^Effects of Korean ginseng berry extract on sexual function in men with erectile dysfunction: a multicenter, placebo-controlled, double-blind clinical study. - Author: Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, and R&D Center, Amorepacific Corporation, Gyeonggi-do, South Korea (20 Dec 2012)
The Science: Chemicals inside these plants called ginsenosides are thought to ramp up the physiological pathway that makes nitric oxide, the neurotransmitter that gets the blood flowing during penile erection. Some studies support that idea: one found that ginsenoside-rich ginseng berry extracts relaxed smooth muscle inside rabbit erectile tissue. But so far there haven’t been high-quality double-blind and randomized trials of the chemicals’ effect on humans. The jury’s still out on whether ginsenosides have any effect on people at all, or (if they do) whether they work as well as medications like Viagra.
A combination of yohimbine and L-arginine is shown to significantly improve erectile function in people with ED. L-arginine is an amino acid that helps expand blood vessels. It’s regarded as safe and effective for ED but can cause side effects like nausea, diarrhea, and stomach cramps. Avoid taking L-arginine with Viagra, nitrates, or any high blood pressure medications.
The study was conducted between April 2000 and March 2003 in western Uganda. To collect this data indirect asking of questions and investigations that do not refer or offend anyone were used since nobody especially men can say openly that they have this problem. These methods are explained in the textbook of ethnobotany and others have been used in the field for this kind of studies in Uganda and elsewhere in the world10,12,13,14,21. These methods included visiting the traditional healers to document the indigenous knowledge (IK), regarding medicinal plants used, gender and socio-cultural aspects and where the plants are harvested. Informal and formal conversations, discussions and interviews, market surveys and field visits were conducted.
DHEA. DHEA, or dehydroepiandrosterone, is a natural hormone that the body uses to make the male hormone testosterone. DHEA and testosterone decrease with age, just as ED increases with age, so it seems that taking DHEA might protect against ED. But Harris says that "it is unlikely that taking DHEA would raise your testosterone enough to make much difference." DHEA should not be used by people with liver problems; it also has many side effects.
Experts feel that treating erectile dysfunction on your own, without consulting a doctor, is unsafe. "If you have ED, the first thing you need is a diagnosis," says impotence expert Steven Lamm, MD, a New York City internist and the author of The Hardness Factor (Harper Collins) and other books on male sexual health. He says men with severe erectile dysfunction probably need one of the prescription ED drugs, which include Levitra (vardenafil) and Cialis (tadalafil) as well as Viagra. But, he says, mild ED -- including the feeling that "you're not as hard as you could be" -- often responds to natural remedies.
Even in the absence of deficiency, L-carnitine supplementation has shown promise for improving erectile function in men. It is available commercially in tablet, capsule and liquid capsule form. Recommended dosage is in the range of 500 – 2000 mg of propionyl L-Carnitine once a day which is often used in combination with a 50 mg dose of Viagra which is given twice a week.
Ginseng. Korean red ginseng has long been used to stimulate male sexual function, but few studies have tried systematically to confirm its benefits. In one 2002 study involving 45 men with significant ED, the herb helped alleviate symptoms of erectile dysfunction and brought "enhanced penile tip rigidity." Experts aren't sure how ginseng might work, though it's thought to promote nitric oxide synthesis. "I would recommend ginseng [for men with ED]," says Espinosa. Discuss with your doctor before taking it since ginseng can interact with drugs you may already be taking and cause allergic reactions.
When you are stressed, your body has to overwork to fight off the stress. Hence you will lose much energy to deal with this condition. Besides, trying to have sex makes the body have to face new stress. This results in the lack of erections. So, if you want to prevent erectile dysfunction, stress is the thing you need to eliminate immediately. Dr. Julian Nesbitt said: “Stress releases cortisol which can negative physical effects as well as emotional psychological effects which you being stressed you may be less likely to maintain an erection. Try to take time for your self and try breathing/ relaxation exercises.” 
