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Erectile Dysfunction

 

Erectile Dysfunction (Impotence) Introduction

Impotence, also known as erectile dysfunction, is defined as an inability to develop and maintain an erection that is satisfactory for sexual activity. Most cases of erectile dysfunction are secondary erectile dysfunction, which means that a man has lost the ability to maintain erections. Primary erectile dysfunction is a situation where the man has never been able to develop an erection. The causes of erectile dysfunction are varied and include: psychological, vascular origins (arteriosclerosis, diabetes), neurological (stroke, injury, seizure), hormonal (low testosterone, Cushings disease), and iatrogenic (drugs, surgery, etc.). Diagnosis of erectile dysfunction is usually arrived at by patient report and determination of a normal phase of nocturnal penile tumescence (NPT). The NPT test can point towards a psychological cause (most common), or one that is organic in nature. Patients with erectile dysfunction of a psychological origin will tend to have nocturnal erections. [1, 2]

Erectile Dysfunction Statistics

  • It is estimated that between 10 and 20 million adult men in the United States are affected by Erectile Dysfunction.
  • Roughly 52% of men between the ages of 40-70 are affected, with the percentage increasing with age. [3]

Erectile Dysfunction Symptoms

Patients complain of an inability to achieve or maintain an erection that is sufficient for sexual intercourse. Patients with Erectile Dysfunction may also show signs of depression, anxiety, prostate surgery, and may have a history of drug use (prescribed or illicit). [4]

Erectile Dysfunction Treatment

Standard treatment for erectile dysfunction depends on both the cause of erectile dysfunction, as well as the ability of the patient to respond to a given treatment. Psychological treatment is often an important component in the treatment of erectile dysfunction and should be undertaken even in situations where the erectile dysfunction is of an organic origin.

Pharmacological therapies for erectile dysfunction include oral Sildenfil (Viagra), and injected PGE1 (Alprostadil). Surgical implantation of a penile prosthetic may be indicated in some cases of erectile dysfunction, but the risks of surgery must be considered and discussed with the Physician. Synthetic Testosterone can be used in cases of hypogonadism or other hormonal disorders. Of course, if the patient’s erectile dysfunction has it’s origins in another organic disease process then the disease in question must be addressed directly and will usually result in an improvement in sexual function. If erectile dysfunction is determined to be the result of medications then the patient and his physician must work together to find other options for medications that may have less sexual side effects. [5, 6]

Supplements helpful for Erectile Dysfunction

Arginine:

Arginine is a conditionally essential amino that is the precursor for the formation of nitric oxide, which is an important compound for the relaxation of blood vessels. The proper relaxation of blood vessels in the penis is necessary in order to develop and maintain an adequate erection. Supplementation with the amino acid L-arginine has been explored for the purpose of treating erectile dysfunction. There have been encouraging results using large doses of L-arginine to correct erectile dysfunction with high success rates taking place over periods of up to 3 months. [7]

Caution: Large doses of L-arginine should be balanced with the amino acid L-lysine, as such doses of L-arginine may lead to outbreaks of Herpes (if the virus is present in your body) lesions, and/or Cold sores.

Pycnogenol:

Pycnogenol is an antioxidant compound derived from the bark of pine trees. Pycnogenol is an important cofactor in the function of the enzyme nitric oxide syntase, which is responsible for the formation of nitric oxide. As already mentioned, nitric oxide is important for developing erections as it causes the relaxation of blood vessels necessary for erections too occur. It has been found that Pycnogenol, when combined with the amino acid L-arginine, can result in improvements in erectile function in a majority of those men involved in the study. [8]

DHEA (Dehydroepiandrosterone):

DHEA is one of the series of compounds that is an intermediary in the synthesis of numerous sex hormones. There is evidence to suggest that in older patients there is some decline in DHEAS (the measured form of DHEA) levels in men with erectile dysfunction as opposed to healthy control groups. The therapeutic effect of DHEA on erectile dysfunction seems to be primarily applicable in cases where erectile dysfunction is not of a neurological origin, due to diabetes mellitus or other organic causes. DHEA does seem to improve erectile function in cases where there is a psychological cause and where DHEAS are low. [9, 10]

Zinc:

Zinc in an important mineral nutrient that is involved in many physiological functions including the synthesis of testosterone. While zinc has not been studied as a therapy for the treatment of men overall, it has shown promise in improving the sexual function of men with serious kidney disease and who are often undergoing dialysis. It seems reasonable to supplement zinc in men that are experiencing erectile dysfunction. It is possible that the zinc will help to optimize testosterone levels and prove healthful in a variety of other areas. [11, 12]

Caution: Anyone with renal disease or who is on dialysis should discuss any dietary changes or supplements use with their physician.

