ERECTILE DYSFUNCTION AND ITS HOMOEOPATHIC APPROACH:

A REVIEW ARTICLE

Dr. Sumanta Kamila, Dr. Sanjay Sarkar, Dr. Rayba Khatoon

ABSTRACT: Erectile dysfunction is a persistent or recurrent inability to attain, or maintain the penile erection.
This replaces the earlier term “Impotence”. Erectile dysfunction can seriously affect the quality of life of the
patients. Erectile dysfunction (ED) is a very common disorder now a days, may be due to modern and sedentary
life style. Since people with ED are so upset to discuss their sexual lives with doctors, so many cases go
undiagnosed. Since psychological causes bears a strong etiological relation to ED, homoeopathy can prove a
rapid, harmless cure in such cases considering the psychological history and other characteristics as well.
KEYWORDS: Erectile dysfunction, Impotence, International Index of Erectile Function (IIEF)
ABBREVIATIONS: Erectile dysfunction (ED), Odds ratio (OR), Chronic renal failure (CRF), International
Index of Erectile Function (IIEF), Sexual Health Inventory for Men (SHIM).
INTRODUCTION [1]: ED is a common medical condition that affects approximately 100
million men worldwide and is currently recognized as a major public health problem . It is
estimated that nearly one-half of men older than 40 years have some degree of ED. While in
1995, ED affected over 152 million men worldwide, it is projected that by 2025, more than
320 million patients will be afflicted with the largest projected increases in the developing
world. The overall prevalence of ED has been reported to be 16-25 per cent in the general
population depending on the cohort of study and the definition of ED being applied. Age is a
strong determinant of occurrence of ED, and epidemiological studies indicate a strong
relationship between ED and advancing age.

PATHOPHYSIOLOGY OF ERECTILE DYSFUNCTION:

ED is the most common sexual problem in men. Some conditions such as diabetes,
atherosclerotic, and drug-related causes account for 80 % of causes of ED in elderly.
[2].
Evidence suggests that ED may result from three basic mechanisms Vascular,
neuropathic and psychological causes are most common causes of erectile dysfunction [3].
Certain neurological disorders [2] are frequently associated with erectile dysfunction, including
multiple sclerosis, temporal lobe epilepsy, Parkinson’s disease, stroke, Alzheimer’s
disease, and spinal cord injury. A direct correlation [1] between the extent of CAD, number
of coronary vessels involved and the severity of ED as measured by the IIEF score has been
reported. Greenstein et al reported that patients with 2- or 3-vessel disease had a worse
erectile function as compared to those with single vessel disease. High concentrations of low-
density lipoprotein seem to be related to ED, although low levels of high-density lipoproteins
have been shown to be predictive of ED [4]. High blood pressure is an independent risk factor
for development of ED. Doppler studies show [5] that penile arterial insufficiency is frequent,
and of higher severity, in men with testosterone deficiency. Cigarette smoking is an important
independent modifiable risk factor and it appears to have a deleterious effect on penile
hemodynamic integrity. Mannino showed an OR of 1.4 for smokers vs. non-smokers. Some
researchers furthermore demonstrated an OR of 1.7 and also that the risk of ED increases
[6]
with duration of this habit . Clinical and basic science studies provide strong indirect
evidence that smoking may affect penile erection by the impairment of endothelium-
dependent smooth muscle relaxation. They also confirmed that the association of ED with
risk factors such as CAD and hypertension appears to be amplified by cigarette smoking [7].
The prevalence of ED is three times higher in diabetic men (28 % vs. 9.6 %), occurs at an
earlier age, and increases with disease duration, being approximately 15 % at age 30 rising to
55 % at 60 years [8]. Men suffering from CRF requiring renal replacement therapy have a high
prevalence of sexual dysfunction (20–50 %) [9]. Uraemia results in a decrease in bioavailable
[10]
NO in erythrocytes. Sarioglu and co-workers demonstrated that a chronic uremic state
resulted in impaired nerve and endothelial-mediated relaxation of rabbit cavernosal smooth
muscle while relaxation induced by NO donors or purinergic activation was preserved
Treatment using higher doses of a thiazide [11] showed a significant increase in ED compared
to placebo. Data from a large UK trial showed that twice as many men taking thiazides for
treatment of mild hypertension reported ED compared to those treated with propanolol or
placebo, this being the commonest reason for withdrawal from the bendro-fluazide arm of the
study [12].