Currently, there are four orally active drugs are available to treat ED. These include: sildenafil citrate (Viagra [Pfizer, USA]), vardenafil hydrochloride (Levitra [Bayer, Germany]), tadalafil (Cialis [Eli Lilly, USA]) and avanafil (Stendra, Spedra [Vivus Inc, USA]). These drugs inhibit the enzyme phosphodiesterase type 5 (PDE-5), which is responsible for the hydrolysis of cGMP. PDE-5 inhibitors and cGMP act as effectors of dilation of smooth muscle of cavernosal bodies. PDE-5 inhibitors are contraindicated in patients taking any kind of nitrate therapy for angina, and may not be appropriate for men with certain health conditions, such as severe heart disease, heart failure, history of stroke or heart attack, uncontrolled high blood pressure or diabetes, and patients with pigmental retinopathy. PDE-5 inhibitors are less effective in men with diabetes and men who have been treated for prostate cancer. PDE-5 inhibitors are also not effective in men with retinitis pigmentosa, a genetic disease involving PDE-5 deficiency. The common side effects of PDE-5 inhibitors include gastrointestinal upset, headache, nasal congestion, back pain and dizziness. The PDE-5 inhibitors may interact with other medications including antihypertension drugs. Nonetheless, the PDE-5 inhibitors are generally safe and effective for most men. The primary mechanism of action of these drugs is through the mediation of NO. NO is one of the key molecules involved in ED. It is a short-lived, highly permeable, pleiotropic, gaseous molecule, secreted from the postganglionic cavernosal parasympathetic nerves, endothelium of the cavernosal blood vessels, platelets in the cavernosal sinuses and phagocytic cells (monocytes, macrophages and neutrophils). NO acts on platelets to inhibit platelets adhesion and aggregation. NO causes relaxation of the smooth muscle of the cavernosal blood vessels of the penis, leading to vasodilation, tumescence and stimulation. Release of NO in the corpus cavernosum of the penis during stimulation activates the enzyme guanylate cyclase, which results in increased levels of cGMP, producing smooth muscle relaxation in the corpus cavernosum and resulting in increased blood flow (5). NO is mainly produced from cavernosal nerves, which are nonadrenergic, noncholinergic nerves within the penis, and acting via its second messenger cGMP. It has been suggested that maintaining normal body weight and mild exercise, as well as dietary supplementation of folic acid, zinc, calcium, vitamin C, vitamin E and L-arginine, a precursor of NO, can support the biochemical pathway leading to NO release [6]. NO is an effector molecule that is involved in a number of intracellular functions such as vasorelaxation, endothelial regeneration, inhibition of leukocyte chemotaxis and platelet adhesion [7]. A small proportion of autonomic nerves do not release either Ach or norepinephrine [8]. For example, the cavernous nerves predominantly release NO in the penis. The exact mechanism is not known, but it is believed to be through increased intracellular calcium. Another gaseous molecule produced in the corpora cavernosa is hydrogen sulphide (H2S), which is also known to be involved in erectile function [9]. H2S activates ATP-sensitive potassium channels in smooth muscle cells. Some reports indicate that NO acts in large vessels and H2S in small vessels. A high level of tumour necrosis factor-alpha has been shown in ED patients [10]. Although current ED therapies using PDE-5 inhibitors are safe and effective, approximately 40% of ED patients do not respond to currently available treatment [11,12]. For these patients, herbal therapy may be useful.
As per Massachusetts Male Aging Study, it is stated that 50% of male population is experiencing this erectile dysfunction at some point in their lifetime, especially at the age of 40 or above. However, men who are suffering from this problem unable to talk about it and suffer in silence, as it leads to low self-esteem, depression and guilty feeling.
Penile implants - are generally used if physical damage (like an accident) makes the anatomical parts needed for an erection not work. These are inserted by surgery and can provide a permanent treatment choice if others fail to work. The implants can be semi-rigid or inflatable. They can be pretty expensive and are not usually available on the NHS.

Many products contain undocumented “fillers” that can cause allergic reactions.  In recent years, the FDA has found over 300 herbal products that contain hidden, deceptively labeled, or dangerous ingredients4. And since 2015, the FDA has released public warnings on more than 160 ED supplements and “male enhancement” products found to contain dangerous ingredients and contaminants5 .   An independent study of FDA data, conducted in 2018, found almost 800 herbal supplements that contained unlisted ingredients6.
As per Massachusetts Male Aging Study, it is stated that 50% of male population is experiencing this erectile dysfunction at some point in their lifetime, especially at the age of 40 or above. However, men who are suffering from this problem unable to talk about it and suffer in silence, as it leads to low self-esteem, depression and guilty feeling.
The semi-structured interviews and discussions were held with the specialist resource users and other knowledgeable people on particular ailments by use of interview schedules for each respondent. Interviewed people were mainly the herbalists (both men and women) and TBAs. In this selection to some extent, ethnic groups were recorded where possible because different people use the same plants differently. The time and place of interviews were arranged according to the schedules of the respondent. Depending on where the interviews and discussions were held, recording was done immediately or afterwards or appointments were made for more details in a more convenient place arranged with the respondent. Key informants were identified and later interviewed separately and even followed for further details. Some of the key questions asked included, name of the respondents, the village or parish or sub-county he or she was coming from, diseases treated, plant local names used, parts harvested, methods of preparation and administration. In addition, ingredients and incantations with which the plants are used for preparation and where the herbal medicines were harvested were documented.
Yohimbe A number of clinical trials have shown that the primary component of this bark from an African tree can improve sexual dysfunction associated with selective-serotonin reuptake inhibitors (SSRIs) used to treat depression. This herb has been linked to a number of side effects, including increased blood pressure, fast or irregular heartbeat, and anxiety. Yohimbe shouldn't be used without a doctor's supervision.
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