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> Health Concerns > Erectile Dysfunction
ERECTILE DYSFUNCTIONVisit The Healthy Living Bookshelf:
Erectile dysfunction (ED) is the inability of a male to attain or sustain an erection sufficient for sexual intercourse. It can be a persistent condition; however, almost half of all men experience ED only occasionally. ED can have physical, psychological, or drug-induced causes.1 Although some doctors used to believe differently, most researchers and doctors now believe that physical factors are responsible for the majority of ED cases. Several conditions may contribute to ED by impairing blood flow to the penis. These include atherosclerosis, diabetes, hypothyroidism, multiple sclerosis, and chronic alcohol abuse. Checklist for Erectile Dysfunction
 What are the symptoms of erectile dysfunction? ED is defined by the symptoms listed above. Symptoms may also include loss of sexual desire (libido), premature ejaculation, or inability to achieve orgasm. How is it treated? Depending on the cause, conventional therapy may include psychological and behavioral counseling, treatment of underlying cardiovascular disease, and avoidance of certain medications (such as cimetidine, antihypertensives, and MAO inhibitors). Drug treatments for ED include male hormone replacement therapy (testosterone, DHEA), sildenafil (Viagra®), and medications inserted or injected into the penis (alprostadil). Penile vacuum devices and surgical options, such as penile implants and vascular repair, are usually limited to those who have not responded to other treatments. Lifestyle changes that may be helpful: Men who smoke have been shown to have an increased incidence of ED.2 Nutritional supplements that may be helpful: Low blood levels of the hormone dehydroepiandrosterone (DHEA) have been reported in some men with ED. In one double-blind trial, 40 men with low DHEA levels and ED were given 50 mg DHEA per day for six months.3 Significant improvement in both erectile function and interest in sex occurred in the men assigned to take DHEA, but not in those assigned to take placebo. No significant change occurred in testosterone levels or in factors that could affect the prostate gland. Experts have concerns about the safe use of DHEA, particularly because long-term safety data do not exist. Dilation of blood vessels necessary for a normal erection depends on a substance called nitric oxide, and nitric oxide formation depends on the amino acid arginine. In a preliminary trial, men with ED were given 2,800 mg of arginine per day for two weeks. Six of the 15 men in the trial were helped, though none improved while taking placebo.4 In a larger double-blind trial, men with ED were given 1,670 mg of arginine per day or a matching placebo for six weeks.5 Arginine supplementation was found to be particularly effective at improving ED in men with abnormal nitric oxide metabolism. Although little is known about how effective arginine will be for men with ED or which subset of these men would be helped, available research looks promising and suggests that at least some men are likely to benefit. Herbs that may be helpful : Yohimbine (the primary active constituent in yohimbe) has been shown in several double-blind trials to help treat men with ED;6 7 negative results have also been reported, however.8 9 Yohimbe dilates blood vessels and may help, regardless of the cause of ED. A tincture of yohimbe bark is often used in the amount of 5 to 10 drops three times per day. Standardized yohimbe extracts are also available. A typical daily amount of yohimbine is 15 to 30 mg. It is best to use yohimbe and yohimbine under the supervision of a physician. Asian ginseng (Panax ginseng) has traditionally been used as a supportive herb for male potency. A double-blind trial found that 1,800 mg per day of Asian ginseng extract for three months helped improve libido and the ability to maintain an erection in men with ED.10 Ginkgo biloba may help some men with ED by increasing blood flow to the penis. One double-blind trial found improvement in men taking 240 mg per day of a standardized Ginkgo biloba extract (GBE) for nine months.11 A preliminary trial, involving 30 men who were experiencing ED as a result of medication use (selective serotonin reuptake inhibitors and other medications), found that approximately 200 mg per day of GBE had a positive effect on sexual function in 76% of the men.12 Damiana (Turnera diffusa) is a traditional herbal treatment for men with ED. However, no modern clinical trials have confirmed its effectiveness. Other integrative approaches that may be helpful: ED that cannot be linked to physical causes has been successfully treated by hypnosis.13 In one trial, three hypnosis sessions per week, later decreased to one per month over a six-month period led to improvement in 75% of men in the trial. Acupuncture might be of some benefit for men with ED. Electroacupuncture, which is acupuncture accompanied by electrical stimulation, was performed on various acupuncture points in men with ED in a preliminary trial of men with this condition.14 Two treatments were administered every week for one month. An improvement in quality of erection was observed in 15% of the participants and an increase in sexual activity was reported by 31% of the men. Another preliminary trial15 found good results in over half of the men treated, but the only controlled trial of electroacupuncture for ED16 found that placebo also produced a large improvement in sexual function—an effect similar to that of acupuncture. Controlled trials with larger groups of men are necessary to better test the efficacy of acupuncture therapy for men suffering from ED. References: 
1. Hernández-López C. Drugs do not only relieve male menopause. BMJ 2000;321:451 [letter]. 2. Condra M, Morales A, Owen JA, et al. Prevalence and significance of tobacco smoking in impotence. Urology 1986;27:495–8. 3. Reiter WJ, Pycha A, Schatzl G, et al. Dehydroepiandrosterone in the treatment of erectile dysfunction: a prospective, double-blind randomized, placebo-controlled study. Urology 1999;53:590–5. 4. Zorgniotti AW, Lizza EF. Effect of large doses of the nitric oxide precursor, L-arginine, on erectile dysfunction. Int J Impot Res 1994;6:33–6. 5. Chen J, Wollman Y, Chernichovsky T, et al. Effect of oral administration of high-dose nitric oxide donor L-arginine in men with organic erectile dysfunction: results of a double-blind, randomized study. BJU Int 1999;83:269–73. 6. Ernst E, Pittler MH. Yohimbine for erectile dysfunction: A systematic review and meta-analysis of randomized clinical trials. J Urol 1998;159:433–6. 7. Carey MP, Johnson BT. Effectiveness of yohimbine in the treatment of erectile disorder: Four meta-analytic integrations. Arch Sex Behav 1996;25:341. 8. Kunelius P, Häkkinen J, Lukkarinen O. Is high-dose yohimbine hydrochloride effective in the treatment of mixed-type impotence? A prospective, randomized, controlled double-blind crossover study. Urol 1997;49:441–4. 9. Mann K, Klingler T, Noe S, et al. Effect of yohimbine on sexual experiences and nocturnal tumescence and rigidity in erectile dysfunction. Arch Sex Behav 1996;25:1–16. 10. Choi HK, Seong DH, Rha KH. Clinical efficacy of Korean red ginseng for erectile dysfunction. Int J Impotence Res 1995;7:181–6. 11. Sohn M, Sikora R. Ginkgo biloba extract in the therapy of erectile dysfunction. J Sec Educ Ther 1991;17:53–61. 12. Cohen AJ, Bartlik B. Ginkgo biloba for antidepressant-induced sexual dysfunction. J Sex Marital Ther 1998;24:139–43. 13. Aydin S, Ercan M, Çaskurlu T, et al. Acupuncture and hypnotic suggestions in the treatment of non-organic male sexual dysfunction. Scand J Urol Nephrol 1997;31:271–4. 14. Kho HG, Sweep CG, Chen X, et al. The use of acupuncture in the treatment of erectile dysfunction. Int J Impot Res 1999;11:41–6. 15. Yaman LS, Kilic S, Sarica K, et al. The place of acupuncture in the management of psychogenic impotence. Eur Urol 1994;26:52–5. 16. Aydin S, Ercan M, Caskurlu T, et al. Acupuncture and hypnotic suggestions in the treatment of non-organic male sexual dysfunction. Scand J Urol Nephrol 1997;31:271–4. |
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