Classically the neuro-physiology of ejaculation traces the 3 Phases in which ejaculation is a complex event involving the (I) the propulsion of sperm and seminal plasma into the prostatic urethra which is accompanied by (II) bladder neck closure and (III) coordinated contractions of the bulbocavernosus and ischiocavernosus muscles, striated muscles of the pelvic floor, lower limbs and trunk. In the Asian Society of the Aging Male Study [2004] 63% have reduced erection, 68% reduced or absent ejaculation and 19% pain or discomfort at ejaculation. Disorders of ejaculation can be due to: (I) disorders of production of sperm or seminal plasma/prostatic secretions (II) disorders of propulsion. In the case of anejaculation (absence of ejaculatory) which is the ultimate disorder of ejaculation, the causes can be best classified as (I) primary or secondary. After covering psychogenic causes of ejaculation failure, the organic causes due to non-dynamic and obstructive etiologies in the prepubertal and post pubertal male will be highlighted. More details will be given on retarded ejaculation, premature ejaculation, aspermia, painful and weak (poor propulsive force) ejaculation. The evaluation of the patient must include a detailed history taken from the patient and often his partner. Aside from haematologic tests, various forms of radiological and ultrasonic imaging, neurophysiologic studies may be required. For the general practitioner the commonest scenario will be in the ED Clinic with abundant men with performance anxiety presenting with premature ejaculation. In the male aging clinic lack of arousal is the commonest cause of retarded orgasm and ejaculation but this group is plagued by decreased touch sensitivity, the need for more direct stimulation, reduced drive to orgasm, a less intense orgasm, ejaculation being weaker and of reduced quantity and disturbing complaints of a longer recovery period and less number of attainable orgasms per day or week. Thus it is not mere rumor that “by the time a man reaches 55, the refractory period to ‘do it again for a man’ increases to 12 hours or even up to a week”. In the STD clinic, painful or bloody ejaculation is frequently seen. The Condom may cause condom retarded orgasm/ejaculation.


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Refusal from smoking can be considered another ED cure. The matter is that the impairment of erectile function is often a result of cardiovascular disorders. Such disorders don’t let the blood normally flow through the body. Blood delivery to the manhood also suffers since the arteries are blocked or narrowed. This is exactly what happens during smoking.
For many men, stopping smoking is an erectile dysfunction remedy, particularly when ED is the result of vascular disease, which occurs when blood supply to the penis becomes restricted because of blockage or narrowing of the arteries. Smoking and even smokeless tobacco can also cause the narrowing of important blood vessels and have the same negative impact. 
Eleuthero, a distant relative of Panax ginseng, has been used in Chinese medicine for 2,000 years. Eleuthero, also called Siberian ginseng, has been shown to enhance physical performance in several studies. Research shows it has antioxidant, immune-boosting, and cholesterol-lowering properties. A study in the Journal of Ethnopharmacology concludes that the active constituents, eleutherosides, alleviate both physical and mental fatigue.
Eleutherococcus senticosis (Siberian Ginseng) is an overall system toner and improves performance and stamina. In the 1950's it was used extensively by Soviet athletes to enhance athletic performance. It can combat stress and is a tonic stimulant for the adrenal hormones. One of the most important active ingredients in Siberian or Oriental Ginseng is the ginsenosides, which greatly promote blood flow to the brain and peripherals, including the penis. In oriental medicine, Ginseng is highly respected and prized as a herb which promotes male or 'yang' energy, improving circulation, boosting vitality and acting as an overall systemic invigorator.
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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.
These three versatile herbs, used for centuries in Chinese and Ayurvedic medicine, have a variety of health benefits for both men and women. However, they work in several ways to address health issues of top concern to men, such as erectile dysfunction (ED) and high blood pressure, and I believe they should be a part of every man’s long-term plan for overall health.
However, in some people there may be a genetic defect which prevents production of carnitine in body. Additionally, certain disorders of liver, kidneys and brain may also impair the production of enough carnitine. Some medications may also cause carnitine deficiency. In such cases, it becomes necessary to supplement carnitine to ensure normal smooth functioning of our body.
Most sincere gratitude to the sponsors, Third World Organisation for Women in Sciences (TWOWS), NUFU Medicinal plants Project through Botany Department, Faculty of Science, Makerere University, UNESCO-MAB Young Scientist Research Award, 2000, Gender studies, Makerere University and WHO-Uganda. The Staff of Queen Elizabeth National Park, Field assistants, local leaders, the resource users and all respondents, particularly the TBAs and traditional healers in Bushenyi, Mbarara and Kasese Districts who provided the information.
For centuries, men have tried all sorts of natural remedies for erectile dysfunction (ED) -- the repeated inability to get or maintain an erection firm enough for sexual intercourse. But do they really work? It is simply not scientifically known at this point. Furthermore, you take these remedies at your own risk, because their safety profiles have not been established. What follows are commentaries by experts and reviews in the field of alternative treatments that are available over the counter for erectile dysfunction and impotence.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

