Current Urology Reports

, Volume 12, Issue 6, pp 470–478 | Cite as

Rise of Herbal and Traditional Medicine in Erectile Dysfunction Management

  • Christopher C. K. Ho
  • Hui Meng TanEmail author
Erectile Dysfunction (Thomas Lue, Section Editor)


Herbal medicine long has been used in the management of sexual dysfunction, including erectile dysfunction. Many patients have attested to the efficacy of this treatment. However, is it evidence-based medicine? Studies have been done on animal models, mainly in the laboratory. However, randomized controlled trials on humans are scarce. The only herbal medications that have been studied for erectile dysfunction are Panax ginseng, Butea superba, Epimedium herbs (icariin), Tribulus terrestris, Securidaca longipedunculata, Piper guineense, and yohimbine. Of these, only Panax ginseng, B. superb, and yohimbine have published studies done on humans. Unfortunately, these published trials on humans were not robust. Many herbal therapies appear to have potential benefits, and similarly, the health risks of various phytotherapeutic compounds need to be elucidated. Properly designed human trials should be worked out and encouraged to determine the efficacy and safety of potential phytotherapies.


Herbal therapy Phytotherapy Traditional medicine Complementary and alternative medicine CAM Traditional Chinese medicine Treatment Erectile dysfunction Panax ginseng Butea superb Epimedium herbs Icariin Tribulus terrestris Securidaca longipedunculata Piper guineense Yohimbine Eurycoma longifolia Tongkat Ali Lepidium meyenii Maca Eucommia ulmoides Eucommia Withania somnifera Fadogia agrestis Mucuna pruriens 



No potential conflicts of interest relevant to this article were reported.


Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Nocerino E, Amato M, Izzo AA. The aphrodisiac and adaptogenic properties of ginseng. Fitoterapia. 2000;71:S1–5.PubMedCrossRefGoogle Scholar
  2. 2.
    Choudhary I, Ur-Rahman A. Elixirs of love. Chem Br. 1997:25–7.Google Scholar
  3. 3.
    Samuelsson G. Drugs of natural origin: a textbook of pharmacognosy. 4th ed. Stockholm: Swedish Pharmaceutical; 1999. p. 171.Google Scholar
  4. 4.
    Chen X, Lee TJF. Ginsenosides-induced nitric oxide-mediated relaxation of the rabbit corpus cavernosum. Br J Pharmacol. 1995;115:15–8.PubMedGoogle Scholar
  5. 5.
    Kim HJ, Woo DS, Lee G, Kim JJ. The relaxation effects of ginseng saponin in rabbit corporal smooth muscle: is it a nitric oxide donor? Br J Urol. 1998;82:744–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Choi YD, Koon HR, Hyung KC. In vitro and in vivo experimental effect of Korean red ginseng on erection. J Urol. 1999;162:1508–11.PubMedCrossRefGoogle Scholar
  7. 7.
    Zhang H, Zhou Q, Li X, et al.: Ginsenoside Re increases human sperm motility by induction of nitric oxide synthase. Arch Pharm Res. 2006;29(2):145–51.PubMedCrossRefGoogle Scholar
  8. 8.
    Park WS, Shin DY, Kim DR, et al. Korean ginseng induces spermatogenesis in rats through the activation of cAMP-Responsive element modulator (CREM). Fertil Steril. 2007;88(4):1000–2.PubMedCrossRefGoogle Scholar
  9. 9.
    • Jang DJ, Lee MS, Shin BC, et al. Red ginseng for treating erectile dysfunction: a systematic review. J Clin Pharmacol. 2008;66(4):444–50. This systemic review analyzed six randomized placebo-controlled trials and showed evidence for the effectiveness of red ginseng in the treatment of erectile dysfunction. Google Scholar
  10. 10.
    Editorial Board of Flora of China. Flora of China, vol. 29. Beijing: Science Press; 2001. p. 262–300.Google Scholar
  11. 11.
    Zheng HZ, Dong ZH, She Q. Modern research and application of traditional Chinese medicine. Beijing: Xueyuan; 1998. p. 4225–54.Google Scholar
  12. 12.
    Xin ZC, Kim EK, Lin CS, et al. Effects of icariin on cGMP-specific PDE5 and cAMP-specific PDE4 activities. Asian J Androl. 2003;5:15–8.PubMedGoogle Scholar
  13. 13.
