2. Erectile Dysfunction
Sexual dysfunction affects 10-52% of men and 25-
63% of women and it is a serious medical and social
problem.
Erectile dysfunction (ED) is a condition in which
the male partner could not obtain or maintain
sufficient stiffness of the penis to have satisfactory
sexual intercourse.
Erectile dysfunction (ED) is an important sexual
health problem worldwide and it affects about 50%
of men aged 40–70 years.
4. Physical Causes of Erectile
Dysfunction
Vasculogenic (Conditions affecting blood flow to the
penis) - Atherosclerosis, Hypertension, Diabetes.
Neurogenic (Conditions affecting nervous system) –
Multiple Sclerosis, Parkinsonism, Spinal injury or disorder,
Stroke.
Hormonal (Conditions affecting hormone levels) -
Hypogonadism, Hypothyroidism, Hyperthyroidism, Cushing's
syndrome.
Anatomical (Conditions affecting the physical
structure of penis) –
Peyronie's disease, Penis injuries.
5. Psychological Causes of
Erectile Dysfunction
Psychological Causes:
Depression
Anxiety
Relationship problems
Lack of sexual knowledge
Past sexual problems
Past sexual abuse
Being in a new relationship
Worry or Fear
8. Medical Systems
The therapies which could be combined with conventional
medicine is termed “Complementary Medicine”.
“Alternative Medicine” includes therapies that are used in
place of conventional medicine.
“Complementary and Alternative Medicine” (CAM)
refers to a wide range of clinical therapies outside the
conventional medicine.
“Conventional Medicine” is a type of medicine practiced
by medical doctors and by allied health professionals, such
as physical therapists, psychologists, and registered nurses. It
is also called Western or Allopathic medicine.
“Integrative Medicine” represents a combination of
conventional medicine, CAM, and evidence-based medicine.
9. CAM Use
An US study reported that the Complementary and Alternative
Medicine (CAM) use is high and continues to increase.
The most important reason cited by patients for the
supplemental CAM use is the perception that CAM is harmless.
CAM use is highest in patients include
Female
Nonsmokers
Physically active
Having normal body mass index (BMI)
Eating low-fat diets with a high fruit and vegetable content
Individuals aged 35 to 54 years with a high level of education.
10. Types of CAM Practices
Mind-Body and Manipulative
Practices
Traditional Medical Systems
"Modern" Medical Systems
11. Mind and Body
Practices
Acupuncture and Acupressure
Yoga
Hypnosis
Massage
Meditation
Reflexology Alexander technique
Tai chi
Spinal manipulation
Therapeutic touch
Guided imagery
Rolfing/structural integration
12. Traditional Medical Systems
• Ayurvedic medicine
• Siddha medicine
• Unani medicine
• Native American medicine
• Tibetan medicine
• Traditional Chinese medicine
• Curanderismo
16. CAM for Erectile Dysfunction
Nutritional supplements:
Arginine
Dehydroepiandrosterone (DHEA)
Folic acid
Zinc
Vitamin E
17. Acupuncture
Acupuncture can be an effective treatment option in more than
two-thirds of patients with psychogenic erectile dysfunction.
http://www.nature.com/ijir/journal/v15/n5/full/3901021
18. Yohimbe Bark
(Pausinvstalia yohimbe)
Yohimbine hydrochloride is the principal alkaloid of the bark of the African
yohimbe tree.
http://www.nature.com/ijir/journal/v14/n1/full/3900803a.html
19. Ginseng (Panax ginseng)
Ginseng cultivated in Korea is classified into three types-
Fresh ginseng (less than 4 years old)
White ginseng (4–6 years old)
Red ginseng (harvested when 6 years old)
Traditionally red ginseng has been used to restore and enhance normal well-
being.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3861174/
20. Ginkgo (Ginkgo biloba)
Ginkgo biloba generally had a positive effect on all 4 phases of the sexual
response cycle such as Desire, Excitement (erection and lubrication), Orgasm, and
Resolution (Afterglow).
