Erectile dysfunction (ED) is a serious problem. Erectile dysfunction, tied closely as it is about ideas of physical well being, can have severe psychological consequences. A man’s inability to achieve or maintain an erection is inevitably linked to complex feelings of inadequacy, frustration, and shaken confidence, which may spill over into other areas of his life. The psychological and quality-of-life consequences of ED must not be underestimated.
Since the introduction of Viagra (sildenafil citrate) in 1998, it has become clear that ED is far more prevalent than may have been suspected previously. A study conducted in the Boston area from 1987 to 1989 found that 52 percent of men between the ages of 40 and 70 suffered some degree of ED (Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB., Construction of a surrogate variable for impotence in the Massachusetts Male Aging Study., J Clin Epidemiol. 1994 May;47(5):457-67).
About 30 million men are affected by ED in the United States (McKay D 2004). Given men’s ever increasing lifespan, it has been further estimated that the incidence of ED worldwide will more than double in the next quarter century (Goldstein I 2000).
The drug Viagra has improved the quality of life for countless millions of men and their partners who might otherwise have faced either years of continued impotence or unpleasant alternatives, such as penile implants or penile injections. ED drugs however, produce a number of side effects (some serious, such as the small risk of blindness) (Akash R et al 2005), and not all men can take them. For about 30 percent of patients, ED drugs don’t work to patients’ satisfaction (Sussman DO 2004). This high failure rate has prompted researchers to search for alternatives.
Western Medical Causes of Erectile Dysfunction
- Drugs (anti-depressants (SSRIs) and nicotine are most common)
- Neurogenic disorders (spinal cord and brain injuries, nerve disorders such as Parkinson's disease, Alzheimer's disease, multiple sclerosis, and stroke)
- Cavernosal disorders (Peyronie's disease)
- Psychological causes: performance anxiety, stress, mental disorders (clinical depression, schizophrenia, substance abuse, panic disorder, generalised anxiety disorder, personality disorders or traits), psychological problems, negative feelings.
- Surgery (radiation therapy, surgery of the colon, prostate, bladder, or rectum may damage the nerves and blood vessels involved in erection. Prostate and bladder cancer surgery often require removing tissue and nerves surrounding a tumor, which increases the risk for impotence.
- Ageing. It is four times higher in men in their 60s than in men in their 40s.
- Kidney failure
- Diabetes causes increeased triglycerides in the the blood therby restricting blood flow
- Lifestyle: smoking is a key cause of erectile dysfunction. Smoking causes impotence because it promotes arterial narrowing.
- Multiple Sclerosis (MS) A few causes of impotence may be iatrogenic (medically caused).
There are no formal tests to diagnose erectile dysfunction. Some blood tests are generally done to exclude underlying disease, such as hypogonadism and prolactinoma. Diabetes is considered a disorder, but is also a risk. Impotence is also related to generally poor physical health, poor dietary habits, obesity, and most specifically cardiovascular disease such as coronary artery disease and peripheral vascular disease.
A useful and simple way to distinguish between physiological and psychological impotence is to determine whether the patient ever has an erection. If never, the problem is likely to be physiological; if sometimes, it could be physiological or psychological.
Duplex ultrasound is used to evaluate blood flow, venous leak, signs of atherosclerosis, and scarring or calcification of erectile tissue. Injecting prostaglandin, a hormone-like stimulator produced in the body, induces erection. Ultrasound is then used to see vascular dilation and measure penile blood pressure.
Penile nerves function
Tests such as the bulbocavernosus reflex test are used to determine if there is sufficient nerve sensation in the penis. The physician squeezes the glans (head) of the penis, which immediately causes the anus to contract if nerve function is normal. A physician measures the latency between squeeze and contraction by observing the anal sphincter or by feeling it with a gloved finger inserted past the anus.
Nocturnal penile tumescence (NPT)
It is normal for a man to have five to six erections during sleep, especially during rapid eye movement (REM). Their absence may indicate a problem with nerve function or blood supply in the penis. A significant proportion of men who have no sexual dysfunction nonetheless do not have regular nocturnal erections.
This test uses electromagnetic vibration to evaluate sensitivity and nerve function in the glans and shaft of the penis.
Dynamic infusion cavernosometry (DICC)
Technique in which fluid is pumped into the penis at a known rate and pressure. It gives a measurement of the vascular pressure in the corpus cavernosum during an erection.
Cavernosography measurement of the vascular pressure in the corpus cavernosum. Saline is infused under pressure into the corpus cavernosum with a butterfly needle, and the flow rate needed to maintain an erection indicates the degree of venous leakage. The leaking veins responsible may be visualised by infusing a mixture of saline and x ray contrast medium and performing a cavernosogram.
Magnetic resonance angiography (MRA)
This is similar to magnetic resonance imaging. Magnetic resonance angiography uses magnetic fields and radio waves to provide detailed images of the blood vessels. Doctors may inject a "contrast agent" into the patient's bloodstream that causes vascular tissues to stand out against other tissues. The contrast agent provides for enhanced information regarding blood supply and vascular anomalies.
Physiology of an Erection
The penis is largely under the control of the central nervous system. The features that allow erection to occur consist of spongy columns of tissue known as the corpus cavernosum and corpus spongiosum. When these specialised tissues engorge with blood, erection is achieved. This process involves complex interactions among psychological and physical stimuli and chemical signals, as well as a shifting balance between inhibitory and excitatory forces.
During sexual stimulation, the brain sends signals that result in the release of nitric oxide (NO) by parasympathetic neurons in the penis. The neurotransmitter that carries the sexual message is acetylcholine (Ach) to trigger the production of nitric oxide (NO). Penile endothelial cells are also stimulated to release nitric oxide. As nitric oxide diffuses into the smooth-muscle cells lining the arteries of the corpus cavernosum and corpus spongiosum, it stimulates the activation of an enzyme called guanylate cyclase. This enzyme produces cyclic guanosine monophosphate (cGMP), which prompts the smooth muscles of penile arteries to relax, allowing more blood to flow into the spongy tissues of the penis. Simultaneously, blood return via penile veins is restricted, trapping blood in the organ, resulting in engorgement and erection.
Eventually, cGMP is broken down by phosphodiesterase type 5 enzymes (PDE5). When this occurs, the erection subsides; blood flow returns to normal, and the penis resumes its normal flaccid state. The chain of events leading to erection presents several opportunities for intervention in the treatment of ED. Increasing the availability of nitric oxide is one, while decreasing the activity of PDE5 is another.
