Hindawi Evidence-Based Complementary and Alternative Medicine Volume 2023, Article ID 6878852, 28 pages https://doi.org/10.1155/2023/6878852 Review Article Medicinal Plants Used in the Management of Sexual Dysfunction, Infertility and Improving Virility in the East African Community: A Systematic Review Christine Kyarimpa ,1 Christine Betty Nagawa ,2 Timothy Omara ,3 Silver Odongo ,4 Patrick Ssebugere ,4 Solomon Omwoma Lugasi ,5 and Ivan Gumula1 1 Department of Chemistry, Faculty of Science, Kyambogo University, P.O. Box 1, Kampala, Uganda Department of Forestry, Biodiversity and Tourism, College of Agricultural and Environmental Sciences, Makerere University, P.O. Box 7062, Kampala, Uganda 3 Chemistry Division (Food Safety aboratories), Testing Department, Standards Directorate, Uganda National Bureau of Standards, P.O. Box 6329, Kampala, Uganda 4 Department of Chemistry, College of Natural Sciences, Makerere University, P.O. Box 7062, Kampala, Uganda 5 Department of Physical Sciences, Jaramogi Oginga Odinga University of Science and Technology, P.O. Box 210, Bondo 40601, Kenya 2 Correspondence should be addressed to Timothy Omara; prof.timo2018@mu.ac.ke Received 15 February 2023; Revised 13 July 2023; Accepted 27 July 2023; Published 12 August 2023 Academic Editor: Chunpeng (Craig) Wan Copyright © 2023 Christine Kyarimpa et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Sexual disorders such as erectile dysfunction (ED), sterility, and sexual inappetence represent some of the complex reproductive challenges that require addressing the underlying causes. Te aim of this paper was to systematically synthesize literature on the ethnobotany, phytochemistry, bioactivities, and safety of plants used as remedies for managing sexual dysfunction and infertility, and improving fertility and virility in the EAC. Trough an extensive review conducted in multidisciplinary electronic databases, 171 plant species were identifed to have been reported for the management of sexual inappetence (i.e., used as aphrodisiacs, 39.4%), ED (35.9%), infertility (18.7%), and increasing fertility (6.0%). Te most used plants are Mondia whitei, Acalypha villicaulis, Combretum illairii, Erythrina abyssinica, Pappea capensis, Rhus vulgaris, and Warburgia ugandensis while roots (44.9%), leaves (21.8%), stem and root barks (16.7%) of shrubs (35%), trees (31%), herbs (26%), and climbers (8%) are the preferred organs for making decoctions (69%). Te research strides to date indicate that Citropsis articulata, Cola acuminata, Ekebergia capensis, Plumbago zeylanica, Tarenna graveolens, Urtica massaica, and Zingiber ofcinale have been assessed for their bioactivity. Te majority (71.4%) of the plants either increased testosterone levels and mounting frequency or elicited prosexual stimulatory efects in male rats. More studies investigating the relevant pharmacological activities (aphrodisiac, fertility, and phosphodiesterase•5 inhibitory activities), safety aspects, responsible compounds, and clinical studies are warranted to establish the pharmacological potential of the unstudied species and elucidate the mechanism of action of the bioactive compounds. 1. Introduction One of the universal interests enshrined in sustainable de• velopment goal (SDG) 3 is good health and well•being. It is linked to and afects other global goals such as SDG 1 (poverty reduction), SDG 2 (end poverty), and SDG 4 (quality and equitable education) [1]. Critical analysis of the global disease burden shows that one•third of the total world population has more than fve ailments [2]. Accordingly, three in fve of the global deaths are ascribed to at least one of the four main noncommunicable diseases (NCDs), namely, cancer, diabetes, cardiovascular, and chronic lung diseases [3–5]. Most global mortalities (up to 71%) are due to NCDs [6], and 77% of these occur in low• and middle•income 2 countries due to limited access to medical services and poverty [7]. Whereas the global focus is on the major NCDs, conditions such as sexual dysfunction, infertility, and anaphrodisia (sexual inappetence) represent some of the complex health challenges. Sexual dysfunction refers to the inability to achieve a normal sexual intercourse. It includes orgasmic disorder, retrograded, retarded, premature ejaculation, and erectile dysfunction [8]. Male erectile dysfunction (ED) or impo• tence is the inability to achieve or maintain an erection sufcient for satisfactory sexual performance and vaginal intercourse, typically for a period of more than six months [9]. Tough to diferent degrees, ED afects more than 52% of men in the age bracket of 40 and 70 years. Erectile dys• function is linked with conditions such as diabetes, sed• entary lifestyle, hypertension, obesity, hypercholesterolemia, and smoking [10–12]. On the other hand, infertility is a medical condition characterized by failure to establish a clinical pregnancy after one year of regular and unprotected sex [13]. Infertility afects more than 48 million couples worldwide. It can be from either one or both partners, but 50% of all cases are due to male infertility [14]. In women, it may be due to endo• metriosis (premature ovarian failure) and uterine disorders such as fbroids or thyroid diseases. In males, infertility is associated with defective sperm function, azoospermia, low sperm counts, varicocele, undescended testes, testicular cancer, and low testosterone levels [13, 14]. Other risk factors for infertility include diabetes, sexually transmitted diseases, stress, obesity, drug abuse, age, exposure to envi• ronmental toxins, radiotherapy, and other cancer treatments [15, 16]. Sexual inappetence is a common reproductive challenge that accompanies or is a direct consequence of ED and infertility [17, 18]. Sexual inappetence (anaphrodisia or lack of desire/libido) is one of the most common sexual dys• functions of women. Together, ED, infertility, and sexual inappetence are among the relatively common fecundity challenges that afect couples medically, sexually, and psy• chologically [17, 18]. With medical advancements in assisted reproduction technologies, the use of synthetic agents such as phosphodiesterase type 5 inhibitors (in intracavernosal injection therapy for ED) and stem cell therapy (for in• fertility) has been encouraged [13]. However, limited access to medical services, long•term treatment tenure, and side efects of injectable fertility drugs have limited their ac• ceptability among the general population [19–21]. For indigenous communities in developing countries, the use of natural products for prevention and the man• agement of reproductive diseases and conditions are com• mon. Te East African Community (EAC) is one of the regions with distinguished ethnomedicinal knowledge and use of natural products [22–25]. Te high reliance of these communities on herbal medicine is explained by the ex• ceptionally rich cultural heritage, acceptance, availability, and perceived efcacy [26–28]. In this context, traditional medicine practitioners correlate sicknesses and other medical conditions with their possible causes [25]. For this Evidence•Based Complementary and Alternative Medicine reason, herbal medications and posology are prescribed based on the supposed cause of the diseases. Critical cases, or those due to supernatural forces, are managed through diviners’ interventions [26, 29]. Illnesses are thought to be induced by external polluting infuences (e.g., consumption of tabooed foods [30], breaching of taboos, witchcraft• related rites, fetishes or social rules, and use of objects planted by ill people) that interfere with body physiology [26, 31–33]. Terefore, traditional management of diseases involves health practices, knowledge, and beliefs that utilize plants and animal• and mineral•based remedies, dispensing of ritually protective herbal medicines or performing rituals for placating spirits [26, 33]. Tese perceptions are similar to traditional medicine concepts in other parts of Africa [34]. In the EAC, chronic poverty and resource•constrained healthcare systems are common, and the use of herbal remedies for the treatment of sexual dysfunction (ED) and infertility, and enhancing fertility and virility has been sporadically mentioned in ethnobotanical studies. How• ever, no study has systematically collated literature on these medicinal plants with in•depth description and analysis of their claimed efcacy, phytochemistry, and safety. Te aim of this paper was, therefore, to system• atically synthesize literature on ethnobotany, phyto• chemistry, bioactivities, and the safety profle of plants used as remedies for managing sexual dysfunction and infertility, and improving fertility and virility in the EAC. As part of an ongoing project, we aimed at identifying highly cited but unstudied species that could be assessed for their aphrodisiac, fertility and phosphodiesterase•5 inhibitory activities, bioactive phytochemicals, and tox• icity profles. Tis could open lead to the discovery of molecules that can be used in modern medicine. 