The document discusses erectile dysfunction (ED), its causes, and natural treatments. It defines ED as the inability to attain or sustain an erection for satisfactory sexual intercourse. Common causes include vascular diseases, hormonal imbalances, neurological disorders, medications, and lifestyle factors like smoking and obesity. The document recommends supplements containing L-arginine, Korean ginseng, saw palmetto, tongkat ali, tribulus terrestris, and trace minerals to help treat ED naturally by improving blood flow and increasing testosterone levels.

1. Chanita Villegas-Chua, M.D., FPOGS, FPSUOG, MFMSF, MSCE

3. 2 Tasks: Urination: releasing urine from the bladder Ejaculation: releasing sperm and seminal fluid from the prostate gland

4. EJACULATION IS A THREE-STEP PROCESS: Man becomes sexually aroused Penis responds by becoming erect Stimulation of the penis causes ejaculation

9. PENIS USES A SIMILAR MECHANISM Instead of using pressurized air to become rigid, the penis uses pressurized blood Penis contains two cigar-shaped structures, corpora cavernosa, that it uses to become erect

10. Think of the corpora cavernosa as balloon-like tubes Arteries : bring blood into these two tubes, and veins carry blood away from them

12. WHAT IS ERECTILE DYSFUNCTION? 1992, the NIH definition: Inability to attain or sustain an erection adequate for satisfactory sexual intercourse . "Erectile Dysfuntion" is more precise than impotence (some associate with being sterile or lacking strength, vigor, or power)

13. WHAT IS ERECTILE DYSFUNCTION? 1992, the NIH definition: The degree to which it bothers the man and his partner Different from other male sexual problems, such as premature (rapid) ejaculation, low sexual desire, or an inability to have an orgasm (climax)

14. WHAT IS ERECTILE DYSFUNCTION? Most common untreated medical disorder >50% of men 40 – 70yo, increases with age (Men can enjoy sexual activity throughout life, although the amount and force of ejaculation and muscular tension decrease)

15. WHAT IS ERECTILE DYSFUNCTION? Affects nearly 30M men in the US Difficult subject for many people to discuss, often accompanied by embarrassment, guilt, and lack of self-esteem Successfully treated over 95% of the time

16. WHAT IS ERECTILE DYSFUNCTION? Key role : Corpora cavernosa and the smooth muscles of the arteriolar & arterial walls If the arteries leading to the penis don't open up properly, difficult or impossible for it to become erect

17. ED Signs, Symptoms, Indicators

18. Inability to maintain erection Normal erections occur during sleep and in the early morning; loss of these erections may signify underlying disease, often cardiovascular in origin

19. ED RISK FACTORS

20. Causes of Male Erectile Dysfunction A. Primary ED - man has never been able to attain or sustain erections, due to psychologic factors: sexual guilt, fear of intimacy, depression, and severe anxiety - Rarely caused by biological factors such as low testosterone levels and other hormonal disorders

21. Causes of Male Erectile Dysfunction B. Secondary ED - a man who could previously attain & sustain erections no longer can, approx. 10% is due to psychologic factors 1. Vascular disorders - major cause: atherosclerosis (decrease amount of blood entering the penis)

22. AGING

23. Obesity ≥ 20% of the desirable body weight BMI ≥ 27kg/m2

24. alcohol

25. POLLUTION

26. SMOKING

27. JUNK FOODS

28. Causes of Male Erectile Dysfunction Diseases that worsen hardening of the arteries and increase the prevalence of erectile dysfunction

29. High Blood Sugar

30. HIGH BLOOD PRESSURE

31. Causes of Male Erectile Dysfunction B. Secondary ED 2. Hormonal disorders: elevated prolactin hypothyroidism Cushings syndrome decrease level of testosterone (current study)

32. GOITER

33. Causes of Male Erectile Dysfunction B. Secondary ED 3. Neurologic disorders multiple sclerosis sensory & autonomic dysfunction

34. Temporal Lobe Seizure

35. Stroke

36. Spinal Cord Injuries

37. Causes of Male Erectile Dysfunction B. Secondary ED 4. Other causes: situational - involving a particular place, time, partner

38. Psychiatric And Psychological Disorders

39. 25% of ED – Medications

40. WHY ERECTILE DYSFUNCTION? In older men, the arteries in the penis aren't dilating enough when the brain sends the signal The man is aroused, and the nerves in the penis are producing NO; but the amount of cGMP produced is not enough to maintain an erection.

41. WAYS TO INCREASE BLOOD FLOW TO THE PENIS Increase the amount of nitric oxide produced in the penis Increase the amount of cGMP produced in the penis in response to the nitric oxide Eliminate the PDE in the penis so that the cGMP builds up instead of getting decomposed by the PDE

43. ED IS POTENTIALLY REVERSIBLE Patients on medications for high blood pressure and for depression Patients who have endocrine problems, like thyroid or pituitary problems Patients who have partner conflict Patients who smoke cigarettes

44. ED IS POTENTIALLY REVERSIBLE Patients who use recreational drugs; Alcohol, Marijuana, Cocaine, Heroin Patients who have an anatomical abnormality of their penis Men <45 yo may have a correctable cause of vascular impotence like those due to diabetes mellitus

