Herbal Dietary Supplements for Erectile Dysfunction: A Systematic Review and Meta-Analysis
- 450 Downloads
Erectile dysfunction (ED) is a common condition that significantly affects quality of life and interpersonal relationships.
Our objective was to perform a systematic review and meta-analysis to evaluate the efficacy of herbal dietary supplements in the treatment of ED.
Materials and Methods
We searched five databases to identify randomized controlled trials (RCTs) that evaluated the clinical efficacy of herbal medicines in ED. Quality was assessed and risk of bias was estimated using the Jadad score and the Cochrane risk-of-bias tool.
In total, 24 RCTs, including 2080 patients with ED, were identified. Among these, 12 evaluated monopreparations (five ginseng [n = 399], three saffron [n = 397], two Tribulus terrestris [n = 202], and one each Pinus pinaster [n = 21] and Lepidium meyenii [n = 50]), seven evaluated formulations (n = 544), and five investigated dietary supplements in combination with pure compounds (n = 410). Ginseng significantly improved erectile function (International Index of Erectile Function [IIEF]-5 score: 140 ginseng, 96 placebo; standardized mean difference [SMD] 0.43; 95% confidence interval [CI] 0.15–0.70; P < 0.01; I2 = 0), P. pinaster and L. meyenii showed very preliminary positive results, and saffron and T. terrestris treatment produced mixed results. Several herbal formulations were associated with a decrease of IIEF-5 or IIEF-15, although the results were preliminary. The quality of the included studies varied, with only seven having a prevalent low risk of bias. The median methodological quality Jadad score was three out of a maximum of five. Adverse events were recorded in 19 of 24 trials, with no significant differences between placebo and verum in placebo-controlled studies.
Encouraging evidence suggests that ginseng may be an effective herbal treatment for ED. However, further, larger, and high-quality studies are required before firm conclusions can be drawn. Promising (although very preliminary) results have also been generated for some herbal formulations. Overall, more research in the field, adhering to the CONSORT statement extension for reporting trials, is justified before the use of herbal products in ED can be recommended.
All authors collectively planned the study. FB and AAI drafted the systematic review manuscript. FB and AAI assessed the eligibility of included articles and extracted data. DD, MI, and CC assessed the quality of the studies. All authors served as adjudicators for disagreements. CC performed the meta-analysis. All authors reviewed the manuscript for intellectual content and approved the final version.
Compliance with Ethical Standards
Conflict of interest
Francesca Borrelli, Cristiano Colalto, Domenico V. Delfino, Marcello Iriti, and Angelo A. Izzo have no conflicts of interest that are directly relevant to the content of this manuscript.
No funding was received in the preparation of this systematic review.
- 2.Baumann F, Hehli D, Makaloski V, Schumacher M, Schönhofen H, Diehm N. Erectile dysfunction—overview from a cardiovascular perspective. Vasa. 2017;10:1–7.Google Scholar
- 15.Higgins JPT, Green S (editors). Cochrane handbook for systematic reviews of interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. http://handbook.cochrane.org.
- 24.Adimoelja A, Ganeshan P. Protodioscin from herbal plant Tribulus terrestris L improves the male sexual functions, probably via DHEA. Int. J. Impot Res. 1997;9(Supp 1):S1–70.Google Scholar
- 34.Ismail SB, Wan Mohammad WM, George A, Nik Hussain NH, Musthapa Kamal ZM, Liske E. Randomized clinical trial on the use of PHYSTA freeze-dried water extract of Eurycoma longifolia for the improvement of quality of life and sexual well-being in Men. Evid Based Complement Alternat Med. 2012;2012:429268.PubMedPubMedCentralGoogle Scholar
- 40.Safarinejad MR, Shafiei N, Safarinejad S. An open label, randomized, fixed-dose, crossover study comparing efficacy and safety of sildenafil citrate and saffron (Crocus sativus Linn.) for treating erectile dysfunction in men naïve to treatment. Int J Impot Res. 2010;22:240–50.CrossRefPubMedGoogle Scholar
- 42.Mohammadzadeh-Moghadam H, Nazari SM, Shamsa A, Kamalinejad M, Esmaeeli H, Asadpour AA, et al. Effects of a topical saffron (Crocus sativus L) gel on erectile dysfunction in diabetics: a randomized, parallel-group, double-blind, placebo-controlled trial. J Evid Based Complementary Altern Med. 2015;20:283–6.CrossRefPubMedGoogle Scholar
- 50.Cai T, Morgia G, Carrieri G, Terrone C, Imbimbo C, Verze P, et al. IDIProst® Gold Study Group. An improvement in sexual function is related to better quality of life, regardless of urinary function improvement: results from the IDIProst® Gold Study. Arch Ital Urol Androl. 2013;85:184–9.CrossRefPubMedGoogle Scholar
- 51.Nishimatsu H, Kitamura T, Yamada D, Nomiya A, Niimi A, Suzuki M, et al. Improvement of symptoms of aging in males by a preparation LEOPIN ROYAL containing aged garlic extract and other five of natural medicines - comparison with traditional herbal medicines (Kampo). Aging Male. 2014;17:112–6.CrossRefPubMedGoogle Scholar
- 52.Udani JK, George AA, Musthapa M, Pakdaman MN, Abas A. Effects of a proprietary freeze-dried water extract of Eurycoma longifolia (Physta) and polygonum minus on sexual performance and well-being in men: a randomized, double-blind, placebo-controlled study. Evid Based Complement Alternat Med. 2014;2014:179529.CrossRefPubMedPubMedCentralGoogle Scholar
- 57.Sansalone S, Leonardi R, Antonini G, Vitarelli A, Vespasiani G, Basic D, et al. Alga Ecklonia bicyclis, Tribulus terrestris, and glucosamine oligosaccharide improve erectile function, sexual quality of life, and ejaculation function in patients with moderate mild-moderate erectile dysfunction: a prospective, randomized, placebo-controlled, single-blinded study. Biomed Res Int. 2014;2014:121396.CrossRefPubMedPubMedCentralGoogle Scholar
- 68.Schoonees A, Visser J, Musekiwa A, Volmink J. Pycnogenol® (extract of French maritime pine bark) for the treatment of chronic disorders. Cochrane Database Syst Rev. 2012;4:CD008294.Google Scholar