2. Methods 2.1. Study Design, iterature Sources, and Systematic Search Procedures. Te Preferred Reporting Items for the Sys• tematic Reviews and Meta•Analyses (PRISMA) 2020 guidelines [35] were followed (Supplementary fle 1). Te protocol used was registered with the International Pro• spective Register of Systematic Reviews (PROSPERO) with registration number CRD42022373152 (https://www.crd. york.ac.uk/prospero/display_record.php?ID=CRD4202237 3152). Nine multidisciplinary electronic databases (Scopus, Web of Science, PubMed, Science Direct, Google Scholar, Wiley Online Library, Taylor and Francis Online, Springer Link, and Scientifc Electronic Library Online) and regional university repositories were searched to gather relevant records on ethnobotany, phytochemistry, biological activi• ties, and toxicity of medicinal plants exploited for the management of sexual dysfunction and infertility, and improving fertility and virility in the EAC. Te dates on which we last consulted the databases were 7th January 2023, 31st December 2022, 20th November 2022, 20th January 2023, 4th January 2023, 17th January 2023, 11th November 2022, 10th January 2023, 24th November 2022, 2nd De• cember 2022, and 2nd January 2023, respectively. Evidence•Based Complementary and Alternative Medicine Te EAC was considered as the region encompassing Uganda, Kenya, Tanzania, Rwanda, Burundi, South Sudan, and Democratic Republic of Congo (DRC) from April 2022 [36]. Te searches were performed in parallel using search strings specifed for a comprehensive search that covered all felds in records but broadened the scope in PubMed ad• vanced search. Within each axis, keywords were combined with the “OR” operator in the Boolean operator and then linked the two axes’ search techniques to the “AND” op• erator. Te keywords used were “plant” “erectile dysfunc• tion” “aphrodisiac” “infertility” OR “fertility” “virility” AND “Uganda” “Kenya” “Tanzania” “Rwanda” “Burundi” “South Sudan” “Democratic Republic of Congo.” For example, in Scopus, the search string used was ALL (plants, AND erectile AND dysfunction, AND aphrodisiac, AND uganda) AND (LIMIT•TO (AFFILCOUNTRY, “Uganda”)) OR ALL (plants, AND erectile AND dysfunction, AND aphrodisiac, AND Kenya) AND (LIMIT•TO (AFFILCOUNTRY, “Kenya”)) Kenya OR ALL (plants, AND erectile AND dysfunction, AND aphrodisiac, AND rwanda) AND (LIMIT•TO (AFFILCOUNTRY, “Rwanda”)) OR ALL (plants, AND erectile AND dysfunction, AND aphrodisiac, AND burundi) AND (LIMIT•TO (AFFILCOUNTRY, “Burundi”)) OR ALL (plants, AND erectile AND dysfunc• tion, AND aphrodisiac, AND south Sudan) AND (LIM• IT•TO (AFFILCOUNTRY, “South Sudan”)) OR ALL (plants, AND erectile AND dysfunction, AND aphrodisiac, AND Democratic Republic of Congo) AND (LIMIT•TO (AFFILCOUNTRY, “Democratic Republic of Congo”)) OR ALL (plants, AND erectile AND dysfunction, AND aph• rodisiac, AND Tanzania) AND (LIMIT•TO (AFFIL• COUNTRY,“Tanzania”)) OR ALL (plant, AND infertility AND fertility AND uganda) AND (LIMIT•TO (AFFIL• COUNTRY, “Uganda”)) OR ALL (plant, AND infertility AND fertility AND Kenya) AND (LIMIT•TO (AFFIL• COUNTRY, “Kenya”)) OR ALL (plant, AND infertility AND fertility AND tanzania) AND (LIMIT•TO (AFFIL• COUNTRY, “Tanzania”)) OR ALL (plant, AND infertility AND fertility AND rwanda) AND (LIMIT•TO (AFFIL• COUNTRY, “Rwanda”)) OR ALL (plant, AND infertility AND fertility AND burundi) AND (LIMIT•TO (AFFIL• COUNTRY, “Burundi”)) OR ALL (plant, AND infertility AND fertility AND south Sudan) AND (LIMIT•TO (AFFILCOUNTRY, “South Sudan”)) OR ALL (plant, AND infertility AND fertility AND democratic republic of congo) AND (LIMIT•TO (AFFILCOUNTRY, “Democratic Re• public of Congo”)). In addition, reference lists of the retrieved studies were also manually searched to access additional articles which were screened for their eligibility for inclusion in the study. Te literature search was performed between 1st June 2022 and 20th January 2023. 2.2. Study Selection. All search results were imported into EndNote X9 (Tomson Reuters, Philadelphia, PA, USA), and duplicate reports were removed. Te screening was done according to the title and abstract of the articles. Tis was ® 3 conducted independently by 4 authors (CK, CBN, TO, and SO). Two independent reviewers (TO and SO) screened the articles against inclusion criteria, and possible contradic• tions during article selection and/or extraction were obvi• ated through discussions and consensus. 2.3. Inclusion and Exclusion Criteria. To refrain the authors from bias, (1) only full•text articles or reports published in or translated into English and French; (2) cross•sectional original papers or reports on the ethnobotany, phyto• chemistry, bioactivities, and clinical trials of plants used in the management of sexual dysfunction and infertility, and improving fertility and virility in EAC; and (3) reports published online until 20th January 2023 were included. Excluded studies were those that (1) provided no data; (2) were neither from EAC nor full•text articles; (3) reported on the use of plants for managing conditions such as menor• rhagia, blocked fallopian tubes, inducing twin birth or birth to a particular sex of children; (4) narrative and systematic reviews, or reports not based on original data (expert opinions, editorials, and perspective papers). 2.4. Risk of Bias Assessment. Quality of the considered re• ports (risk of bias) was established following the Joanna Briggs Institute quality assessment tool [37]. Two authors (TO and SO) independently assessed the quality of the included studies. Variations in the fnal risk of bias as• sessment among them were declared by discussing the prespecifed criteria. Te evaluation tool consisted of seven parameters: (1) appropriate sampling design; (2) correct sampling technique; (3) acceptable sample size; (4) adequate study subject and location explanation; (5) appropriate data investigation; (6) use of valid methods for identifcation of plants and the conditions that they treat; and (7) use of appropriate statistical/ethnobotanical analysis indices. Be• cause most studies met parameters 5 to 7 that were similar across them, we relied on parameters 1 to 4 to ascertain the risk of bias status. A study that did not meet each parameter was scored as 1 if not 0. Te risks for biases were classifed as either low (total score, 0•1), moderate (total score, 2), or high (total score, 3•4) [38]. 2.5. Data Extraction. Data were collated in a predesigned Microsoft Excel 2019 standardized sheet. Information on the reported medicinal plants, such as botanical names (and synonyms), plant family, traditional name(s), growth habit, part(s), and their uses (conditions treated), mode of prep• aration and administration, isolated pure compounds, and relevant efcacy reports were extracted. For each dataset, the frst author’s last name, year of publication, and country were also extracted. Missing information in some reports such as local names, growth forms, and misspelled botanical names was checked from Google and botanical databases (WFO Plant List, International Plant Names Index, and Tropicos). 4 2.6. Data Analysis. Descriptive statistical methods were used to analyze the collected data. Results were expressed as ranges, percentages, and frequencies and presented as tables and charts. Tese analyses were performed in Microsoft Excel 2019 for Windows (Microsoft Corporation, Wash• ington, DC, USA). 3. Results and Discussion 3.1. Description of Included Studies. Our systematic search (Figure 1) retrieved no previous review on the subject in East Africa. From databases, registers, and other websites, the search returned 396 unique reports published between 1962 and 2022. Te highest number of reports were from Scopus (n � 172) and Google Scholar (n � 108), followed by Web of Science (n � 44), Science Direct (n � 42), Wiley Online Li• brary (n � 11), Taylor & Francis Online (n � 7), Springer Link (n � 4), PubMed (n � 3), regional university repositories (n � 3), and SciELO (n � 2). Of these, duplicates (n � 47) were removed, and 349 unique articles were screened. A total of 235 articles were excluded after reading their titles and abstracts, while 47 others were excluded because they were not from any country within the EAC. Terefore, 67 records were assessed for their eligibility and inclusion in the study. Based on the inclusion and exclusion criteria, some full•text articles were excluded with reasons, namely, (i) articles not in English or French (n � 11), (ii) review articles (n � 9), and (iii) those that did not provide any data (n � 8). A manual search resulted in 7 eligible articles. Tus, data were extracted from a total of 46 articles in this systematic review. Regarding the assessment of the risk of bias among studies, most reports were judged as having a low (47.8%) or moderate risk of bias (34.8%) (Supplementary fle 2). 