Viagra and other drugs for ED such as Cialis and Levitra are selective inhibitors of PDE5. By inhibiting the degradation of cGMP, which is the direct intracellular mediator of the nitric oxide pathway, these drugs promote better erections but have side effects and risks. For example, all the drugs in this class are contraindicated for men organic nitrates for cardiovascular conditions. Mixing these drugs may result in dangerously low blood pressure. Viagra may temporarily affect colour vision and in rare cases may cause blindness (Akash R et al 2005). And any of these drugs may induce a sustained erection that does not subside after more than four hours—a potentially damaging condition known as priapism. Less severe side effects commonly associated with this class of drugs include headaches, nasal congestion, and flushing (Gresser U et al 2002).
Western Medical Treatment of Erectile Dysfunction
Phosphodiesterase type 5 inhibitors (PDE5 inhibitors)
The cyclic nucleotide phosphodiesterases constitute a group of enzymes that catalyze the hydrolysis of the cyclic nucleotides cyclic AMP and cyclic GMP. They exist in different molecular forms and are unevenly distributed throughout the body.
One of the forms of phosphodiesterase is termed PDE5. The prescription PDE5 inhibitors sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) are prescription drugs which are taken orally. They work by blocking the action of PDE5, which causes cGMP to degrade. These druigs are effective but not without side effects.
Side Effect of synthetic PDE5 inhibitors
Nervous system side effects have included headache, observed in up to 16% of patients. Other nervous system side effects have included dizziness in 2%, and, in less than 2%: ataxia, hypertonia, neuralgia, neuropathy, paresthesias, tremor, vertigo, depression, insomnia, somnolence, abnormal dreams, decreased reflexes, and hypesthesia.
Cardiovascular side effects have included flushing (vasodilation) in 10% and dizziness in 2% of patients. Consistent with its known effects on the nitric oxide/cGMP pathway, use of sildenafil has been shown to potentiate the hypotensive effects of nitrates, and its administration to patients who are concurrently taking organic nitrates is considered contraindicated.
The following cardiovascular side effects have been associated with the use of sildenafil in less than 2% of patients: angina pectoris, AV block, migraine, syncope, tachycardia, palpitation, hypotension, postural hypotension, myocardial ischemia, cerebral thrombosis, cardiac arrest, heart failure, abnormal electrocardiogram, chest pain, and cardiomyopathy.
Postmarketing studies have reported serious cardiovascular events, including myocardial infarction, sudden cardiac death, ventricular arrhythmia, cerebrovascular hemorrhage, transient ischemic attack, and hypertension in temporal association with the use of sildenafil. Most patients had preexisting cardiovascular risk factors.
Gastrointestinal side effects have included dyspepsia (7%) and diarrhea (3%). Less common gastrointestinal side effects have included abdominal pain, vomiting, glossitis, colitis, dysphagia, gastritis, gastroenteritis, esophagitis, stomatitis, dry mouth, abnormal liver function tests, rectal hemorrhage, and gingivitis.
Respiratory system side effects have included nasal congestion (4%). Other respiratory system side effects have included wheezing, dyspnoea, laryngitis, pharyngitis, sinusitis, bronchitis, increased sputum production, and cough.
Genitourinary side effects have included urinary tract infection in 3% of patients. Less commonly, occurring in less than 2% of patients, cystitis, nocturia, urinary frequency, breast enlargement, urinary incontinence, abnormal ejaculation, genital edema, and anorgasmia have been reported. Prolonged erection greater than 4 hours and priapism (painful erections greater than 6 hours in duration) have been reported infrequently since market approval of sildenafil. In the event of an erection that persists longer than 4 hours, the patient should seek immediate medical assistance.
Sildenafil is selective for phosphodiesterase-5 (PDE5). It has lesser affinity for other PDE isoenzymes, one of which is PDE6, an enzyme found in the retina. This lower selectivity is thought to be the basis for abnormalities related to color vision observed with higher doses or plasma levels. Nonarteritic anterior ischemic optic neuropathy developed in one eye within minutes to hours after ingestion of sildenafil. Four of the five patients had no vascular risk factors for ischemic optic neuropathy.
Ocular side effects have included mild and transient blue or colored tinged vision, sometimes associated with photosensitivity or blurred vision. Less common ocular side effects (less than 2% of patients) have included mydriasis, conjunctivitis, photophobia, tinnitus, eye pain, deafness, ear pain, eye hemorrhage, cataract, and dry eyes. Several cases of optic neuropathy have been associated with sildenafil use. Dermatologic Dermatologic side effect have included rash which was reported in at least 2% of patients.
Other Western Medical Options
Often, as a last resort if other treatments have failed, the most common procedure is prosthetic implants which involves the insertion of artificial rods into the penis.
The device helps draw blood into the penis by applying negative pressure. This type of device is sometimes referred to as penis pump and may be used just prior to sexual intercourse. Several types of FDA approved vacuum therapy devices are available with a doctor's prescription.
Naturopathic Causes and Treatment of Erectile Dysfunction
- Sympathetic nervous system dominance ie. Stress.
- Low Testosterone AKA Andropause.
- Adrenal exhaustion and low DHEA.
- Oestrogen Excess AKA Oestrogen dominance.
- Excess aromatase activity.
- Low Sex Hormone Binding Globulin (SHBG).
- Poor enterohepatic (liver/bowel) circulation.
- Deficiency of Nitric Oxide (AKA Endothelial derived Relaxing Factor ENDR)
- Deficiency of cyclic nucleotide cGMP.
- Excess enzyme activity of PDE5.
- Underlying coronary artery disease.
- Diabetes causes peripheral vascular disease.
- Circulatory disorder due to excess vasoconstriction.
- Poor physical health, poor dietary habits, obesity.
Naturopathic Treatment Principles in Erectile Dysfunction
- Activate the parasympathetic nervous sytstem, ie promote relaxation.
- Increase Testosterone.
- Tonify the adrenals and increase DHEA.
- Avoid Xenoestrogens including avoid excess phytoestrogen.
- Inhibit excess aromatase activity.
- Increase Sex Hormone Binding Globulin SHBG
- Improve enterohepatic function.
- Increase NO.
- Lower homocysteine levels to increase NO.
- Increase cGMP /improve the ratio cAMP:cGMP.
- Inhibit the enzyme PDE5.
- Adopt a diet to reduce cardiovascular disease and diabetes.
- Loose weight
1. Activate the parasympathetic nervous sytstem, ie promote relaxation
In order for an erection to occur the parasympathetic nervous system must be activated. When the body is relaxed the parasympathetic nervous system, is activated. It is very important to promote relaxation, either in the way of Taichi, Qi gong, yoga or meditation, relaxation exercises or simply deep breathing.
