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Sildenafil citrate, tadalafil and vardenafil hydrochloride are contraindicated in patients with a known hypersensitivity to any organic nitrates (oral, sublingual, transdermal or by inhalation) due to the risk of developing potentially life-threatening hypotension. Concomitant use of PDE-5 inhibitors is contraindicated with HIV protease inhihibitors (indinavir, ritinovir, saquinavir) as well as ketoconazole, itraconazole, cimetidine and erythromycin, because these drugs are potent inhibitors of cytochrome P450 3A4 and can raise the plasma levels of PDE-5 inhibitors. Coadministration of PDE-5 inhibitors to patients taking alpha-adrenergic blockers such as alfluzocin or tamsulosin may lead to symptomatic postural hypotension, including dizziness and lighheadedness in some individuals.
Epimedium extract (Horny Goat Weed) (11), (Figure 9): the Chinese refer to this herb as ‘yin yang huo’, which has been loosely translated as ‘licentious goat plant’; hence, its common name is well known as ‘horny goat weed’ by many Western cultures. Scientifically, studies have shown that Epimedium may restore low levels of both testosterone and thyroid hormone, bringing low levels back to their normal levels (5), which may account for some of its benefits in improving sexual libido. Other benefits to Epimedium involve increased muscle mass. Used for fatigue and aging, And vasodilatation effect; thus, most frequently used in treatment of sexual dysfunction in Traditional Chinese Medicine (12). The active substance from horny goat weed was reported by Xin Zhong Cheng at Beijing Medical University as Icarin—acts by increasing sexual activities and ICP levels in castrated rats after long term oral administration. It has no effects on serum testosterone level in castrated rats after long term oral administration. Instead Icariin increases nNOS and iNOS mRNA and protein expression in the corpus cavernosum after long term oral administration and hence may have long term efficacy on erectile dysfunction after oral administration.

Gecko (Gejie): this toad-headed lizard (Gekko gecko L.) is caught in summer. The internal organs are removed, and the eyes are cut and drained. Pieces of bamboo are used to fix the body, and then the gecko is baked and put in a dry place. It is used to treat Impotence due to kidney efficiency. Gecko (Gejie) is used with Ginseng (Renshen), Pilose antler (Lurong) and Epimedium (Yinyanghuo). It can be used alone for this treatment.


L-arginine, an amino acid that is naturally present in the body and helps make nitric oxide, supports a successful erection. Nitric oxide is responsible for making the blood vessels relax, which helps sustain an erection for men. A 1999 study, observed the effects of six weeks of high-dose (5 grams/day) orally administered nitric oxide (NO) donor L-arginine on men with organic ED. Thirty-one percent of those who took 5 grams/day of L-arginine experienced significant improvements in sexual function. Burns told Medical Daily, “l-arginine and deer antler velvet” have been the most popular go-to natural treatments for men.
Impotence, or erectile dysfunction (ED), is the inability for a man to sustain an erection long enough for normal, satisfying sexual intercourse.  To understand the underlying causes of impotence, it helps to know the basics about how an erection develops, along with potential problems that get in the way. Erections begin in the brain with a thought related to sexual desire. Then a chemical message travels from the brain to the penis. Blood flow to the penis increases as blood vessels leading to the reproductive system relax and allow for increased circulation.

In the East, many herbal tonics and preparations are used to assist the aging male improve his ability to have sexual drive or perform penetrative sex by increasing sexual stimulation, erectile, ejaculatory, orgasmic and other responses for sexual function and satisfaction. Currently available herbals, tonics and therapies range from Tongkat Ali, Ginseng, Tribulus etc. Those that act as testosterone releasers have some value especially if the male has andropause and those containing some pick-me-ups II and energizers like ginseng help the tired and fatigued male and possibly those with asthenia. Deer horn contains growth factors and taking these may help improve nocturnal erections in the male with somatopause. Popular in historic Singapore were remedies such as “Penis Soup II” (Figure 2) and Snake Meat, whilst Surabaya was known for Cobra meat (Figure 3) and Cobra Blood which had claims of improving erectogenic prowess-these myths including that of taking dog, cow, wild boar, bull and ostrich testicles (Figures 10,​,11)11) are mainly Village doctor remedies still being practiced widely in the developing regions of Asia. In China, the horny goat weed (Figure 9) is currently still popular and may have some scientific merit (11) for enhancing sexual drive.
Nitric oxide is made internally from L-arginine, which is an amino acid found in red meat, poultry, fish, and dairy products. In other words, L-arginine is the building block for nitric oxide, which is essential for erections. A lack of one can lead to a lack of the other. However, there’s a problem when it comes to treating L-arginine deficiency with supplements.