3.2. Inventory of Medicinal Plants Reported. Tis review identifed 46 reports on plants used in the management and treatment of ED and infertility, and increasing fertility and sexual appetence (virility) in the EAC. Some of the sexual dysfunctions captured from herbalists include erectile dis• orders, pain during penetration, premature ejaculation, lack of sexual arousal, and short•lasting erections (among men) and lack of orgasm, dyspareunia, lack of sexual arousal, atrophic vaginitis, and short orgasms among women [39]. In total, 171 plant species from 59 botanical families have been reported for the management of sexual inappetence, i.e., used as aphrodisiacs (39.4%), ED (35.9%), infertility (18.7%), and increasing fertility (6.0%) (Table 1). Te highest number of plants cited was from Kenya (96), followed by Uganda (66), Tanzania (24), Rwanda (1), and DRC (1). Burundi and South Sudan had no reports on plants in the category under scrutiny. It is not surprising that Kenya ranked the highest, as it is known to have diversifed fora with over 7,000 plant species [23, 40]. Tis is also supported by the fact that most of the ethnobotanical reports reviewed (n � 25) were from Kenya as compared to Uganda (n � 18), Tanzania (n � 7), Rwanda (n � 1), and DRC (n � 1). Evidence•Based Complementary and Alternative Medicine Analysis of transregional distribution of the plants revealed that Uganda and Kenya shared 8 species and Tanzania and Kenya shared 6 species while Kenya and Rwanda shared one species (Tagetes minuta L.). Only one plant (Pachycarpus robusta) was cited to be used in Uganda, Kenya, and Tanzania [41]. Te rest of the countries did not share any plant. Such marked divergence in the use of plants across the region could be due to their preference which is related to specifc cultural beliefs and traditions or centred around human relationships [42–44]. Te majority of the plants retrieved in this study were from families: Fabaceae (16.9%, 29 species), Euphorbiaceae (7.0%, 12 species), Asteraceae (5.8%, 10 species), Apoc• ynaceae, Rubiaceae (5.3%, 9 species each), and Capparaceae (4.7%, 8 species) (Figure 2). Species from these botanical families have been reported to have aphrodisiac and fertility potential in ethnobotanical surveys from Ethiopia [45], Southern Africa [46], Iran [47], and India [48]. Te dom• inance of families, especially Fabaceae and Asteraceae, is due to the extensive range of their distribution across global biomes [49]. Moreover, they contain phytochemicals such as phenolics, tannins, and alkaloids which are known to have therapeutic efects [50, 51]. At the genus level, the most represented genera were Acacia (6 species), Combretum (5 species), Cassia and Tragia (3 species each), Abrus, Allium, Boscia, Cadaba, Cleome, Croton, Impatiens, Maytenus, Sonchus, Uvaria, Vachellia, and Vernonia (2 species each). Te commonly mentioned plants were Mondia whitei (12 times), Warburgia ugandensis (4 times), Acalypha villicaulis, Combretum illairii, Erythrina abyssinica, Pappea capensis, and Rhus vulgaris (3 times each). Some of the plants listed such as Abrus precatorius, Allium sativum, Cola acuminata, Combretum hereroense, Mondia whitei, Plumbago zeylanica, Ricinus communis, and Syzygium guineense are traditionally used for treating in• fertility and ED in South Africa [52], Ghana [53], Cameroon, Guinea, Gabon [54], Iran [47], Benin [55], and Ethiopia [45]. It is worth mentioning that organs of some of the highly cited species such as Abrus precatorius and Erythrina abyssinica are used in Uganda for rituals and ceremonies of love, weddings, and childbirth [56]. In regards to the treatment of infertility, most plan species recorded were indicated to be used for the treatment of female infertility (Table 2). Te most cited species were Erythrina abyssinica and Combretum illairii (3 times each). Interestingly, some species (Cadaba glandulosa, Cadaba farinose, Combretum illairii, Hoslundia opposita, and Allo• phylus pervilleria) were shown to be used for the treatment of both female and male infertility, which could make them good candidates for further studies of their biological activities. 3.3. Growth Habit, Organs Used, Dosage Forms, and Posology of the Herbal Remedies. Te plants occurred as shrubs (35%), trees (31%), herbs (26%), and climbers (8%) (Figure 3). Figure 4 illustrates which plant organs are widely used in Evidence•Based Complementary and Alternative Medicine Studies included in a previous version of review (n = 0) Identification of new studies from databases, registers and other websites Records identied from; All Databases (N = 396) Scopus (n = 172) Web of Science (n = 44) PubMed (n = 3) Science Direct (n = 42) Wiley Online Library (n = 11) Taylor & Francis Online (n = 7) Springer Link (n = 4) Google Scholar (n = 108) SciELO (n = 2) University repositories (n = 3) Registers (n = 0) Records removed before screening Duplicate records removed (n = 47) Eligibility Screening Identification Previous studies 5 Records screened (n = 349) Records excluded based on titles and abstracts (n = 235) Studies not from EAC (n = 47) Records sought for retrieval (n = 7) Records not retrieved (n = 0) Included Records assessed for eligibility (n = 67) Full-text articles excluded with reasons Articles not in English or French (n = 11) Review articles (n = 9) Did not provide any data (n = 8) Total studies included in the review (n = 46) Figure 1: PRISMA fow diagram showing the retrieval and exclusion steps of the systematic review adapted from Page et al. [35]. preparation of the herbal remedies, that is, roots (44.9%), leaves (21.8%), and stem and root barks (16.7%). Te fre• quent use of roots is unsustainable but may be linked to the fact that the conditions treated are internal to the body (are hidden), just as root structures are hidden in the ground. On the other hand, the relatively frequent use of leaves could be related to their availability and the fact that they are the photosynthetic sheet of plants that accumulate therapeutic phytochemicals [57]. Tis review noted a tendency of including more than one plant part and adjuvants in herbal remedies. For multiple plant parts, a total of 13 species were encountered to be used in combination with others. For example, in Kenya, de• coction of Uvaria leptocladon, Boscia coriaceae, and Com• bretum hereroense roots is used for treating ED. For infertility in women, the roots are used with Croton dichagamus roots [58, 59]. Similarly, the decoction of Markhamia zanzibarica roots mixed with Uvaria acuminata roots is administered as an aphrodisiac. For infertility in women, it is used with Salvadora persica and Uvaria acu• minata roots [58, 59]. A striking example of using adjuvants is from Tanzania where roots of Polygala aphrodisiaca are cooked with a young cock while Duosperma kilimand• scharicum leaf and root decoction are taken with goat blood or goat meat soup as an aphrodisiac [41]. Te use of cow and goat milk for preparation of Morus mesozygia roots as an aphrodisiac was also documented in Kenya [60]. In Uganda, Acanthus pubescens leaves are taken in tonto, a traditional beer prepared from Musa × paradisiaca L. var. sapientum fruits [61]. Te use of more than one plant organ and ad• juvants as witnessed in this review are tailored to various reasons. For instance, it may be an obvious way of masking the toxicity of herbal remedies or hiding the secrecy of the formularies [62, 63]. Te commonest method of preparing herbal remedies is decoctions (69%). Tis could be because decoction pro• cedures allow for better extraction of the bioactive phyto• chemicals in plant matrices [64]. However, the plant organs 6 Table 1: Plants used in the management of sexual disorders, infertility, and improving sexual virility and fertility in the East African Community. Plant family Local name Part used Habit Preparation mode Amatovu (Luganda) Leaves Shrub Decoction Duosperma kilimandscharicum (C. B. Clarke) Dayton Not reported Leaves, roots Alliaceae Allium cepa L Katunguru (Runyankore) Alliaceae Allium sativum L Tungurusumu (Rukonjo) Aloeaceae Aloe volkensii Engl. Hargeis, D’aar (Orma) Anacardiaceae Mangifera indica L Anacardiaceae Ozoroa insignis ssp. reticulata (Baker f.) J. B. Gillett Acanthaceae Acanthaceae Annonaceae Annonaceae Annonaceae Apocynaceae Apocynaceae Bulb, leaves, root tuber Stem bulb, leaves, roots tuber Reference Aphrodisiac Uganda [61] Aphrodisiac Tanzania [41] ED Uganda [39, 65] Oral in water, and in food ED Uganda [65] Leaves Herb Decoction Used to wash genital area thrice daily Infertility Kenya [58] Muyembe (Luganda) Bark Tree Decoction Oral Infertility (women) Uganda [22] Not reported Roots Tree Decoction Oral Aphrodisiac Tanzania [41] Shrub Used directly, decoction Oral, chewed ED, aphrodisiac Uganda, Kenya [41, 60, 65] Oral ED, infertility Kenya [61, 62] Oral, a glass daily for 5 days Aphrodisiac Kenya [59] Oral, half a glass daily for 5 days. For infertility, half glass thrice daily