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Rise of Herbal and Traditional Medicine in Erectile Dysfunction Management

  • Erectile Dysfunction (Thomas Lue, Section Editor)
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Abstract

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.

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References

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

  1. Nocerino E, Amato M, Izzo AA. The aphrodisiac and adaptogenic properties of ginseng. Fitoterapia. 2000;71:S1–5.

    Article  PubMed  CAS  Google Scholar 

  2. Choudhary I, Ur-Rahman A. Elixirs of love. Chem Br. 1997:25–7.

  3. Samuelsson G. Drugs of natural origin: a textbook of pharmacognosy. 4th ed. Stockholm: Swedish Pharmaceutical; 1999. p. 171.

    Google Scholar 

  4. Chen X, Lee TJF. Ginsenosides-induced nitric oxide-mediated relaxation of the rabbit corpus cavernosum. Br J Pharmacol. 1995;115:15–8.

    PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    CAS  Google Scholar 

  10. Editorial Board of Flora of China. Flora of China, vol. 29. Beijing: Science Press; 2001. p. 262–300.

  11. Zheng HZ, Dong ZH, She Q. Modern research and application of traditional Chinese medicine. Beijing: Xueyuan; 1998. p. 4225–54.

    Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  17. Zhong-Cheng X. Studies on natural component icariin on erectile dysfunction. J Sex Med. 2006;3 suppl 2:163.

    Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  20. Dikova N, Ognyanova V. Pharmacokinetic studies of Tribestan. Anniversary scientific Session’35 Chemica, 1993.

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  28. Chye PH. Traditional Asian folklore medicines in sexual health. Indian J Urol. 2006;22:241–5.

    Article  Google Scholar 

  29. Ang HH, Sim MK. Eurycoma longifolia Jack enhances libido in sexually experienced male rats. Exp Anim. 1997;46(4):287–90.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  31. Ang HH, Sim MK. Eurycoma longifolia Jack and orientation activities in sexually experienced male rats. Biol Pharm Bull. 1998;21:153–5.

    Article  PubMed  CAS  Google Scholar 

  32. Sambandan TG, Rha C, Kadir AA, et al. Bioactive fraction of Eurycoma longifolia. 2006. Patent No.: US 7132117 B2.

  33. Chan KN, Low BS, Ho D, Sue S. Polar organic extract of Eurycoma longifolia. 2008. International Publication No.: WO 2008/018785 A1.

  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.

    Article  PubMed  CAS  Google Scholar 

  35. Tambi MI, Imran MK. Eurycoma longifolia Jack in managing idiopathic male infertility. Asian J Androl. 2010;12(3):376–80.

    Article  PubMed  Google Scholar 

  36. Boonyaprapat N, Chokchaijarunporn A. Folk medicinal plants (Thai). Bangkok: Prachachon Ltd; 1996. p. 308.

    Google Scholar 

  37. Tocharus C, Smitasiri Y, Jeenapongsa R. Butea superba Roxb. enhances penile erection in rats. Phytother Res. 2006;20:484–9.

    Article  PubMed  Google Scholar 

  38. Cherdshewasart W, Nimsakul N. Clinical trial of Butea superba, an alternative herbal treatment for erectile dysfunction. Asian J Androl. 2003;5:243–6.

    PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  42. Parmar VS, Jain SC, Bisht KS, et al. Phytochemistry of the genus Piper. Phytochemistry. 1997;46(4):597–673.

    Article  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  44. Mills TM. Androgens and penile erection: a review. J Androl. 1996;17:633–8.

    PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  48. Mills TM, Wiedmeier VT, Stopper SV. Androgen maintenance of function in the rat penis. Biol Reprod. 1992;46:342–8.

    Article  PubMed  CAS  Google Scholar 

  49. Leon T. The ‘Maca’ (Lepidium meyenii): a little known food plant of Peru. Econ Bot. 1964;18:122–7.

    Article  Google Scholar 

  50. Obregon L. Maca. Planta Medicinal y Nutritiva del Peru. Lima: Instituto de Fitoterapia Americano; 1998. p. 1–182.

    Google Scholar 

  51. Bogani P, Simonini F, Iriti M, et al. Lepidium meyenii (Maca) does not exert direct androgenic activities. J Ethnopharmacol. 2006;104:415–7.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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. Sun XY, Sun FPY. Shennong Bencao Jing. Taiyuan: Shanxi Science and Technology Publishing House; 1991. p. 41–2.

    Google Scholar 

  64. Li SZ. Bencao Gangmu (The great pharmacopoeia). Beijing: The People’s Health Publishing House; 1981.

    Google Scholar 

  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. 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. Jiangsu New Medical College. Chinese Materia Medica. Shanghai: Shanghai Science and Technology Publishing House; 1977.

    Google Scholar 

  68. Ong VY, Tan BK. Novel phytoandrogens and lipic augmenters from Eucommia ulmoides. BMC Compl Alternative Med. 2007;7:3.

    Article  Google Scholar 

  69. Morales A, Surridge DHC, Marshall PG, Fenemote J. Non-hormonal pharmacology treatment of organic impotence. J Urol. 1982;128:45–7.

    PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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. 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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  74. Sathiyanarayanan L, Arulmozhi S. Mucuna pruriens Linn.—a comprehensive review. Pharmacogn Rev. 2007;1(1):157–62.

    CAS  Google Scholar 

  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. Misra L, Wagner H. Extraction of bioactive principle from Mucuna pruriens seeds. Ind J Biochem Biophys. 2007;44:56–60.

    CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  79. WHO Traditional Medicine Strategy 2002–2005. Available at http://whqlibdoc.who.int/hq/2002/WHO_EDM_TRM_2002.1.pdf. Accessed 28 March 2011.

  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.

    Article  PubMed  CAS  Google Scholar 

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  1. Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia

    Christopher C. K. Ho

  2. Medical and Educational Research Unit, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia

    Hui Meng Tan

  3. Sime Darby Medical Centre, No. 1, Jalan SS 12/1A, Selangor Darul Ehsan, Malaysia

    Hui Meng Tan

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  1. Christopher C. K. Ho
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Ho, C.C.K., Tan, H.M. Rise of Herbal and Traditional Medicine in Erectile Dysfunction Management. Curr Urol Rep 12, 470–478 (2011). https://doi.org/10.1007/s11934-011-0217-x

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