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.
Cistanche is usually consumed in stem form, which grows in an extremely arid area with intensive sunshine. It contains various chemical constituents that have some bio-activities such as antioxidation, neuroprotection and overall antiaging. It is shown in a study to shorten erectile latency and prolong erectile duration in castrated rats. Cistanche extract also improves sex hormone levels, improving overall sexual health. The constituent known as echinacoside, promotes relaxation of aortic rings through the NO-cGMP pathway, in other words, it relaxes blood vessels in the penis and improves Nitric Oxide flow.

A list of 33 medicinal plants both cultivated and wild-harvested generated show that herbal remedies are greatly utilized by men for managing sexual impotence and erectile dysfunction in western Uganda. Erectile dysfunction and sexual impotence are old problem and traditionally the indigenous knowledge had ways of treating or managing these conditions associated with male reproductive system. These plants in the tables we are discussing have been in use for centuries in treating or managing conditions in male reproductive organs.
The search for a cure for erectile dysfunction (ED) dates back way before the introduction of Viagra in the 1990s. Natural aphrodisiacs, from ground rhinoceros horn topa chocolate, have long been used to increase libido, potency, or sexual pleasure. These natural remedies are also popular because they’re said to have fewer side effects than prescribed medications.

The estimated range of men worldwide suffering from ED is from 15 million to 30 million23. According to the National Ambulatory Medical Care Survey (NAMCS), for every 1,000 men in the United States, 7.7 physician office visits were made for ED in 1985. By 1999, that rate had nearly tripled to 22.3. This is in USA, where statistics are clearly compiled, the level of awareness and education is high as compared to sub Saharan countries like Uganda. This is a clear indication that there are many silent men, particularly couples affected by ED.

^Effects of Korean ginseng berry extract on sexual function in men with erectile dysfunction: a multicenter, placebo-controlled, double-blind clinical study. - Author: Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, and R&D Center, Amorepacific Corporation, Gyeonggi-do, South Korea (20 Dec 2012)


Generally, erectile dysfunction (ED) is a neurovascular condition directly involving the endothelium of the corpora cavernosal arterial blood vessels in the penis, and is indirectly linked to cardiovascular diseases. The underlying mechanisms of ED are, however, complex and involve psychogenic, neurogenic, hormonal and vascular factors. ED occurs in aging men, with a prevalence of 52% in men 40 to 70 years of age [1-3]. Conditions that may cause ED include hypertension, diabetes, diseases of the prostate and heart, and obesity. ED may also be caused by the effects of certain medications as well as physical injury or anatomical deformity of the penis [4], or may result from endocrine disorders such as low testosterone, hypogonadism, adrenal insufficiency and hypothyroidism. Changes in blood flow to the male reproductive organs as a result of hardening of the arteries or atherosclerosis, hypertension and hypercholesterolemia may result in ED. It is generally accepted that there are vascular and neuropathic components to the pathophysiology of the disease, and ED has been recognized as a potential indicator of underlying cardiovascular disease. Chronic infections and/or inflammation of the prostate and irritation of the bladder may contribute to the pathogenesis of ED.
Maca root (Lepedium meyenii W): this native Peruvian root has been cultivated for thousands of years. Considered an integral part of the diet, the Incans found maca root so potent (14), it was restricted to royal use only. Known for its energy enhancing abilities, maca root enjoys a special place amongst herbalists and health seekers. Like ginseng, this plant is employed to increase strength, libido and sexual function (14). Clinically its effects have been proved with experimental animals (5,15).
W somnifera (ashwagandha), also referred to as winter cherry (family Solanaceae), grows in Africa, the Mediterranean, India, Pakistan, Bangladesh, Afghanistan, South Africa, Egypt, Morocco, Congo and Jordan [36]. The roots of the plant contain steroid alkaloids and steroidal lactone, which are the main constituents of ashwagandha; these compounds are referred to as withanolides. Among the various alkaloids, withnine is the main constituent. The other alkaloids are somniferin, somnine, somniferine, withananine, pseudowithanine, tropine, pseudotropine, cuscohygrine, anferine and anhydrine. Two acyl steryl glucosides (sitoindoside VII and sitoindoside VIII) have been isolated from the root. The withanolides contain a C28 steroidal nucleus with a C9 side chain and six-membered lactone rings. Ashwagandha root also contains flavonoids and many ingredients of the withanolide class. It has several medicinal applications (aphrodisiac, liver tonic, anti-inflammatory agent, astringent), and is used to treat bronchitis, asthma, ulcers, insomnia, senility and dementia. Clinical trials and studies involving animal models support the use of ashwagandha for anxiety, cognitive and neurological disorders, inflammation and Parkinson’s disease. It also provides cryoprotective benefits to patients undergoing radiation and chemotherapy, and shows beneficial effects for nervous exhaustion. W somnifera is used as an aphrodisiac, sedative and rejuvenative, and is also used to treat chronic fatigue, dehydration, bone weakness, muscle weakness, loose teeth, impotency, premature ejaculation, debility, constipation, senility, rheumatism, nervous exhaustion, memory loss, drug withdrawal symptoms, anxiety and arthritis pain in the knee. Extracts from W somnifera inhibit transcription factor nuclear factor kappa B (NF-κB); thus, it acts as an anti-inflammatory agent. This has been attributed to its ability to interact with IKKB, a kinase that is responsible for the nuclear translocation of NF-κB and activation of inflammatory signalling pathways [37].
The estimated range of men worldwide suffering from ED is from 15 million to 30 million23. According to the National Ambulatory Medical Care Survey (NAMCS), for every 1,000 men in the United States, 7.7 physician office visits were made for ED in 1985. By 1999, that rate had nearly tripled to 22.3. This is in USA, where statistics are clearly compiled, the level of awareness and education is high as compared to sub Saharan countries like Uganda. This is a clear indication that there are many silent men, particularly couples affected by ED.
Reproductive Health care is the second most prevalent health care problem on African continent4. Reproductive health care did not appear on the health agenda until recent after the Cairo conference on population and the Peking conference on women that it indeed became a live issue4. In some instances RH certainly includes the RH needs of the youth or adolescents.

Erectile dysfunction supplements and other natural remedies have long been used in Chinese, African and other cultures. But unlike prescription medications for erectile dysfunction, such as sildenafil (Viagra), vardenafil (Levitra, Staxyn), tadalafil (Cialis, Adcirca) and avanafil (Stendra), erectile dysfunction herbs and supplements haven't been well-studied or tested. Some can cause side effects or interact with other medications. And the amount of the active ingredient can vary greatly from product to product.

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