for 3 days ED, infertility (women) Kenya [58, 59] Oral, taken as tea Aphrodisiac Tanzania, Kenya [64] Oral Aphrodisiac Kenya [65] Mundagoni, murori (Pokomo) Sholole (Orma) Roots Roots Leketetwo (Marakwet), Carissa spinarum L. Logetetwa (Pokot), Roots, bark (Synonym: Carrisa edulis Omukuyomonza Forssk. (Vahl)) Acokanthera schimperi (A.D.C) Schweinf Country Used directly, decoction Mukanja (Runyankore), Bark, roots, leaves, Mukanza (Rukonjo), whole plant Musatsa (Wanga) Ovariodendron anisatum Ndonga (Embu) Whole plant Uvaria leptocladon Herb Decoction. Taken with goat blood or Oral extract from goat meat Used directly, Oral in water, and in decoction food or just chewed Use Herb Rhus vulgaris Meikle Uvaria acuminata Oliv Shrub Administration Oral in a local brew (tonto) Not reported Roots Herb Shrub Shrub Shrub Tree Decoction Decoction. Used with Markhamia zanzibarica Decoction. Used with Boscia coriaceae and Combretum hereroense. For infertility, use with Croton dichagamus Decoction with Elaedendron buchanannii bark or powder mixed with Tragia furialis Infusion of powder Evidence•Based Complementary and Alternative Medicine Anacardiaceae Botanical name Acanthus pubescens (T. Toms.) Engl. Plant family Apocynaceae Botanical name Local name andolphia swynnertonii Mokokwet (Marakwet) Part used Habit Preparation mode Administration Roots Shrub Decoction Oral Use Increasing fertility (women) ED, aphrodisiac, fertility enhancer Country Reference Kenya [66] Uganda, Kenya [22, 23, 27, 39, 41, 65, 67–72] Apocynaceae Mondia whitei (Hook. f.) Skeels Omulondo (Luganda), Omurondo (Runyankore), Mukombelo (Luhya) Roots/root bark Vine Used directly (chew when raw or dry), decoction Oral in tea and in food Apocynaceae Cryptolepis obtusa N. E. Br Not reported Roots Shrub Decoction (Tanzania), used directly Drunk, chewed Aphrodisiac Kenya, Tanzania [73] Not reported Roots Climber Used directly Fresh root chewed Aphrodisiac Tanzania [60] Not reported Roots Herb Not specifed Not specifed Aphrodisiac East Africa [41] Not reported Roots Climber Decoction Oral, once in the evening Aphrodisiac Kenya [60] Roots/milky Climber/ latex liana Decoction Oral Fertility Kenya [75] Uganda, Kenya [59, 65] Apocynaceae Apocynaceae Apocynaceae Apocynaceae Arecaceae Asparagaceae Asphodelaceae Asteraceae Asteraceae Asteraceae Asteraceae Asteraceae Asteraceae Asteraceae Dregea rubicunda K. Schum Pachycarpus robusta (A. Rich.) Bullock Parquetina nigrescens Afzel Periploca linearifolia Dill. & Rich Phoenix reclinata Jacq Chlorophytum comosum (Tunb.) Jacques Aspidoglossum biforum E. Mey Bidens pilosa L aunaea cornuta (Hochst. Ex Oliv. & Hiern) C. Jefrey actuca inermis Forssk. (L. Capensis Turnb.) Microglossa pyrifolia (Lam.) Kuntze Sonchus asper Psiadia punctulata (DC.) Vatke Sonchus schweinfurthii Oliv. & Hiern Sinendet (Nandi) Akakindo, Mukindo (Runyankore), Mukindu (Pokomo) Roots, leaves Shrub Decoction Nalwebe (Lusoga) Tuber Herb Not specifed Not specifed Infertility Uganda [31] Drege (Kiswahili) Roots Herb Not specifed Not specifed Aphrodisiac Tanzania [41] Mucege, Enyabarashana (Runyankore) Shoot, fowers Herb ED, increase fertility Kenya, Uganda [27, 76] Uthuunga (Kikamba) Leaves, stems Herb Infusion Oral Infertility (women) Kenya [77] Not reported Roots Herb Not specifed Not specifed Aphrodisiac Uganda [56] Omuhe/Mkuraiju Leaves Herb Not specifed Not specifed Aphrodisiac Tanzania [41] Iviuviu (Embu) Konocho (Marakwet), Shiro (Luhya) Whole plant Herb Decoction Oral Kenya [61] Roots Herb Decoction Oral ED Aphrodisiac, sterility (men) Kenya [23] Sungasunga Roots Herb Decoction Oral Aphrodisiac Tanzania [78] Oral, a glass daily for ED, aphrodisiac 3 days Decoction of young Oral, 500 ml daily for fowers as tea 2 days for ED Evidence•Based Complementary and Alternative Medicine Table 1: Continued. 7 Plant family Part used Habit Preparation mode Administration Shoot Herb Decoction Oral Kayayana (Luganda) Leaves, roots Shrub Used directly, decoction Shiroho Roots Shrub Balanites aegyptiaca Del Ng’oswet (Marakwet) Roots Balsaminaceae Impetiens species Entungwa baishaija (Runyankore) Balsaminaceae Impatiens tinctoria A. Rich Chemakalbayi Asteraceae Asteraceae Asteraceae Balanitaceae Botanical name Tagetes minuta L Vernonia cinerea (L.) less (or Cyanthillium cinereum (L.) H. Rob.) Vernonia lasiopus O Hofn Local name Nyiramunukanabi (Kinyarwanda) 8 Table 1: Continued. Use Increase fertility, ED Country Kenya, Rwanda Reference Oral ED Uganda [65] Decoction/infusion Oral, infusion drunk twice a day Aphrodisiac Kenya [60] Tree Decoction Oral Increasing fertility (women) Kenya [66] Whole plant Herb Used directly (chew), decoction Oral ED Uganda [39, 65] Roots Herb Decoction Oral Fertility Kenya [80] Aphrodisiac (men), infertility (women) Kenya [58, 59] Decoction. Used with U. acuminata roots. For infertility, Oral, a glass (or twice for infertility) daily it is used with for 5 days Salvadora persica and Uvaria acuminate [76, 79] Markhamia zanzibarica Mubwoka (Pokomo) Roots Tree Bignoniaceae Spathodea campanulata Buch. •Harm. ex DC Kifabakazi Bark Tree Decoction Oral Infertility (men) Uganda [22] Boraginaceae Ehretia cymosa Tonn Roots, leaves Shrub Decoction Oral Aphrodisiac Kenya [23, 75] Boraginaceae Kigelia africana Lam Morori (Marakwet), Ponponat (Pokot), Shekhutu (Luhya) Sausage tree (English) Fruits, seeds Tree Decoction Aphrodisiac Tanzania [81] Canellaceae Warburgia ugandensis Sprague Mwiha (Runyaruguru), Bark, leaves, Mugeta (Embu) roots Tree Decoction Oral Oral in tea, 1 spoonful thrice daily or in porridge; 250 ml drunk ED Uganda, Kenya [27, 61, 65, 71] Cannabaceae Cannabis sativa L Njayi, olusambya (Luganda), Njaga (Runyankore) Leaves, roots Shrub Used directly (chew), decoction Oral, inhaling fumes (smoking) ED Uganda [65, 72] Capparaceae Boscia coriaceae Pax Kalkacha (Orma) Roots Shrub Decoction with U. leptacladon and C. hereroense roots Oral, half a glass daily for 5 days ED Kenya [59] Capparaceae Boscia solicifolia Oliv Chelel (Marakwet) Roots Tree Decoction Oral Increases fertility (male and female) Kenya [66] Evidence•Based Complementary and Alternative Medicine Bignoniaceae Plant family Capparaceae Botanical name Cadaba glandulosa Forssk Capparaceae Cadaba farinose Capparaceae Capparis tomentosa Lam Capparaceae Cleome gynandra L Local name Part used Habit Preparation mode Alakal (Orma) Roots Shrub Decoction Kumis (Orma) Roots Shrub Decoction Roots Climber Decoction Leaves, roots, fowers Herb Used directly (chew), decoction Oral or as food Kumbolwop kimaget (Marakwet) Esobyo/Amarera (Runkonjo), Eshogi (Runyankore) Administration Use Oral, half a glass daily Infertility (men for 5 days and women) Oral, half a glass daily Infertility (men for 3 days and women) Increasing Oral fertility Country Reference Kenya [58, 59] Kenya [58, 59] Kenya [66] ED, aphrodisiac Uganda [65, 82] Oral, one cup is taken before food twice daily Aphrodisiac Kenya [60] Capparaceae Cleome usambarica Pax Not reported Roots Herb Infusion. Mixed with roots of Macaranga usambarensis Capparaceae Maerua triphylla A. Rich Chokotwa (Marakwet), Chokowa (Pokot), Olamalogi (Massai) Stem bark, leaves Tree Infusion Oral Aphrodisiac Kenya [23, 28] Celastraceae Catha edulis Forsk Mairungi (Runyankore) Leaves, stem Shrub Used directly Oral (chewed) ED Uganda [39, 65] Celastraceae Elaeodendron buchananii Loes Omuharanyi Roots Tree Decoction or powder used in porridge Oral Aphrodisiac Tanzania [64] Maytenus putterlickioides (Loes.) Excell & Mendonca Maytenus senegalensis (Lam.) Exell Pristimera andogensis var. volkensii (Loes.) N. Hallé Muthuthi Roots Shrub Decoction Oral Aphrodisiac Kenya [60] Omuwaiswa (Lusoga) Roots Shrub Not specifed Not specifed Infertility Uganda [31] Not reported Roots Climber Infusion Oral Aphrodisiac Kenya [60] Combretaceae Combretum constrictum (Benth.) Laws Not reported Roots Climber Decoction with salt or used directly Kenya [60] Combretaceae Combretum hereroense Schinz Konkon (Orma) Roots Tree Kenya [59, 83] Combretaceae Combretum illairii Engl Mshinda alume (Pokomo) Root bark Tree Kenya [58, 59, 83] Combretaceae Combretum molle R. Br. ex G. Don Omurama (Runyangkore) Leaves Tree Uganda [27] Celastraceae Celastraceae Celastraceae Oral, a cup drunk twice a day; root Aphrodisiac chewed Decoction. Used Oral, a glass daily ED, infertility with U. leptacladon until efective Oral, a glass daily for Decoction. Used 7 days (or 2•3 times ED, infertility with Grewia tenax daily for 14 days for (men & women) for men infertility in women) Drink 500 ml (adult) ED Decoction daily Evidence•Based Complementary and Alternative Medicine Table 1: Continued. 