    Ning H, Xin ZC, Lin G, et al. Effects of icariin on phosphodiesterase-5 activity in vitro and cyclic guanosine monophosphate level in cavernous smooth muscle cells. Urology. 2006;68(6):1350–4.PubMedCrossRefGoogle Scholar
  14. 14.
    Chiu JH, Chen KK, Chien TM, et al. Epimedium brevicornum Maxim extract relaxes rabbit corpus cavernosum through multitargets on nitric oxide/cyclic guanosine monophosphate signaling pathway. Int J Impo Res. 2006;18(4):335–42.CrossRefGoogle Scholar
  15. 15.
    Liu WJ, Xin ZC, Xin H, et al. Effects of icariin on erectile function and expression of nitric oxide synthase isoforms in castrated rats. Asian J Androl. 2005;7(4):381–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Chen KK, Chiu JH. Effect of Epimedium brevicornum Maxim extract on elicitation of penile erection in the rat. Urology. 2006;67(3):631–5.PubMedCrossRefGoogle Scholar
  17. 17.
    Zhong-Cheng X. Studies on natural component icariin on erectile dysfunction. J Sex Med. 2006;3 suppl 2:163.Google Scholar
  18. 18.
    Shindel AW, Xin ZC, Lin G, et al. Erectogenic and neurotrophic effects of icariin, a purified extract of horny goat weed (Epimedium spp.) in vitro and in vivo. J Sex Med. 2010;7(4 Pt 1):1518–28.PubMedCrossRefGoogle Scholar
  19. 19.
    Tyagi RM, Aswar UM, Mohan V, et al. Study of furostenol glycoside fraction of Tribulus terrestris on male sexual function in rats. Pharm Biol. 2008;46(3):191–8.CrossRefGoogle Scholar
  20. 20.
    Dikova N, Ognyanova V. Pharmacokinetic studies of Tribestan. Anniversary scientific Session’35 Chemica, 1993.Google Scholar
  21. 21.
    Gauthaman K, Adaikan PG, Prasad RNV. Aphrodisiac properties of Tribulus Terrestris extract (Protodioscin) in normal and castrated rats. Life Sci. 2002;71:1385–96.PubMedCrossRefGoogle Scholar
  22. 22.
    Simonsen U, Prieto D, Hernández M, et al. Prejunctional 2-adrenoceptors inhibit nitrergic neurotransmission in horse penile resistance arteries. J Urol. 1997;157:2356–60.PubMedCrossRefGoogle Scholar
  23. 23.
    Mann K, Klingler T, Noe S, et al. Effects of yohimbine on sexual experiences and nocturnal tumescence and rigidity in erectile dysfunction. Arch Sex Behav. 1996;25(1):1–16.PubMedCrossRefGoogle Scholar
  24. 24.
    Teloken C, Rhoden EL, Sogari P, et al. Therapeutic effects of high dose yohimbine hydrochloride on organic erectile dysfunction. J Urol. 1998;159(1):122–4.PubMedCrossRefGoogle Scholar
  25. 25.
    Ernst E, Pittler MH. Yohimbine for erectile dysfunction: a systematic review and meta-analysis of randomized clinical trials. J Urol. 1998;159(2):433–6.PubMedCrossRefGoogle Scholar
  26. 26.
    Lebret T, Herve JM, Gorny P, et al. Efficacy and safety of a novel combination of L-arginine glutamate and yohimbine hydrochloride: a new oral therapy for erectile dysfunction. Eur Urol. 2002;41:608–13.PubMedCrossRefGoogle Scholar
  27. 27.
    Montorsi F, Strambi LF, Guazzoni G, et al. Effect of yohimbine-trazodone on psychogenic impotence: a randomized, double-blind, placebo-controlled study. Urology. 1994;44:732–6.PubMedCrossRefGoogle Scholar
  28. 28.
    Chye PH. Traditional Asian folklore medicines in sexual health. Indian J Urol. 2006;22:241–5.CrossRefGoogle Scholar
  29. 29.
    Ang HH, Sim MK. Eurycoma longifolia Jack enhances libido in sexually experienced male rats. Exp Anim. 1997;46(4):287–90.PubMedCrossRefGoogle Scholar
  30. 30.
