Erectile dysfunction (ED)

by Savvas Ioannides N.D.

Let me say first that “Erection starts in the brain”.


Erectile dysfunction is defined as the constant inability to maintain an erect penis sufficiently for sexual intercourse.

Failure to achieve an erection less than 20% of the time is not unusual and treatment is rarely needed. Failure to achieve an erection more than 50% of the time, however, generally indicates there is a problem requiring treatment.

Approximately 30% of men at age 50, 50% at age 60 and 70% at age 70 suffer from some type of ED and only 8% of these men are completely impotent.


An erection requires three conditions to occur:

  1. Proper functioning of the nerves that supply the penis.
  2. Adequate blood circulation to the penis.
  3. There must be a stimulus from the brain.

A full erection will be prevented if there is something interfering with any or all of these conditions.

Kegel_Exercises_for_Men1Most ED is caused by a physical condition that affects the nerves or blood vessels responsible for erections. Diseases associated with ED include heart disease, atherosclerosis, iron overload, hypertension, multiple sclerosis, vascular disease, Parkinson’s disease, diabetes, surgery or radiation therapy for prostate cancer, psychological factors such as stress, depression, and performance anxiety, injury to the penis and hormonal imbalances such as imbalances of thyroid hormones, prolactin and testosterone. Chronic illness, tobacco, alcohol, drug use and certain medications can also cause ED.

In almost 80% of the cases, the cause is an organic disease such as penile arterial insufficiency or drug side effects. There are many drugs that are associated with ED and the most common are listed below:

  • Diuretics and Antihypertensives such as Hydrochlorothiazide, Furosemide, Methyldopa, Clonidine, Verapamil, Nifedipine, Hydralazine, Enalapril, Propranolol, Atenolol, Spironolactone and other.
  • Antidepressant, anti-anxiety and antiepileptic drugs such as Fluoxetine, Sertraline, Amitriptyline, Amoxipine, Chlordiazepoxide, Diazepam, Phenytoin and other.
  • Antihistamines such as Dimehydrinate, Diphenhydramine, Hydroxyzine, Meclizine and Promethazine.
  • NSAIDs such as Naproxen and Indomethacin.
  • Parkinson’s disease medications such as Biperiden, Levodopa and other.
  • Antiarrhythmics such as Disopyramide.
  • Histamine H2-receptor antagonists such as Cimetidine, Nizatidine and Ranitidine.
  • Muscle relaxants such as Cyclobenzaprine and Orphenadrine.
  • Prostate cancer medications such as Flutamide and Leuprolide.
  • Chemotherapy medications such as Busulfan and Cyclophosphamide.

Other substances that may cause ED by suppressing the central nervous system and/or cause damage to the blood vessels include:

  • Alcohol
  • Amphetamines
  • Barbiturates
  • Cocaine
  • Marijuana
  • Methadone
  • Nicotine
  • Opiates

Erectile dysfunction should not be taken lightly as it might be a warning of poor cardiovascular health due to atherosclerotic plaque. Men with ED are at high risk of coronary occlusion and strokes.

Herbal Therapeutic Protocol

Exercise, diet and nutritional supplements are very important as well as psychotherapy if needed. Physical means such as vacuum constrictive devices and penile prosthesis have also been used with some success but with few complications and a large patient drop out.

Panax ginseng (Korean Ginseng)

There is now enough scientific evidence that Korean ginseng is useful for impotence or erectile dysfunction. It is suggested that it may have an effect at different levels of the hypothalamus-pituitary-testes axis to improve male fertility. It has been shown to improve the ability to achieve and maintain erections even in patients with severe ED. Ginsenosides, a group of chemical constituents found in the root of ginseng, can facilitate penile erection by directly inducing the vasodilation and relaxation of the penile corpus cavernosum. In addition, ginseng has shown to increase nitric oxide (NO) release from the endothelial cells and perivascular nerves. In clinical trials, Korean red ginseng was found to significantly improve the Mean International of Erectile Function scores compared with placebo. In a double-blind, placebo-controlled, crossover trial, Korean red ginseng has shown significant improvement in erectile function, sexual desire, and intercourse satisfaction in 45 subjects after 8 weeks (Hong et al, 2003).

Gingko biloba (Gingko)

Gingko may be used in ED due to its vasodilatory effects if compromised circulation is suspected. In an uncontrolled trial, it was found to be 84% effective in treating ED secondary to antidepressant drug use in 63 patients without any adverse effects. A positive effect was reported on all four phases of the sexual response cycle from both male and female subjects: desire, excitement (erection and lubrication), orgasm and resolution.

Tribulus terrestris (Tribulus)

Tribulus leaf is used in Ayurveda tradition to treat spermatorrhoea, gonorrhoea, impotence, uterine disorders after parturition, cystitis, kidney stones and gout. It is very famous amongst body builders and athletes for its testosterogenic activity to increase muscle mass and strength.

The active ingredient protodioscin is found only in the leaf of Tribulus especially of Eastern European origin (Bulgaria and Slovakia). It appears that the mechanism by which Tribulus influences sexual behaviour is by increasing androgenic status and NO release. Its main actions are: aphrodisiac, tonic, androgenic in males, oestrogenic in females and as a fertility agent.

In vivo studies, it has shown to improve libido, sexual activity and intracavernous pressure in rats, and a proerectile effect on corpus cavernosum smooth muscle of rabbits. Increased testosterone levels, improved semen production and normalised sexual activity in rams with sexual impotence have also shown in vivo. Improvement in sexual function was observed in male patients convalescing from postmyocardial infarction and in male diabetics. Patients with oligospermia showed objective improvement. Sperm count and motility improved in approximately 60–70% of subfertile and oligospermic men. See Aphrodisiac activity of Tribulus leaf.


Erectile dysfunction should be treated according to the cause whether is stress (See Combat Stress With Natural Remedies), atherosclerosis or decreased blood flow to the penis. A detailed case history should be taken by your physician/naturopath to assess your current state of health. Diet, nutritional supplements such as arginine, exercise, herbal therapy and sometimes psychotherapy or stress management may all be integrated in the client’s treatment protocol. Caution should be taken to select high quality products. You may contact me for more information on products and product dosages.


About Naturopathy by Savvas Ioannides
Savvas Ioannides is a Naturopathic, Herbal and GAPS Diet practitioner who studied at Nature Care College in Sydney. Savvas uses holistic and natural therapies including Herbal remedies and Nutrition to boost your vitality and help you achieve optimum levels of health.

One Response to Erectile dysfunction (ED)

  1. Pingback: Tribulus (Tribulus terrestris) | Naturopathy by Savvas Ioannides N.D.

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