9 Plant family Botanical name Local name Part used Habit Combretaceae Combretum pentagonum Laws Not reported Roots Climber Cucurbitaceae Cucurbita maxima Ocwica (Lango) Leaves/ seeds Herb Leaves Shrub Decoction Roots Shrub Roots Qashin a’adha, Muuqaadhi (Orma) Roots Mualikaji, Muyama (Pokomo) Mboga (Pokot) Roots, leaves Roots Olpopongi Ebenaceae Euphorbiaceae Euphorbiaceae Flueggea virosa (Roxb. Ex Lukandwa/mukandula Willb.) Voigt Acalypha villicaulis Kaisokampanga Hochst. ex A. Rich (Lusoga) Clutia abyssinica Jaub & Kapkurelwo Spach (Marakwet) Croton dichagamus Euphorbiaceae Croton menyharthii Pax Euphorbiaceae Erythrococca fscheri Pax Euphorbia candelabrum Kotschy Euphorbia tirucalli L Euphorbiaceae Euphorbiaceae Euphorbiaceae Flueggea virosa (Willd.) Voigt Euphorbiaceae Euphorbiaceae Euphorbiaceae Ricinus communis L Tragia benthamii Baker Tragia brevipes Pax Not reported Omukarara (Runyaruguru), Omukalali (Rukonjo) Omukaakale (Lusoga) Kamyu (Luganda) Engyenyi (Runyankore) Euphorbiaceae Tragia furialis Boj Mgonampili Preparation mode Administration Oral, a cup drunk Decoction with salt twice/thrice a day or or used directly root is chewed Stew eaten or raw Decoction/used seeds chewed twice directly daily Use Country Reference Aphrodisiac Kenya [60] Aphrodisiac Uganda [82] Oral Infertility in women Uganda [22, 65] Infusion Oral ED, aphrodisiac Uganda, Kenya [31, 60, 65] Shrub Decoction Oral ED Kenya [84] Tree Decoction. Used with Uvaria leptocladon roots Taken, half glass 3 times daily for 6 days Infertility in women Kenya [58] Tree Decoction [58] Decoction Infertility in women Infertility Kenya Shrub Oral, half glass 2•3 times daily for 5 days Oral Kenya [23] Roots Tree Not specifed Not specifed Infertility Kenya [70] Juice Tree Not specifed Not specifed Aphrodisiac Tanzania [41] Leaves, roots Shrub Decoction Oral ED, infertility Uganda [22, 65] Leaves Roots Leaves Shrub Herb Herb Not specifed Oral Oral ED ED ED Uganda Uganda Uganda [31] [71] [65] Roots Climber Not specifed Decoction Decoction Decoction. Mixed with Elaeodendron buchanannii or Spathodea campanulata and Carisa spinarum Oral Aphrodisiac Tanzania [64] Evidence•Based Complementary and Alternative Medicine Euphorbiaceae 10 Table 1: Continued. Plant family Botanical name Fabaceae Abrus precatorius Fabaceae Abrus schimperi Hochst. Ex Benth Fabaceae Acacia brevispica Harms Fabaceae Fabaceae Fabaceae Fabaceae Fabaceae Fabaceae Fabaceae Fabaceae Acacia abysinica Hochst ex.Benith Acacia drepanolobium Harms ex Sjöstedt Local name Part used Roots, Mudanda, muturituri, Mudwadwa (Pokomo) leaves, seeds Not reported Kiptare (marakwet), Kiptara (Pokot) Munyinya (Runyankore) Eluai (Massai) Ngobgwa (Marakwet), Kopokwo (Pokot) Leina (Marakwet), Acacia refciens subsp. Panyarit (Pokot), Misera (Vatke) Brenan Olchurrai (Massai) Munyinya Acacia sieberiana Scheele (Runyankore, Runyaruguru) Afzelia africana Pers Eiya (Lugbara) Albizia coriaria Welw ex Omusisa (Runyankore) Oliver Ebinyobwa (Runyankore), Arachis hypogaea L Binyebwa (Rukonjo) Acacia nilotica (L.) Delile Habit Shrub Preparation mode Used directly. Seed powder taken or with seed extract or powder of Indigofera cordifolia or stem powder of Tinospora cordifolia; root also chewed Administration Use Country Reference Oral Aphrodisiac Kenya, Tanzania [59, 60] Roots Shrub Decoction Oral Aphrodisiac Tanzania [41] Roots Tree Decoction Oral Aphrodisiac Kenya [23] Bark Tree Decoction Oral ED Uganda [39] Stem bark Shrub Not specifed Not specifed For fertility Kenya [28] Leaves, bark, roots Tree Decoction Oral Aphrodisiac Kenya [23] Root/stem bark Tree Decoction Oral Aphrodisiac Kenya [23, 67] Bark Tree Decoction Oral ED Uganda [65] Bark Leaves, stem Tree Decoction Oral Aphrodisiac Uganda [85] Tree Decoction Oral Aphrodisiac Uganda [39] Herb Used directly (eaten raw or roasted) Oral ED Uganda [27, 65, 72] Oral Aphrodisiac Kenya [62] Seeds Fabaceae Caesalpinia volkensii Harms Mucuthi, Muvuthi (Embu), Mujuthi (Meru) Roots Shrub Used directly (eaten raw or cooked), taken with palm wine Fabaceae Cajanus cajan (L.) Millsp Entondiirwa (Runyankore) Leaves Shrub Decoction Oral, drink 250 ml ED Uganda [27] Fabaceae Cassia abbreviata Mubaraka wa guba (Pokomo) Roots Tree Decoction with Cissampelos mucronata roots Oral, a glass 3 times daily for 4 days ED Kenya [59] Evidence•Based Complementary and Alternative Medicine Table 1: Continued. 11 Plant family Botanical name Fabaceae Cassia didymobotrya Fresen Fabaceae Cassia occidentalis L Fabaceae Desmodium salicifolium Poir. DC Fabaceae Fabaceae Fabaceae Dolichos compressus Wilczec Eriosema psoraleoides G.Don. Lam Entada abyssinica Steud. ex A. Rich Local name Mugabagaba (Runyankore), Mukyora (Runyaruguru), Mucora (Rukonjo) Mwitanzoka (Runyankore, Rukonjo) 12 Table 1: Continued. Habit Preparation mode Administration Use Country Reference Leaves, roots Shrub Used directly (chew), decoction Oral ED Uganda [65] Leaves, roots Herb Oral ED Uganda [65] Mkongorana Leaves, roots Shrub Oral, a glass taken daily Aphrodisiac Tanzania [64] Chebugaa Roots Herb Decoction Oral Fertility Kenya [80] Orutandaigwa Leaves, roots Shrub Decoction Oral Aphrodisiac Tanzania [64] Stem, bark Tree Not specifed Not specifed Infertility Kenya [60] Bark (stem bark), roots, stem Tree Decoction Oral, eaten Infertility (in women) Kenya, Uganda [22, 70, 86] Bark Tree Decoction Oral ED Uganda [39, 65] Herb Decoction Oral ED Uganda [65] Herb Decoction (tea) Decoction. Used with Zanthoxylum usamel root bark Oral Aphrodisiac Uganda [85] Oral, one teaspoonful daily for 5 days Infertility in women Kenya [58] Used directly (chew), decoction Decoction. Mixed with Elaeodendron buchananii and Tragia furialis Fabaceae Dichrostachys cinereal (L.) Wight & Arn Macrotyloma axillare (E.Mey.) Verdc Mucuna pruirens (L.) DC Jjiirikiti (Luganda), Omutembe (Kuria), Muhuti (Kikuyu), Oloponi Muremanjojo (Runyankore) Akaihabukuru (Runyaruguru) Mukuna Fabaceae Prosopis julifora Mathenge Root bark Tree Not reported Roots, stem Tree Not specifed Not specifed Aphrodisiac Kenya [87] Not reported Stem bark, roots Tree Decoction Oral Aphrodisiac Tanzania [41, 60] Not reported Roots Tree Decoction Oral Aphrodisiac Tanzania [41] Bojo (Lango) Ekalepulepu (Ateso) Leaves Roots Herb Herb Decoction (stewed) Decoction Oral Oral Aphrodisiac ED Uganda Uganda [82] [88] Fabaceae Fabaceae Fabaceae Fabaceae Fabaceae Fabaceae Fabaceae Flacourtiaceae Erythrina abyssinica Lam. Ex DC Senegalia brevispica (Harms) Seigler & Ebinger Vachellia nilotica (L.) P. J. H. Hurter & Mabb Vachellia sieberiana (DC.) Kyal. & Boatwr var. vermoesenii (De Wild.) Keay & Brenan Vigna unguiculata Ocoba spinosa Forssk Leaves, roots Seeds Evidence•Based Complementary and Alternative Medicine Part used Plant family Flacourtiaceae Botanical name Xylotheca tettensis (Klotzsch) Gilg Local name Part used Habit Preparation mode Decoction or used directly Not reported Roots Shrub Not reported Not specifed Herb Decoction Roots, leaves Shrub Decoction Leaves Shrub Roots Shrub Administration Use Country Reference Oral, taken or chewed Aphrodisiac Kenya [60] Kenya [89] Kenya [23, 58, 59] ED Uganda [27] ED Kenya [59] Fertility Kenya [80] Genital stimulant/ depressant Aphrodisiac, Oral, a glass 2•3 times infertility (men daily for 14 days and women) Lamiaceae Becium obovatum (E. Mey. Ex. Benth) N. E. Br Lamiaceae Hoslundia opposita Vahl Lamiaceae Ocimum suave Wild Lamiaceae Plectranthus barbatus Andrews Papaha (Pokomo), Kan’gurwet (Markwet) Loganiaceae Buddleia polystachya Fres Roots Herb Lythraceae Punica granatum L Seeds Shrub Decoction Oral ED, infertility Kenya [61, 62] Malvaceae Adansonia digitata L Chorwet Mukungumanga (Embu, mbeere), Kukumanga (Meru) Muramba (Embu), Mbamburi (Swahili) Bark Tree Decoction Oral ED Kenya [61] Malvaceae Dombeya burgessiae Gerrard ex Harv Mukusa (Luhya) Bark Tree Oral Aphrodisiac Kenya [23] Malvaceae Hibiscus fuscus Garcke Oral Aphrodisiac Kenya [23] Malvaceae Sida tenuicarpa Vollesen Ekebergia capensis Sparrm Oral ED Uganda [65] Oral ED Uganda [69] Kenya [23] Meliaceae Simbaywa (Pokot), Shikuma (Luhya), Mtserere (Giriama) Omujaaja (Runyangkore) Cheptelia (Marakwet), Pkapuyan (Pokot) Keyeyo (Rukonjo) Roots Herb Leaves Herb Cape ash (English) Stem bark Tree Decoction Tree Decoction (roots), used directly (leaves, branches and bark) Oral Aphrodisiac, infertility (women and men) Tree Used directly (exudate used) Oral Aphrodisiac Tanzania [41] Melianthaceae Kipset (Marakwet) Melianthaceae Xylocarpus benadirensis Mattei Not reported Moraceae Artocarpus integer (Tunb.) Merr Decoction with rock Oral, drink 500 ml salt Decoction. Used Oral, half glass daily with C. rotundifolia for 30 days for frst 4 days Decoction Oral Used directly (chewed) Used directly (chewed) Decoction Bersama abyssinica Fresen Cissampelos micronata A. Menispermaceae Rich Oral Roots, leaves, branches, bark Unripe fruits Chovi, kivila kya mani (Pokomo), kashikiropaka (Giriama) Roots Herb Decoction. Used with C. abbreviate Oral, half glass daily for 3 days Aphrodisiac, infertility, azoospermia Kenya [59] Fenensi (Runyangkore) Seeds Tree Decoction Oral, taken as tea ED Uganda [27] Evidence•Based Complementary and Alternative Medicine Table 1: Continued. 