¢ Erectile dysfunction (ED) is a condition in which the male partner could not obtain or maintain sufficient stiffness of the penis to have satisfactory sexual intercourse. ¢ Acupuncture could be useful to improve Erectile dysfunction (ED). Herbal Supplements such as Yohimbe bark (Pausinvstalia yohimbe), Ginseng (Panax ginseng – Korean Red Ginseng), Ginkgo (Ginkgo biloba), Saffron (Crocus sativus), Nutmeg (Myristica fragrans), Tongkat Ali (Eurycoma longifolia), Maca (Lepidium meyenii - Peruvian Ginseng), Kaempferia parviflora (Thai black Ginger, Thai Ginseng), Mondia whitei, Schisandra chinensis, Horny Goat Weed (Epimedium), Fadogia agrestis have some scientific backup to use in Erectile dysfunction (ED). Foods like Water Melon (Citrullus lanatus), Dates (Phoenix dactylifera), Drumstick (Moringa oleifera), Pomegranate (Punica granatum), Fig (Ficus carica), Groundnuts (Arachis hypogaea), Pistachio Nuts (Pistacia vera), Onion (Allium Cepa), Coffee, Ginger (Zingiber officinale), Flavonoids rich Foods (Blueberries, Cranberries, Oranges, Grapefruit, Tea, Apples, Pears, Dark Chocolate), Omega-3 Fatty Acids rich Foods ((Flaxseed, Fish (Mackerel, Salmon, Sardines), Walnuts, Chia seeds, etc.), Zinc rich Foods (Beef, Shrimp, Oysters, Kidney beans, Flax Seeds, Watermelon seeds, Pumpkin Seeds, Spinach, Nuts, Dark chocolate, Mushrooms, etc.), Arginine rich Foods (Meats, Pumpkin Seeds, Nuts) might also have some potentials to improve erection.

1. Complementary and
Alternative Therapies for
Erectile Dysfunction
Dr. P.Naina Mohamed PhD
Pharmacologist

2. Erectile Dysfunction
 Sexual dysfunction affects 10-52% of men and 25-
63% of women and it is a serious medical and social
problem.
 Erectile dysfunction (ED) is a condition in which
the male partner could not obtain or maintain
sufficient stiffness of the penis to have satisfactory
sexual intercourse.
 Erectile dysfunction (ED) is an important sexual
health problem worldwide and it affects about 50%
of men aged 40–70 years.

3. Physiological Mechanism of
Erection
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3731873/

4. Physical Causes of Erectile
Dysfunction
 Vasculogenic (Conditions affecting blood flow to the
penis) - Atherosclerosis, Hypertension, Diabetes.
 Neurogenic (Conditions affecting nervous system) –
Multiple Sclerosis, Parkinsonism, Spinal injury or disorder,
Stroke.
 Hormonal (Conditions affecting hormone levels) -
Hypogonadism, Hypothyroidism, Hyperthyroidism, Cushing's
syndrome.
 Anatomical (Conditions affecting the physical
structure of penis) –
Peyronie's disease, Penis injuries.

5. Psychological Causes of
Erectile Dysfunction
 Psychological Causes:
 Depression
 Anxiety
 Relationship problems
 Lack of sexual knowledge
 Past sexual problems
 Past sexual abuse
 Being in a new relationship
 Worry or Fear

6. Other Causes of Erectile
Dysfunction
 Medicines (Diuretics, Betablockers, Fibrates,
Antipsychotics, Antidepressants, Corticosteroids, H2
blockers, Anticonvulsants, Antihistamines,
Antiandrogens, Cytotoxics)
 Excessive Alcohol intake
 Smoking
 Inadequate physical activity
 Obesity
 Illegal drugs like Cannabis, Heroin or Cocaine
 Cycling

7. Management of Erectile
Dysfunction
 Pharmacological Management:
 Phosphodiesterase-5 (PDE-5) inhibitors – Sildenafil (Viagra), Tadalafil (Cialis), Vardenafil
(Levitra), Avanafil (Spedra).
 Alprostadil
 Hormone therapy
 Non-Pharmacological Management:
 Quit Smoking
 Avoid Alcohol and other illegal drugs
 Exercise regularly & Lose Weight
 Reduce stress
 Psychological treatments:
 Sensate focus
 Psychosexual counselling
 Cognitive behavioural therapy (CBT)
 Pelvic floor muscle exercises
 Vacuum pump
 Penile implants - Semi-rigid implants, Inflatable implants
 Surgery

8. Medical Systems
 The therapies which could be combined with conventional
medicine is termed “Complementary Medicine”.
 “Alternative Medicine” includes therapies that are used in
place of conventional medicine.
 “Complementary and Alternative Medicine” (CAM)
refers to a wide range of clinical therapies outside the
conventional medicine.
 “Conventional Medicine” is a type of medicine practiced
by medical doctors and by allied health professionals, such
as physical therapists, psychologists, and registered nurses. It
is also called Western or Allopathic medicine.
 “Integrative Medicine” represents a combination of
conventional medicine, CAM, and evidence-based medicine.