Ginkgo biloba found to be effective to treat antidepressant -induced sexual
dysfunction.
https://www.ncbi.nlm.nih.gov/pubmed/9611693
22. Nutmeg (Myristica fragrans)
oNutmeg (Myristica fragrans) may be used as an effective and
safe alternative remedy in sexual disorders.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1187868/
23. Tongkat Ali (Eurycoma longifolia)
http://www.sciencedirect.com/science/article/pii/S0965229
24. Maca (Lepidium meyenii -
Peruvian Ginseng)
The potential bioactive ingredients of Maca (Lepidium meyenii - Peruvian
Ginseng) include macaridine, macamides, macaene, gluosinolates, maca alkaloid,
and maca nutrients (Amino acids, Iiodine, Iron and Magnesium).
Men who took 3 grams of maca per day for 8 weeks reported an improvement
in sexual desire more often than men who didn’t take it.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2928177/
25. Kaempferia parviflora
(Thai black Ginger, Thai Ginseng)
Kaempferia Parviflora (KP) might be useful to treat Age-related erectile
dysfunction.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4056445/
26. Mondia whitei
Approximately 30% of men across all age groups are
affected by Premature or rapid ejaculation.
Mondia whitei could be used in men with rapid ejaculation.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3544574/
27. Schisandra chinensis
Schisandra has been used in Traditional Chinese medicine (TCM)
to increase the sexual performance.
http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2011.10567.x/fu
28. Horny Goat Weed
(Epimedium)
Horny Goat Weed (Epimedium) is used in Traditional Chinese
Medicine (TCM) to treat erectile dysfunction and low libido.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3551978/
29. Fadogia agrestis
Saponins present in the aqueous extract of Fadogia agrestis maight be
responsible for the increase in the body natural endogenous
testosterone levels.
http://onlinelibrary.wiley.com/doi/10.1111/j.1745-7262.2005.00052.x/abst
30. Watermelon (Citrullus lanatus)
Watermelon is one of the largest food sources of L-citrulline.
Watermelon could be used effectively in men with Mild– Moderate
Erectile Dysfunction.
http://www.sciencedirect.com/science/article/pii/S0090429510016614
33. Pomegranate (Punica granatum)
Drinking pomegranate juice daily could be an important addition to the diet in
the management of Mild to Moderate Erectile Dysfunction.
http://www.nature.com/ijir/journal/v19/n6/full/3901570a.html
34. Fig (Ficus carica)
Fig (Ficus carica) has been found to improve sperm motility, count, and
testosterone level in diabetic rats.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4745414/
35. Groundnuts (Arachis hypogaea)
Groundnut consumption is also associated with
significant increase in HDL-Cholesterol in male rats.
http://tmj.or.tz/index.php/tmj/article/view/1
36. Pistachio Nuts (Pistacia vera)
Pistachio nuts are rich sources of some plant proteins, dietary fibers and especially
antioxidant substances (Resveratrol and Anthocyanins ).
Pistachio nuts can also decrease the platelet count leading to improved blood flow
and improvement in penile erection.
http://www.nature.com/ijir/journal/v23/n1/full/ijir201033a.html
37. Onion (Allium Cepa)
Onion (Allium Cepa) might be useful to treat Antidepressant-induced sexual
dysfunction and also to improve copulatory behavior in sexually potent male.
http://journals.sagepub.com/doi/abs/10.1177/1535370213508360?url_ver=Z39.88-200
38. Coffee
According to a research, men who drink 2-3 cups of coffee a day
are less likely to develop Erectile Dysfunction (ED).
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.012354
39. Ginger (Zingiber officinale)
Ginger might be useful to relieve Age-associated and
Diabetic ED.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4578663/
40. Flavonoids rich Foods
Flavonoids are present in many plant-based foods and beverages,
including fruit, vegetables, tea, herbs, and wine.
http://ajcn.nutrition.org/content/early/2016/01/06/ajcn.115.122010.fu
41. Omega-3 Fatty Acids rich
Foods
The protective effects of Omega-3 fatty acids such as lowering of
oxidative stress, reduction of secretion of pro-inflammatory
cytokines, and attenuation of atherosclerotic plaques also useful to
prevent Erectile Dysfunction (ED).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4810342/
42. Arginine
Arginine is an amino acid found in high-protein foods like meats
and nuts.