13 Plant family Botanical name Local name Part used Habit Preparation mode Moraceae Ficus natalensis Hochst Ekitooma (Runyangkore) Roots, root bark Tree Decoction Moraceae Morus mesozygia Stapf Not reported Roots Tree Moringaceae Moringa oleifera Lam Moringa (English) Seeds, leaves Mujeje (Runyankore) Roots, bark Myricaceae Myrtaceae Olacaceae Myrica salicifolia Hochst. ex A.Rich Syzygium guineense (Willd.) DC Capparis sepiaria var. cafra Lamaiwo (Marakwet), Leaves, bark Cheptimanwa (Pokot) Hamwalika (Pokomo), Mugwada paka Root bark (Giriama) Administration Oral, drunk 250 ml daily or 100 ml thrice daily (fresh root bark) Use Country Reference ED Uganda [27] Decoction in cow/ goat milk Oral Aphrodisiac Kenya [60] Tree Decoction, teas, food condiment Oral; seed powder as tea; eat leaves as sauce; drink 100 ml ED Uganda [27] Shrub Decoction Oral ED Uganda [65] Oral Aphrodisiac, infertility Kenya [23, 60] Oral, half glass daily for 10 days Aphrodisiac Kenya [59] Tree Shrub Used directly (sap used) Decoction. used with Grewia plagiophylla Mujoka (Pokomo) Roots/stem Climber Decoction Not reported Muhoko (Runyankore), Ruhuko (Rukonjo) Leaves Roots, leaves Herb Not specifed Shrub Used directly Piper umbellatum L Not reported Roots Climber Plumbaginaceae Plumbago zeylanica L Not reported Roots Shrub Polygalaceae Polygala aphrodisiaca Gürke Not reported Roots Herb Pedaliaceae Phytolaccaceae Piperaceae Polygalaceae Polygalaceae Polygonaceae Polygonaceae Polygonaceae Polygonaceae Polygala sphenoptera Not reported Roots Fresen Securidaca Omukondwa (Luganda) Leaves, bark longipedunculata Fres Cofea species Mwani (Runyankore) Seeds Hallea rubrostipulata (K. Muziiko (Runyankore) Bark, roots Schum.) J. F. Leroy Mufumbagyesi Leaves, (Runyankore), Rumex abyssinicus Jacq stem Kasekekambaju (Luganda) Rumex usambarensis Kaseke kambajjo Leaves (Dammer) Dammer (Luganda) Oral, half glass daily for 3 days Not specifed Smear on ripe banana and roast Decoction with Oral, one cup taken Aframomum roots daily and strained Decoction Oral Decoction, i.e., cooked with a young Oral, eaten in food cock Infertility in women Aphrodisiac Kenya [58] Kenya [41] ED Uganda [65] Aphrodisiac Kenya [60] ED Uganda [70] Aphrodisiac Tanzania [41] Herb Infusion Oral Aphrodisiac Kenya, Tanzania [23, 41, 60] Tree Decoction Oral ED Uganda [72] Shrub Roasted and chewed Oral as a beverage ED Uganda [65] Tree Decoction Oral ED Uganda [65] Shrub Used directly (chewed) Oral ED Uganda [65] Herb Decoction Oral Aphrodisiac Uganda [61] Evidence•Based Complementary and Alternative Medicine Adenia gummifera (Harv.) Harms Sesamum indicum L Phytolacca dodecandra L’Her Passiforaceae 14 Table 1: Continued. Plant family Polygonaceae Pteridaceae Ranunculaceae Rhamnaceae Rubiaceae Rubiaceae Rubiaceae Rubiaceae Rubiaceae Rubiaceae Rubiaceae Rubiaceae Botanical name Tarenna graveolens (S. Moore) Bremek Actinopteris semifabellata Pic. Serm Clematis hirsuta Guill. & Perr Berchemia discolor (Klotsch) Hemsl Cofea arabica L Cofea canephora Pierre ex A. Froehner (synonym: Cofea robusta) Craterispermum schweinfurthii Hiern Heinsia crinite Molinda citrifolia Benth Psychotria capensis subsp. riparia (K. Schum. & K. Krause) Verdc Psychotria cyathicalyx E.M. A. Petit Psychotria lauracea (K. Schum.) E. M. A. Petit Local name Munyamazi (Rukonjo, Runyaruguru) Part used Leaves, roots, bark Mwii wa ivia (Kikamba) Whole plant Habit Preparation mode Administration Use Country Uganda, Kenya Reference Shrub Decoction Oral ED, aphrodisiac Herb Infusion Oral Infertility in women Kenya [77] [65, 92] Omunkaamba (Runyagkore) Leaves Vine Decoction Oral ED Uganda [27] Muchukwo (Marakwet) Roots Tree Decoction Oral ED Kenya [84] Mwani (Runyankore) Seeds Shrub Oral as a beverage ED Uganda [39, 65] Oral ED, aphrodisiac Uganda, Kenya [27, 60, 72] Oral Aphrodisiac Kenya [60] Not specifed Oral ED ED DRC Uganda [93] [39] Not reported Roots Shrub Not reported Muziiko (Runyankore) Stem bark Roots Shrub Tree Roasted and chewed Decoction of leaves and fruits, used directly (chew seeds) or cook with food Decoction, used directly (chew) Not specifed Decoction Not reported Roots Shrub Infusion/decoction Oral Aphrodisiac Kenya [60] Not reported Roots Shrub Decoction Oral Aphrodisiac Kenya [60] Not reported Roots Shrub Decoction Oral Aphrodisiac Kenya [60] Roots Shrub Decoction Oral ED, infertility Kenya [23] Roots, bark Tree Uganda [39, 61, 65] Kenya [58] Leaves, Omwaani (Runyankore) fruits, seeds, roots Shrub Rubiaceae Vangueria infausta Burch Rutaceae Citropsis articulata Swingle & Kellerman Tabirirwo (Marakwet), Komolwo (Pokot) Katimbolo (Luganda), Muboro (Runyankore) Rutaceae Citrus sinensis (L) Osbeck Mudimu (Giriama) Roots/stem bark Tree Rutaceae Fagaropsis hildebrandtii (Engl.) Milne•Redh Muvindavindi (Kamba) Leaves Shrub Decoction Oral Infertility Kenya [94] Salicaceae Flacourtia indica (Burm.f.) Merr Roots Tree Decoction Oral Infertility Kenya [23] Roots Shrub Decoction Kenya [58, 59] Sapindaceae Allophylus pervilleria (A.Rich) Engl Tungururwo (Marakwet), Tingoswa (Pokot) Mnyanga kitswa (Pokomo) Decoction, used Oral as a beverage in ED, aphrodisiac directly (chew) tea Decoction. Mixed Infertility in with Acacia robusta Oral, a glass 3 times daily for 3 days women and Cissus rotundifolia roots Oral, a glass daily for Infertility (men 7 days and women) Evidence•Based Complementary and Alternative Medicine Table 1: Continued. 15 Plant family Sapindaceae Sapindaceae Solanaceae Solanaceae Solanaceae Sterculiaceae Sterculiaceae Stilbaceae Tiliaceae Tiliaceae Urticaceae Verbenaceae Local name Part used Habit Preparation mode Administration Use Country Reference Akambula (Lusoga) Leaves Climber Not specifed Not specifed Infertility Uganda [31] Oltimigomi (Massai) Bark Tree Decoction Oral Aphrodisiac Kenya, Tanzania [28, 41, 70] Herb Used directly (chew), decoction Orally in food ED Uganda [65, 72] Herb Used directly (chew) Oral ED Kenya [23] Herb Decoction ED Kenya [61] ED Uganda [65] ED Kenya [84] Aphrodisiac Tanzania [78] Aphrodisiac Kenya [59] Kamurari (Luganda), Fruits, Eshenda (Runyankore) leaves, bark Labotwa (Marakwet), Solanum incanum L Lopotwo (Pokot), Roots Maduranzura (Luhya) Solanum nigrum L Managu (Embu) Whole plant Cola acuminata Schott & Engongoli (Rukonjo, Fruits Endl Runyaruguru) Sterculia africana (Lou.r) Ililwo (Marakwet) Seeds Fior Nuxia foribunda Benth Mngogo Roots Grewia plagiophylla. K. Mkoi (Pokomo) Root bark Schum Mukarara Leaves, bark Grewia similis K. Schum (Runyaruguru) Deeka (Orma), Grewia tenax (forssk.) Mubavubavu, mukawa Root bark Fiori wa guba (Pokomo) Whole Urtica massaica Mildbr Engyenyi (Runyankore) plant, roots Roots, root Clerodendrum myricoides Munjuga iria bark (Hocst.) Vatke Capsicum frutescens L Tree Tree Tree Shrub Oral Oral in tea, porridge, Roasted and chewed milk Used directly Oral (chewed) Decoction Oral Decoction. Used Oral, a glass daily for with C. sepiaria 10 days Shrub Decoction Oral ED Uganda [65] Shrub Decoction. Used with Combretum illairii Oral, a glass daily for 7 days ED, aphrodisiac, infertility Kenya [58, 59] Herb Decoction Oral ED, aphrodisiac Uganda, Kenya [65, 76] Shrub Decoction Oral Aphrodisiac Kenya [41, 76] Kenya, Tanzania [59, 66] Decoction. Oral, a glass daily for ED, increasing Sometimes used 7 days female fertility with P. barbatus for the frst 4 days Cissus rotundifolia (forsk.) Mkwembe, Maneke, Neke (Pokomo), Arma (Orma) Roots Tree Cyphostemma adenocaule (Steud.ex. A. Rich) Desc.ex. Wild & R. B. Drumm Akabombo akatono Bark Herb Decoction Oral ED Uganda [71] Zingiberaceae Zingiber ofcinale Roscoe Ntangahuzi (Runyankore) Rhizome Herb Decoction Oral in tea, milk, porridge ED Uganda [65, 72] Zygophylaceae Tribulus terrestris L Kilesan (Marakwet) Whole plant Herb Used directly (chewed) Oral ED Kenya [84] Vitaceae Note. ED: erectile dysfunction; languages: Luganda, Lusoga, Lango, Rukonjo, and Runyankore are spoken in Uganda; Marakwet, Luhya, Nandi, Kikamba, Pokot, Orma, Wanga, Pokomo, Massai, Giriama, and Swahili are spoken in Kenya and Kinyarwanda in Rwanda. Evidence•Based Complementary and Alternative Medicine Tiliaceae Botanical name Cardiospermum halicacabum L Pappea capensis Eckl. & Zeyh. var. radlkoferi Schinz 16 Table 1: Continued. 30 17 29 25 20 9 8 5 5 5 Polygonaceae 9 Combretaceae 10 10 Celastraceae 12 15 Capparaceae Rubiaceae Apocynaceae Asteraceae 0 Euphorbiaceae 5 Fabaceae Number of species reported Evidence•Based Complementary and Alternative Medicine Family Figure 2: Major botanical families from which remedies used for treating sexual dysfunction and infertility and improving virility are obtained in the EAC. may also be used directly, i.e., chewed raw (16%) or prepared as an infusion (5%) and taken (Figure 5). Te remedies are administered orally, either by taking decoctions, infusions, and eating or chewing. Only one study reported inhalation of fumes from Cannabis sativa leaves for treatment of ED in Uganda [65]. Aloe volkensii (leaf decoction) in Kenya when utilized for treating infertility is used as a wash for genitals [58], hinting that internally mediated fertility efects would be unlikely when such herbal remedies are administered orally. While most of the plants had their method of preparation and routes of administration indicated in the use reports, up to 8% of the species identifed did not have specifcations of the method of preparation and adminis• tration of the herbal remedies. 