When the bitter flavour stimulates the taste buds on the tongue, it sets in motion a series of physiological responses incuding the activation of the parasympathetic nerve to promote salivation, bile flow, stomach acid and pancreatic juices to imporve digestion, absorption and assimilation of nutrients from food. Through activating the parasympathetic nervous system, bitters not only improve digestion absorption and assimilation but also relax the mind, in this case assisting erectile function. Carahealth Male Tonic contains maong many other herbal actions, bitter herbs.
The neurotransmitter that carries the sexual message is acetylcholine (Ach) to trigger the production of nitric oxide (NO). ACh also seems to control sexual behavior through its activity in the brain. For women, ACh is also a very important part of sexual function. Numerous studies confirm a key role for cholinergic nerve transmission in sexual responses. Simply speaking, with too little ACh, sexual activity goes down. Increase ACh levels, and sexual activity goes up.
Cholinergic drugs enhance cholinergic activity, but these drugs have unpleasant or even dangerous side effects. One way to safely and effectively enhance ACh levels is to take supplements of choline, along with vitamin B5, so that the body will manufacture more ACh.
2. Increase Testosterone and Balance Hormones
It may also be important for men to test their blood levels of free testosterone and oestradiol (an oestrogen). As men age, they often suffer from a deficiency of free testosterone while producing too much oestrogen. Sexual desire and performance are strongly affected by these hormones. The good news is that there are safe ways of increasing free testosterone and reducing excess oestrogen, which can lead to a significant improvement in a man’s sexual function.
Low Testosterone and dehydroepiandrosterone (DHEA)
Andropause or male menopause, sometimes colloquially called "man-opause" is a name that has been given to a menopause-like condition in aging men. This relates to the slow but steady reduction of the production of the hormones testosterone and DHEA in middle-aged men, and the consequences of that reduction, which is associated with a decrease in Leydig cells.
Unlike women, middle-aged men do not experience a complete and permanent physiological shutting down of the reproductive system as a normal event. A steady decline in testosterone levels with age (in both men and women) is well documented.
Western medical treatments for andropause
- Hormone replacement therapy.
- Exercise, dietary changes, stress reduction.
- Selective androgen receptor modulators have also been proposed.
Testosterone Therapy for ED
Testosterone is well known as the primary male hormone ( women also make it) associated with vigour, libido, and masculinity. While it is fairly well established that testosterone plays a role in libido, or sexual desire, its precise contribution to erectile function remains unclear (Martinez-Jabaloyas JM et al 2006; Mikhail N 2006; Traish AM et al 2006). ED occurs in men with normal or moderately low levels of testosterone, so it cannot be concluded that testosterone is the primary modulator of erectile function.
Among men diagnosed with hypogonadis however, a condition characterised by abnormally low testosterone, erections do, in fact, improve after testosterone supplementation. For these men with ED, testosterone therapy is recommended to maintain secondary sex characteristics and restore erectile function (Bhasin S et al 2006). Recent evidence suggests that “a significant proportion of men over 60 years of age have biochemical hypogonadism” (Caretta N et al 2005). It may be hypothesised that testosterone replacement therapy be recommended as a second-line approach to treatment of ED when prescription medications alone have failed and when prostate cancer has been ruled out.
Current therapies in prostate cancer suppress testosterone. Western medical supplementation with synthetic testosterone hormone increases the risk of certain types of prostate cancer. So, from a naturopathic perspective, increasing testosterone naturally is the way to go in ED and indeed in all men, without risking prostate disease.
Testosterone and prostate disease
Prostate cancer by the way occurs as their is low testosterone. What the body does then is to increase copnversion of testosterone to Dihydrotestosterone (DHT). It is the DHT that causes the prostate to enlarge, increasing risk of Benign Prostatic Hyperplasia (BHP) and prostate cancer. So in fact encouraging healthy testosterone levels in men in a natural way actually protects the prostate.
Herbal medicine to increase testosterone
Saw Palmetto is a Native American plant known historically to stimulate male libido and increase sexual energy. Components in saw palmetto are also believed to have aphrodisiac qualities, reduce prostate size, enhances sexual functioning, increase desire, reduce serum cholesterol and fatty acids.
It's primary role is as a 5 alpha reductase inhibitor is to inhibit the conversion of testosterone to dihydrotestosterone DHT. DHT is the main contributing factor in male pattern baldness and Benign Prostatic Hyperplasia BPH. By inhibiting the conversion of testosterone, this allows for mroea testosterone availability. As a prostate tonic, it improves blood flow to the prostate and genital region.
Maca (Lepidium meyenii) is a root vegetable that has been cultivated and consumed in the Peruvian Andes for centuries (Chung F et al 2005). It is availiable as a powder that can be added to porridge. Indigenous people have traditionally used maca root for its presumed aphrodisiac properties and its purported ability to enhance fertility (Rowland DL et al 2003).
Animal studies suggest that maca may enhance sexual behavior and other parameters associated with sexual health. Stuudies have shown that Maca increases litter size, boosts sperm production, and even protects sperm from damage by stressors such as high altitude, pesticides, and lead (Rubio J et al 2006; Bustos-Obregon E et al 2005; Chung F et al 2005; Ruiz-Luna AC et al 2005; Gonzales GF et al 2004; Cicero AF et al 2001, 2002; Zheng BL et al 2000).
In traditional Chinese medicine Tribulus terrestris is known under the name bai ji li (白蒺藜). Tribulus terrestris has long history in Ayurvedic medicine and Tradional Chinese Medicine of use as an aphrodisiac. Tribulus terrestris extract can produce statistically significant increases in levels of testosterone, dihydrotestosterone and dehydroepiandrosterone and produces effects suggestive of aphrodisiac activity.
Carahealth Male herbal tincture contains;
Horny Goat Weed /Yin Yang Huo 淫羊藿 Epimedium sagittatum, Tribulus / Bai Ji Li 白蒺藜 Tribulus terrestris, Damiana Turnera aphrodisiaca,Sarsaparilla /Tu Fu Ling土茯苓 Smilax ornata, Saw palmetto Serenoa serrulata, Ginseng / Ren Shen 紅蔘Panax spp
This tincture contains a combination of aphrodisiac and tonic herbs that tonify the kidney energy in Traditional Chinese Medicine, which, according to TCM, is responsible for fertility and reproduction. The herbs tonify the adrenal glands and improve strength and resistance. The herbs increase healthy testosterone levels to improve sperm production, erectile function and increase libido.
