The medical ethnobotanical indigenous knowledge were collected by visiting traditional healers and documenting the medicinal plants used and other socio-cultural aspects allied with sexual impotence and erectile dysfunction. The methods used to collect the relevant information regarding the medicinal plants used included informal and formal discussions, field visits and focused semi-structured interviews.
The basis of ED herbal therapies is that they are anti-inflammatory, antioxidant and immunomodulatory, and can stimulate testosterone production. On the other hand, the synthetic drugs act via NO. The principal mediator of the relaxation of corporal smooth muscle of the penis has been shown to be NO, which is released mainly from parasympathetic nerves and endothelium [13]. NO is believed to relax the corporal smooth muscle by activating soluble guanylate cyclase to increase cGMP content [14,15]. Penile rigidity depends on maximizing inflow of blood while minimizing outflow [6]. The increased blood flow in the cavernous sinuses puts pressure on the walls of the surrounding veins, causing the lumen of the veins narrow, temporarily interfering with the flow of blood but causing tumescence. Normally, the parasympathetic nerve produces Ach. Ach acts on muscarinic receptors and nicotinic cholinergic receptors. When the parasympathetic nerve is stimulated, preganglionic neurons release Ach at the ganglion, which acts on nicotinic receptors on postganglionic receptors. Postganglionic neurons then release Ach to stimulate muscarinic receptors of the target organs. The muscarinic receptor M3, present in the endothelial cells and smooth muscle, is activated, and the M2 receptor in the heart may also be activated. This may result in the production of Ach, which can cause endothelial cells to produce NO. Ach released from postganglionic parasympathetic nerves acting through G-protein-mediated muscarinic receptors and nicotinic cholinergic receptors helps to release NO. Normally, M1, M2 and M3 receptors are found in secretory glands, heart, smooth muscle and endothelial cells, respectively. M1, M2 and M3 receptors cause activation of phospholipase C and generate inositol trisphosphate and diacylglycerol, which increase calcium. Activation of M4 may inhibit adenylate cyclase, decreasing the messenger cyclic AMP. This mechanism may be involved in the relaxation and contraction of cavernosal smooth muscle cells.
In this day and age, there is a wide spectrum of innovative drug and other methods of treatment including psychosexual therapy and counseling, topical and systemic drug therapy, device-assisted therapy, electromagnetic stimulation to improve nerve and vascular function of the pelvis and perineal muscles. Electro-ejaculation and the less often done surgical techniques are currently available. The simpler electrovibration can help create or maintain erection or stimulate ejaculation. Although we give so much emphasis on ejaculation, in the Chinese traditional medical teaching, there is reference to improving health by ejaculatory control and abstaining from ejaculating during sexual activity—hence the popular belief that EJACULATING TOO MUCH will lead to WEAKNESS and ILL HEALTH!
A daily dose of niacin improves erectile function, particularly in men with high cholesterol, according to a 2011 study in The Journal of Sexual Medicine. The vitamin helps increase blood flow and reduce inflammation—one of the underlying causes of both high cholesterol and erectile dysfunction. “Vitamin B3 is also used to make sex hormones and other important chemical-signal molecules,” says Fisch. Like many of the others on our list, this tablet is most powerful when taken in conjunction with others: A cocktail of propionyl, L-carnitine, L-arginine, and niacin taken for three months improved 40% of erections in a study from researchers at Sapienza University of Rome in Italy.

In this day and age, there is a wide spectrum of innovative drug and other methods of treatment including psychosexual therapy and counseling, topical and systemic drug therapy, device-assisted therapy, electromagnetic stimulation to improve nerve and vascular function of the pelvis and perineal muscles. Electro-ejaculation and the less often done surgical techniques are currently available. The simpler electrovibration can help create or maintain erection or stimulate ejaculation. Although we give so much emphasis on ejaculation, in the Chinese traditional medical teaching, there is reference to improving health by ejaculatory control and abstaining from ejaculating during sexual activity—hence the popular belief that EJACULATING TOO MUCH will lead to WEAKNESS and ILL HEALTH!
