Complementary and alternative therapies for erectile dysfunction

Complementary and
Alternative Therapies for
Erectile Dysfunction
Dr. P.Naina Mohamed PhD
Pharmacologist

 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.

Physiological Mechanism of
Erection
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3731873/

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.

Psychological Causes of
 Psychological Causes:
 Depression
 Anxiety
 Relationship problems
 Lack of sexual knowledge
 Past sexual problems
 Past sexual abuse
 Being in a new relationship
 Worry or Fear

Other Causes of Erectile
Dysfunction
 Medicines (Diuretics, Betablockers, Fibrates,
Antipsychotics, Antidepressants, Corticosteroids, H2
blockers, Anticonvulsants, Antihistamines,
Antiandrogens, Cytotoxics)
 Excessive Alcohol intake
 Smoking
 Inadequate physical activity
 Obesity
 Illegal drugs like Cannabis, Heroin or Cocaine
 Cycling

Management of Erectile
Dysfunction
 Pharmacological Management:
 Phosphodiesterase-5 (PDE-5) inhibitors – Sildenafil (Viagra), Tadalafil (Cialis), Vardenafil
(Levitra), Avanafil (Spedra).
 Alprostadil
 Hormone therapy
 Non-Pharmacological Management:
 Quit Smoking
 Avoid Alcohol and other illegal drugs
 Exercise regularly & Lose Weight
 Reduce stress
 Psychological treatments:
 Sensate focus
 Psychosexual counselling
 Cognitive behavioural therapy (CBT)
 Pelvic floor muscle exercises
 Vacuum pump
 Penile implants - Semi-rigid implants, Inflatable implants
 Surgery

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.

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.

Types of CAM Practices
 Mind-Body and Manipulative
Practices
 Traditional Medical Systems
 "Modern" Medical Systems

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

Traditional Medical Systems

• Ayurvedic medicine
• Siddha medicine
• Unani medicine
• Native American medicine
• Tibetan medicine
• Traditional Chinese medicine
• Curanderismo

"Modern" Medical Systems

•Homeopathy
•Naturopathy
•Osteopathy
•Chiropractic
•Anthroposophic medicine

CAM for Erectile Dysfunction
 Mind and Body Practices:
 Acupuncture
 Herbal Supplements:
 Yohimbe bark (Pausinvstalia yohimbe)
 Ginseng (Panax ginseng – Korean Red Ginseng)
 Ginkgo (Ginkgo biloba)
 Saffron (Crocus sativus)
 Nutmeg (Myristica fragrans)
 Tongkat Ali (Eurycoma longifolia)
 Maca (Lepidium meyenii - Peruvian Ginseng)
 Kaempferia parviflora (Thai black Ginger, Thai Ginseng)
 Mondia whitei
 Schisandra chinensis
 Horny Goat Weed (Epimedium)


 Foods & Juices
 Water Melon (Citrullus lanatus)
 Dates (Phoenix dactylifera)
 Drumstick (Moringa oleifera)
 Pomegranate (Punica granatum)
 Fig (Ficus carica)
 Groundnuts (Arachis hypogaea)
 Pistachio Nuts (Pistacia vera)
 Onion (Allium Cepa)
 Coffee
 Ginger (Zingiber officinale)
 Flavonoids rich Foods (Blueberries, Cranberries, Oranges, Grapefruit, Tea, Apples, Pears, Dark
Chocolate)
 Omega-3 Fatty Acids rich Foods ((Flaxseed, Fish (Mackerel, Salmon, Sardines), Walnuts, Chia
seeds, etc.)
 Zinc rich Foods (Beef, Shrimp, Oysters, Kidney beans, Flax Seeds, Watermelon seeds, Pumpkin
Seeds, Spinach, Nuts, Dark chocolate, Mushrooms, etc.)
 Arginine rich Foods (Meats, Pumpkin Seeds, Nuts)

 Nutritional supplements:
Arginine
Dehydroepiandrosterone (DHEA)
Folic acid
Zinc
Vitamin E

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

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

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.

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

Saffron (Crocus sativus)
 http://journals.sagepub.com/doi/full/10.1177/2156587
215583756

Nutmeg (Myristica fragrans)
oNutmeg (Myristica fragrans) may be used as an effective and
safe alternative remedy in sexual disorders.

Tongkat Ali (Eurycoma longifolia)
http://www.sciencedirect.com/science/article/pii/S0965229

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.

Kaempferia parviflora
(Thai black Ginger, Thai Ginseng)
 Kaempferia Parviflora (KP) might be useful to treat Age-related erectile
dysfunction.

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.

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

Horny Goat Weed
(Epimedium)
 Horny Goat Weed (Epimedium) is used in Traditional Chinese
Medicine (TCM) to treat erectile dysfunction and low libido.

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

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.

Dates (Phoenix dactylifera)

Drumstick (Moringa oleifera)

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

Fig (Ficus carica)
 Fig (Ficus carica) has been found to improve sperm motility, count, and
testosterone level in diabetic rats.

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

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

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

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

Ginger (Zingiber officinale)
 Ginger might be useful to relieve Age-associated and
Diabetic ED.

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

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).

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

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.

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

Zinc
 Foods high in zinc include Beef, Shrimp, Oysters, Kidney
beans, Flax Seeds, Watermelon seeds, Pumpkin Seeds,
Spinach, Nuts, Dark chocolate, Mushrooms, etc.

Vitamin E
 Vitamin E ameliorates the Age-associated Erectile Dysfunction.

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)

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

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.

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.

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.

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

References
 http://onlinelibrary.wiley.com/doi/10.1002/j.1939-
4640.1999.tb03371.x/abstract
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC256111
3/
 http://www.hindawi.com/journals/bmri/2014/868062/
 http://www.sciencedirect.com/science/article/pii/S0378
512211002106#bib0100
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC318442
0/
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC292817
7/

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