Pharmacological actions include a natural 5-alpha reductase inhibitor that works like the drug Finasteride to prevent the conversion of testosterone to DHT, a cancer promoting and hair follicles damaging testosterone. The tincture also contain a natural Phosphodiesterase-5 inhibitors (PDE5-I), that work like the drug Viagra to inhibit Nitric Oxide breakdown to enlarge the penis. The tincture is indicated to prevent prostate disease and male pattern baldness, elevated DHT being the main cause of this condition.
The mix is indicated to increase fertility and libido and is a general male tonic designed to increase stamina and promote resistance to stress. Although it is promoted as a fertility tonic, it can be used by any males, from business man driving 4 hours a day to get to and from work, to a world class athlete looking to increase muscle mass and stamina. It is specifically indicated for men who have sweaty or clammy palms, a condition known as palmer hyperhidrosis, which is a symptom of adrenal exhaustion.
For prostate disease specifically See also Carahealth Prostate Support Tonic
3. Tonify the adrenals and increase Dehydroepiandrosterone (DHEA)
DHEA is a steroid hormone produced in the adrenal gland that is a precurser to oestrogen and testosterone. When cortisol hormones are high as occurs during excess stress, thisa results in lower levels of DHEA as the adrenal become exhausted. Symptoms of low DHEA niclude erectile dysfunction and the symptoms of “andropause”.
Men over 65 and testosterone levels
A 2006 study supplemented DHEA to men of average 65 years of age, and found that the men experienced significant increases in testosterone and cGMP (Cyclic guanosine monophosphate), and significant decreases in low-density lipoprotein (LDL).
Ginseng increases DHEA availability
Cortisol is natural antagonist of dehydroepiandrosterone (DHEA) activity and is the basis of the “fight or flight mechanism.” Ginseng reduces cortisol production. By reducing the amount of cortisol, and hence the cortisol to DHEA ratio, ginseng increases the relative effectiveness of available DHEA. 1134.
James M. Howard, Ginseng enhances the effectiveness of DHEA, CMAJ. 2006 April 11; 174(8).
Adaptogens also lower cortisol and improve availability of DHEA
An adaptogen produces an increase in power of resistance against stress whether it is physical, chemical, biological or emotional in origin. Adaptogens restore and normalise physiological functions in the event of stress. Adaptogens specifically help our bodies adapt to changes in what is known as our circadian rhythm or body clock due to seasonal changes, shift work and crossing time zones. They are used specifically to prevent and treat Seasonal Affective Disorder SAD. When a stressful situation occurs, consuming adaptogens generates a degree of generalised adaptation that allows our physiology to handle the stressful situation in a more resourceful manner.
Function of Adaptogens
- Lowers cortisol levels during times of stress
- Improve the availibility of DHEA
- Boost immunity
- Increase energy levels
- Improve resistance to stress
- Improve concentration
- Improves the symptoms of SAD
4. Avoid Xenoestrogens including in ED, avoid excess phytoestrogens
Oestrogen dominance is a theory about a metabolic state where the level of oestrogen outweighs the level of progesterone in the body. This is said to be caused by a decrease in progesterone without a subsequent decrease in oestrogen. From a naturopathic perspective, oestrogen dominance is not only to do with internal hormone imbalance however even more so by external environmental oestrogens known as xenoestrogens.
Health conditions in women and men associated with excess oestrogen
- Weight gain
- Mood swings
- Irregular periods
- Heavy bleeding
- Low libido
- Fibrocystic breast disease
- Polycystic Ovarian Syndrome
- Breast cancer
- Ovarian cancer
- Endometrial cancer
- Colon cancer
- Benign Prostatic Hyperplasia (BPH)
- Prostate cancer (oestrogen is a major influence in prostate cancer)
- Gynaecomastia (Man boobs)
- Male patterned baldness
- Low libido
- Erectile Dysfunction
- Weight gain
Xenoestrogens are "foreign" oestrogens often widely used industrial compounds such as PCB, BPA and Phthalates, that exert oestrogenic effects though they differ chemically from the naturally occurring oestrogens produced by the endocrine system. Xenoestrogens are also called "environmental hormones" or "EDC" (Endocrine Disrupting Compounds). Most scientists that study xenoestrogens, including The Endocrine Society, regard them as serious environmental hazards that have hormone disruptive effects on both wildlife and humans.
Xenoestrogens include pharmacological oestrogens (oestrogenic action is an intended effect, as in the drug ethinyl oestradiol used in contraceptive pill), and other chemicals that have oestrogenic effects. Xenoestrogens have been introduced into the environment by industrial, agricultural and chemical companies and consumers only in the last 70 years. Xenoestrogens also include phytoestrogens (oestrogenic substances from plants), but these do not pose health risks but instead exert a protective effect.
Xenoestrogens and fish
Discharge from humans including runoff and water flowing out of wastewater treatment plants release a large amount of xenoestrogens into streams, which lead to immense alterations in aquatic life, fish being extremely susceptible to pollutants. When comparing fish from above a wastewater treatment plant and below a wastewater treatment plant, studies found cell changes in ovaries and testicless, gonadal intersex (appearing to be female on the outside, but having mostly male-typical anatomy on the inside), reduced gonad size, and altered sex ratios. Sperm concentrations and motility perimeters are reduced in male fish exposed to xenoestrogens in addition to disrupt stages of spermatogenesis. If it is'nt good for fish it isn't good for us.
Xenoestrogens are everywhere
A 2008 report demonstrates further evidence of widespread effects of feminising chemicals on male development as a worldwide phenomenon. 99% percent of over 100,000 recently introduced chemicals are underregulated, according to the European Commission.
Chemicals shown to have oestrogenic effect
- alkylphenols (intermediate chemicals used in the manufacture of other chemicals)
- atrazine (weedkiller)
- 4-Methylbenzylidene camphor (4-MBC) (sunscreen lotions)
- butylated hydroxyanisole, BHA (food preservative)
- bisphenol A ( monomer for polycarbonate plastic and epoxy resin; plastic bottles, antioxidant in plasticizers)
- dichlorodiphenyldichloroethylene (one of the breakdown products of DDT)
- erythrosine, FD&C Red No. 3
- ethinylestradiol (combined oral contraceptive pill) (released into the environment [via urine] as a xenoestrogen)
- heptachlor (restricted insecticide)
- lindane, hexachlorocyclohexane (restricted insecticide)
- metalloestrogens (a class of inorganic xenoestrogens)
- methoxychlor (banned insecticide)
- nonylphenol and derivatives (industrial surfactants; emulsifiers for emulsion polymerisation; laboratory detergents; pesticides)
- pentachlorophenol (restricted general biocide and wood preservative)
- polychlorinated biphenyls, PCBs (banned; formerly used in electrical oils, lubricants, adhesives, paints)
- parabens (creams/lotions)
- phenosulfothiazine (a red dye)
- phthalates (plasticisers)
- DEHP (plasticiser for PVC)
- Propyl gallate (used to protect oils and fats in products from oxidation)
- Aluminum deodorantsaluminium (mimics oestrogen)
Naturopathic Lifestyle Advice to avoid xenoestrogens
- Avoid commercially-raised, non-organic meats such as beef, chicken, and pork. Lamb is relatively clean meat.
