ObjectiveWe performed a systematic review to assess the effectiveness and safety ofTribulus terrestristo treat female sexual dysfunction (FSD).Data sourcesWe performed unrestricted electronic searches in the MEDLINE, CENTRAL, EMBASE, LILACS, CINAHL, PsycINFO, WHO-ICTR, Clinicaltrials.gov and OpenGrey databases.Selection of studiesWe included any randomized controlled trials (RCTs) that comparedT. terrestrisversus inactive/active interventions. After the selection process, conducted by two reviewers, 5 RCTs (n= 279 participants) were included.Data collectionData extraction was performed by two reviewers with a preestablished data collection formulary.Data synthesisDue to lack of data and clinical heterogeneity, we could not perform meta-analyses. The risk of bias was assessed by the Cochrane Risk of Bias (RoB) tool, and the certainty of evidence was assessed with Grading of Recommendations, Assessment, Development and Evaluations (GRADE).ResultsAfter 1 to 3 months of treatment, premenopausal and postmenopausal women randomized toT. terrestrishad a significant increase in sexual function scores. Three months of treatment withT. terrestrisshowed a significant increase in the serum testosterone levels of premenopausal women. There was no report of serious adverse events, and none of the studies assessed health-related quality of life. The certainty of the evidence was very low, which means that we have very little confidence in the effect estimates, and future studies are likely to change these estimates.ConclusionMore RCTs are needed to support or refute the use ofT. terrestris. The decision to use this intervention should be shared with the patients, and the uncertainties around its effects should be discussed in the clinical decision-making process.Number of Protocol registration in PROSPERO database: CRD42019121130