Thirty-three medicinal plants both cultivated (Table 1) and wild harvested (Table 2) were documented and identified in the area of study. In the description below these results of these two table are combined as presented below. All the identified medicinal plants in both tables belong to 25 families and 30 genera. The family Rubiaceae (4) is the most represented followed by Alliaceae, Euphorbiaceae, Mimosaceae, Papilionaceae and Caesalpinaceae families which have two species each and the rest with one species. The composition is that 42.4% are shrubs, 39.4% herbs and herb climbers and 18.2% trees. Leaves (57.6%) are the commonest plant parts followed by roots (42.1%), barks (27.3%) and the rest of the plant parts harvested have less than 10% of the parts harvested. From Allium cepa, Allium sativum, Rhus vulgaris, Warburgia ugandensis, Cleome gynandra and Tarenna graveolens, three different plant parts, are harvested for use in sexual impotence and erectile dysfunction. In the case of Impetiens species and Urtica massaica, the whole plants are harvested while the rest of the species one or two different plant parts are used. The conservation status of these documented plants is that 27.3% are cultivated while 72.7% are collected from wild places. The common methods of plant medicine preparation included boiling, chewing, pounding, cooking, roasting and smoking. The commonest method of herbal administration was by oral means as food, herbal teas or by mixing in several drinks including locally made beer.
The field visits and excursions were arranged with the healers for places far from their homesteads or took place concurrently with the interviews and discussions. When going to the forests, game reserves or other areas where herbalists collect plant specimens, prior arrangements were made with the community leaders and park staff. This was done with individuals or groups depending on where the herbs are collected. In the shared areas such as the fishing villages, or the multiple use areas, group and individual excursions were conducted. Some of the medicinal plants that are harvested from distant places such as the Democratic Republic of Congo, other districts and unsafe areas within the reserve were not collected but their local names were recorded. The data collected were to supplement the information on plant names, plant parts used, collection of the herbarium voucher specimens and conservation status of these medicinal plants. The medicinal plants collected were given the voucher numbers and then later identified in Botany Department herbarium of Makerere University.
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.

Feeling fatigued, very stressed, depressed or dealing with another mood-related issue that can lower libido. Sources of stress and diminished quality of life — such as “deteriorating economic position,” unhappiness with one’s job or other aspects that lower emotional health — are believed to be major causes for sexual dysfunction in both men and women

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.
There have been some studies to suggest that a placebo effect that improves ED may work for some men. One study found that men taking an oral placebo pill showed as much improvement in ED symptoms as men who took actual medication to improve ED. Conversely, men who were given therapeutic suggestions to improve ED did not see signs of symptom improvement.
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 key respondents were mainly old men, male traditional healers, traditional birth attendants and young women and all in total about 160 traditional healers were interviewed. To document male related ailments men are particularly more knowledgeable and most men share their problems with men. In addition, the old men and healers are the ones in charge of administering these herbal remedies. Young women through the informal discussions, interviews and market surveys are particularly more dynamic in the use of herbs for themselves, husbands and children besides being the most active reproductive age group. The medical ethnobotanical data collected has been analysed, medicinal plants from the study areas have been listed and methods of administering the herbal drugs were also documented. In checking for the proper updated naming, spellings and authors of the medicinal plants, besides using voucher specimens in Makerere University Herbarium, several reference books were used1,3,9,15,16,20,22,27.

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
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"Just because there is evidence doesn't mean it's good evidence," says Andrew McCullough, MD, associate professor of clinical urology at New York University Langone Medical Center in New York City, and one of the original clinical investigators for the ED drug Viagra (sildenafil). "And before men with ED start down the naturopathic route, it's smart to make sure that there isn't some underlying medical condition that needs to be corrected." Moreover, it is estimated that 30 million American men have erectile dysfunction, and 70% of cases are a result of a potentially deadly condition like atherosclerosis, kidney disease, vascular disease, neurological disease, or diabetes. Additionally, ED can also be caused by certain medications, surgical injury, and psychological problems.