9. CAM Use
 An US study reported that the Complementary and Alternative
Medicine (CAM) use is high and continues to increase.
 The most important reason cited by patients for the
supplemental CAM use is the perception that CAM is harmless.
 CAM use is highest in patients include
 Female
 Nonsmokers
 Physically active
 Having normal body mass index (BMI)
 Eating low-fat diets with a high fruit and vegetable content
 Individuals aged 35 to 54 years with a high level of education.

10. Types of CAM Practices
 Mind-Body and Manipulative
Practices
 Traditional Medical Systems
 "Modern" Medical Systems

11. Mind and Body
Practices

 Acupuncture and Acupressure
 Yoga
 Hypnosis
 Massage
 Meditation
 Reflexology Alexander technique
 Tai chi
 Spinal manipulation
 Therapeutic touch
 Guided imagery
 Rolfing/structural integration

12. Traditional Medical Systems

• Ayurvedic medicine
• Siddha medicine
• Unani medicine
• Native American medicine
• Tibetan medicine
• Traditional Chinese medicine
• Curanderismo

13. "Modern" Medical Systems

•Homeopathy
•Naturopathy
•Osteopathy
•Chiropractic
•Anthroposophic medicine

14. CAM for Erectile Dysfunction
 Mind and Body Practices:
 Acupuncture
 Herbal Supplements:
 Yohimbe bark (Pausinvstalia yohimbe)
 Ginseng (Panax ginseng – Korean Red Ginseng)
 Ginkgo (Ginkgo biloba)
 Saffron (Crocus sativus)
 Nutmeg (Myristica fragrans)
 Tongkat Ali (Eurycoma longifolia)
 Maca (Lepidium meyenii - Peruvian Ginseng)
 Kaempferia parviflora (Thai black Ginger, Thai Ginseng)
 Mondia whitei
 Schisandra chinensis
 Horny Goat Weed (Epimedium)


15. CAM for Erectile Dysfunction
 Foods & Juices
 Water Melon (Citrullus lanatus)
 Dates (Phoenix dactylifera)
 Drumstick (Moringa oleifera)
 Pomegranate (Punica granatum)
 Fig (Ficus carica)
 Groundnuts (Arachis hypogaea)
 Pistachio Nuts (Pistacia vera)
 Onion (Allium Cepa)
 Coffee
 Ginger (Zingiber officinale)
 Flavonoids rich Foods (Blueberries, Cranberries, Oranges, Grapefruit, Tea, Apples, Pears, Dark
Chocolate)
 Omega-3 Fatty Acids rich Foods ((Flaxseed, Fish (Mackerel, Salmon, Sardines), Walnuts, Chia
seeds, etc.)
 Zinc rich Foods (Beef, Shrimp, Oysters, Kidney beans, Flax Seeds, Watermelon seeds, Pumpkin
Seeds, Spinach, Nuts, Dark chocolate, Mushrooms, etc.)
 Arginine rich Foods (Meats, Pumpkin Seeds, Nuts)

16. CAM for Erectile Dysfunction
 Nutritional supplements:
Arginine
Dehydroepiandrosterone (DHEA)
Folic acid
Zinc
Vitamin E

17. Acupuncture
 Acupuncture can be an effective treatment option in more than
two-thirds of patients with psychogenic erectile dysfunction.
http://www.nature.com/ijir/journal/v15/n5/full/3901021

18. Yohimbe Bark
(Pausinvstalia yohimbe)
 Yohimbine hydrochloride is the principal alkaloid of the bark of the African
yohimbe tree.
http://www.nature.com/ijir/journal/v14/n1/full/3900803a.html

19. Ginseng (Panax ginseng)
 Ginseng cultivated in Korea is classified into three types-
 Fresh ginseng (less than 4 years old)
 White ginseng (4–6 years old)
 Red ginseng (harvested when 6 years old)
 Traditionally red ginseng has been used to restore and enhance normal well-
being.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3861174/

