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-linolinic 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
- 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.
- 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.
- 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.
- Andersson KE, Stief CG. Neurotransmission and the contraction and relaxation of penile erectile tissues. World J Urol 1997; 15(1):14-20.
- Product website. http://www.zestra.com/. Accessed September 26, 2012.
-
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 massage oil 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:
Ten normal women and ten women with female sexual arousal disorder 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 to 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.
Last updated: September 26, 2012
acid (A-sid)
A chemical that gives off hydrogen ions in water and forms salts by combining with certain metals. Acids have a sour taste and turn certain dyes red. Some acids made by the body, such as gastric acid, can help organs work the way they should. An example of an acid is hydrochloric acid. Acidity is measured on a scale called the pH scale. On this scale, a value of 7 is neutral, and a pH value of less than 7 to 0 shows increasing acidity.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)angelica root (an-JEH-lih-kuh root)
The root of any of a group of herbs called Angelica. It has been used in some cultures to treat certain medical problems, including gastrointestinal problems such as loss of appetite, feelings of fullness, and gas.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)antidepressant (AN-tee-dee-PREH-sunt)
A drug used to treat depression.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)arousal (uh-ROW-zul)
The state of being alert and ready to respond, or waking from sleep.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)biological (BY-oh-LAH-jih-kul)
Pertaining to biology or to life and living things. In medicine, refers to a substance made from a living organism or its products. Biologicals may be used to prevent, diagnose, treat or relieve of symptoms of a disease. For example, antibodies, interleukins, and vaccines are biologicals. Biological also refers to parents and children who are related by blood.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)blood (blud)
A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)cancer (KAN-ser)
A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)chemotherapy (KEE-moh-THAYR-uh-pee)
Treatment with drugs that kill cancer cells.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)clinical (KLIH-nih-kul)
Having to do with the examination and treatment of patients.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)compound (KOM-pownd)
In science, a substance that is made up of more than one ingredient.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)CP
A chemotherapy combination used to treat chronic lymphocytic leukemia (CLL). It includes the drugs chlorambucil hydrochloride and prednisone. Also called chlorambucil-prednisone, chlorambucil-prednisone regimen, and CP regimen.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)disorder (dis-OR-der)
In medicine, a disturbance of normal functioning of the mind or body. Disorders may be caused by genetic factors, disease, or trauma.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)dysfunction (dis-FUNK-shun)
A state of not functioning normally.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)extract (EK-strakt)
In medicine, a preparation of a substance obtained from plants, animals, or bacteria and used as a drug or in drugs.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)genital (JEH-nih-tul)
Refers to the genitalia (external and internal sex organs and glands).
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)hormone (HOR-mone)
One of many chemicals made by glands in the body. Hormones circulate in the bloodstream and control the actions of certain cells or organs. Some hormones can also be made in the laboratory.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)hypersensitivity (HY-per-SEN-sih-tih-vih-tee)
An exaggerated response by the immune system to a drug or other substance.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)infection (in-FEK-shun)
Invasion and multiplication of germs in the body. Infections can occur in any part of the body and can spread throughout the body. The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever and other problems, depending on where the infection occurs. When the body’s natural defense system is strong, it can often fight the germs and prevent infection. Some cancer treatments can weaken the natural defense system.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)libido (lih-BEE-doh)
Sexual desire or the mental energy or emotion related to sex.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)menopause (MEH-nuh-pawz)
The time of life when a woman’s ovaries stop producing hormones and menstrual periods stop. Natural menopause usually occurs around age 50. A woman is said to be in menopause when she hasn’t had a period for 12 months in a row. Symptoms of menopause include hot flashes, mood swings, night sweats, vaginal dryness, trouble concentrating, and infertility.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)nerve (nerv)
A bundle of fibers that receives and sends messages between the body and the brain. The messages are sent by chemical and electrical changes in the cells that make up the nerves.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)orgasm (OR-ga-zum)
The final part of the sex act, which involves contraction of sexual organs and a sudden release of endorphins, leading to a feeling of pleasure. In males, orgasm usually occurs with release of semen.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)physician (fih-ZIH-shun)
Medical doctor.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)placebo (pluh-SEE-boh)
An inactive substance or treatment that looks the same as, and is given the same way as, an active drug or treatment being tested. The effects of the active drug or treatment are compared to the effects of the placebo.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)prostaglandin (PROS-tuh-GLAN-din)
One of several hormone-like substances made by the body. Different prostaglandins control blood pressure, contraction of smooth muscles, and other processes within tissues where they are made. Certain prostaglandins are being studied as cancer biomarkers. Also called PG.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)psychological (SY-koh-LAH-jih-kul)
Having to do with how the mind works and how thoughts and feelings affect behavior.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)radiation (RAY-dee-AY-shun)
Energy released in the form of particle or electromagnetic waves. Common sources of radiation include radon gas, cosmic rays from outer space, medical x-rays, and energy given off by a radioisotope (unstable form of a chemical element that releases radiation as it breaks down and becomes more stable).
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)randomized
Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments.
(http://www.cancer.gov/dictionary)serotonin (SAYR-uh-TOH-nin)
A hormone found in the brain, platelets, digestive tract, and pineal gland. It acts both as a neurotransmitter (a substance that nerves use to send messages to one another) and a vasoconstrictor (a substance that causes blood vessels to narrow). A lack of serotonin in the brain is thought to be a cause of depression. Also called 5-hydroxytryptamine.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)significant (sig-NIH-fih-kunt)
In statistics, describes a mathematical measure of difference between groups. The difference is said to be significant if it is greater than what might be expected to happen by chance alone. Also called statistically significant.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)SSRI
A type of drug that is used to treat depression. SSRIs slow the process by which serotonin (a substance that nerves use to send messages to one another) is reused by nerve cells that make it. This increases the amount of serotonin available for stimulating other nerves. Also called selective serotonin reuptake inhibitor.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)stress (stres)
The response of the body to physical, mental, or emotional pressure. This may make a person feel frustrated, angry, or anxious, and may cause unhealthy chemical changes in the body. Untreated, long-term stress may lead to many types of mental and physical health problems.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)surgery (SER-juh-ree)
A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)therapy (THAYR-uh-pee)
Treatment.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)vaginal (VA-jih-nul)
Having to do with the vagina (the birth canal).
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)
