Sexual health can be a confusing subject. While study of television programming found that in an average day, 70% of programs had sexual content;^[1] up to 48% of teenager are engaging in intercourse^[2]; sexuality among older adults is marginalized and even denied to some degree. Dr. Caroline Roberston describes that “the frenetic pre-occupation with sex in western culture is often completely unrelated to sexual needs but more an expression of a thirst for intimacy.”^[3] Ayurvedic medicine teaches us that sexuality and intimacy are a natural and essential part of the individual’s life. Ayurveda looks at the entirety of the individual’s life carefully and clearly outlines phases of life as follows.

The 4 Goals Of Life

All of our activities are aligned towards the following four goals.

1. Dharma –These activities are opportunity for the individual to serve their community and universe, and dharma is to preserve the eco-system of the universe.
2. Artha– This category of activity refers to work that produces income for the individual and their family. Earning for one’s living is thus considered one of goals of life.
3. Kama – This refers to activities undertaken to satisfy one’s senses. These include eating, drinking, and other pleasurable, sensual experiences. Ultimate goal of Kama is to procreate and maintain one’s species.
4. Moksha – This word means “liberation” or “salvation”. This category of activities concerns pursuit of Spiritual development and transcendence from material world. The goal is practice non-attachment and to surrender to the Universe or the Creator. This is the most popularized goal of life among those attracted to Spiritual philosophy of Eastern cultures.

The four goals of life are pursued by the individual throughout one’s life. However, each phase of life has a unique focus. The individual’s life is divided into the following four phases.

1. Brahmacharya – This phase lasts from birth until the age of 25. This is considered a time for learning as well as personal and spiritual development. Most individuals complete their education by the age of 25 and begin their career and even start a family.
2. Grihasta – The second phase of life last from age 26 to 50. This is considered a time for growing in one’s career, applying all the academic, personal, and spiritual resources to one’s work in the world. This is also when one begins life as a householder, marrying a beloved one, starting a family, having children, and growing old in this crucible.
3. Vanaprastha – The third phase of life ranges from 51 to 75 years of age. In this phase, one embraces the gift of eldership and leadership. One freely shares their knowledge, experience, and wisdom gathered over the course of one’s life. During these years, many of us become grandparents and have the opportunity to share our gifts with the younger generations helping them learn from our experiences.
4. Sanyasa – The final phase is described as lasting from 76 to death. This is the most spiritually focused phase of life, where one gives up worldly pursuits to dedicate life toward spiritual transcendence or moksha.

Individuals are living longer and older adults are sexually active longer. As much as 50-70% of individuals between the age of 50-75 continue to be sexually active, up to 26% remain active between the ages of 75-85.^[4] Adapting the principles of balance taught by Ayurveda to our modern life is essential for optimizing sexual experiences, intimacy, health, and vitality.

Ayurvedic Wisdom To Optimize Sexual Health And Intimacy

All tissues in the human body are developed from nutrition that is ingested by the individual. The nutrition comes in three main forms: food, breath, and thoughts. Purity and balance in these three forms of nutrition becomes the basis of purity and balance of tissues in the individual. As the tissues of the body are developed, shukra or sexual fluids are the last to be refined.^[5]

Shukra dhatu or sexual tissue is considered a physiological treasure of energy. Its appropriate use can promote health and spiritual evolution. Imbalanced use can lead to weakness and disease. One metaphor for function of shukra is like a cup. As the cup fills, our reserve of sexual energy grows, giving us a sense vitality and virility. As the full shukra cup overflows, this energy is refined further to create ojas.

More refined than the physical shukra dhatu, ojas nourishes the subtle body, by strengthening the immunity and vitality of the individual. Ojas represents the restorative or self-healing capacity of the body. Healthy ojas indicates the perfect balance of body, mind and spirit, where body achieves physiological homeostasis and bio-rhythms. Ojas also represents the resilience and susceptibility of the individual to diseases.

Excessive and inappropriate sexual activity causes depletion of shukra and ojas. Ayurveda “advices judicious indulgence in sex, and considers sexual union as a sacred, consciousness expanding experience that opens up our hearts to love ourselves, (our beloved) and all beings with increased passion.”^[3]

The Balance of Masculine + Feminine

Ayurveda relates the concept of Ardh-nar-ishwar (see image). Here in, each individual is made of a divine masculine and divine feminine aspect. Balance among these polarities brings balance to all levels (physical, mental, emotional, and spiritual) of the individual. Integration of Male and female through sexual union promotes balance. Males and females have all the hormones, although males have dominance of testosterone; estrogen and progesterone are minor hormones. In females, estrogen and progesterone are major and testosterone is minor.^[6] while optimal levels of testosterone, the “male hormone”, have been shown to improve sexual desire and function to improve overall health among both male and female.^[7] Still, balance is essential because too much testosterone in women can lead to diseases, while too much estrogen among men can lead to diseases as well and vice versa.

Even though, we have both masculine and feminine expression in each of us, outwardly we conduct ourselves as the individual male or female person. Our sexual partner represents the opposite aspect of this outward expression. Thus, sexual union has the capacity to promote balance among the masculine and feminine within us. The concept of “Ardh-nar-ishwar” calls on lovers to approach sex as a sacred act of making love to the Divine in our beloved one. This involves engaging with one’s partner with deep intimacy, love and vulnerability. Engaging in this way promotes divine satisfaction within relationships, marital or otherwise.^[9] Intimacy can also promote emotional skillfulness in marriage.^[10]

With regards to hormones, within the 24 hours following sex there is an increase of Growth Hormone observed in both sexes.^[8] This hormone has positive impact on body composition, muscle strength, exercise performance, cardiovascular system, metabolism, and immune function.^[11] An attitude of sacredness and divine union purifies the effect of these positive outcomes of sexual activity, thus making it a healing act rather than a primal need.