- Avoid non-orgainc ommercial dairy products including milk, butter, cheese, and ice cream (organic products do not contain bovine growth hormone) Avoid unfiltered water, including water you bathe in, Use Carahealth Water Filter, Carahealth Bath Filter and the Carahealth Shower Filter.
- Avoid plastic water filters and water in plastic bottles.
- Avoid non eco laundry detergent.
- Avoid Primpro, DES, Premarin, Cimetidine (Tagamet) and Birth Control Pills.
- Avoid Hormone replacement therapy (HRT).
- Avoid creams made with paraben preservatives.
- Avoid synthetic processed soy.
- Avoid shampoos, lotions, soaps, cosmetics that contain paraben or phenoxyethanol.
- Avoid reheating foods in plastic or styrofoam containers.
- Avoid drinking out of plastic cups and containers.
- Avoid air fresheners (contain pthalates).
- Use glass or ceramics whenever possible to store food and water. Heat up your food using a glass or ceramic bowl covered with dish. When plastic is heated, it diffuses very rapidly into food.
- Use Condoms without spermicide for Birth control instead of Birth Control Pills
- Eat plenty of foods naturally high in phytoestrogens
DO NOT avoid phytoestrogens as epidemiological studies everywhere have shown these to be effective in reducing rates of hormone dependant cancers, including breast and prostate. Many websites say to avoud phytoestrogens this is completely the wrong advice altogether.
Instead avoid synthetic derivations of soy including soy protein isolate.
Phytoestrogens are amphoteric
Phytoestrogens are plant-derived xenoestrogens consumed by eating phytoestrogonic plants. Phytoestrogens exert their effects primarily through binding to oestrogen receptors (ER) and stimulate the synthesis of sex hormone binding globuline (SHBG). They have the ability to cause oestrogenic or/and antiestrogenic effects. This is known as amphoterism, meaning they are capable of either occupying oestrogen receptors in cases of oestrogen deficiency and exerting an oestrogen effect, or alternatively in cases of oestrogen excess, phytoestrogens can occupy the oestrogen receptors and block the negative effects of excess oestrogen allowing for removal of this excess oestrogen via the enterohepatic circulation (healthy liver and bowel). In erectile dysfunction consuming healthy amounts of phytoestrogens will help rid the body of environmental synthetic xenoestrogens and excess endogenous oestrogens made by the male body.
Other health benefits of phytoestrogens
Researchers are exploring the nutritional role of these substances in the regulation of cholesterol, and the maintenance of proper bone density post-menopause. Evidence is accruing that phytoestrogens may have protective action against diverse health disorders, such as prostate, breast, bowel, and other cancers, cardiovascular disease, brain function disorders and osteoporosis, and epidemiological information from Asian culture shows that phytoestrogens alleviate the symptoms of menopause.
Excess phytoestrogens may effect male fertility and libido
Consuming excess in the male species may affect their fertilty. In the 1940s it was noticed for the first time that red clover (a phytoestrogens-rich plant) pastures had effects on the fertility of grazing sheep. According to Buddhist monks, soy suppresses sexual desire.
A 2010 meta-analysis however, of fifteen placebo-controlled studies said that "neither soy foods nor isoflavone supplements alter measures of bioavailable testosterone concentrations in men." Furthermore, Isoflavones supplementation has no effect on sperm concentration, count or motility, and show no changes in testicular or ejaculate volume.
Whilst normal amounts of isoflavone rich foods are advisable for men, protecting them from xenoestrogens, the advice in erectile dysfunction is to avoid excess consumption of these foods. The main offenders are excess, soy products, including soy flour, soy milk, tofu and tempeh, flaxseed, and hops (in beer).
5. Inhibit excess aromatase activity
Aromatase is a cytochrome P450 enzyme. The enzyme aromatase converts testosterone to oestradiol. Excess aromatase activity in men will result in lower testosetrone levels and can lead to low libido.
Aromatase activity in women
Excess aromatase in women is associated with endometriosis, uterine fibroids, breast cancer and endometrial cancer. Aromatase is a very important pharmacological target for the treatment of breast cancer.
Aromatase activity in men
In men aromatase converts testosterone into oestrogen. Excess aromatase activity is associasted with prosate cancer. Aromatase inhibitor drugs are prescribed for prostate cancer although these drugs are not without their side effects. By inhibiting aromatase activity in men, this will result in increased testosterone levels. There are many natural aromatase inhibitors that have no unwanted side effects. Aromatase is overactive in obesity so weight loss is advisable.
Natural Aromatase inhibitors [AKA Natural Aromadex (Arimimdex)]
Resveratrol, oleuropein, quercetin, chrysin, naringenin, apigenin and are all powerful flavonoids from whole foods that inhibit aromatase in men.
Resveratrol is natural phenol, produced by several plants when under attack by pathogens such as bacteria or fungi that has anti-cancer, anti-inflammatory, blood-sugar-lowering and other beneficial cardiovascular effects of resveratrol have been reported. Resveratrol inhibits aromatase (Wang Y et al 2006). Resveratrol is found in the skin of red grapes and in other fruits. Red wine contains a high level of it.
Oleuropein is a chemical compound found in olive leaf from the olive tree. Oleuropein and its metabolite hydroxytyrosol have powerful antioxidant activity and give extra-virgin olive oil its bitter, pungent taste. Oleuropein strengthens the immune system and enhances thermogenesis by increasing the thermogenin content in brown adipose tissue and the secretion of noradrenaline and adrenaline.
Quercetin is a plant-derived flavonoid found in fruits, vegetables, leaves and grains. Several laboratory studies show quercetin may have anti-inflammatory and antioxidant properties.