    Ang HH, Ngai TH. Aphrodisiac evaluation in non-copulator male rats after chronic administration of Eurycoma longifolia Jack. Fundam Clin Pharmacol. 2001;15:265–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Ang HH, Sim MK. Eurycoma longifolia Jack and orientation activities in sexually experienced male rats. Biol Pharm Bull. 1998;21:153–5.PubMedCrossRefGoogle Scholar
  32. 32.
    Sambandan TG, Rha C, Kadir AA, et al. Bioactive fraction of Eurycoma longifolia. 2006. Patent No.: US 7132117 B2.Google Scholar
  33. 33.
    Chan KN, Low BS, Ho D, Sue S. Polar organic extract of Eurycoma longifolia. 2008. International Publication No.: WO 2008/018785 A1.Google Scholar
  34. 34.
    Zanoli P, Zavatti M, Montanari C, Baraldi M. Influence of Eurycoma longifolia on the copulatory activity of sexually sluggish and impotent male rats. J Ethnopharmacol. 2009;126(2):308–13.PubMedCrossRefGoogle Scholar
  35. 35.
    Tambi MI, Imran MK. Eurycoma longifolia Jack in managing idiopathic male infertility. Asian J Androl. 2010;12(3):376–80.PubMedCrossRefGoogle Scholar
  36. 36.
    Boonyaprapat N, Chokchaijarunporn A. Folk medicinal plants (Thai). Bangkok: Prachachon Ltd; 1996. p. 308.Google Scholar
  37. 37.
    Tocharus C, Smitasiri Y, Jeenapongsa R. Butea superba Roxb. enhances penile erection in rats. Phytother Res. 2006;20:484–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Cherdshewasart W, Nimsakul N. Clinical trial of Butea superba, an alternative herbal treatment for erectile dysfunction. Asian J Androl. 2003;5:243–6.PubMedGoogle Scholar
  39. 39.
    • Cortés-González JR, Arratia-Maqueo JA, Gómez-Guerra LS, Holmberg AR. The use of Butea superba (Roxb.) compared to sildenafil for treating erectile dysfunction. BJU Int. 2010;105(2):225–8. This article showed patients who took Butea superb, 100 mg, had better IIEF score compared to those who took sildenafil, 50 mg. PubMedCrossRefGoogle Scholar
  40. 40.
    Meyer JJ, Rakuambo NC, Husseinm AA. Novel xanthones from Securidaca longepedunculata with activity against erectile dysfunction. J Ethnopharmacol. 2008;119:599–603. This article demonstrated the ability of Securidaca longepedunculata’s xanthones to stimulate the relaxation of corpus cavenosum smooth muscle.PubMedCrossRefGoogle Scholar
  41. 41.
    Rakuambo NC, Meyer JJ, Huyser C, et al. In vitro effect of medicinal plants used to treat erectile dysfunction on smooth muscle relaxation and human sperm. J Ethnopharmacol. 2006;105:84–8.PubMedCrossRefGoogle Scholar
  42. 42.
    Parmar VS, Jain SC, Bisht KS, et al. Phytochemistry of the genus Piper. Phytochemistry. 1997;46(4):597–673.CrossRefGoogle Scholar
  43. 43.
    Kamtchouing P, Mbongue GYF, Dimo T, et al. Effects of Aframomum melegueta and Piper guineense on sexual behavior of male rats. Behav Pharmacol. 2002;13:243–7.PubMedCrossRefGoogle Scholar
  44. 44.
    Mills TM. Androgens and penile erection: a review. J Androl. 1996;17:633–8.PubMedGoogle Scholar
  45. 45.
    Lugg JA, Rajfer J, Gonzalez Cadavid NF. Dihydrotestosterone is the active androgen in the maintenance of nitric oxide-mediated penile erection in the rat. Endocrinology. 1995;136:1495–501.PubMedCrossRefGoogle Scholar
  46. 46.
    Schirar A, Bonnefond C, Meusnier C, Devinoy E. Androgens modulate nitric oxide synthase messenger ribonucleic acid expression in neurones of the major pelvic ganglion in the rat. Endocrinology. 1997;138:3093–102.PubMedCrossRefGoogle Scholar
  47. 47.
