SAN DIEGO — Before you recommend a treatment for erectile dysfunction, make sure to rule out underlying factors that may contribute to the condition.
“Treat the whole person. Try to take care of other medical problems they might have,” Dr. Edward (Lev) Linkner advised at a meeting sponsored by the Scripps Center for Integrative Medicine and the American Board of Integrative Holistic Medicine.
Medical conditions that should be ruled out include arteriosclerosis, diabetes, Syndrome X (cardiometabolic syndrome), hypothyroidism, and hypogonadism. Emotional etiologies such as depression and relationship difficulties should also be investigated, as should stress and lifestyle habits, especially smoking and alcohol consumption.
“Even bicycling can put abnormal pressure on pelvic nerves and result in erectile dysfunction,” said Dr. Linkner, a founder of the American Board of Holistic Medicine and current member of their board of directors. He is in private practice in Ann Arbor, Mich.
If erectile dysfunction is secondary to a treatable disease or condition, treatment of that disease or condition may be all that's necessary. If not, consider one of the following herbs:
▸ Yohimbine. This herb is derived from bark shavings of a West African tree, Pausinystalia yohimbe. “Some studies show positive results, some don't,” Dr. Linkner said. “The major side effects are hypertension, anxiety, nausea, trembling, and insomnia.” Yohimbine is contraindicated for use by those with liver and kidney disease. It is available in tablet form as the prescription drug Yocon (yohimbine hydrochloride), an alpha2-adrenergic blocker that increases blood flow to the penis. “It may be especially helpful for erectile dysfunction induced by the use of selective serotonin reuptake inhibitors,” Dr. Linkner said. He recommends a dose of one-half to one whole 5.4-mg tablet t.i.d.
▸ Ginkgo biloba. A German study showed that this herb increased blood flow to the penis within 8 weeks of starting treatment, and half of the participants regained normal potency (J. Sex Educ. Ther. 1991;17:53–61). The recommended dose is 60–120 mg b.i.d.
▸ Damiana (Turnera diffusa). Although poorly studied, this herb has been used as an aphrodisiac for centuries, especially in Mexico. Its leaves also are used to make a tea. The recommended dose is 300–450 mg once daily.
▸ Ginseng. Panax ginseng appears to works best for erectile dysfunction, but Siberian ginseng also can be used. Ginsenoside, a triterpenoid saponin, increases nitric oxide and “works like a natural Viagra,” Dr. Linkner said. The recommended dose is 200–1,000 mg.
▸ Muria puama. In European studies, this extract of a shrub (Ptychopetalum olacoides) from the Amazon has been shown to increase erections and libido. It is listed in the British Herbal Pharmacopoeia as a treatment for erectile dysfunction and dysentery.
▸ Maca (Lepidum meyenii). This radishlike plant native to the Peruvian Andes is thought to increase sexual function and stamina. The recommended dose is 1.5–3 g daily.
Adaptogens—herbs that are restorative or enhance physical performance—also may have a role in the treatment of erectile dysfunction, said Dr. Linkner, also of the University of Michigan, Ann Arbor. They “increase energy and resistance to all types of stress, thereby preventing fatigue, enhancing memory, concentration, and improving work performance.” Some adaptogens are cordyceps, ashwagandha, and rhodiola.
Other herbs with historical use in treating erectile dysfunction include oats, which increase stamina and decrease irritability; rosemary, which may help the adrenal gland produce more sex hormones; and catuba, a Brazilian herb that may increase libido.
Arginine, a biologic precursor to nitric oxide, also is used as a treatment for erectile dysfunction. However, it may reduce blood pressure, so precautions should be taken with patients on antihypertensive medications. The recommended dose of arginine is 500–1,500 mg b.i.d., or 1,000 mg 30 minutes before sex.
Dr. Linkner had no conflicts of interest to disclose.