Foods sources of quercetin
- Black and green tea (Camellia sinensis; 2000–2500 mg/kg)
- onion, especially red onion (higher concentrations of quercetin occur in the outermost rings)
- red grapes
- citrus fruit
- broccoli and other leafy green vegetables
- Berries including; raspberry, bog whortleberry, lingonberry, cranberry, chokeberry, sweet rowan, rowanberry, sea buckthorn berry, crowberry prickly pear cactus.
- Organic vegetables have been showed to cntain significantly more quercetin than their conventional counterparts.
Chrysin is a naturally occurring plant-derived flavanoid. Chrysin is another aromatase inhibitor. Although the bioavailability of chrysin by itself is problematic, the addition of piperine greatly increases the absorbability of this testosterone-boosting phytochemical (Khajuria A et al 2002).
Food sources of Chrysin
- Passion flower
Naringenin is a flavanone, a type of flavonoid, that is considered to have a bioactive effect on human health as antioxidant, free radical scavenger, anti-inflammatory, carbohydrate metabolism promoter, and immune system modulator.
Food sources of naringenein
- Grapefruit. It is the predominant flavanone in grapefruit.
- Tomato (skin)
- Naringenin can be absorbed from cooked tomato paste.
Apigenin is a citrus bioflavonoid. Apigenin, like most flavonoids, has antioxidant, anti-inflammatory and antitumour properties. Apigenin is commonly recognised as to mediate at least part of the chemopreventive action of vegetables and fruits in the cancerous process. Recently it was shown that Apigenin induces a process called autophagia (a kind of cellular dormancy) which may well explain it chemopreventive properties but at the same time induces resistance against chemotherapy. Apigenin is a potent inhibitor of CYP2C9, an enzyme responsible for the metabolism of many pharmaceutical drugs in the body so avoid if taking a supplement if on medication. Natural foods sources are safe.
Food sources of apegenin
- Dandelion root coffee
- Lemon balm
- Red wine
- Tomato sauce
Other aromatase inhibitors
Grape seed extract
Another such aromatase inhibitor is grape seed extract. It has been shown to be useful in the treatment of oestrogen-dependent breast cancer, due to its ability to prevent the conversion of androgens (male hormones) to oestrogens.
Zinc may be of benefit in helping to boost testosterone through inhibition of aromatase (Kaya O et al 2006; He F et al 2005).
Excess betaglucuronidase activity in men
Betaglucaronidase converts weak oestrogen to cancer causing oestrogen in the bowel. Betaglucuronidase is 3.6 x higher in prostatic carcinoma than in prostatic hyperplasia.
Jeffrey P. Pearson BA., et al., Betaglucuronidase activity in prostatic carcinoma and benign prostatic hyperplasia Cancer Volume 64, Issue 4, pages 911–915, 15 August 1989.
Natural Betaglucuronidase inhibitors
Calcium D-glucarate is the calcium salt of D-glucaric acid, a natural substance found in many fruits and vegetables. Calcium D-glucarate has been shown to inhibit beta-glucuronidase, an enzyme found in certain bacteria that reside in the gut.
Foods sources high in glucaric acid (a form of calcium D-glucarate) include;
- brussels sprouts
- bean sprouts
- scutellaria baicalensis
6. Increase SHBG and improve enterohepatic clearance of xenoestrogens
Sex hormone-binding globulin (SHBG) blances hormones Sex hormone-binding globulin (SHBG) is a glycoprotein that binds to sex hormones, specifically testosterone and oestradiol. Conditions with low SHBG include polycystic ovary syndrome diabetes. There has recently been research to link high SHBG levels with breast and testicular cancer as well. A low fat high fibre diet with regular exercise naturally increase SHBG and decreases the risk of hormone dependant cancers.
TymchukCN,etal., Effects of diet and exercise on insulin, sex hormone-binding globulin, and prostate-specificantigen. Nutr Cancer 1998;31(2):127-31.
- Brassicacaea family vegetables such as brocolli, cauliflower,cabbage, curly kale, pakchoi ect., also increase SHBG thereby improving the removal of excess hormones form circulation.
- Nettle root normalises SHBG.
- Exercise and fibre also increase SHBG.
Poor Enterohepatic Circulation
In layman terms this is a sluggish liver and poor bowl flora. As hormones are fatty substances they need a healthy bile flow to break them down and healthy bowel flora to remove them from the bowel.
See also Sluggish Liver Explained
7. Increase Nitric Oxide (NO)
Nitric oxide and circulation NO is also known as Endothelium-derived relaxing factor (EDRF). EDRFis produced and released by the endothelium to promote smooth muscle relaxation. NO is essential to promote blood flow to the penis.
Ageing and deficiency of NO
Risk factors for ED include conditions such as high blood pressure, abnormally high blood lipids (i.e., elevated low-density lipoprotein cholesterol and triglycerides), obesity, diabetes, and smoking (McKay D 2004). Recently, some US scientists reported that it may be necessary to add aging itself to the list of risk factors that produce vascular dysfunction of the kind associated with ED. This age-associated dysfunction was judged to occur even in the absence of clinically diagnosed atherosclerosis and was related to alterations in the production of endothelial nitric oxide (Al-Shaer MH et al 2006).
The link between ED and vascular disease is so strong that physicians are advised to consider men who present with ED but no diagnosis of heart disease as undiagnosed cardiovascular patients until proven otherwise (Jackson G et al 2006). It is believed that alterations in the availability of vascular endothelial nitric oxide represent the common thread linking these interrelated pathologies (Sullivan ME et al 1999).
Arginine is an amino acid the body uses to produce nitric oxide, which relaxes smooth muscle, thus allowing for increased blood flow in many parts of the body. This action may explain why ED is more common in men with forms of vascular disease in which disorders of nitric oxide play a role, such as ischemic heart disease and stroke. For example, 75 percent of men with ischemic heart disease suffer from ED (Kloner RA et al 2003).
Arginine has been shown to improve ED and other nitric oxide–dependent conditions, including atherosclerosis (Napoli C et al 2006). One recent study of healthy people who took sustained-release arginine showed that a moderate dose improved endothelial function and blood pressure. Blood pressure reductions, especially in patients with borderline or frank hypertension, occurred after just one week of L-arginine therapy (Miller AL 2006).
McKay D., Nutrients and botanicals for erectile dysfunction: examining the evidence., Altern Med Rev. 2004 Mar;9(1):4-16.
For more than two thousand years, Panax ginseng has been used in China for its tonic and restorative properties. Sometimes called Korean ginseng, this herb is believed to enhance physical performance and promote health and longevity (McKay D 2004). Modern scientists have identified active constituents, especially saponin glycosides known as ginsenosides, which may be responsible for some of ginseng’s antioxidant and health preserving properties.