W somnifera (ashwagandha), also referred to as winter cherry (family Solanaceae), grows in Africa, the Mediterranean, India, Pakistan, Bangladesh, Afghanistan, South Africa, Egypt, Morocco, Congo and Jordan [36]. The roots of the plant contain steroid alkaloids and steroidal lactone, which are the main constituents of ashwagandha; these compounds are referred to as withanolides. Among the various alkaloids, withnine is the main constituent. The other alkaloids are somniferin, somnine, somniferine, withananine, pseudowithanine, tropine, pseudotropine, cuscohygrine, anferine and anhydrine. Two acyl steryl glucosides (sitoindoside VII and sitoindoside VIII) have been isolated from the root. The withanolides contain a C28 steroidal nucleus with a C9 side chain and six-membered lactone rings. Ashwagandha root also contains flavonoids and many ingredients of the withanolide class. It has several medicinal applications (aphrodisiac, liver tonic, anti-inflammatory agent, astringent), and is used to treat bronchitis, asthma, ulcers, insomnia, senility and dementia. Clinical trials and studies involving animal models support the use of ashwagandha for anxiety, cognitive and neurological disorders, inflammation and Parkinson’s disease. It also provides cryoprotective benefits to patients undergoing radiation and chemotherapy, and shows beneficial effects for nervous exhaustion. W somnifera is used as an aphrodisiac, sedative and rejuvenative, and is also used to treat chronic fatigue, dehydration, bone weakness, muscle weakness, loose teeth, impotency, premature ejaculation, debility, constipation, senility, rheumatism, nervous exhaustion, memory loss, drug withdrawal symptoms, anxiety and arthritis pain in the knee. Extracts from W somnifera inhibit transcription factor nuclear factor kappa B (NF-κB); thus, it acts as an anti-inflammatory agent. This has been attributed to its ability to interact with IKKB, a kinase that is responsible for the nuclear translocation of NF-κB and activation of inflammatory signalling pathways [37].


Arginine. The amino acid L-arginine, which occurs naturally in food, boosts the body's production of nitric oxide, a compound that facilitates erections by dilating blood vessels in the penis. Studies examining L-arginine's effectiveness against impotence have yielded mixed results. A 1999 trial published in the online journal BJU International found that high doses of L-arginine can help improve sexual function, but only in men with abnormal nitric oxide metabolism, such as that associated with cardiovascular disease. In another study, published in 2003 in the Journal of Sex & Marital Therapy, Bulgarian scientists reported that ED sufferers who took L-arginine along with the pine extract pycnogenol saw major improvements in sexual function with no side effects. Arginine can be helpful, says Geo Espinosa, ND, director of the Integrative Urological Center at NYU Langone Medical Center. Espinosa says that men with known cardiovascular problems should take it only with a doctor's supervision; L-arginine can interact with some medications.

Acupuncture. Though acupuncture has been used to treat male sexual problems for centuries, the scientific evidence to support its use for erectile dysfunction is equivocal at best. In 2009, South Korean scientists conducted a systematic review of studies on acupuncture for ED. They found major design flaws in all of the studies, concluding that "the evidence is insufficient to suggest that acupuncture is an effective intervention for treating ED."
Prescription drugs called “oral phosphodiesterase-5 (PDE5) inhibitors” are considered the “first-line non-invasive treatment” options for patients with ED. These include the drugs that go by brand names: Sildenafil, Vardenafil or Tadalafil. They work by helping the smooth muscle cells lining the blood vessels that supply the penis with blood to work properly. This allows a man to maintain an erection more easily.

With wide-ranging action, ginseng (Panax ginseng), also called Asian ginseng, has been shown in human studies to have an anti-stress effect; improve physical and mental performance, memory, and reaction time; and to enhance mood. Ginseng increases physical working capacity in humans in many ways, including by stimulating the central nervous system, and regulating blood pressure and glucose levels. A 2015 study found that active constituents in ginseng had significant benefit for ED in men with diabetes.
Research is mixed on the effectiveness of acupuncture as an erectile dysfunction cure, but one study published in November 2013 in the Journal of Alternative and Complementary Medicine found that acupuncture can be beneficial for men experiencing erectile dysfunction as a side effect of antidepressants, including selective serotonin reuptake inhibitors (SSRIs) and serotonin noradrenaline reuptake inhibitors (SNRIs).
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