    Clark JT, Gabriel SM, Simkirs JW, Kalra PS. Chronic morphine and testosterone treatment. Effect on sexual behavior and dopamine metabolism in male rats. Neuroendocrinology. 1988;48:97–104.PubMedCrossRefGoogle Scholar
  48. 48.
    Mills TM, Wiedmeier VT, Stopper SV. Androgen maintenance of function in the rat penis. Biol Reprod. 1992;46:342–8.PubMedCrossRefGoogle Scholar
  49. 49.
    Leon T. The ‘Maca’ (Lepidium meyenii): a little known food plant of Peru. Econ Bot. 1964;18:122–7.CrossRefGoogle Scholar
  50. 50.
    Obregon L. Maca. Planta Medicinal y Nutritiva del Peru. Lima: Instituto de Fitoterapia Americano; 1998. p. 1–182.Google Scholar
  51. 51.
    Bogani P, Simonini F, Iriti M, et al. Lepidium meyenii (Maca) does not exert direct androgenic activities. J Ethnopharmacol. 2006;104:415–7.PubMedCrossRefGoogle Scholar
  52. 52.
    Gasco M, Aguilar J, Gonzales GF. Effect of chronic treatment with three varieties of Lepidium meyenii (Maca) on reproductive parameters and DNA quantification in adult male rats. Andrologia. 2007;39:151–8.PubMedCrossRefGoogle Scholar
  53. 53.
    Gonzales GF, Nieto J, Rubio J, Gasco M. Effect of Black Maca (Lepidium meyenii) on one spermatogenic cycle in rats. Andrologia. 2006;38:166–72.PubMedCrossRefGoogle Scholar
  54. 54.
    Gonzales GF, Gasco M, Córdova A, et al. Effect of Lepidium meyenii (Maca) on spermatogenesis in male rats acutely exposed to high altitude (4340 m). J Endocrinol. 2004;180:87–95.PubMedCrossRefGoogle Scholar
  55. 55.
    Bustos-Obregon E, Yucra S, Gonzales GF. Lepidium meyenii (Maca) reduces spermatogenic damage induced by a single dose of malathion in mice. Asian J Androl. 2005;7:71–6.PubMedCrossRefGoogle Scholar
  56. 56.
    Rubio J, Riqueros MI, Gasco M, et al. Lepidium meyenii (Maca) reversed the lead acetate induced damage on reproductive function in male rats. Food Chem Toxicol. 2006;44:1114–22.PubMedCrossRefGoogle Scholar
  57. 57.
    Gonzales GF, Cordova A, Gonzales C, et al. Lepidium meyenii (Maca) improved semen parameters in adult men. Asian J Androl. 2001;3:301–3.PubMedGoogle Scholar
  58. 58.
    Gonzales GF, Cordova A, Vega K, et al. Effect of Lepidium meyenii (Maca) on sexual desire and its absent relationship with serum testosterone levels in adult healthy men. Andrologia. 2002;34:367–72.PubMedCrossRefGoogle Scholar
  59. 59.
    Gonzales GF, Cordova A, Vega K, et al. Effect of Lepidium meyenii (Maca), a root with aphrodisiac and fertility-enhancing properties, on serum reproductive hormone levels in adult healthy men. J Endocrinol. 2003;176:163–8.PubMedCrossRefGoogle Scholar
  60. 60.
    • Shin BC, Lee MS, Yang EJ, et al. Maca (L. meyenii) for improving sexual function: A systematic review. BMC Complement Altern Med. 2010;10:44. This article analyzed four randomized controlled trials, including one on ED. In this trial, Maca showed significant improvement on IIEF score. CrossRefGoogle Scholar
  61. 61.
    • Zenico T, Cicero AF, Valmorri L, et al. Subjective effects of Lepidium meyenii (Maca) extract on well-being and sexual performances in patients with mild erectile dysfunction: a randomised, double-blind clinical trial. Andrologia 2009;41(2):95–9. This article showed that Maca has a small but significant effect on subjective perception of general and sexual well-being in mild ED. PubMedCrossRefGoogle Scholar
  62. 62.
    Takeshi D, Sansei N, Yoshihisa N. Constituents and pharmacological effects of Eucommia and Siberian ginseng. Acta Pharmacol Sin. 2001;12:1057–70.Google Scholar
  63. 63.
