About 70 – 80% of the Ugandan population still rely on traditional healers for day-to-day health care. In some rural areas the percentage is around ninety compared to 80% reported world-wide10,13,14. WHO32 had earlier estimates that the usage of traditional medicine in developing countries is 80 %. This is an indication that herbal medicine is important in primary health care provision in Uganda. There are several reproductive ailments that local communities have been handling and treating for ages such as sexual impotence and erectile dysfunction (ED). The concept of reproductive health care has been focusing mainly on women disregarding men and yet men are part.
Ginseng is generally indicated for daily, consistent use in moderate doses. Do not use ginseng as a short-term stimulant. Ginseng and other adaptogens work best after long-term (one–three months) use by regulating hormone levels and other biological functions to protect us against the damaging effects of chronic stress,” says herbalist Christopher Hobbs, author of The Ginsengs. A typical dose is 4,000–6,000 mg per day.

A recent study tested whether ginseng extract would influence exercise-induced muscle damage and inflammation responses. Male college students took either ginseng or a placebo, and then performed a high-intensity uphill treadmill running task. In those taking ginseng, inflammation markers were significantly decreased during recovery, suggesting that ginseng could reduce exercise-induced muscle damage.
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.
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.

Red Ginseng — One small randomized trial found evidence that red ginseng may offer modest improvements in ED symptoms (as compared with placebo). A meta-anaylsis published in the British Journal of Clinical Pharmacology states, “Traditionally red ginseng has been used to restore and enhance normal well-being, and is often referred to as an adaptogenic….Possible mechanisms of action of red ginseng include hormonal effects similar to those of testosterone. Others have postulated that red ginseng might induce relaxation of the smooth muscles.”  (5)
Acupuncture. Acupuncture has been used for centuries to treat ED and impotence in China. A recent review of studies on acupuncture for erectile dysfunction was published in the British Journal of Urology International. After reviewing four studies, the authors concluded that there was not sufficient evidence to say that acupuncture worked. However, some experts believe it's worth trying. "Acupuncture can work," says Gilbert. "It probably works best to treat the psychological component of ED. There is very little downside to trying it."
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.
Ashwagandha’s reputation as a sexual enhancement herb is supported by research. One animal study showed that extracts of ashwagandha increased production of sex hormones and sperm, presumably by exerting a testosterone-like effect. In another clinical trial, the herb (taken at a dose of 3 gm per day for 1 year) was given to healthy male adults 50–59 years of age. Among benefits noted: serum cholesterol levels decreased, gray hair was reduced, and a vast majority (over 70%) reported improvement in sexual performance.
Yohimbine is the principal alkaloid of the bark of the West African evergreen P johimbe (formerly known as C johimbe), family Rubiaceae. The main active chemical present in P johimbe bark is yohimbine hydrochloride (an indole alkaloid), which has stimulant and aphrodisiac effects. However, the levels of yohimbine that are present in P johimbe bark extract are variable and often very low. Therefore, although P johimbe bark has traditionally been used to treat ED [38], there is insufficient scientific evidence to form a definitive conclusion in this area. It is an antagonist of α2-receptors and has no direct relation to erection. It acts as a sex motivation stimulant. Yohimbine has been used as both an over-the-counter dietary supplement in the form of an herbal extract, and as a prescription medicine in purified form for the treatment of sexual dysfunction. Yohimbine 20 mg or adjusted dose has been found to be effective in the treatment of orgasmic dysfunction. Yohimbine was recently associated as a treatment for type 2 diabetes mellitus in animal and human models carrying polymorphisms of the alpha-2A adrenergic receptor gene [39]. The National Institutes of Health states that yohimbine hydrochloride is the standardized form of yohimbine that is available as a prescription medicine in the United States, and has been shown in human studies to be effective in the treatment of male impotence. Yohimbine hydrochloride USP has been used to treat ED. Controlled studies suggest that it is not always an effective treatment for impotence, and evidence of increased sex drive (libido) is anecdotal only. It cannot be excluded that orally administered yohimbine can have a beneficial effect in some patients with ED. The conflicting results available may be attributed to differences in drug design, patient selection and definition of positive response. Yohimbine has been shown to be effective in the reversal of sexual satiety and exhaustion in male rats, and has also been shown to increase the volume of ejaculated semen in dogs, with the effect lasting at least 5 h after administration. Yohimbine has also been shown to be effective in the treatment of orgasmic dysfunction in men, and has also been used for the treatment of sexual side effects caused by some antidepressants, and female hyposexual disorder. Yohimbine has significant side effects, such as anxiety reactions. Higher doses of oral yohimbine may create numerous side effects, such as rapid heart rate, high blood pressure, overstimulation, insomnia and/or sleeplessness. More serious adverse effects may include seizures and renal failure. Yohimbine should not be consumed by individuals with liver, kidney or heart disease, or psychological disorders. The therapeutic index of yohimbine is low; the range between an effective dose and a dangerous dose is very narrow. Side effects include gastrointestinal upset, increased blood pressure, headache, agitation, rash, tachycardia and frequent urination [40].
