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Erectile dysfunction (ED) or male impotence is defined as inability of a man to achieve or maintain penile erection sufficient for sexual activity. It is primarily a neuronal and endothelial dysfunction of the corpus cavernosum of penile tissue, and is partly characterized by reduced production of nitric oxide (NO). Other factors that may contribute to the pathogenesis of ED include androgen deficiency in aging men, hypertension, high cholesterol levels, atherosclerosis, diabetes mellitus, diseases of the prostate and heart, and anatomical deformity of the penis. ED may also be caused by some medications, prostate surgery and spinal cord injury. Psychological and social conditions such as stress, depression and unhappy marital relationship may contribute to the problem. Chronic infections and inflammation can also contribute to the disease process. ED is linked to an increased risk for cardiovascular diseases and stroke. Several orally active drugs (sildenafil, vardenafil, tadalafil, avanafil) are currently prescribed for treating ED to improve the arterial blood flow to the penile tissue. Medicinal plants and their extracts have been used in traditional medicine in southwest Asia and other countries to treat ED. The current review focuses on four medicinal plants that have been used as aphrodisiacs for enhancing sexual performance and for the treatment of ED. These plants include Eurycoma longifolia Jack (tongkat ali); Chlorophytum borivilianum (safed musli); Withania somnifera (ashwagandha); and Pausinystalia johimbe (formerly known as Corynanthe johimbe). Suggested mechanisms of action for each of the plant extracts will be discussed.
Despite the name, horny goat weed actually helps improve your erection, not libido.  Botanically known as epimedium, this herb has been used by the Chinese for centuries to treat, among other things, low libido and erectile dysfunction. “A growing body of research shows that isolated icariin—the extract of epimedium—inhibits the enzyme phosphodiesterase-5 (PDE-5) and significantly increases nitric oxide synthase, helping to improve erectile function,” says Fisch. In fact, this is the same mechanism that Viagra works through (but the herb comes with a way better name).
L-arginine, or arginine, is an amino acid found in red meat, poultry, fish, and dairy products that helps expand blood vessels and increase blood flow. “The body uses this semi-essential amino acid as the primary building block for nitric oxide,” explains Harry Fisch, M.D., clinical professor of urology and reproductive medicine at Weill Cornell Medical College/New York Presbyterian Hospital.
Prescription drugs called “oral phosphodiesterase-5 (PDE5) inhibitors” are considered the “first-line non-invasive treatment” options for patients with ED. These include the drugs that go by brand names: Sildenafil, Vardenafil or Tadalafil. They work by helping the smooth muscle cells lining the blood vessels that supply the penis with blood to work properly. This allows a man to maintain an erection more easily.
The neurovascular mechanism of erection is complex and involves multiple factors including hormones, neurotransmitters, elements of the autonomic nervous system (sympathetic and parasympathetic) and vasodilators such as NO. The common causes of ED include psychogenic disturbance with failure to relax cavernous smooth muscle, arterial insufficiency as a result of atheromatous disease, damage to the parasympathetic nervous system, spinal cord injury, diabetes or following pelvic surgery such as radical prostatectomy, radical cystectomy or bowel resection [4]. It is important to note that cavernous nerves are unique in that although they belong to the autonomic nerves system they do not release either acetylcholine (Ach) or norepinephrine; however, they release NO in the penis. NO relaxes the smooth muscle of the corpora cavernosa via cyclic GMP (cGMP), allowing expansion of the cavernosal lacunar spaces, blood flow and erection. Thus, NO is not a direct dilator of the smooth muscle of cavernosal bodies, but it is an important mediator in this process. Erectile function may also be adversely affected by cigarette smoking, excess alcohol consumption, obesity and systemic diseases such as mononucleosis, hepatitis, HIV and cancer. Some men are prone to develop an erection that fails to subside after ejaculation (ie, priapism). The condition is associated with sickle-cell disease and leukemia, or may be a result of intracavernosal injection of drugs such as prostaglandin E1 [4]. Peyronie’s disease causes a physical bend in the erect penis and also contributes to ED.
While these side effects mainly create discomfort, some individuals are at risk for more serious, even life-threatening reactions to these drugs. Some men have reported fainting after taking impotence medications, and priapism (a painful condition involving an erection that does not subside after more than four hours) has also occurred as an effect of impotence drugs. This condition can lead to permanent nerve damage; injectable drugs may also cause irreversible damage to the penis if used incorrectly.

