Efficacy of Chinese herbal medicine in the treatment of anxiety and depression in male sexual dysfunction: a systematic review and meta-analysis

Abstract

Background: Male Sexual Dysfunction (MSD), comprising erectile dysfunction (ED) and premature ejaculation (PE), exhibits an age-related prevalence affecting 50% of males beyond their fourth decade. Beyond physiological manifestations, MSD with comorbid anxiety and depression exerts profound psychosocial impacts. Emerging evidence suggests Chinese Herbal Medicine (CHM) may offer therapeutic potential for addressing this clinical intersection.

Aim: To systematically assess the efficacy of CHM on alleviating anxiety and depression in patients with MSD via a comprehensive systematic review and meta-analysis.

Methods: This study systematically searched four Chinese databases (China National Knowledge Infrastructure, Wanfang Database, China Biomedical Database, and VIP Database) and four international databases (PubMed, Web of Science, EMBASE, and Cochrane Library). Randomized controlled trials (RCTs) investigating CHM interventions for MSD with comorbid anxiety and depression were identified.

Outcomes: The primary outcome focused on changes in symptoms of anxiety and depression, while secondary outcomes encompassed overall male sexual function improvement.

Results: By synthesizing data from 12 RCTs involving 1050 participants, our findings provide the first robust evidence that CHM significantly alleviates anxiety and depression in MSD, while concurrently improving core symptoms of MSD, such as PE and ED. Notably, CHM formulations demonstrated superior efficacy over SSRIs in improving both psychological scales, including Self-Rating Anxiety Scale [MD = -9.11, 95% CI (-11.53, -6.70), P < .05], Self-Rating Depression Scale [MD = -9.85, 95% CI (-14.07, -5.63), P < .05], the Hamilton Depression Rating Scale (HAMD) [MD = -5.30, 95% CI (-11.61, 1.01), P > .05], and the Hamilton Anxiety Rating Scale [MD = -3.89, 95% CI (-4.52,-3.27), P < .05], as well as MSD-specific metrics, such as International Index of Erectile Function-5 [MD = 3.26, 95% CI (1.98, 4.53), P < .05] and intravaginal ejaculation latency time [MD = 1.60, 95% CI (0.82, 2.37), P < .05]. Importantly, the lack of statistical significance in HAMD scores in our analysis may be attributed to the differences in treatment responses between the PE and ED populations.

Clinical implications: It provides evidence-based support to address the limitations of separating physical and mental symptoms in traditional treatment, further substantiates its application value within the integrated medical model, and explores new research avenues for designing personalized treatment plans for patients.

Strengths and limitations: A first-of-its-kind systematic evaluation was conducted to assess the comprehensive efficacy of traditional CHM in alleviating anxiety and depression symptoms while improving sexual function indicators among patients with MSD. The limited number of studies constitutes the most significant limitation.

Conclusions: Our findings provide the first robust evidence that CHM significantly alleviates anxiety and depression in MSD patients, while concurrently improving core MSD symptoms, such as PE and ED.

Keywords: Chinese herbal medicine; anxiety; depression; male sexual dysfunction; psychosexual health; systematic review.

Figure 1

Flow chart showing results of the literature search and study inclusion. The process followed the PRISMA guidelines. PRISMA = preferred reporting items for systematic reviews and meta-analyses.

Figure 2

Risk of bias assessment. Green indicates low risk of bias, yellow indicates medium risk of bias, and red indicates high risk of bias.

Figure 3

(A) Forest plot of studies for the SAS scores. (B) Subgroup analysis for the SAS scores.

Figure 4

(A) Forest plot of studies for the SDS scores; (B) Subgroup analysis for the SDS scores.

Figure 5

(A) Forest plot of studies for the HAMD scores. (B) Subgroup analysis for the HAMD scores.

Figure 6

Forest plot of studies for the HAMA scores.

Figure 7

(A) Forest plot of studies for the IIEF-5 scores; (B) Subgroup analysis for the IIEF-5 scores.

Figure 8

(A) Forest plot of studies for the IELT scores; (B) Subgroup analysis for the IELT scores.