3.4. Bioactivity and Phytochemistry of the Reported Plants. To decipher the therapeutic mechanisms and compounds responsible for the bioactivities of the plants reported in EAC, a holistic review of their bioactivity related to the traditional claims and phytochemistry was undertaken. However, only fve reports on bioactivity from EAC were encountered for seven plants reported in this study. In this context, the aqueous extract of Citropsis articulata root bark was reported to increase the in vivo levels of serum tes• tosterone and mounting frequency in male rats [66, 67]. Joseph et al. [68] found that aqueous extract of Cola acu• minata (fruits) and Zingiber ofcinale (rhizome) had no signifcant efect on mounting frequency and testosterone levels in rats. Aqueous extract of Tarenna graveolens roots increased testosterone levels but had no signifcant efect on mounting frequency while aqueous extract of Urtica mas• saica leaves elicited no appreciable increase in mounting frequency and testosterone levels in male rats [68]. Other reports were for ethanolic stem bark extract of Ekebergia capensis which alleviated sexual dysfunction by increasing the mounting frequency and testosterone levels of male rats to 2.38 ± 0.02 ng/ml, 7.68 ± 0.66, and 14.5 ± 0.777 ng/mL at doses of 300, 400, and 500 mg/kg, respectively [69]. Te latest report is on Plumbago zeylanica, whose aqueous root extract administered at 150, 300, and 450 mg/kg was found to elicit prosexual stimulatory efects in male rats [70]. Tough some of these reports supported the traditional use of the me• dicinal plants, most studies performed preliminary phyto• chemical screening only but not isolation and structural elucidation of the responsible bioactive compounds. Ndukui et al. [69], for example, found saponins and steroid glyco• sides as the major secondary metabolites in Ekebergia capensis stem bark. Traces of tannins, anthraquinones, al• kaloids, carotenoids, favonoids, and anthracyanosides were also detected. Some of these secondary metabolites (tannins, phlobatannins, glycosides, phenols, saponins, quinones, terpenoids, and steroids) were also detected in Plumbago zeylanica [70]. It is worth noting that none of these studies probed into the mechanism of action of the extracts. We, therefore, performed further searches and retrieved other 9 species (along with Zingiber ofcinale) cited in the EAC that have been explored for their phytochemical profles as well as aphrodisiac, procopulatory, and fertility efects (Table 3). One of the most studied plants in this context is Allium cepa (A. cepa) which is locally used in culinary recipes. It has been reported to improve copulatory behaviour in sexually experienced rats [71]. Malviya et al. [72] indicated that ethyl acetate fraction of A. cepa bulb at 200 mg/kg restored the mating behaviour (ejaculatory la• tency, postejaculatory interval, mount, intromission, and ejaculatory frequencies and mount and intromission la• tencies) of drug•mediated sexually dysfunctional male rats. 18 Table 2: Synopsis of the most used plant species for the treatment of infertility among men and women in the East African Community. Medicinal plant Parts used Mode of preparation Decoction Decoction with roots of Salvadora persica and Uvaria acuminata Mode of administration Oral, half glass thrice daily for 3 days Group treated (country) Women (Kenya) Oral Women (Kenya) [58, 59] References Roots Markhamia zanzibarica Roots Spathodea campanulata Buch.• Harm. ex DC Mangifera indica L Flueggea virosa (Roxb. Ex Willb.) Voigt Bark Decoction Oral Men (Uganda) [22] Bark Decoction drunk Oral Women (Uganda) [22] Leaves Decoction drunk Oral Women (Uganda) [22, 65] Bark (stem bark), roots, stem Decoction, eaten directly Cadaba glandulosa Forssk Roots Decoction Cadaba farinose Roots Decoction Combretum illairii Engl Root bark Decoction used with Grewia tenax for men Hoslundia opposita Vahl Leaves Decoction Allophylus pervilleria (A. Rich) Engl Roots Decoction Erythrina abyssinica Lam. Ex [58, 59] Women (Uganda, [22, 70, 86] Kenya) Women and men [58, 59] Oral, half a glass daily for 5 days (Kenya) Women and men [58, 59] Oral, half a glass daily for 3 days (Kenya) Oral, a glass daily for 7 days (or 2•3 times daily for Women and men [58, 59, 83] 14 days for infertility in women) (Kenya) Women and men [58, 59] Oral, a glass 2•3 times daily for 14 days (Kenya) Women and men [58, 59] Oral, a glass daily for 7 days (Kenya) Oral Evidence•Based Complementary and Alternative Medicine Uvaria leptocladon Evidence•Based Complementary and Alternative Medicine 19 Climber (vine) 8% Herb 26% Shrub 35% Tree 31% Figure 3: Life form of plants used for the preparation of remedies used in the treatment of erectile dysfunction and infertility, and increasing fertility and virility in the EAC. 120 105 Frequency of use 100 80 60 51 39 40 20 0 11 Roots Leaves Bark (stem and root) Seeds 10 Whole plant/shoot 9 Stem 5 Fruits 2 1 Flowers Branches Plant part Figure 4: Plant organs used in herbal preparations for treating erectile dysfunction and infertility, and enhancing fertility and virility in the EAC. Quercetin (1) (Figure 6), a favonoid present in extracts of A. cepa, enhanced sperm motility through the regulation of protein kinase C•mediated activation of the human voltage• gated proton channel and could explain its therapeutic efect when used in the treatment of human infertility [14]. Similarly, S•allyl cysteine (2) isolated from Allium sativum restored erectile function in diabetic rats through inhibiting reactive oxygen species formation via modulation of nico• tinamide adenine dinucleotide phosphate oxidase subunit expression in penile tissues [73]. Te third highly investigated species is Mondia whitei. It has been found to increase sexual arousal and copulatory efciency and improve sexual sensation in rats [74–78]. A follow•up study with a polyherbal formulation containing Mondia whitei, Dracaena arborea, and Bridelia ferruginea deduced that the administration of the formula enhanced the sexual performances and increased the mounting and intromission frequencies of normal rats and prediabetic rats [79]. Zingiber ofcinale (ginger) is the most thoroughly studied plant cited in this report. A bioactive compound from this species (zingerone, 5) attenuated zearalenone• induced steroidogenesis impairment in TM3 Leydig cell lines [80] and elicited dose•dependent enhancement of fertility in male and female rats as witnessed by increments in gonadal weights and sperm counts [81]. A gingerol (6)• rich fraction of ginger at 50, 100, and 200 mg/kg when administered to male rats with carbendazim•induced tox• icity led to increased sperm motility and count but atten• uated sperm abnormality [82]. 20 Evidence•Based Complementary and Alternative Medicine Infusion 5% Used directly 16% Not specified 8% Decoction 69% Roasted and chewed 2% Figure 5: Methods of preparation of herbal remedies used in the treatment of erectile dysfunction and infertility, and enhancing fertility and virility in the EAC. Herbal extracts from plants such as Allium cepa, Allium sativum, Mondia whitei, and Zingiber ofcinale improve semen quality and sperm parameters such as concentration, viability, motility, morphology, and DNA integrity through increment in gonadal hormone levels (testosterone and luteinising hormone), sequestering free radicals and en• hanced production of nitric oxide [83–85]. Such studies substantiate that the traditional claims of using the plants in the treatment of sexual dysfunction in EAC may be credible. Te contraceptive efect observed in plants such as Catha edulis (cathinone) and Cannabis sativa seed extracts is supported by studies which instead link their use to ED [86]. Nevertheless, plant extracts from certain families have been shown to elicit contradictory efects in fertility studies. Such diferential bioactivities are species•specifc and may depend on the extraction method and solvents employed [87, 88]. 3.5. Clinical Studies. Clinical evaluation of herbal products is a requirement before they are promoted and used. In this study, we did not fnd any clinical studies in EAC that was performed on the extracts or isolated compounds from the cited plants. Further searches for global reports indicated that Zingiber ofcinale is the only plant encountered in this study that have been subjected to clinical studies in• vestigating its efect on male ED, female sexual function, and infertility [89]. For example, its capsules improved the sexual function and quality of life in four weeks of a randomized, double•blind clinical trial involving women of reproductive age (n � 190) [90]. Another randomized double•blind placebo•controlled trial found that 3•month oral treat• ment using 500 mg/powder/day reduced sperm DNA fragmentation in infertile men [91]. Such promising clinical results demonstrate the need for more clinical trials on species such as Mondia whitei, Acalypha villicaulis, Combretum illairii, Erythrina abyssinica, Pappea capensis, Rhus vulgaris, and Warburgia ugandensis that are widely used in the region. 