Health Care Professional Information

Clinical Summary

Zestra is a topical botanical formulation of borage seed oil, evening primrose oil, angelica root extract, Coleus forskohlii extract, ascorbyl palmitate, and dl-alpha tocopherol. It is being promoted to relieve symptoms associated with female sexual dysfunction. Sexual dysfunction may involve painful intercourse, loss of libido, difficulty in maintaining arousal, or difficulty in achieving orgasm. It may be caused by factors such as stress, hormonal changes, cancer treatment involving surgery, radiation, chemotherapy or hormone therapy, use of antidepressants, or menopause. Use of Zestra results in increased clitoral and vaginal warmth, heightened arousal, and increased sexual pleasure. The borage, primrose, angelica, and coleus extracts may contribute to Zestra's activity by increasing blood flow and nerve conduction (2) (3) (4). Clinical studies show that Zestra benefits both normal women and those with sexual disorders (1) (6).

Zestra has not been studied in cancer patients. Adverse effects from use of Zestra include mild burning sensation locally. It is contraindicated in women who are pregnant, breastfeeding, and in those trying to conceive.

Purported Uses
  • Female sexual dysfunction
Constituents
  • Borage seed oil
  • Evening primrose oil
  • Angelica root extract
  • Coleus forskohlii extract
  • Ascorbyl palmitate
  • dl-alpha tocopherol
  • Natural fragrances
Mechanism of Action

Studies show that borage and evening primrose oils are rich in gamma-linolenic acid that is metabolized to prostaglandin E1 in the skin (2). This process is known to increase blood flow and nerve conduction. Osthole, a compound present in Angelica root extract was found to increase the levels of cGMP and cAMP (3). The Coleus forskohlii extract contains forskolin, coleonol, and related diterpenes that are known to stimulate adenylate cyclase (4).

Pharmacokinetics

Zestra is absorbed through the skin and within 4-5 minutes of its application, results in gradual genital warming. The manufacturer claims that the effects of a single application can last up to 30-45 minutes.

Warnings

Sexual dysfunction could be a result of other complex underlying physical, biological, or psychological disorders. Patients should consult and be monitored by a physician when using this product.

Contraindications
  • Women trying to conceive and pregnant women
  • Women who are breastfeeding
  • Hypersensitivity to any of the ingredients
  • Vaginal irritation, atrophy, or infection
Adverse Reactions
  • Mild to moderate genital burning following application of Zestra has been reported (1) (6).
Literature Summary and Critique

Ferguson DM, et al. Randomized, placebo-controlled, double-blind, crossover design trial of the efficacy and safety of Zestra for Women in women with and without female sexual arousal disorder. J Sex Marital Ther 2003;29 Suppl 1:33-44.
Ten women with and ten women without female sexual arousal disorder (FSAD) were randomized to receive 5 doses of Zestra or placebo oil to use at home while continuing sexual activities. During their second visit, subjects were assessed by questionnaires and were given 5 doses of crossover treatment (the women who were initially given Zestra were switched to placebo and those on placebo received Zestra). Subjects were again assessed by questionnaires at their third visit. Results of the study indicated that all women, both normal and those with FSAD showed statistically significant improvements in level of sexual arousal, sexual desire, genital sensation, ability to have orgasms, and sexual pleasure. The study also found that Zestra was equally effective in women using antidepressants (7 subjects) of the SSRI class (selective serotonin reuptake inhibitors) as in those not using any antidepressants (13 subjects). Researchers concluded that Zestra improves sexual function in both normal and FSAD women irrespective of antidepressant use. However, due to the small sample size of the study, the results may not be generalized. Future studies involving large sample size are warranted.

Dosage (Inside MSKCC Only)
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References
  1. Ferguson DM, Steidle CP, Singh GS, Alexander JS, Weihmiller MK, Crosby MG. Randomized, placebo-controlled, double blind, crossover design trial of the efficacy and safety of Zestra for Women in women with and without female sexual arousal disorder. J Sex Marital Ther 2003; 29 Suppl 1:33-44.
  2. Dines KC, Cotter MA, Cameron NE. Effectiveness of natural oils as sources of gamma-linolenic acid to correct peripheral nerve conduction velocity abnormalities in diabetic rats: modulation by thromboxane A2 inhibition. Prostaglandins Leukot Essent Fatty Acids 1996; 55(3):159-165.
  3. Teng CM, Lin CH, Ko FN, Wu TS, Huang TF. The relaxant action of osthole isolated from Angelica pubescens in guinea-pig trachea. Naunyn Schmiedebergs Arch Pharmacol 1994; 349(2):202-208.
  4. Andersson KE, Stief CG. Neurotransmission and the contraction and relaxation of penile erectile tissues. World J Urol 1997; 15(1):14-20.
  5. Product website. http://www.zestra.com/. Accessed September 26, 2012.
  6. Ferguson DM, Hosmane B, Heiman JR. Randomized, placebo-controlled, double-blind, parallel design trial of the efficacy and safety of Zestra in women with mixed desire/interest/arousal/orgasm disorders. J Sex Marital Ther. 2010;36(1):66-86.

Consumer Information

How It Works

Bottom Line: Zestra may improve sexual function in normal women and in those suffering from female sexual disorders.

Zestra is a personal product for women that contains borage seed oil, evening primrose oil, angelica root extract, Coleus forskohlii extract, ascorbyl palmitate (vitamin C), and dl-alpha tocopherol (vitamin E). It is being promoted to relieve symptoms of female sexual dysfunction. Sexual dysfunction may include painful intercourse, loss of desire, and difficulty in achieving arousal or orgasm. Stress, changes in hormone, cancer treatment, drugs, or menopause are some of the factors that may cause sexual dysfunction. The manufacturer claims that use of Zestra results in increased clitoral and vaginal warmth, increased sexual arousal, and sexual pleasure. Scientists believe that the borage, evening primrose, angelica, and Coleus forskohlii may be responsible for Zestra's activity. A recent small scale study showed that Zestra can improve sexual function in both normal women and in those suffering from female sexual arousal disorder.
Zestra has not been studied in cancer patients. Women who are pregnant, breastfeeding, or those trying to get pregnant should not use Zestra.

Purported Uses

Female sexual dysfunction
Clinical studies show that Zestra can improve sexual function in women.

Research Evidence

Female sexual dysfunction:
In a small study, ten women with female sexual arousal disorder and ten women without problems were given five doses of Zestra or placebo (oil that has no active ingredients) for home use while continuing normal sexual activities. During their second visit, the women who received Zestra were switched to placebo and those taking placebo to Zestra. Results were based on questionnaires filled by the subjects and showed that Zestra significantly improved sexual arousal, desire, and sexual pleasure compared with the placebo oil. The study also found that Zestra was equally effective in women using antidepressants of the SSRI class (selective serotonin reuptake inhibitors) as in those not using any antidepressants.

Patient Warnings

Sexual dysfunction could be a result of other complex underlying physical, biological, or psychological disorders. Patients should consult and be monitored by a physician when using this product.

Do Not Take If
  • You are pregnant or breastfeeding
  • You are trying to get pregnant
  • You are sensitive to any of the components
  • You have a vaginal infection or irritation
Side Effects
  • Mild to moderate genital burning was reported following use of Zestra.
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