    Sun XY, Sun FPY. Shennong Bencao Jing. Taiyuan: Shanxi Science and Technology Publishing House; 1991. p. 41–2.Google Scholar
  64. 64.
    Li SZ. Bencao Gangmu (The great pharmacopoeia). Beijing: The People’s Health Publishing House; 1981.Google Scholar
  65. 65.
    Chinese Pharmacopeia Committee of Ministry of Public Health of the People’s Republic of China. The Chinese Pharmacopeia. Beijing: Chemical Industry Publishing House; 2000.Google Scholar
  66. 66.
    Institute of Materia Medica, Chinese Academy of Medical Sciences. Manual of Chinese medicines; version 5. Beijing: The People’s Health Publishing House; 1995.Google Scholar
  67. 67.
    Jiangsu New Medical College. Chinese Materia Medica. Shanghai: Shanghai Science and Technology Publishing House; 1977.Google Scholar
  68. 68.
    Ong VY, Tan BK. Novel phytoandrogens and lipic augmenters from Eucommia ulmoides. BMC Compl Alternative Med. 2007;7:3.CrossRefGoogle Scholar
  69. 69.
    Morales A, Surridge DHC, Marshall PG, Fenemote J. Non-hormonal pharmacology treatment of organic impotence. J Urol. 1982;128:45–7.PubMedGoogle Scholar
  70. 70.
    Abdel-Magied EM, Abdel-Rahman HA. The effect of aqueous extracts of Cynomorium coccineum and Withania somnifera on testicular development in immature Wistar rats. J Ethnopharmacol. 2001;75:1–4.PubMedCrossRefGoogle Scholar
  71. 71.
    Ahmad MK, Mahdi AA, Shukla KK, et al. Withania somnifera improves semen quality by regulating reproductive hormone levels and oxidative stress in seminal plasma of infertile males. Fertil Steril. 2010;94(3):989–96.Google Scholar
  72. 72.
    Yakubu MT, Akanji MA, Oladiji AT. Aphrodisiac potentials of the aqueous extract of Fadogia agrestis (Schweinf. Ex Hiern) stem in male albino rats. Asian J Androl. 2005;7(4):399–404.PubMedCrossRefGoogle Scholar
  73. 73.
    Yakubu MT, Akanji MA, Oladiji AT. Effects of oral administration of aqueous extract of Fadogia agrestis (Schweinf. Ex Hiern) stem on some testicular function indices of male rats. J Ethnopharmacol. 2008;115:288–92.PubMedCrossRefGoogle Scholar
  74. 74.
    Sathiyanarayanan L, Arulmozhi S. Mucuna pruriens Linn.—a comprehensive review. Pharmacogn Rev. 2007;1(1):157–62.Google Scholar
  75. 75.
    Dhanukar S, Hazra A. Heal with herbs: publication and information directorate. New Delhi: Council of Scientific and Industrial Research; 1995. p. 53–74.Google Scholar
  76. 76.
    Misra L, Wagner H. Extraction of bioactive principle from Mucuna pruriens seeds. Ind J Biochem Biophys. 2007;44:56–60.Google Scholar
  77. 77.
    Ahmad MA, Mahdi AA, Shukla KK, et al. Effect of Mucuna pruriens on semen profile and biochemical parameters in seminal plasma of infertile men. Fertil Steril. 2008;90(3):627–35.PubMedCrossRefGoogle Scholar
  78. 78.
    Shukla KK, Mahdi AA, Ahmad MK, et al. Mucuna pruriens improves male fertility by its action on the hypothalamus-pituitary-gonadal axis. Fertil Steril. 2009;92(6):1934–40.PubMedCrossRefGoogle Scholar
  79. 79.
    WHO Traditional Medicine Strategy 2002–2005. Available at Accessed 28 March 2011.
  80. 80.
    Esposito K, Giugliano F, Di Palo C, et al. Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. JAMA. 2004;291(24):2978–84.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of SurgeryUniversiti Kebangsaan Malaysia Medical CentreCheras, Kuala LumpurMalaysia
  2. 2.Medical and Educational Research Unit, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
  3. 3.Sime Darby Medical CentreSelangor Darul EhsanMalaysia

Personalised recommendations