Ginseng, specifically “red ginseng,” is known as the “herbal Viagra” that helps puts to rest men’s bedroom woes. Red ginseng is when the root has been steamed and then dried. The ginseng root is the part of the plant that is mostly used as a natural remedy when in its supplement form. However, the plant must be grown for a minimum of five years before it can be used. In a 2008 review, seven studies on red ginseng and ED, ranging in dosages from 600 to 1,000 milligrams three times a day, were found to provide evidence for the effectiveness of the herb in ED treatment.
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).
There’s no bedroom bummer quite like having to fly at half mast, but your penis problems are likely more common than you think: As many as 30 million American men suffer from erectile dysfunction, and one in four who seek treatment for ED are actually under the age of 40, according to a study in The Journal of Sexual Medicine. We all know there’s a little blue pill that can fix the failure to launch—but you don’t necessarily have to fill a ‘script to save your stiffy.

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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].
Garlic is one of the most common vegetables found at home that's beneficial in the treatment of sexual impotence. Dr. Mani says, "Garlic has often referred to as "the poor man's penicillin" because it serves as an effective antiseptic and immune booster. Being a sex rejuvenator, it can improve sexual activities that have been damaged due to an accident or a disease. Garlic is important for people who overindulge in sex to protect themselves from nervous exhaustion."
ED may occur at any age, but tends to have a greater psychological effect when it occurs in midlife. ED invokes stress related to midlife intimacy and the physiological realities of aging. Although the prevalence of ED increases with age, it is not an inevitable consequence of aging. Rather, ED becomes more prevalent as men grow older because of its relationship with various age-related diseases. Several studies have found that age is an independent risk factor for severe ED, even after adjustment for other age-related diseases. The aging male requires more penile stimulation; it takes longer to get an erection and the erection may not be hard enough for vaginal penetration. Also, it takes more time to reach ejaculation in elderly individuals. Absence of sexual interest in the partners of older men can lead to ED simply by the man not receiving sufficient direct penile stimulation. Testosterone replacement therapy for aging men has become a topic for discussion among health care providers. There are no established norms for testosterone levels in aging men. Studies in healthy men show that testosterone levels, particularly free bioactive testosterone levels, decline with age although there is considerable interindividual variation. The percentage of men who actually become ‘testosterone deficient’ is unknown. The diagnosis of androgen deficiency in aging men is associated with a wider range of symptoms than a mere impact on hormone levels per se. If the patient has no clinical signs of an androgen deficiency, testosterone replacement therapy will have no clinical effect.