Sexual Debility

The problems of sexual dysfunction are prevalent among middle aged and older adult males and females. Testosterone, DHEA, Estrogen, and Progesterone are the main hormones that affect the sexual functions among men and women. Androgens, testosterone and DHEA are predominant among men; while, Estrogen and Progesterone are predominant in women. Testosterone levels have been found to increase in men leading up to and even after sexual activity, relative to days without sex^[12]. Among women, this function is attributed to the hormone estrogen^[13]. On the other hand, progesterone stops sexual motivation.

Unfortunately, the prevalence of sexual dysfunction is on the rise in the United States. There has been a worsening trend of abnormal sperm quality among men and declining fertility among women. A recent study found that 52% of young men tested had at least one sperm abnormality; 52% had abnormal sperm motility, 18% had low sperm concentration, 14% had abnormal sperm structure, and 4% had no measurable sperm.^[14] The number of men with erectile dysfunction (ED) in the US is up to 18.5 million; the incidence of ED is growing with age.^[15] Among women, prevalent problems regarding sexual dysfunction are low sexual interest in up to 32%, inability have an orgasm in 28%, pain during sex in up to 21%, and sex is not pleasurable for up to 27% of women.^[16] Overall 26.7% of pre-menopausal women and 52.4% of post-menopausal women in US experience such sexual dysfunction.^[17]

As we age, men experience andropause, a drop in androgen hormones; women experience menopause, a drop in estrogenic hormones. These contribute to increased levels of sexual dysfunction among older adults. Ayurveda can come to the rescue and help you maintain your sexual fluids for optimal sexual activity and pleasure.

Herbs For Sexual Health

We have already discussed the emotional and spiritual attitudes towards sexuality. The attitude of love and reverence for one’s partner promotes mental states of relaxation, emotional connection and passion in the relationship. These attitudes lead to a shared sense of responsibility, open communication, integrity, and mindfulness in the relationship. In my opinion, these form the foundation of a successful relationship. Sexual activity is also a form of exercise, and if you are not active, you lose it and even your sexual organ muscles get weaker. Ayurveda provides great tools for overcoming challenges like these.

Ayurveda describes two specific branches of herbs called rasayana and vajikarana. Rasayana herbs are rejuvenative medicines that are holistic in their regenerative functions. These herbs promote tonifying effects on all tissues, which ultimately trickles down to shukra dhatu and ojas. Vajikarana herbs are focused regeneratives that promote efficacy of shukra dhatu or sexual tissues, including hormones and physical organs. Following are some herbs that are beneficial rasayana and vajikarana medicines.

Ashwagandha – Withania somnifera – This is a rasayana, a rejuvenative herb. The main function of Ashwagandha as a rasayana is to rejuvenate the antioxidant enzymes of the body. This controls the oxidation-related damage to all tissues of the body.^[18] This action contributes to Ashwagandha’s anti-aging activity. The steroidal lactones in Ashwagandha also help regulate sex hormones.

In clinical studies, treatment with Ashwagandha tripled the virility for men with low sperm count, as well as improved sperm motility.^[19] Benefit was also seen with normal males; for them, virility improved by 50%.^[19] In another study, when given to men with low sperm count, Ashwagandha increased sperm count by 167%, semen volume by 53%, and sperm motility by 57%.^[20] Thus, we begin to see the pattern of how Ashwagandha promotes normal function at all tissue levels, ultimately restoring sexual function and vitality.

Shatavari – Asparagus racemosa – Shatavari is considered the premier women’s health tonic in Ayurvedic medicine. Shatavari is one of the richest sources of phytoestrogens in the form of steroidal saponins (Shatavarin I-IV) and isoflavones (diadzin and genestien).^[21] These compounds are essential for shatavari’s effect on sexual function. A clinical study revealed that among young females, shatavari improved egg maturation and ovulation.^[22] Among older females, shatavari helped to soothe menopausal symptoms and tonify sexual organs.^[23] It is also a source of various minerals^[24] including zinc, manganese, cobolt, copper, potassium, calcium, magnesium, et cetera.

Gokhsura – Tribulus terrestris – This herb is commonly recognized as an aphrodisiac. Gokhsura has been found to affect hormone levels; researchers have observed that Tribulus extract has the capacity to raise levels of a regulating hormone called Luteinizing hormone; as well as all androgens, including testosterone, DHEA and dihydrotestosterone.^{25 ,26} Tribulus has also been observed to improve sexual interest and sexual function in men.^[27,28]

Shilajeet – Asphaltum punjabium – This unique medicine is petrified plant material that is harvested in small quantities from steep rock faces at altitudes between 1000 and 5000 meters among the Himalayan mountains. It is considered an excellent source of 85 minerals in ionic form. In clinical study on men, shilajeet increased levels of hormones testosterone and follicle stimulating hormones.^[29] These men also experienced 61% improvement in sperm count and motility improved by 18% with 90 days of treatment.

Many females experience vaginal dryness and painful intercourse as they age, this is due to low levels of estrogens. Estrogen creams provide relief but, we also have developed a special non-hormonal Ayurvedic cream, which has shown very good results in vaginal dryness.

Loyal to its holistic tradition, Ayurvedic medicine prescribes these herbs in the context of comprehensive dietary and lifestyle changes. Plant-based diet, regular exercise and adequate sleep are essential for effective healing and efficient function of any medicines. These can be enhanced with the regular practice of breathing exercises and meditation, which promote emotional and spiritual transformation.

DR. ANUP MULAKALURI, ND PROVIDED TECHNICAL AND RESEARCH ASSISTANCE IN WRITING THIS ARTICLE.