45. SEX AND YOUR HEART Because sex makes the heart work harder, sexual activity is not advisable for some men with certain heart problems. Some men have serious forms of heart disease, such as: A recent heart attack or stroke (within the past 2 or 3 months) Certain heart rhythm problems

46. SEX AND YOUR HEART Severe (unstable) angina Untreated or severe high blood pressure Severe heart failure Severe heart valve disease (aortic stenosis)

47. Eat whole, fresh, unrefined, and unprocessed foods. Include fruits (lots of richly pigmented berries to support vascular integrity), vegetables, whole grains, soy, beans, seeds, nuts, olive oil, and cold-water fish (salmon, tuna, sardines, halibut, and mackerel) NUTRITION

48. Avoid sugar, dairy products, refined foods, fried foods, junk foods, caffeine Eliminate food sensitivities. Use an elimination and challenge diet to determine food sensitivities Drink 50% of your body weight in ounces of water daily (e.g., if you weigh 150 lbs, drink 2.25L/day) NUTRITION

49. COMPONENTS OF ENDUROMAX L – Argenine Korean Ginseng Saw Palmetto Selenium Tongkat Ali Trace Minerals Trebulus Terrestris Plus a combination of other proprietary herbs!

50. KOREAN GINSENG

51. GINSENG Panax ginseng , also called Asian, Korean or Chinese ginseng Asian ginseng has &quot;heating&quot; properties, which are good for improving circulation The active compounds in ginseng are believed to be steroid-like components called &quot;ginsenosides&quot;

52. GINSENG The word Panax comes the Greek word meaning &quot;all-healing“ In much of Asia, ginseng is prized as a revitalizer for the whole body This is partly due to the shape of the root, which resembles the human body

53. “ adaptogen”, which means it increases resistance to physical, chemical, & biological stress & builds energy & general vitality Good for Diabetes – lowers fasting blood glucose levels, mood, psychophysical performance, also resulted in improved Hb A1C levels GINSENG

54. Erectile Dysfunction – in a study, 60% of the participants reported improvement in their symptoms compared with 30% of those using the placebo; appears to be useful for erectile dysfunction if taken on a continuous basis GINSENG

55. L – ARGININE an amino acid that the body uses to make NITRIC OXIDE , a substance that signals smooth muscle surrounding blood vessels to relax, which dilates the blood vessels and increases blood flow Relaxation of smooth muscle in the penis allows for enhanced blood flow, leading to an erection

56. TONGKAT ALI

57. TONGKAT ALI Eurycoma longifolia & Longjack Dubbed the &quot;Asian Viagra&quot; in a May 1999 report in the New Sunday Times used in Malaysia for many years by men to increase sexual desire, libido, sexual performance and to treat erectile dysfunction

58. TONGKAT ALI increase levels of testosterone: - responsible for the growth and development of male reproductive organs, including the penis, testicles, scrotum, prostate, & seminal vesicles - Normal levels maintain energy level, mood, fertility, and sexual desire - used by bodybuilders to increase muscle mass and strength

59. SAW PALMETTO

60. SAW PALMETTO to increase sex drive Other uses: for urinary symptoms associated with an enlarged prostate gland (also called benign prostatic hyperplasia, or BPH) chronic pelvic pain bladder disorders hair loss

61. SAW PALMETTO Improve body strength Beneficial for both sexes in supporting healthy hormonal balance Support healthy immune function Increase libido

62. TRIBULUS TERRESTRIS

63. TRIBULUS TERRESTRIS heightened sexual behavior and increased intracavernous pressure due to increase testosterone Other uses: urinary disorders remedy for inflammation and arthritis use it to improve strength & stamina

64. TRIBULUS TERRESTRIS reduction in cholesterol reduction in high blood pressure inhibition of stress-induced clumping of blood platelets increases in strength of contraction of the heart muscle reductions in sodium & fluid retention

65. TRIBULUS TERRESTRIS prevention of kidney stones improvement of the profile of red and white blood cells strong anti-bacterial, anti-malarial, and anti-fungal properties anti-inflammatory activity and action

66. TONGKAT ALI Both produce testosterone but are different from the action of testosterone products, which act like the body's own testosterone and therefore causes the Leydig cells to shut down their production of the hormone. For this reason, all exogenous testosterone products, including anabolic steroids, cause testicular and penile shrinkage. TRIBULUS TERRESTRIS

67. IONIC TRACE MINERALS Zinc is required for the production of testosterone, and the zinc content of the prostate gland and sperm, is higher than in any other body tissues not only helps produce testosterone, but also helps to maintain semen volume and adequate levels of testosterone, therefore maintaining sex drive and keeping sperm healthy

68. IONIC TRACE MINERALS Magnesium is a trace mineral that is important for the production of sex hormones for enhancement such as androgen, estrogen & neurotransmitters that modulate the sex drive - such as dopamine and norepinephrine

69. IONIC TRACE MINERALS provides a balance of essential minerals in whom scientists and scholars officially agree, to be very necessary to maintain health & that no other nutrient can be substituted increases the potency & effectivity of the other components

70. SELENIUM Believed to be good for sperm production and mobility nearly 50% of the selenium in a man is in the testes and seminal ducts; men lose selenium in their semen Getting enough selenium is vital for peak sexual performance and male sexual enhancement