Erectile Dysfunction

Erectile dysfunction (ED) is the inability to get and maintain normal penile erection. Another name for ED is impotence, but impotence means more than erectile dysfunction and is starting to replaced by the more appropriate term (Impotentia is a Latin word that mean inability; there are several different forms of inability related to reproduction i.e. the inability to get pregnant). ED is very common, for instance in the Massachusetts Male Aging Study, an ongoing survey of 1,709 men over 40; more than half the participants (52 percent) report at least some erection difficulty.

Ed can have two causes, physical and psychological. Psychological factors are responsible for 10%-20% of all cases of ED. Stress, depression, anxiety, low self esteem, indifference to life and guilt are situations that can effect a man’s sexual well being.

Physical causes of ED can range from cardiovascular disease, diabetes and other endocrine disorders, medications and neurological disorders such as stroke and multiple sclerosis. Cardiovascular disease as a cause is most common and is usually associated with atherosclerosis and high blood pressure.

Primary ED a condition where a man has never had the ability to maintain or sustain erections. Secondary ED is much more common, and occurs when a man has had the ability to have erectionsin the past but experiences a problem later in life.

Diagnosis and Pharmaceutical Interventions

Diagnosis is usually from a detailed history given to a health care practitioner. Duplex ultrasound may be used to evaluate blood flow, venous leak, signs of artherosclerosis, and scarring or calcification of erectile tissue. Penile nerves function tests such as the bulbocavernosus reflex test are used to determine if there is sufficient nerve sensation in the penis. The physician squeezes the glans (head) of the penis, which immediately causes the anus to contract if nerve function is normal. A physician measures the latency between squeeze and contraction by observing the anal sphincter or by feeling it with a gloved finger inserted past the anus. Specific nerve tests are used in patients with suspected nerve damage as a result of diabetes or nerve disease. Nocturnal penile tumescence (NPT) is testing done while the man is asleep; it is normal for a man to have five to six erections during sleep, especially during rapid eye movement (REM). Their absence may indicate a problem with nerve function or blood supply in the penis.

Conventional Therapies

Oral medications used to treat erectile dysfunction include selective enzyme inhibitors that increase the amount of nitric oxide, which dilates the blood vessels e.g. sildenafil (Tradename – Viagra), vardenafil HCl (Tradename- Levitra) and tadalafil (Tradename- Cialis). Selective enzyme inhibitors are available by prescription and may be taken up to once a day to treat ED. They improve partial erection. There have been problems associated with the use of these drugs, eye problems leading to blindness and sudden death. The cannot be taken concurrently with medications for heart disease.

Vacuum Devices

Vacuum devices (commonly known as “Swedish Pumps”) work best in men who are able to achieve partial erections on their own. They are easy to use at home, require no other procedure, and typically improve erections regardless of the cause of impotence. Some men experience a numbing feeling afterwards. Since the penis is flaccid between the ring and the body, the erection may be somewhat floppy. Vacuum devices work by manually creating an erection.

Penile Implants

Surgery usually has one of three goals: to implant a device that can cause the penis to become erect; to reconstruct arteries to increase flow of blood to the penis; to block off veins that allow blood to leak from the penile tissues. Implanted devices, known as prostheses, can restore erection in many men with ED.

Lifestyle and Dietary Modifications

Men who smoke have been shown to have an increased incidence of ED. In a study of obese men with erectile dysfunction, a two-year lifestyle program consisting of a low-calorie diet plus regular exercise resulted in a significant improvement in erectile function, which became normal in 31% of the participants.

Nutritional Factors Shown to be Beneficial

L-Arginine

Dilation of blood vessels necessary for a normal erection depends on a substance called nitric oxide, and nitric oxide formation depends on arginine. Arginine supplementation has been found to be particularly effective at improving ED in men with abnormal nitric oxide metabolism.
Dose: 1-3 grams a day

Panax Ginseng

Asian ginseng (Panax ginseng) has traditionally been used as a supportive herb for male potency.
Dose: 1-2 g a day or 100 mg of the standardized extract (standardized to 4% total ginsenosides) twice a day.

Ginkgo Biloba

Gingko can help ED by improving blood flow to the penis.
Dose: 240 mg twice a day

Butea superba

Butea is a Thai plant that has been used traditionally to increase sexual vigor.
Dose: 500-1000 mg a day

Tribulus terrestris

Extracts of Tribulus contain the constituent protodioscin have been studied for sexual effects. Tribulus is thought to stimulate the conversion of testoseterone, and possesses aphrodisiac activity.
Dose: 500 – 750 mg of the standardized extract