3.6. Adverse Side Efects and Toxicity of Medicinal Plants and Bioactive Phytochemicals Reported. Further analysis of re• ports considered in this systematic review showed that no ethnobotanical survey captured the side efects of herbal preparations used in the management of sexual dysfunction, infertility, and improving virility in the EAC. However, some of the plants such as Abrus precatorius (roots, leaves, and seeds) cited in the EAC are known to contain highly poi• sonous compounds (abrine, precatorine, and hypaphorine) [139]. It could be positioned that the preparation of remedies with more than one plant and plant part or with the addition of adjuvants may be a way of masking the toxicity of the medicinal plants [36, 93]. From available toxicological studies, extracts from six of the investigated bioactive species have been shown to be safe (Table 4). Four species (Abrus precatorius, Catha edulis, Cannabis sativa, and Parquetina nigrescens) have been in• dicated to elicit marked toxicity, indicating that their use may lead to adverse reactions in herbal medicine practice. For bioactive compounds identifed in the listed species (Table 3), quercetin (1) is potentially cytotoxic and hepa• totoxic at higher doses (100 to 2,000 mg/kg) [94, 95]. Sim• ilarly, cathinone (3) is a psychoactive compound that is toxic to sperm cells [96], and its abuse has been associated with fatal renal, hepatic, and cardiac injuries [97]. On the other hand, S•allyl cysteine (2) is considered to be safe, with very minor acute/subacute toxicity in mice and rats (LD50 > 54.7 mM/kg) when administered intraperitoneally [98]. Sesamine (4) is the major lignan in sesame seeds and has been confrmed to be safe. It attenuated reactive oxygen Plant Part used Extract Abrus precatorius Seeds Methanol Allium cepa L Bulb Aqueous, ethyl acetate Allium sativum L Bulb Aqueous, petroleum ether Cannabis sativa Seeds Ethanol Shoots, small branches Chloroform: diethyl ether extract (1 : 3) Kigelia africana Fruits Powder used directly Mondia whitei Root bark, roots Aqueous, hexane Parquetina nigrescens Leaves Aqueous Sesamum indicum Seeds Ethanol Zingiber ofcinale Rhizome Catha edulis Forsk Bioactivity/mechanism of action and active phytoconstituents Antifertility efect in rats [101]. Enhanced copulatory behaviour in male rats [71, 106]. Ethyl acetate fraction of extract at 200 mg/kg restored the mating behaviour of drug•mediated sexually dysfunction male rats [72]. Quercetin (1) isolated from the plant•enhanced sperm motility [14]. Increased weight of seminal vesicles and epididymides in male rats [72, 106–108]. S•allyl cysteine (2) isolated from this species•promoted fertility [73]. Reduced epididymal sperm count in rats (contraceptive efect) [87, 88, 103]. Improvement of sexual behaviour and increase in plasma testosterone levels [112–114]. Cathinone (3) is toxic to sperm cells [96]. Increase sperm count, motility, and fertilization ability in African catfsh increase in testicular weight, body weight, testosterone levels, and follicle•stimulating hormone [116, 117]. Increased sexual arousal, copulatory efciency, sexual sensation [74–78] through the activation/stimulation of nitric oxide synthase activity resulting in the elevation of levels of cyclic guanosine monophosphate [83]. Te extracts improved sexual activity, behaviour, and competence through improving sexual hormone secretion [102, 125]. It promotes body weight gain, seminal parameters, antioxidant action, and testosterone level [126]. Sesamin (4), a compound in this species, resisted cyclophosphamide•induced sperm nuclear maturity and DNA damage by increasing the expression levels of histones H2A and H2B in the testis [127]. Powder at 100 mg has been cited to elicit positive efects in folliculogenesis and implantation [128]. Zingerone (5) isolated from the plant extract normalized zearalenone•impaired steroidogenesis in TM3 cells [80]. Similarly, a gingerol (6)•rich fraction of ginger enhanced sperm motility and count but attenuated sperm abnormality in male rats with carbendazim•induced toxicity [82]. Evidence•Based Complementary and Alternative Medicine Table 3: Bioactivity and phytochemical profle of some plants used in the treatment of ED and infertility, and enhancing virility and fertility in EAC. 21 22 Evidence•Based Complementary and Alternative Medicine O OH HO O O H2N OH S OH OH OH NH2 O (1) (3) (2) O O O H O O O HO O H O (4) (5) O OH O HO (6) Figure 6: Some of the bioactive molecules characterized from extracts of plants reported in EAC for treatment of ED and infertility, and enhancing fertility and virility (based on studies outside the region). Te numbers 1 to 6 refer to the molecules mentioned in Table 3. Table 4: Toxicity profle of plants with reports of efcacy that is used in the treatment of ED and infertility, and enhancing virility and fertility in EAC. Plants Abrus precatorius Allium cepa L Allium sativum L Cannabis sativa Catha edulis Forsk Kigelia africana Mondia whitei Parquetina nigrescens Sesamum indicum Zingiber ofcinale Toxicity reports Seeds contain abrin, a toxalbumin with a human lethal dose of 0.1–1 μg/kg [148]. Poisoning is characterized by severe vomiting and abdominal pain, bloody diarrhoea, convulsions, and alteration of sensorium with depression of central nervous system [149]. Oral administration of extracts to mice at 250 and 500 mg/kg/day for 30–90 days had no visible toxicity symptoms. An oral dose of 30 g/kg/day for 30 days resulted into hypothermia, tachypnea, tachycardia, piloerection, and polyuria in the treated mice [150]. Its bulb extract induced mild alterations at 300 mg/kg in mice, indicating that it is relatively safe [151]. Cannabidiol (a major nonpsychotropic constituent of this species) in extracts of this species is potentially toxic through the inhibition of hepatic drug metabolism, alterations of in vitro cell viability, reduced fertilization capacity, and decreased activities of p•glycoprotein and other drug transporters [152]. Crude khat can damage the liver and kidneys and modulate levels of liver enzymes, urea, creatinine, and electrolytes essential for liver and kidney functions [153]. Low to moderately toxic [154]. Low toxicity in mice exposed to the extract for 90 days [155]. Toxic to rats at 100 and 300 mg/kg of methanol leaf and aerial part extract. Renal haemorrhage, infammation, and hepatic infammation were noted [156]. Ethanolic extract had low toxicity at 500 mg/kg body weight [157]. Extract had no toxicity at 5,000 mg/kg body weight [158]. Evidence•Based Complementary and Alternative Medicine species and nitric oxide production in zebra fsh (LD50) [99]. Toxicity studies with zingerone (5) and gingerol (6) have shown that they are safe [100, 104]. 4. Conclusion Te EAC has a rich ethnobotanical knowledge of herbal remedies for the management of sexual dysfunction and infertility, and improving fertility and virility. Tough we retrieved 171 medicinal plants being used, most of the species have not been subjected to phytochemical and bioactivity studies that lend credence to traditional claims of using them. We recommend performing toxicity studies and clinical trials using compounds isolated from some of the investigated species. Five highly cited unstudied species from this review (Acalypha villicaulis, Combretum illairii, Erythrina abyssinica, Pappea capensis, Rhus vulgaris, and Warburgia ugandensis) have been selected for further in• vestigation of their phytochemistry, aphrodisiac, fertility, and phosphodiesterase•5 inhibitory activities. Data Availability Tis is a systematic review article, and no raw experimental data were collected. All data generated or analyzed during this study are included in this article. Conflicts of Interest Te authors declare that there are no conficts of interest. Supplementary Materials Supplementary fle 1: PRISMA 2020 checklist for the sys• tematic review of medicinal plants used in the management of sexual dysfunction and infertility, and improving virility in the East African Community. Supplementary fle 2: Risk of bias assessment of studies included for systematic review on medicinal plants used in the management of sexual dysfunction and infertility, and improving virility in the East African Community. (Supplementary Materials) References [1] B. Y. F. Fong and V. T. S. Law, Sustainable Development Goal 3: Health and Well•Being of Ageing in Hong Kong, Taylor & Francis, New York, NY, USA, 2022. [2] T. Vos, R. M. Barber, B. 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