20. Ginkgo (Ginkgo biloba)
 Ginkgo biloba generally had a positive effect on all 4 phases of the sexual
response cycle such as Desire, Excitement (erection and lubrication), Orgasm, and
Resolution (Afterglow).
 Ginkgo biloba found to be effective to treat antidepressant -induced sexual
dysfunction.
https://www.ncbi.nlm.nih.gov/pubmed/9611693

21. Saffron (Crocus sativus)
 http://journals.sagepub.com/doi/full/10.1177/2156587
215583756

22. Nutmeg (Myristica fragrans)
oNutmeg (Myristica fragrans) may be used as an effective and
safe alternative remedy in sexual disorders.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1187868/

23. Tongkat Ali (Eurycoma longifolia)
http://www.sciencedirect.com/science/article/pii/S0965229

24. Maca (Lepidium meyenii -
Peruvian Ginseng)
 The potential bioactive ingredients of Maca (Lepidium meyenii - Peruvian
Ginseng) include macaridine, macamides, macaene, gluosinolates, maca alkaloid,
and maca nutrients (Amino acids, Iiodine, Iron and Magnesium).
 Men who took 3 grams of maca per day for 8 weeks reported an improvement
in sexual desire more often than men who didn’t take it.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2928177/

25. Kaempferia parviflora
(Thai black Ginger, Thai Ginseng)
 Kaempferia Parviflora (KP) might be useful to treat Age-related erectile
dysfunction.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4056445/

26. Mondia whitei
 Approximately 30% of men across all age groups are
affected by Premature or rapid ejaculation.
 Mondia whitei could be used in men with rapid ejaculation.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3544574/

27. Schisandra chinensis
 Schisandra has been used in Traditional Chinese medicine (TCM)
to increase the sexual performance.
http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2011.10567.x/fu

28. Horny Goat Weed
(Epimedium)
 Horny Goat Weed (Epimedium) is used in Traditional Chinese
Medicine (TCM) to treat erectile dysfunction and low libido.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3551978/

29. Fadogia agrestis
 Saponins present in the aqueous extract of Fadogia agrestis maight be
responsible for the increase in the body natural endogenous
testosterone levels.
http://onlinelibrary.wiley.com/doi/10.1111/j.1745-7262.2005.00052.x/abst

30. Watermelon (Citrullus lanatus)
 Watermelon is one of the largest food sources of L-citrulline.
 Watermelon could be used effectively in men with Mild– Moderate
Erectile Dysfunction.
http://www.sciencedirect.com/science/article/pii/S0090429510016614

31. Dates (Phoenix dactylifera)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4248157/

32. Drumstick (Moringa oleifera)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4357367/

33. Pomegranate (Punica granatum)

 Drinking pomegranate juice daily could be an important addition to the diet in
the management of Mild to Moderate Erectile Dysfunction.
http://www.nature.com/ijir/journal/v19/n6/full/3901570a.html

34. Fig (Ficus carica)
 Fig (Ficus carica) has been found to improve sperm motility, count, and
testosterone level in diabetic rats.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4745414/

35. Groundnuts (Arachis hypogaea)
 Groundnut consumption is also associated with
significant increase in HDL-Cholesterol in male rats.
http://tmj.or.tz/index.php/tmj/article/view/1

36. Pistachio Nuts (Pistacia vera)
 Pistachio nuts are rich sources of some plant proteins, dietary fibers and especially
antioxidant substances (Resveratrol and Anthocyanins ).
 Pistachio nuts can also decrease the platelet count leading to improved blood flow
and improvement in penile erection.
http://www.nature.com/ijir/journal/v23/n1/full/ijir201033a.html

37. Onion (Allium Cepa)
 Onion (Allium Cepa) might be useful to treat Antidepressant-induced sexual
dysfunction and also to improve copulatory behavior in sexually potent male.
http://journals.sagepub.com/doi/abs/10.1177/1535370213508360?url_ver=Z39.88-200

38. Coffee
 According to a research, men who drink 2-3 cups of coffee a day
are less likely to develop Erectile Dysfunction (ED).
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.012354

39. Ginger (Zingiber officinale)
 Ginger might be useful to relieve Age-associated and
Diabetic ED.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4578663/

40. Flavonoids rich Foods
 Flavonoids are present in many plant-based foods and beverages,
including fruit, vegetables, tea, herbs, and wine.
http://ajcn.nutrition.org/content/early/2016/01/06/ajcn.115.122010.fu