CLINICAL EVALUATION OF THE MALE WITH ERECTILE DYSFUNCTION:[13]

A detailed sexual history is critically important, aimed at determining the severity, onset, and
duration of the ED, and serves to provide additional information as to the potential etiology
of ED. The patient should be queried as to the presence of nocturnal erections, to distinguish
between organic and psychogenic causes. A psychosocial assessment is essential, and
clinicians should consider using validated questionnaires to provide objective assessment of
erective function. Such questionnaires include the gold standard IIEF and the abridged, five
item version of the IIEF, the SHIM. Nevertheless, a standard general physical exam, with
particular focus on the cardiovascular examination (including evaluation of blood pressure,
heart rate, and peripheral pulses), should be performed. Furthermore, a focused genital
examination, evaluating the penis for lesions, scars, tunical plaques, and meatal position, as
well as examination of the testes for size, consistency, and presence of masses, is warranted.

BIOCHEMICAL AND HORMONAL AND IMAGING TESTS

All patients with ED must undergo [2] a fasting glucose and lipid profile if not assessed in the
previous 12 months. Total (and free) testosterone should be measured in all ED patients.
[14]
. Additional hormonal tests, e.g., prolactin, follicle-stimulating hormone (FSH), and
luteinizing hormone (LH), must be carried out when low testosterone levels are
detected.[15] A number of further tests [3]
include nocturnal tumescence monitoring [3]
to
establish whether blood supply and nerve function are sufficient to allow erections to occur
during sleep; Intra-cavernosal injection [3] of prostaglandin E1 to test the adequacy of blood
supply; and internal pudendal artery angiography. The classical specialized tests such as
penile colour Doppler ultrasound [2] accurately assess cavernous artery inflow and venous
leakage. Neurological testing (penile bio-thesiometry, dorsal nerve conduction velocity) is
useful to assess somatic pathways [16]. The measurement of peak systolic velocity by using a
[17]
dynamic penile Doppler ultrasound alone represents a reliable marker for detecting
penile vascular damage. Recent research-based techniques that attempt to assess penile
endothelial dysfunction and to differentiate men with vasculogenic ED from those without
include the penile nitric oxide release test and Endo-PAT2000 . Dynamic infusion
cavernosometry[18] and cavernosography is the most accurate assessment of erectile haemo-
dynamics.

TREATMENT AND MANAGEMENT:

[6]
Lifestyle Modification: Normal erectile function relies on the interaction of vascular,
neurologic, hormonal, and psychologic mechanisms. Various comorbidities like hypertension
diabetes etc and a number of lifestyle risk factors have been associated with ED, including
reduced physical activity, tobacco use, alcohol consumption, and obesity. Thus, physician
directed counselling and modification of these risk factors can positively impact erectile
function. In a randomized study of obese patients [19] those men who adopted lifestyle changes
including reduced caloric intake and increased physical activity reported an increase of three
points on the International Index of Erectile Function (IIEF), a validated instrument for the
assessment of erectile function. A recent meta-analysis [20] demonstrated improved IIEF scores
after only 6 weeks of lifestyle modification and pharmacotherapy for cardiovascular risk
[21]
factors. Smoking is linked with elevated rates of ED. It doubles the risk of ED For
instance, in a group of patients where a strong association between cigarette smoking and
[22]
degree of ED was observed. Massachusetts Male Aging Study found that men who
initiated physical activity in midlife had a 70 % reduced risk for erectile dysfunction relative
[23]
to those who remained sedentary. Gastric bypass surgery reliably induces substantial
weight loss in the majority of the morbidly obese . It has been shown that substantial weight
loss in patients underwent gastric bypass surgery normalizes sexual function in the morbidly
obese males. Mechanical devices (e.g., vacuum pumps with constriction rings) [7]6 are simple
to use and are effective in all types of erectile problem, but patients may find them intrusive
and expensive.

HOMOEOPATHIC APPROACH:

 In Master Kent’s repertory [24] GENITALIA>ERECTION, troublesome

 In Boericke’s repertory MALE SEXUAL SYSTEM> Impotence.
 In Murphy’s repertory MALE>IMPOTENCY, sexual
 In BBCR repertory SEXUAL IMPULSE> Impotency and weakened power
 In BTPB repertory SEXUAL ORGANS>Impotency

From Aconite to zincum any remedy come through totality of symptoms but for therapeutics
[24,25]
purpose some remedies are discussed below:

ACIDUM PHOSPHORICUM
Absence of sexual desire. Frequent erections without desire for coition. Weakness of sexual
organs, with onanism, and little sexual desire. Onanism; esp. when patient is much distressed
by the culpability of the act.
AGNUS CASTUS
The penis is small and flaccid, so relaxed that voluptuous fancies excite no erection. The
testicles are cold, swollen, hard and painful.
ARGENTUM NITRICUM
Erection fails when coition is attempted. Want of desire. Penis shrivelled. Coition painful,
sensitive at orifice.
ARNICA MONTANA
Sexual desire increased, with erections, pollutions, and seminal emission on the slightest
amorous excitement. Impotence from excess or abuse.
CALADIUM SEGUINUM
Erection when half asleep; cease when fully awake. Impotency relaxation of penis during
excitement.
CALCAREA CARBONICA
Weakness of the genital functions, and absence of sexual desire. Erections of too short
continuance, and emission of semen too slow and frequent and too feeble during coition.
CHINA OFFICINALIS
Impotency with excited, lascivious fancy. Swelling of the testes and spermatic cord. Quick
discharge of semen during intercourse followed by profound neurasthenia.
COBALTUM METALLICUM
Frequent nocturnal seminal emissions with lewd dreams, waking him up from sleep; with
headache. Impotence and nocturnal emissions without erections. Severe pain in right testicle
better after passing urine, yellow brown spots on the genitals.
KALIUM PHOSPHORICUM
Nocturnal emission, sexual power diminished, utter prostration after coitus.
CLEMATIS ERECTA
Violent erections with stitches in urethra, testicles hang heavy or retracted.
LECITHINUM
Male power lost or enfeebled.
MEDORRHINUM
nocturnal emission followed by great weakness, impotence.
MENYANTHES TRIFOLIATA
Increase in sexual desire, without excitement of the imagination or erection. Both testicles
drawn up, spermatic cord painful to touch.
MOSCHUS
Violent desire, involuntary emissions, Impotence, associated with diabetes, premature
senility. Nausea and vomiting after coition. Painful involuntary pollutions without erections.
Erections with desire to urinate, uncontrollable laughter; faints easily; hysterical women and
men.
NUPHAR LUTEUM
Entire absence of erections and desire; Penis retracted, scrotum relaxed, diminution
lascivious thoughts. Involuntary emissions during sleep with lascivious dreams, at stool and
when urinating with complete absence of erections.
ONOSMODIUM VIRGINIANUM
Constant sexual excitement, psychical impotence. Loss of desire, speedy emissions. Deficient
erections.
PHOSPHORUS
Very strong sexual desire, with constant wish for coition. Impotence after excessive
excitement and onanism. Erections which are too energetic in evening or morning. Frequent
(involuntary) pollutions. Feeble erections or none at all. Feeble and too speedy emission
during coition.
SABAL SERRULATA
Prostatic troubles, enlargements; discharge of prostatic fluid, wasting of testes and loss of
sexual power. Coitus painful at the time of emission. Sexual neurotics.
SELENIUM METALLICUM
loss of sexual power with lascivious fancies/ increased desire but decreased ability
STAPHISAGRIA
Face sunken and melancholic due to bad effect of onanism and too frequent nocturnal
emission. Organs relaxed with backache and weakness of the lower extremities. Seminal
emissions followed by great chagrin and mortification
URANIUM NITRICUM
Complete impotency, with nocturnal emissions. Organ cold, relaxed, sweaty.
YOHIMBINUM
Strong and lasting erections, Neurasthenic impotence.

CONCLUSION: The present modern medicines have many adverse effects. The most well-
known ED medications include: tadalafil (Cialis) sildenafil (Viagra) vardenafil (Levitra)
avanafil (Stendra). The most common side effects are flushing, headache, dyspepsia,
unintentional incomplete sexual arousal and palpitation. Homoeopathic drugs operate on the
principle of similia similibus curentur and are very effective, economic and safe, so they can
be used as a first line treatment for erectile dysfunction.
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About the Authors

1. Dr. Sumanta Kamila, BHMS(WBUHS). PG Scholar (Part- II), Department of Practice of
Medicine of The Calcutta Homoeopathic Medical College & Hospital. Kolkata- 09, WB.
Email Id- sumantakamila5350@gmail.com (correspondence author)
2. Dr. Sanjay Sarkar, BHMS(WBUHS). PG Scholar (Part- II), Department of Practice of
Medicine of The Calcutta Homoeopathic Medical College & Hospital. Kolkata- 09, WB.
Email Id- sarkar.sanjay2710@gmail.com
3. Dr. Rayba Khatoon, BHMS (WBUHS). PG Scholar (Part-I), Department of Practice of
Medicine of The Calcutta Homoeopathic Medical College & Hospital. Kolkata- 09, WB.
Email Id- raybakhatoon24@gmail.com