Currently, there are four orally active drugs are available to treat ED. These include: sildenafil citrate (Viagra [Pfizer, USA]), vardenafil hydrochloride (Levitra [Bayer, Germany]), tadalafil (Cialis [Eli Lilly, USA]) and avanafil (Stendra, Spedra [Vivus Inc, USA]). These drugs inhibit the enzyme phosphodiesterase type 5 (PDE-5), which is responsible for the hydrolysis of cGMP. PDE-5 inhibitors and cGMP act as effectors of dilation of smooth muscle of cavernosal bodies. PDE-5 inhibitors are contraindicated in patients taking any kind of nitrate therapy for angina, and may not be appropriate for men with certain health conditions, such as severe heart disease, heart failure, history of stroke or heart attack, uncontrolled high blood pressure or diabetes, and patients with pigmental retinopathy. PDE-5 inhibitors are less effective in men with diabetes and men who have been treated for prostate cancer. PDE-5 inhibitors are also not effective in men with retinitis pigmentosa, a genetic disease involving PDE-5 deficiency. The common side effects of PDE-5 inhibitors include gastrointestinal upset, headache, nasal congestion, back pain and dizziness. The PDE-5 inhibitors may interact with other medications including antihypertension drugs. Nonetheless, the PDE-5 inhibitors are generally safe and effective for most men. The primary mechanism of action of these drugs is through the mediation of NO. NO is one of the key molecules involved in ED. It is a short-lived, highly permeable, pleiotropic, gaseous molecule, secreted from the postganglionic cavernosal parasympathetic nerves, endothelium of the cavernosal blood vessels, platelets in the cavernosal sinuses and phagocytic cells (monocytes, macrophages and neutrophils). NO acts on platelets to inhibit platelets adhesion and aggregation. NO causes relaxation of the smooth muscle of the cavernosal blood vessels of the penis, leading to vasodilation, tumescence and stimulation. Release of NO in the corpus cavernosum of the penis during stimulation activates the enzyme guanylate cyclase, which results in increased levels of cGMP, producing smooth muscle relaxation in the corpus cavernosum and resulting in increased blood flow (5). NO is mainly produced from cavernosal nerves, which are nonadrenergic, noncholinergic nerves within the penis, and acting via its second messenger cGMP. It has been suggested that maintaining normal body weight and mild exercise, as well as dietary supplementation of folic acid, zinc, calcium, vitamin C, vitamin E and L-arginine, a precursor of NO, can support the biochemical pathway leading to NO release [6]. NO is an effector molecule that is involved in a number of intracellular functions such as vasorelaxation, endothelial regeneration, inhibition of leukocyte chemotaxis and platelet adhesion [7]. A small proportion of autonomic nerves do not release either Ach or norepinephrine [8]. For example, the cavernous nerves predominantly release NO in the penis. The exact mechanism is not known, but it is believed to be through increased intracellular calcium. Another gaseous molecule produced in the corpora cavernosa is hydrogen sulphide (H2S), which is also known to be involved in erectile function [9]. H2S activates ATP-sensitive potassium channels in smooth muscle cells. Some reports indicate that NO acts in large vessels and H2S in small vessels. A high level of tumour necrosis factor-alpha has been shown in ED patients [10]. Although current ED therapies using PDE-5 inhibitors are safe and effective, approximately 40% of ED patients do not respond to currently available treatment [11,12]. For these patients, herbal therapy may be useful.
Dadder seed (Tusizi): there are 2 species i.e., (I) Cuscuta chinensis Lam and (II) Cuscuta japonica. The ripe seeds are collected in autumn, and then they are dried in the sun or boiled. Used to treat deficient kidneys manifesting as impotence, nocturnal emissions, premature ejaculation; Dadder seed (Tusizi) can be used with Schisandra fruit (Wuweizi), Cnidium fruit (Shechuangzi), Flattened milkvetch seed (Shayuanzi) and Grossy privet fruit (Nuzhenzi) for impotence.
Poor sleep patterns can be a contributing factor for erectile dysfunction, Mucher says. One review published in the journal Brain Research emphasized the intricate relationship between the level of sex hormones like testosterone, sexual function, and sleep, noting that testosterone levels increase with improved sleep, and lower levels are associated with sexual dysfunction. Hormone secretion is controlled by the body’s internal clock, and sleep patterns likely help the body determine when to release certain hormones. 
Research is mixed on the effectiveness of acupuncture as an erectile dysfunction cure, but one study published in November 2013 in the Journal of Alternative and Complementary Medicine found that acupuncture can be beneficial for men experiencing erectile dysfunction as a side effect of antidepressants, including selective serotonin reuptake inhibitors (SSRIs) and serotonin noradrenaline reuptake inhibitors (SNRIs).
Erectile dysfunction (ED) is commonly called impotence. It’s a condition in which a man can’t achieve or maintain an erection during sexual performance. Symptoms may also include reduced sexual desire or libido. Your doctor is likely to diagnose you with ED if the condition lasts for more than a few weeks or months. ED affects as many as 30 million men in the United States.
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