41. Omega-3 Fatty Acids rich
Foods
 The protective effects of Omega-3 fatty acids such as lowering of
oxidative stress, reduction of secretion of pro-inflammatory
cytokines, and attenuation of atherosclerotic plaques also useful to
prevent Erectile Dysfunction (ED).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4810342/

42. Arginine
 Arginine is an amino acid found in high-protein foods like meats
and nuts.
 Pycnogenol is extracted from Pine bark (Pinus pinaster).
https://www.ncbi.nlm.nih.gov/pubmed/12851125

43. Dehydroepiandrostreone
(DHEA)
 Dehydroepiandrostreone (DHEA) supplementation might be beneficial for ED patients with
Hypertension.
 20-75 milligrams of oral DHEA for up to six months, could be used to treat Erectile
dysfunction.
http://www.sciencedirect.com/science/article/pii/S0090429598005718

44. Folic Acid
 The administration of Folic acid may constitute a strategy for reducing Erectile
Dysfunction in patients with Diabetes Mellitus.
http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2008.07911.x/full

45. Zinc
 Foods high in zinc include Beef, Shrimp, Oysters, Kidney
beans, Flax Seeds, Watermelon seeds, Pumpkin Seeds,
Spinach, Nuts, Dark chocolate, Mushrooms, etc.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2800928/

46. Vitamin E
 Vitamin E ameliorates the Age-associated Erectile Dysfunction.
http://www.sciencedirect.com/science/article/pii/S0024320512000082

47. TIPS for Better Sex
 Avoid Stressful situations
 Quit Smoking
 Avoid Alcohol
 Walk at least 30 minutes a day
 Eat a balanced Diet rich in fruit, vegetables, whole grains,
and fish.
 Maintain blood pressure, blood sugar, blood cholesterol,
and blood triglycerides in normal range.
 Get slim and stay slim
 Move pelvic floor muscle (Two sets of Kegel exercises
daily)

48. Herbal Viagra
 Herbal Viagra products are available as Over-The-Counter
(OTC) herbal supplements to treat Erectile Dysfunction (ED).
 The laboratory analysis of such herbal supplements by US FDA,
found to contain hidden ingredients like PDE5 inhibitors such as
Sildenafil (Viagra), Tadalafil (Cialis), etc. which are approved as
Prescription-only medicines.
 Due to the presence of hidden chemicals, Herbal Viagra can
cause dangerous Hypotension and can interact with other
prescription drugs.
 The products labeled as “Herbal Viagra”, “All Natural”, “Free
from side effects”, etc. should be avoided.
https://www.fda.gov/Drugs/ResourcesForYou/Consumers/Buyin
gUsingMedicineSafely/MedicationHealthFraud/ucm234539.htm

49. TIPS for Smart Use of Herbal
Remedies
 Consult with the healthcare professional before trying any herbal
products.
 Always look for scientific-based sources of information.
 Beware of commercial claims.
 Stop taking the herbal product and notify the healthcare
professional, if there is any side effects such as nausea, vomiting,
rapid heartbeat, anxiety, insomnia, diarrhea, or skin rashes.
 Purchase only the products which contain details such as herb's
common and scientific name, the name and address of the
manufacturer, a batch and lot number, expiration date, dosage
guidelines, and potential side effects.
 Discuss with the Doctor or Pharmacist about possible Herb -
Drug Interactions.

50. TIPS on choosing
Dietary Supplements
 Before considering any dietary supplement, consult with
a Doctor or Pharmacist.
 Do not replace scientifically proven drugs with unproven
health products or practices.
 Always remember that dietary supplements may interact
with medications or other dietary supplements.
 Discuss with the health care providers about the current
use of any CAM approaches.

51. Conclusion
 Indulge in Healthy activities.
 Beware of “Herbal Viagra” products.
 Use of Herbal products should always be discussed with the
Doctor or Pharmacist.
 Always remember that dietary supplements may interact with
medications or other dietary supplements.
 The patients should discuss with their health care provider
regarding the use of CAM therapy.
 The patients should be advised not to replace their conventional
treatment with an unproven product or practice.

52. References
 Textbook of Complementary and Alternative Medicine
Chun-Su Yuan, Eric J. Bieber
 Evidence Based Guide to Complementary and Alternative
Medicine
Bradly P. Jacobs, Katherine Gundling
 Male Sexual Dysfunction: Pathophysiology and Treatment
Fouad R. Kandeel
 Complementary & Alternative Medicine for Prostate and
Urologic Health
Mark A. Moyad, MD, MPH

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