Ginsenosides have been shown to increase the release of nitric oxide in the erectile tissue of laboratory animals, thus demonstrating a potential mechanism of action for this folk remedy in the treatment of organic ED (Choi YD et al 1998, 1999; Kim HJ et al 1998; Chen X et al 1995). Human clinical trials have demonstrated ginseng’s potential usefulness as a treatment for ED.
Korean researchers divided 90 men with ED into three equal groups. Participants received Panax ginseng, placebo, or trazodone, an oral antidepressant drug that has occasionally been used to enhance sexual function. Afterwards, participants were evaluated for indicators of healthy erectile function, such as frequency of intercourse, premature ejaculation, and morning erections. None of these parameters changed among the three groups. But participants who received Panax ginseng demonstrated a significant improvement in objective and subjective erection parameters such as penile rigidity, girth, duration of erection, improved libido, and patient satisfaction. Serum testosterone levels were unaffected. Overall, the therapeutic efficacy of ginseng on ED was 60 percent, while participants taking trazodone or placebo experienced only 30 percent efficacy (Choi HK et al 1995).
The herb Tribulus terrestris has been used since ancient times in India as a treatment for both male and female sexual problems. Tribulus has been widely tested for its efficacy in enhancing sperm quality and mobility, and for increasing libido and sexual performance in experimental animals and men. It is also widely used as a body building substance. Tribulus administration results in an increase of Luteinizing hormone (LH) levels by 72%, and free testosterone levels by 41%.
Recently, tribulus has been clinically proven to improve sexual desire and enhance erection. Researchers at the Surabaya School of Medicine and Naval Hospital, Indonesia, studied Protodioscin (PTN), a phytochemical agent isolated from Tribulus terrestris. They found that tribulus works via the conversion of protodioscine to DHEA.
Animal studies are beginning to shed light on how tribulus extracts exert their proerectile effect. Researchers working with New Zealand white rabbits measured the ability of oral tribulus to relax corpus cavernosa tissues--necessary for achieving erections. Their study found that the active ingredient in tribulus, protodioscin, worked by increasing corpus tissue responses to acetylcholine, nitroglycerin and electrical field stimulation. The researchers concluded that the enhanced erections and aphrodisiac effects observed with tribulus were due to increases in the release of nitric oxide (NO) from the endothelium and nitrergic nerve endings.
8. Lower Homocysteine to increase NO
Hyperhomocysteinaemia is a medical condition characterised by an abnormally large level of homocysteine in the blood. Simply put high homocysteine results in low levels of Nitric Oxide NO also know as Endothelial Derived Relaxing Factor EDRF. Whilst adrenalin causes vasoconstriction in peripheral arterioles, it is NO that allows these to relax resulting in a decrease in blood pressure.
Several studies have linked plasma homocysteine levels to blood pressure. Homocysteine-lowering therapies with folic acid-based treatments have resulted in decreases in blood pressure.
How does homocysteine decrease Nitric Oxide levels?
Homocysteine post-translationally inhibits DDAH enzyme activity, causing ADMA to accumulate and inhibit nitric oxide synthesis. Homocysteine elevates blood levels of asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase the enzyme involved in the production of NO.The effect is associated with the reduced activity of dimethylarginine dimethylaminohydrolase (DDAH), the enzyme that degrades ADMA.
Homocysteine and folic acid, B12 and B 6
Deficiencies of the vitamins folic acid, B6 or B12. results in the poor methylation of homocysteine and thus accumulation. Supplementation with pyridoxine, folic acid, B12 or trimethylglycine (betaine) reduces the concentration of homocysteine in the bloodstream.
Hyperhomocysteinaemia and Erectile Dysfunction
Hyperhomocysteinaemia is a risk factor for coronary artery disease (plaque build up on coronary arteries). Coronary heart disease is indicated in erectile dysfunction.
A study investigated the role of homocysteine (Hcys) in erectile dysfunction (ED), Hyperhomocysteinemia, known to be an important risk factor in endothelial dysfunction, seems to be an important determinant in ED also. Elevated Homocysteine levels are significantly related with arterial and probably endothelial dysfunction in patients with ED.
Demir et al., Hyperhomocysteinaemia and Erectile Dysfunction, Metabolism 2006 Dec;55(12):1564-8.
Causes of hyperhomocysteinaemia
1. Two Gene Defects
- Hyperhomocysteinaemia usually occurs in people with at least one defective gene, which affects the breakdown of homocysteine. The first gene codes for an enzyme. This gene is known as Methylenetetrahydrofolate reductase or MTHFR.
- The second common defective gene is methioninesynthetase or MS.
2. Dietary deficiencies of Folate and vitamin B6 and B12
The effect upon those people is greater than the people with only one gene defect.
9. Increase cGMP (improve the ratio cAMP:cGMP)
During an erection NO diffuses into the smooth-muscle cells lining the arteries of the corpus cavernosum and corpus spongiosum, it stimulates the activation of an enzyme called guanylate cyclase. This enzyme produces cyclic guanosine monophosphate (cGMP), which prompts the smooth muscles of penile arteries to relax, allowing more blood to flow into the spongy tissues of the penis.
Imbalance of cAMP:cGMP
In naturopathic terms erectile dusfunction can occur as a result of an imblance in cyclic nucleotides, cAMP:cGMP.
The normal pathway for penile erection may not work properly if the cGMP level in corpus cavernosum smooth muscle cells is not elevated sufficiently or if relaxation of smooth muscle in this tissue is deficient (Jeremy et al, 1997; Corbin and Francis, 1999). PDE-5 inhibitors enhance erectile function during sexual stimulation by penetrating into smooth muscle cells and inhibiting PDE-5. This results in decreased degradation of cGMP, which maintains sufficient cellular levels of cGMP in both corpus cavernosum and the vessels supplying it. This increases relaxation of the smooth muscle, which dilates the corporeal sinusoids resulting in increased blood flow, allowing an erection to occur.
Sildenafil or one of the other PDE-5 inhibitors foster accumulation of the cell cGMP by competitively inhibiting PDE-5, which triggers penile erection. PDE-5 inhibitors do not increase the nitric oxide level, but they potentiate the nitric oxide effect to stimulate erection. Without sexual arousal, this effect activates the nerve-nitric oxide pathway, these inhibitors are ineffective.
Ginsenosides from Panax ginseng, cGMP levels, Nitric oxide NO and increase blood flow. Han SW, Kim H., Ginsenosides stimulate endogenous production of nitric oxide in rat kidney. Int J Biochem Cell Biol. 1996 May;28(5):573-80.