Consider this:  penicillin, the first successful antibiotic, was derived from molds that inhibit bacterial growth.  Scientists had to figure out why the molds slowed bacteria, and refine the active ingredients.  Using herbal supplements is somewhat like putting mold on a wound.  It might help, a little, but it’s certainly not going to help as much as using penicillin.
Usually patients will try less invasive alternatives to treat impotence before opting for surgery. These alternatives may include supplements, herbs, lifestyle changes and even medications. In cases where other treatments do not work to resolve ED, surgery might be a last-resort option. Surgery involves implanting a penile prosthesis. This is a saline-filled silicone device or a malleable device. Although the likelihood of serious side effects is considered to be low, certain risks are associated with surgery to correct erectile dysfunction. These side effects may include: anesthetic risk, device infection, and device malfunction or mechanical failure. Some studies have found that five years following surgery around 10–20 percent of men experience device malfunction and failure. Infection rates are low. Around one percent of men who opt for this type of surgery get an infection.

Oyster meat: totally natural, oyster extract is excellent for men’s reproductive health and endurance. It is a rich source for the amino acid taurine, which is used for cardiac health and nerve transmission. Historically known as an aphrodisiac, flavonoids in oyster meat have been shown to stimulate the reproductive system. However, still its potency is under question (5).

Pomegranate juice. Drinking antioxidant-rich pomegranate juice has been shown to have numerous health benefits, including a reduced risk for heart disease and high blood pressure. Does pomegranate juice also protect against ED? No proof exists, but results of a study published in 2007 were promising. The authors of this small-scale pilot study called for additional research, saying that larger-scale studies might prove pomegranate juice's effectiveness against erectile dysfunction. "I tell my patients to drink it," says Espinosa. "It could help ED, and even if it doesn't, it has other health benefits."