Botanicals:

Yohimbe (Pausinystalia yohimbe): Yohimbe is a well known herbal aphrodisiac that is indigenous to Africa where it reputed to be a sexual tonic. Yohimbe shows a moderate ability to increase erections and libido in situations where there is a psychological or physiological cause.[13]

Panax ginseng:

Ginseng is considered to be in the group of “adaptogenic” plants which have been used in Chinese medical herbology for centuries. Clinical studies on Red Ginseng has shown that statistically significant numbers of men experience improvement in sexual function. Parameters that have been shown to be improved due to Red Ginseng include; penetration, erection maintenance, penile rigidity, and early detumesence. [14, 15]

Ginkgo (Ginkgo biloba):

Ginkgo is a popular herbal treatment for improving memory as well as cognitive function. It has also been applied to the treatment of erectile dysfunction. It is thought that the circulation enhancing effects of Ginkgo are responsible for its sexual function enhancing properties. Ginkgo has shown particular efficacy in the treatment of erectile dysfunction that has been induced by the SSRI family of anti-depressants. It is important to note that women have also had enhanced sexual function with the use of Ginkgo as well. [16]

References

[1] Beers and Berkow, The Merck Manual (Whitehouse: Merck Research Labs, 1999), 1836-38.

[2] Yarnell, Naturopathic Urology and Men’s Health (Wenachee, WA: Healing Mountain Publishing, 2001), 299-312.

[3] Beers and Berkow, The Merck Manual (Whitehouse: Merck Research Labs, 1999), 1836-38.

[4] Beers and Berkow, The Merck Manual (Whitehouse: Merck Research Labs, 1999), 1836-38.

[5] Beers and Berkow, The Merck Manual (Whitehouse: Merck Research Labs, 1999), 1836-38.

[6] Yarnell, Naturopathic Urology and Men’s Health (Wenachee, WA: Healing Mountain Publishing, 2001), 299-312.

[7] Zorgniotti AW, Lizza EF. Effect of large doses of the nitric oxide precursor, L-arginine, on erectile dysfunction. Int J Impot Res. 1994 Mar;6(1):33-5; discussion 36.

[8] Stanislavov R, Nikolova V.Treatment of erectile dysfunction with pycnogenol and L-arginine. J Sex Marital Ther. 2003 May-Jun;29(3):207-13.

[9] Reiter WJ, Schatzl G, Mark I, Zeiner A, Pycha A, Marberger M. Dehydroepiandrosterone in the treatment of erectile dysfunction in patients with different organic etiologies. Urol Res. 2001 Aug;29(4):278-81.

[10] Reiter WJ, Pycha A, Schatzl G, Klingler HC, Mark I, Auterith A, Marberger M. Serum dehydroepiandrosterone sulfate concentrations in men with erectile dysfunction. Urology. 2000 May;55(5):755-8.

[11] Mahajan SK, Abbasi AA, Prasad AS, Rabbani P, Briggs WA, McDonald FD. Effect of oral zinc therapy on gonadal function in hemodialysis patients. A double-blind study. Ann Intern Med. 1982 Sep;97(3):357-61.

[12] Khedun SM, Naicker T, Maharaj B.Zinc, hydrochlorothiazide and sexual dysfunction. Cent Afr J Med. 1995 Oct;41(10):312-5.

[13] Yarnell, Naturopathic Urology and Men’s Health (Wenachee, WA: Healing Mountain Publishing, 2001), 299-312.

[14] Hong B, Ji YH, Hong JH, Nam KY, Ahn TY. A double-blind crossover study evaluating the efficacy of korean red ginseng in patients with erectile dysfunction: a preliminary report. J Urol. 2002 Nov;168(5):2070-3.

[15] Choi HK, Seong DH, Rha KH. Clinical efficacy of Korean red ginseng for erectile dysfunction. Int J Impot Res. 1995 Sep;7(3):181-6.

[16]Cohen AJ, Bartlik B. Ginkgo biloba for antidepressant-induced sexual dysfunction. J Sex Marital Ther. 1998 Apr-Jun;24(2):139-43.