9. Inhibit the enzyme PDE5 to increase NO
Natural PDE5 inhibitors
A phosphodiesterase (PDE) is an enzyme that catalyzes the hydrolysis of phosphodiester bonds. There are 11 families of phosphodiesterases, namely PDE1-PDE11. These enzymes are responsible for the degradation of the cyclic nucleotides cAMP and cGMP. They are therefore important regulators of signal transduction mediated by these molecules. Consider Passion Rx for herbal sexual enhancement.
Phosphodiesterase and Erectile Dysfunction
The oral phosphodiesterase type 5 (PDE5) inhibitors have become quite popular for the treatment of erectile dysfunction. Phosphodiesterase type 5 inhibitors enhance cavernosal smooth muscle relaxation, vasodilatation and penile erection. However, phosphodiesterase type 5 inhibitors are not always effective. Decreased efficacy, cost, incorrect administration, lack of sexual stimulation, vascular risk factors associated with ED and vascular or neurogenic diseases are causes of phosphodiesterase type 5 inhibitor failure. A substance found in horny goat weed herb, called icariin, has been shown to inhibit phosphodiesterase type 5 activity.
Epimedium /Horny Goat Weed
Epimedium, also known as Horny Goat Weed, or Yin Yang Huo (Chinese: 淫羊藿) has reputed aphrodisiac qualities. According to legend, this property was discovered by a Chinese goat herder who noticed sexual activity in his flock after they ate the weed. Epimedium is an endangered species. The over-exploitation of wild populations of Epimedium for use in traditional Chinese medicine is having potentially serious consequences for the long-term survival of several species, so I don't use it personally.
The "active ingredient" in Epimedium is icariin. Icariin is purported to work by increasing levels of nitric oxide, which relax smooth muscle. Like sildenafil (Viagra), icariin, the active compound in Epimedium, inhibits the activity of PDE-5. Horny Goat weed is a natural phosphodiesterase inhibitor Plant extracts traditionally used for male impotence were tested for PDE5 Inhibition. Only icariin, the compound in Horny Goat Weed, proved to be a potent PDE5 inhibitor. Dell'Agli M. et al., Potent inhibition of human phosphodiesterase-5 by icariin derivatives. J Nat Prod. 2008 Sep;71(9):1513-7. Epub 2008 Sep 9.
Methylated xanthines and derivatives caffeine, theobromine and theophylline are nonselective phosphodiesterase inhibitors
Caffeine was the first known PDE inhibitor. In 1960 it was discovered that caffeine was a PDE inhibitor, although this drug has effects on other non-PDE proteins that cause some of its symptoms. One or two cups of real coffee per day may be advisable and certainly drinking green tea which has caffeine will act as natural PDE5 inhibitors.
Theobromine is a bitter alkaloid of the cacao plant, with the chemical formula C7H8N4O2. It is found in chocolate, as well as in a number of other foods, including the leaves of the tea plant, and the kola (or cola) nut.
It is naturally found in tea and cocoa beans.
A diet to ruduce risk of cardiovascular disease and diabetes
Excersise and loose weight Cardiovascular disease brisk factors measured in mid-life, including age, smoking, obesity, hypercholesterolemia, and hypertriglyceridemia, were associated with incident ED 25 years later. Exercise increases Nitric Oxide, the chemical which relaxes blood vessels throughout your body including the penis. Exercise, particularly aerobic exercise is perhaps the most effective treatment for erectile dysfunction. Exercise improves blood flow. Studies have found that putting men with erection problems on an exercise program was just as effective for improving erection capacity as taking Viagra. It appears the moderate and high physical activities were associated with a lower risk of ED.
Low Fat Diet
A low fat diet will on average achieve a 16% drop in blood pressure, a 17% drop in cholesterol, a 19% drop in LDL and a 20% drop in triglycerides, lowering risk factors for cardiovascular disease and protecting the delicate veins and arteries supplying the penis. Exercise also raises HDL, the good cholesterol. HDL moves cholesterol from the arteries to the liver for excretion. HDL also increases nitric oxide.
For tips on a good diet please see Naturopathic Dietary Guidelines and Naturopathic Causes and Treatment of Hypertension.
Acupuncture for Erectile Dysfunction
The combination of acupuncture and moxibustion for erectile dysfunction is successful. According to Traditional Chinese Medicine (TCM), functional erectile dysfunction is caused by excessive masturbation or excessive sexual activity leading to decline or deficiency of fire from the Gate of Life, or by mental injury, which damages the heart and spleen as well as the kidney or Kidney Yang Deficiency.
A 40-year-old man received 2 acupuncture treatments in combination with moxibustion in the first 5 weeks of treatment and then, once weekly for 25 sessions. In the 6th week, moxibustion was eliminated. At the end of treatment, the patient could perform sexually without use of sildenafil.
The TCM the diagnosis included Wind-Cold Syndrome and Kidney Yang Deficiency.1,5 Treatment included acupuncture with moxibustion.5,6 Treatment principles included eliminating wind and cold, strengthening Yang, and replenishing the Kidney essence.
Selected Acupuncture Points for Erectile Dysfunction
The patient gave informed consent for treatment. Points stimulated were BL 23 (Shenshu), GV 4 (Mingmen), GV 20 (Baihui), ST 36 (Zusanli), CV 6 (Qihai), CV 4 (Guanyuan), CV 3 (Zhongji), SP 6 (Sanyinjiao), GB 20 (Fengchi), GB 41 (Zulinqi), LI 4 (Hegu), and LU 9 (Taiyuan).
Acupuncture points BL 23 and GV 4 warm and tonify primary Yang of the kidney. CV 3, 4 directly warm and strengthen the penis due to their location near the penis; thus, needling these points increases blood supply in the penis. LU 9 is an influential point dominating pulse and vessels, which promotes blood circulation also in the penis. SP 6 nourishes Yin to tonify Yang. GV 20 and ST 36 raise the depressed Yang; GB 20, 41, and LI 4 eliminate wind and cold; CV 6 reinforces Qi and strengthens Yang.
Moxibustion was applied to BL 23, GV 4, CV 3, 4, and 6, ST 36, and SP 6. In this case, moxibustion was used for tonification and increasing blood flow to the penis.3 The application of burning moxa was limited to a few minutes until the local skin flushed.
Carina Harkin BHSc.Nat.BHSc.Hom.BHSc.Acu.
Cert IV TAE. ARCHTI mem.