Salvia officinalis scent on postmenopausal women's sexual function and satisfaction: a randomized controlled trial. BMC Womens Health. 2023;23(1):442.
To investigate the effects of Salvia officinalis aromatherapy on sexual function and satisfaction in postmenopausal women
Inhalation of 2 drops of sage essential oil twice daily, 5 days per week for 6 weeks, may support both sexual function and sexual satisfaction in postmenopausal women.
Double-blind, randomized, controlled trial
Investigators randomized 64 participants; 26 in the active group and 28 in the control group completed the trial, for a total of 54 participants assessed. Participants were postmenopausal, heterosexual (married and living with husbands) women in Iran, aged 58.59 ± 1.5 years with a mean age of menopause of 52.01 ± 2.67 years. Noteworthy inclusion criteria included a score of ≤28 on the Female Sexual Function Index (FSFI), not having mental or physical illness, not smoking, and no alcohol consumption. Participants were excluded if they had a history of allergic rhinitis or asthma or a major stressful event within 6 months of the study’s initiation.
The active intervention group received a sage essential oil 10% (“purchased from a pharmaceutical research center in Tehran”) in odorless almond oil with propylene glycol as a stabilizer. The placebo was odorless almond oil (“purchased from the herbal market in Kermanshah”). Participants placed 2 drops of oil on their forearm twice daily, at approximately 10 am and 10 pm. They were instructed to inhale the odor for 5 minutes per session, with a distance of approximately 30 cm between forearm and nose.
Study Parameters Assessed
Investigators used 2 tools to measure outcomes:
- The Female Sexual Function Index (FSFI) contains 19 questions rated 0 to 5. Scores range from 0 to 36, and less than 28 indicates sexual dysfunction.
- Linda Berg’s Sexual Satisfaction Questionnaire contains 17 questions scored from 1 to 5. Scores range from 17 to 85, where a score between 17 and 51 represents poor satisfaction, 52 to 67 moderate satisfaction, and 65 to 85 to good satisfaction.
Subjective responses via indices of sexual function and sexual satisfaction as reported by participants
The mean total score of sexual function on the FSFI was 28.28 ± 2.13 in the sage group compared to 17.9 ± 1.59 in the placebo group, which is statistically significant (P<0.001). The mean total sexual satisfaction score on the Linda Berg questionnaire was also statistically significant: 71.53 ± 5.86 in the sage group compared to 50.44 ± 10.41 in the placebo group (P<0.001).
The study was funded by Kermanshah University of Medical Sciences (KUMS) in Iran. Trial registry: https://en.irct.ir/user/ trial/50212/view. Authors declared no conflicts of interest.
Practice Implications & Limitations
This study provides preliminary evidence for the use of common sage (Salvia officinalis) as aromatherapy for improving sexual function and sexual desire in postmenopausal women.1 However, the results should be interpreted with a degree of caution. Because this study recruited only women in Iran and required participants to be married and heterosexual, we cannot extrapolate to other cultures, ethnicities, unmarried and/or multipartner women, or homosexual sexual relations.
Furthermore, this study was quite small, yet it detected statistically significant differences in results. The investigators did not control well the application/use of the inhaled materials, though they did conduct follow-up telephone calls with participants. Dose and timing may have varied. Investigators also did not document a mechanism to demonstrate adherence to the active or control group.
Furthermore, this study was quite small, yet it detected statistically significant differences in results.
While the primary outcomes were sexual function and sexual satisfaction, and these are typically considered subjective experiences, the investigators did not collect objective data to correlate potential mechanisms or effects that would explain the improvements. They also did not document frequency of intercourse in this study, even as a participant report. While sexual dysfunction was part of the inclusion criteria based on self-reported answers to the FSFI, the investigators did not report any attempt to categorize or determine cause of sexual function.
Finally, the short-term effects found in the study cannot be extrapolated to longer or more sustained effects of Salvia officinalis as aromatherapy for sexual function or sexual satisfaction of postmenopausal women. Designing aromatherapy trials is complicated by the fact that participants may detect they have received placebo, which may affect how they respond to subjective questionnaires.
The strengths of this study include the randomization and blinding methods used (participant, investigator, and statistician were all blinded to which participants received active vs control) and the achievement of statistically significant results with a small study population.
In postmenopausal women, sexual function and sexual satisfaction are often treated with hormone replacement therapy (HRT or HT). While methods of HT vary, accepted side effects include gastrointestinal complications, weight gain, increased risk of breast and endometrial cancers, heart disease, thromboembolism, and liver adenoma.2 Many women may opt to use nonhormonal options, or they may have contraindications to using hormonal therapy. Therefore, there is an interest in finding useful natural or nonhormonal interventions.
Researchers have previously studied oral Salvia officinalis at 100 mg, 3 times daily for 12 weeks, in postmenopausal women and found improvements in several symptom domains.3 Another study evaluated 100 mg of Salvia officinalis daily for 4 weeks in a similar population, and the authors noted some improvements in symptoms, but sexual desire was not affected.4
Other studies have investigated aromatherapy for menopausal symptoms, including sexual desire. In a study of 100 women, lavender essential oil was found to be potentially helpful when used twice daily, 20 minutes per session, for 12 weeks.5 A similar trial, again using lavender essential oil in the same manner over 4 weeks, showed menopausal symptom improvement.6 A systematic review evaluated aromatherapy and found significant improvement of sexual function in postmenopausal women.7 This review combined studies evaluating different preparations used in aromatherapy.
Sexual function in postmenopausal women may include desire, arousal, lubrication, orgasm, satisfaction, and pain reduction, which are also the domains of the FSFI. Sexual function plays a role in quality-of-life measures and is, thus, a healthcare consideration. Menopause can have a significant impact on sexual function.8 Sexual problems in women increase with age, and disorders occur at a rate of 27.3% in those aged 18 to 44 years, whereas the rate is significantly higher, at 44.6%, in those aged 45 to 64 years.9
While this study is far from conclusive, when we consider the favorable, low-side-effect profile of Salvia officinalis and the promising results of this study, aromatherapy with common sage essential oil may be a useful addition to clinicians’ tools to improve sexual function in postmenopausal women.
Conflict of Interest Disclosure
Employee of a company (Gaia Herbs) that sells products containing Salvia officinalis.