Erectile Dysfunction

By Bonnie Jenkins, Advanced Natural Medicine

My husband is a huge fan of NASCAR. Most weekends you can find him in front of the TV cheering for his favorite driver, Mark Martin in the Viagra car. Unfortunately, the Viagra car hasn’t done so well this season. The drug, on the other hand, is still riding high on the charts despite disturbing reports of adverse effects.

Viagra (sildenafil citrate) works by increasing the blood flow to the penis and helps establish and maintain an erection. But, those little blue pills can also cause headaches, facial flushing, dyspepsia, urinary tract infections, diarrhea, dizziness and muscle pain. More frightening, within the first 13 months of its release, an investigation by researchers at Cedars-Sinai Medical Center in Los Angeles discovered that, of the 1,473 major adverse effects reported to the FDA, 522 men died of a heart attack within hours of taking Viagra. Earlier reports had linked the drug’s deadly side effects to its reaction with medications containing nitrates – medications like nitroglycerine which are often prescribed to older heart patients. Since both drugs dilate the blood vessels, it was thought that the combination caused blood pressure to plummet. In response to these reports, the FDA warned cardiac patients to avoid Viagra. But this study found that Viagra was somehow implicated in the deaths of men under the age of 65 with no history of heart disease. Although some of the men who died after taking Viagra were elderly and on heart medication, 88 percent of the deaths actually occurred in younger men who weren’t taking nitrates.

Ok, so life-threatening side effects aren’t that uncommon in pharmaceuticals. But Viagra has two other strikes against it – half of all men who have tried the drug have found it ineffective and it doesn’t address the underlying causes of erectile dysfunction (ED).

One Problem, Many Causes

You deserve a pleasurable and fulfilling sex life – and so does your partner. But you needn’t turn to prescriptions riddled with side effects to re-ignite your fire and rejuvenate your erection. First, it’s important to realize that ED is a common, and often temporary, problem. The inability to sustain an erection sufficient for intercourse affects more than half of all American men at some time in their lives and for a number of reasons. Diabetes, arteriosclerosis, neurological disorders, psychological issues or prolonged stress can all be at the root of the problem. Blood pressure medications and antidepressants may also lead to impotency, especially in older men. Dietary factors also fuel the problem. Men with diets high in caffeine, sugar and alcohol are at greater risk of developing ED, as are men who smoke.

An erection is a hydraulic event. Blood enters the penis through blood vessels or arteries at a greater rate than the blood leaving the penis. The resulting rigidity is called an erection. The brain and spinal cord work in concert to produce an erection; the brain acting on erotic thoughts and the spinal cord responding to touch. This reflex action is assisted by the male hormone testosterone and by neurotransmitters, particularly nitric oxide (NO), a relaxant that allows the blood vessels to enlarge and leads to increased blood flow and swelling of erectile tissue. As the penile tissue relaxes and penile arteries expand, the blood flow into the erection chambers increases and the penis grows in width and length. After the initial burst of nitric oxide from the nerve endings, the blood vessels take over, releasing even more nitric oxide to maintain the erection. But, before you start thinking that NO is the best thing since sliced bread, be aware that this neurotransmitter doesn’t act directly on the penis. Instead, it works through a chemical intermediary called cyclic guanosine monophosphate (cGMP). It’s cGMP that actually triggers the muscular and vascular changes that lead to an erection. Once the brain stops sending NO, another chemical kicks in to break down cGMP. This chemical, an enzyme known as PDE-5, gobbles up the erection-sustaining cGMP and causes the smooth muscle to contract.

It’s easy to see how even a small glitch in this complex chain of events can sabotage an erection. Fortunately, there are a number of safe, natural alternatives to Viagra. The first step is to develop healthy eating habits. Nutrients such as vitamins C, E, zinc and essential fatty acids are important to a man's normal sexual function. Diets high in antioxidant-rich fruits and vegetables help to maintain vascular integrity and sufficient blood flow to the penis's erectile tissue. A healthy diet also prevents lipid peroxidation that decreases the hormones and neurotransmitters needed for a normal erection.

Uplifting Herbs

Botanicals are another option and offer many of the same therapeutic benefits found in pharmaceuticals, but without the side effects. In several studies, Ginkgo (Ginkgo biloba) caused increased peripheral blood flow both in normal, healthy subjects and those with arteriosclerosis. One unblinded study involving 30 men who were experiencing medication-induced ED found that taking 200 mg. per day of ginkgo had a positive effect on sexual function in 76 percent of the participants.

Herbal yohimbe (Coryanthe yohimbe), shown to increase libido and shorten the latency period between ejaculations, also enhances erectile function in patients with diabetic neuropathy. It also has a positive effect on depression and often alleviates the impotency associated with it. While herbal yohimbe has many positive effects, pure yohimbine has side effects such as increased blood pressure, racing heart rate, tremors and irritability, headache, nausea or vomiting, sweating, dizziness, flushed skin and frequent urination. But even herbal yohimbe should be used with caution. Anyone with a heart condition, kidney disease, glaucoma or history of gastric or duodenal ulcers should avoid herbal yohimbe because it elevates blood pressure and excites the central nervous system. This herbal medicine should only be prescribed by a health care provider familiar with its effects.

Another herb that’s gaining a lot of recognition is Epimedium grandiflorum. You may have heard of this botanical by it more common, and I think rather humorous, nickname: horny goat weed. Kidding aside, researchers believe that the herb increases libido by modulating cortisol levels, the primary stress hormone. Increased cortisol levels are known to cause fatigue and depress sexual desire. By balancing cortisol levels, epimedium helps restore normal metabolism, energy levels and libido. Epimedium also functions a bit like an adaptogen by increasing low levels of epinephrine, norepinephrine, serotonin and dopamine – brain chemicals that are important to the health of your cardiovascular and central nervous systems.

While most herbs work to slowly correct imbalances that can result in ED, Cnidium monnier works “on demand.” In other words, you don’t need to take a daily dose to get the desired effects. Used for centuries in Traditional Chinese Medicine, according to a joint study by the Institute of Clinical Medicine, National Yang-Ming University and National Research Institute of Chinese Medicine, one of the coumarins in Cnidium monnier possesses a relaxant effect on tissue and smooth muscle, allowing for maximum arterial dilation. Cnidium is taken orally and often combined with Xanthoparmelia scabrosa to enhance smooth muscle relaxation.

One Last Thing ...

A brand new study by Cologne University Medical Centre in Germany suggests that exercise can be as effective as Viagra in some forms of ED. In the study, 104 patients with mild to moderate ED were randomly assigned to Viagra, placebo or exercise consisting of squats, pelvic lifts and leg lifts. Overall, 80 percent of the exercise group reported better erections compared to 74 percent of those taking Viagra and 18 percent of the placebo group.

Sexual health goes far beyond the physical. It can add to your emotional well-being and rekindle the love between your partner and yourself. And, in a world where we are constantly bombarded by negative thoughts and images, we could all use a little more love in our lives.

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References:

Chen J, et al. “Effect of the plant-extract osthole on the relaxation of rabbit corpus cavernosum tissue in vitro.” Journal of Urology. 2000; 163:1975-80.

Cohen AJ, et al. “Ginkgo biloba for antidepressant-induced sexual dysfunction.” Journal of Sex and Marital Therapy. 1998; 24:139-143.

Ernst E, et al. “Yohimbine for erectile dysfunction: A systematic review and meta-analysis of randomized clinical trials.” Journal of Urology. 1998;159:433-436.

Jia X, et al. “Chemical constituents of the root of Epimedium acumiantum Franch.” Zhongguo Zhong Yao Za Zhi. 1998; 23:162-164.