Erectile dysfunction (ED) is defined as the “inability to reach and maintain erection during the intercourse” (1) leading to the victim’s experience of inadequate libido, inefficient orgasm and retarded or premature ejaculation. In Recent times, ED has been labeled as the most common sexual problem among pleasure-seeking males and a complaint of all men irrespective of their age, race and culture but age is the most important risk factor for ED (2). It is reported that nearly 100 million people around the world are living with erectile dysfunction. Yet, only 10% of these 100 million, i.e., 10 million are opting for treatment, despite enormous advancements and treatment facilities in all parts of the world (2). To cite a few countries, in China and Korea only 9% and 30% males voluntarily admit to having ED (2) and in most of the other countries in Asia, it is still considered very sensitive with considerable social stigma and secretly will resort to herbal remedies and tonics before seeking conventional medical help.
Counselling or sex therapy (58% of people find this works for them) –mind-related causes of erectile dysfunction can affect anyone. They are more likely if you experience erectile dysfunction at a younger age. Talking to a counsellor or therapist can help some people overcome erectile dysfunction related to these problems, possibly for good. They can also help you if your erectile dysfunction is causing you stress, as this can make matters worse.
Cavallini, G., Modenini, F., Vitali, G., & Koverech, A. (2005, November). Acetyl-L-carnitine plus propionyl-L-carnitine improve efficacy of sildenafil in treatment of erectile dysfunction after bilateral nerve-sparing radical retropubic prostatectomy. Urology, 66(5), 1080-5. Retrieved from http://www.sciencedirect.com/science/article/pii/S0090429505006515
Do herbs work to rectify ED in the Aging Male? We will take some of these and discuss their properties. These herbals can be found throughout Asia and range from Eurycoma longifolia (Tongkat Ali), Ginseng and Tribulus etc. Those that act as Testosterone releasers have some value especially if the male has andropause and those containing some-pick-me-ups and energizers like Ginseng helps the tired and fatigued male and possibly those with asthenia. Deer horn contains growth factors and taking these do help improve nocturnal erections in the male with somatopause. Popular in historic Singapore was Penis soup and Snake meat (Figure 2), whilst Surabaya was known for Cobra meat and Cobra blood (Figure 3) which had claims of improving erectogenic prowess-the myths and realities concerning these and other Village doctor remedies are what they are—myths!
The informal conversations were held with the specialist resource users and other knowledgeable people on particular ailments. The meeting places were the gardens, women group meetings, at their homes, and any other places convenient to them. Through conversations, the sources of knowledge of the healers on medicinal plants, the medicinal plants used and changes in the availability of medicinal plants were established. Those who were more knowledgeable were later followed and interviewed further especially the TBAs, and some knowledgeable men healers. Focused discussions were held with them later for formal recording. In some instances, young mothers were visited too. This was done to verify the information gathered and the spread of the indigenous knowledge (IK) in reproductive health care among the different reproductive groups particularly on ED management.

Most sincere gratitude to the sponsors, Third World Organisation for Women in Sciences (TWOWS), NUFU Medicinal plants Project through Botany Department, Faculty of Science, Makerere University, UNESCO-MAB Young Scientist Research Award, 2000, Gender studies, Makerere University and WHO-Uganda. The Staff of Queen Elizabeth National Park, Field assistants, local leaders, the resource users and all respondents, particularly the TBAs and traditional healers in Bushenyi, Mbarara and Kasese Districts who provided the information.
The Institute of Medicine recommends cumulative daily vitamin D intake of 600 international units (IU) for adults between 18 and 70 years of age , and 800 IU for those over 80. A 3oz serving of salmon contains about 450IU, while an 8oz. glass of milk only has about 100IU. Low vitamin D levels may be an independent, potentially modifiable risk for ED, so it’s worth taking Vitamin D supplements for your “D.” However, keep your daily vitamin D supplement intake below 4,000IU, as too much vitamin D can be toxic.

“Obecalp” is “placebo” spelled backwards. It might help – treatment with inactive placebos (inert substances used in evaluation of new drug treatments) works about one-third of the time in scientific studies when patients don’t know they’re getting a fake drug. Placebos are generally safe since they contain no known active agent. (However, I personally never give patients inactive placebos, and many physicians regard them as unethical.)