Pycnogenol is extracted from Pine bark (Pinus pinaster).
https://www.ncbi.nlm.nih.gov/pubmed/12851125
43. Dehydroepiandrostreone
(DHEA)
Dehydroepiandrostreone (DHEA) supplementation might be beneficial for ED patients with
Hypertension.
20-75 milligrams of oral DHEA for up to six months, could be used to treat Erectile
dysfunction.
http://www.sciencedirect.com/science/article/pii/S0090429598005718
44. Folic Acid
The administration of Folic acid may constitute a strategy for reducing Erectile
Dysfunction in patients with Diabetes Mellitus.
http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2008.07911.x/full
45. Zinc
Foods high in zinc include Beef, Shrimp, Oysters, Kidney
beans, Flax Seeds, Watermelon seeds, Pumpkin Seeds,
Spinach, Nuts, Dark chocolate, Mushrooms, etc.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2800928/
46. Vitamin E
Vitamin E ameliorates the Age-associated Erectile Dysfunction.
http://www.sciencedirect.com/science/article/pii/S0024320512000082
47. TIPS for Better Sex
Avoid Stressful situations
Quit Smoking
Avoid Alcohol
Walk at least 30 minutes a day
Eat a balanced Diet rich in fruit, vegetables, whole grains,
and fish.
Maintain blood pressure, blood sugar, blood cholesterol,
and blood triglycerides in normal range.
Get slim and stay slim
Move pelvic floor muscle (Two sets of Kegel exercises
daily)
48. Herbal Viagra
Herbal Viagra products are available as Over-The-Counter
(OTC) herbal supplements to treat Erectile Dysfunction (ED).
The laboratory analysis of such herbal supplements by US FDA,
found to contain hidden ingredients like PDE5 inhibitors such as
Sildenafil (Viagra), Tadalafil (Cialis), etc. which are approved as
Prescription-only medicines.
Due to the presence of hidden chemicals, Herbal Viagra can
cause dangerous Hypotension and can interact with other
prescription drugs.
The products labeled as “Herbal Viagra”, “All Natural”, “Free
from side effects”, etc. should be avoided.
https://www.fda.gov/Drugs/ResourcesForYou/Consumers/Buyin
gUsingMedicineSafely/MedicationHealthFraud/ucm234539.htm
49. TIPS for Smart Use of Herbal
Remedies
Consult with the healthcare professional before trying any herbal
products.
Always look for scientific-based sources of information.
Beware of commercial claims.
Stop taking the herbal product and notify the healthcare
professional, if there is any side effects such as nausea, vomiting,
rapid heartbeat, anxiety, insomnia, diarrhea, or skin rashes.
Purchase only the products which contain details such as herb's
common and scientific name, the name and address of the
manufacturer, a batch and lot number, expiration date, dosage
guidelines, and potential side effects.
Discuss with the Doctor or Pharmacist about possible Herb -
Drug Interactions.
50. TIPS on choosing
Dietary Supplements
Before considering any dietary supplement, consult with
a Doctor or Pharmacist.
Do not replace scientifically proven drugs with unproven
health products or practices.
Always remember that dietary supplements may interact
with medications or other dietary supplements.
Discuss with the health care providers about the current
use of any CAM approaches.
51. Conclusion
Indulge in Healthy activities.
Beware of “Herbal Viagra” products.
Use of Herbal products should always be discussed with the
Doctor or Pharmacist.
Always remember that dietary supplements may interact with
medications or other dietary supplements.
The patients should discuss with their health care provider
regarding the use of CAM therapy.
The patients should be advised not to replace their conventional
treatment with an unproven product or practice.
52. References
Textbook of Complementary and Alternative Medicine
Chun-Su Yuan, Eric J. Bieber
Evidence Based Guide to Complementary and Alternative
Medicine
Bradly P. Jacobs, Katherine Gundling
Male Sexual Dysfunction: Pathophysiology and Treatment
Fouad R. Kandeel
Complementary & Alternative Medicine for Prostate and
Urologic Health
Mark A. Moyad, MD, MPH