Ginkgo biloba. Known primarily as a treatment for cognitive decline, ginkgo has also been used to treat erectile dysfunction -- especially cases caused by the use of certain antidepressant medications. But the evidence isn't very convincing. One 1998 study published in the Journal of Sex & Marital Therapy found that it did work. But a more rigorous study, published in Human Pharmacology in 2002, failed to replicate this finding. "Ginkgo has come out of fashion in the past few years," says Ronald Tamler, MD, assistant professor of medicine and codirector of the men's health program at Mount Sinai Medical Center in New York City. "That's because it doesn't do much. I can say that in my practice, I have not seen ginkgo work -- ever."
There is no single cause for erectile dysfunction. Achieving an erection involves a complex series of physiological events; in order for an erection to occur, the body is required to coordinate nervous system responses with tactile sensations, emotional triggers, and signals from certain hormones. If any of these events are disrupted, impotence is likely to occur.
The semi-structured interviews and discussions were held with the specialist resource users and other knowledgeable people on particular ailments by use of interview schedules for each respondent. Interviewed people were mainly the herbalists (both men and women) and TBAs. In this selection to some extent, ethnic groups were recorded where possible because different people use the same plants differently. The time and place of interviews were arranged according to the schedules of the respondent. Depending on where the interviews and discussions were held, recording was done immediately or afterwards or appointments were made for more details in a more convenient place arranged with the respondent. Key informants were identified and later interviewed separately and even followed for further details. Some of the key questions asked included, name of the respondents, the village or parish or sub-county he or she was coming from, diseases treated, plant local names used, parts harvested, methods of preparation and administration. In addition, ingredients and incantations with which the plants are used for preparation and where the herbal medicines were harvested were documented.
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.
There is no single cause for erectile dysfunction. Achieving an erection involves a complex series of physiological events; in order for an erection to occur, the body is required to coordinate nervous system responses with tactile sensations, emotional triggers, and signals from certain hormones. If any of these events are disrupted, impotence is likely to occur.
This study was carried out in areas in and around Queen Elizabeth Biosphere Reserve (QEBR) and some other sub counties such as Katerera, Kichwamba and Kitagata in Bushenyi and Munkunyu, Kayonza and Kitsinga in Kasese districts in Western Uganda. The sampling sites were located in the parishes around the biosphere reserve, and in the selected fishing villages within the biosphere reserve. These included, Katwe, Mweya, Katunguru, Hamukungu, Kahendero and Kayanja Fishing Villages and many other villages.
In fact, one common reason many younger men visit their doctor is to get erectile dysfunction medication. Often, men with erectile dysfunction suffer with diabetes or heart disease, or may be sedentary or obese, but they don’t realize the impact of these health conditions on sexual function. Along with erectile dysfunction treatment, the doctor may recommend managing the illness, being more physically active, or losing weight.
Nettle leaf (Urtica dioica): amongst its many properties, nettle leaf has lately shown itself possibly effective for prostate health and prevention of prostate conditions, especially prostatitis, which is an inflammation of the prostate gland (16). There is speculation that nettle leaf may help with male pattern baldness. Prostate health is essential for men, no matter how young or old. Prevention starts when men are young, so as to avoid problems associated with aging. Prostate problems can interfere with a healthy sex life. Nettle is also considered to be an overall restorative for the body, as well as a natural diuretic and anti-inflammatory remedy (16). It is rich in iron, zinc, and chlorophyll.
Impotence, or erectile dysfunction (ED), is the inability for a man to sustain an erection long enough for normal, satisfying sexual intercourse.  To understand the underlying causes of impotence, it helps to know the basics about how an erection develops, along with potential problems that get in the way. Erections begin in the brain with a thought related to sexual desire. Then a chemical message travels from the brain to the penis. Blood flow to the penis increases as blood vessels leading to the reproductive system relax and allow for increased circulation.
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.

This calls for serious conservation strategies of plant targets in drug development borrowing from the indigenous knowledge of the local people. For instance, medicinal plants documented in this study like Warburgia ugandensis and Cirtopsis articulata used in erectile dysfunction and sexual impotence and ED need to be conserved based on their demand and medicinal value to the people. In the event of increased biotechnology and the use of modified living organisms in agriculture, health and environment, most people will go for natural products18,26. Furthermore, research in natural products is on the increase in both developed and developing nations to show that there is renewed interest in medicines of natural origin.

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


Many products contain undocumented “fillers” that can cause allergic reactions.  In recent years, the FDA has found over 300 herbal products that contain hidden, deceptively labeled, or dangerous ingredients4. And since 2015, the FDA has released public warnings on more than 160 ED supplements and “male enhancement” products found to contain dangerous ingredients and contaminants5 .   An independent study of FDA data, conducted in 2018, found almost 800 herbal supplements that contained unlisted ingredients6.
Tribulus Terrestris is the fruit of the Zygophyllaceae plant and it grows primarily in North China. It is a well-known aphrodisiac with records that trace back to ancient times. There are plenty of animal experiments that verify the effectiveness of Tribulus for improving erectile function. These effects are mostly due to its androgen enhancing ability, namely increasing testosterone levels. Though testosterone doesn’t directly cause an erection, it does play a role. Erection is made possible by many factors, but mostly it's through receptors on cells lining our arteries that stimulate a chain reaction that relaxes the blood vessels that go to the penis, allowing blood flow to get in. Low testosterone is often associated with overall poor metabolic and cardiovascular health. When the test is low, estrogen is usually high, leading to oxidative stress and calcification of the arteries, including the penis, restricting blood flow to the penis. So, improving testosterone levels, and improving overall metabolic function, while reducing oxidative stress is a good plan for improving overall sexual function and erection.
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