The herb is particularly effective for those whose willy woes are based on other medications: An older study from the University of California found ginkgo biloba is 76% effective in treating sexual dysfunction caused by antidepressants. “Gingko helps counteract sexual dysfunction caused by certain antidepressants called SSRIs by blocking serotonin activity in the erectile centers of the brain, ultimately leading to better synthesis and bioavailability of nitric oxide,” Walker explains.
L-arginine. L-arginine is an important amino acid that the body needs to build proteins. Because L-arginine has been shown to improve blood flow, some alternative practitioners have recommended that the supplements be used to treat ED. The Natural Medicines Comprehensive Database, which is a reliable authority on alternative medicines, says L-arginine is possibly effective for treating erectile dysfunction. But Harris warns that "although this supplement could improve blood flow, side effects can be dangerous." L-arginine can cause an allergic reaction or worsen asthma in some people; it can also lower blood pressure.
Dr. Niket Sonpal is the Associate Program Director of the Internal Medicine Residency at Brookdale Hospital Medical Center in Brooklyn and an Associate Professor at Touro College of Osteopathic Medicine. He's a practicing Gastroenterologist and Hepatologist with a focus on Men's and Women's Health, and a regular contributor to Women's health, Shape and Prevention Magazine.
Older age. A man’s risk increases past the age of 40, as age is the variable most strongly associated with impotence. This is due to changing hormones, higher risk for heart problems and those affecting circulation, and decreased sexual desire that often occurs with increasing age. For example, based on findings from the National Health and Social Life Survey, it’s been found that “men between 50–60 years old are more than 3 times as likely to experience erection problems and to report low sexual desire compared to men aged 18 to 29 years.” (3)
How common is impotence? According to findings from several studies, including “The Massachusetts Male Aging Study,” overall prevalence for men between 40–70 years old is around 52 percent (or around 30 percent of all men between 18–60 years old). That’s right — nearly half of all men over 40 experience erectile dysfunction symptoms at some point. Not surprisingly, research demonstrates that impotence is increasingly prevalent with age. Around 40 percent of men in their 40s experience sexual dysfunction. Up to 70 percent of men in their 70s experience ED. (1) Every year more than 617,000 new cases of impotence occur in the United States alone.

Although there are few men who are born absolutely impotent, the number of men with erectile problems are many especially those tending to 50 years and above. Pfizer28 reported that about 40% of men above years, 50% of men above 50 years, 60% of men above 60 years and in any population are affected by ED. ED has profound effect on psychological well being, it can be devastating, it can lead to low self-esteem, depression, negative effect on relationships and reduced life satisfaction28. Among several other causes, aging is one of the factors leading to ED. There are some other social causes of ED such as high unemployment rates, and diseases like diabetes, hypertension, HIV/AIDS, high cholesterol levels, stress, smoking and obesity28. ED is slowly creating adverse problems in homes in Uganda and particularly, among the mid-aged and old men. The men with sexual impotence and erectile dysfunction deserve proper diagnosis of the conditions and treatment. Thus, the plant remedies described may be healthy if administered
Experts feel that treating erectile dysfunction on your own, without consulting a doctor, is unsafe. "If you have ED, the first thing you need is a diagnosis," says impotence expert Steven Lamm, MD, a New York City internist and the author of The Hardness Factor (Harper Collins) and other books on male sexual health. He says men with severe erectile dysfunction probably need one of the prescription ED drugs, which include Levitra (vardenafil) and Cialis (tadalafil) as well as Viagra. But, he says, mild ED -- including the feeling that "you're not as hard as you could be" -- often responds to natural remedies.
The Plant: It’s true, the name’s hilarious. But as it turns out, it’s not just one plant: supplement manufacturers might put any one of 15 different species from this genus of shade-loving perennials inside that pill. That’s important to keep in mind, because the types and amounts of biologically active molecules the plant contains can differ from species to species.
Wild oats: a study in 1986 by the Institute for Advanced Study of Sexuality in San Francisco reported effects like heightened sexual awareness, increased sexual thoughts, more orgasms (36% in men and 29% in women) and some male subjects showed increased levels of testosterone attributed to unbinding of testosterone from TBG. Oats supply steroidal saponins which modulate hormonal balance (5).
Ginkgo biloba may increase blood flow to the penis. Researchers discovered the effect of gingko on ED when male participants in a memory enhancement study reported improved erections. Another trial saw improvement in sexual function in 76 percent of the men who were on antidepressant medication. This is why researchers believe that ginkgo may be effective for men who are experiencing ED due to medication.
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