E longifolia is a medicinal plant (family Simaroubaceae) native to Indonesia, Malaysia, Thailand, Vietnam and Laos. The root extract has been found to be the most powerful herbal aphrodisiac [17]. Tongkat ali extracts contain many alkaloids, quassinoids, phenolic compounds, tannins, high-molecular-weight glycoproteins and mucopolysaccharides. The main bioactive compounds are eurycomaoside, eurycolactone, eurycomalactone, eurycomanone and pasakbumin-B. It is considered to be natural ‘Viagra’. It increases sexual desire, and enhances performance and general well-being [17- 19]. In addition to its aphrodisiac effect, other medicinal effects, such as antimalarial, antibacterial, antipyretic, antiulcer and antitumour effects, have been reported [20,21]. Root decoction has been used as a general tonic (18,22]. Laboratory animal studies show that root extract enhances sexual characteristics and performance in rodents [22-25]. In a study involving a boar model, it was found that E longifolia root extract-treated boars increased sperm counts and semen volume; the effect was attributed to increased level of plasma testosterone [26]. Reports also suggest that E longifolia extract reverses the inhibitory effects of estrogen on testosterone production and spermatogenesis in rats [27]. Oral administration of E longifolia extract to inexperienced castrated male rats produced dose-dependent increases in sexual performance [28]. Zakaria et al [29] found that eurycomanone, a potential bioactive compound in the root extract of E longifolia, induced apoptosis in hepatocarcinoma (Hep G2) cells. Furthermore, their work suggested that eurycomanone was cytotoxic to Hep G2 cells and less toxic to normal Chang’s liver and WLR-68 cells. Tambi and Imran [19] investigated the effects of water-soluble extract of the root of E longifolia Jack and found that the extract increased semen volume, sperm concentration, percent of normal sperm morphology and sperm motility in male partners of subfertile couples with idiopathic infertility. Supplementation with E longifolia elevated the testosterone levels and upregulated osteoprotegerin gene expression in male Sprague-Dawley rats [30].
Six herbs for treating erectile dysfunction Erectile dysfunction can be an embarrassing condition that can leave men unable to achieve an erection or a full orgasm. This MNT Knowledge Center article talks about six different herbal supplements that could help people with erectile dysfunction, including ginkgo biloba, horny goat weed, and red ginseng. Read now
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.
A cold slice of watermelon can do more than just satisfy thirst and hunger during the warm summer months; it can help with bedroom satisfaction. Citrulline, the amino acid found in high concentrations of watermelon, is found to improve blood flow to the penis. A 2011 study revealed men who suffered from mild to moderate ED and took L-citrulline supplementation showed an improvement with their erectile function and were very satisfied. Natural watermelon juice, or “nature’s Viagra,” can also be easier on the stomach, since taking pills like Viagra can cause nausea and diarrhea.
A 2011 study of 160 men with moderate or severe erectile dysfunction divided the group in two—80 men were given niacin supplements, and 80 a placebo. The group given niacin reported improved ability to “maintain an erection versus the control group.” It’s not exhaustive research, but still promising. The best part about niacin is that it’s naturally found in foods like turkey, avocado, and peanuts (yum). If you’re not a turkey sandwich fan, you can supplement with a vitamin B complex.
Saw palmetto. Saw palmetto comes from the fruit of a small palm tree. It has been used to treat symptoms in men with an enlarged prostate gland, such as difficulty urinating, and it has been recommended to treat ED caused by an enlarged prostate. However, several recent clinical trials did not show that saw palmetto works any better on an enlarged prostate than a placebo does. "There is no evidence that saw palmetto should be used to treat erectile dysfunction," says Dr. Gilbert. Like ginkgo biloba, saw palmetto can interact with some prescription medications.
A variety of personal habits and lifestyle choices have been linked to ED. In some ways, this is a good thing, since habits can be broken and choices reconsidered. What's more, many of the lifestyle factors that contribute to sexual problems are ones that affect overall health and well-being, both physical and mental. Addressing these factors, therefore, can have benefits beyond improving erectile dysfunction.
Much of the evidence shows high rates of vitamin D deficiency in patients with erectile dysfunction. In fact, one study of 3,400 participants found that men with vitamin D deficiency were 32% more likely to have trouble with erections when all other risk factors were controlled for. It’s a little on the nose that you need vitamin D for your “D,” but hey—science can be funny too.
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.
Just because a product claims to be natural doesn't mean it's safe. Many herbal remedies and dietary supplements can cause side effects and dangerous interactions when taken with certain medications. Talk to your doctor before you try an alternative treatment for erectile dysfunction — especially if you're taking medications or you have a chronic health problem such as heart disease or diabetes.
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