Erectile Dysfunction: An Update

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4 Advances in Medical, Dental and Health Sciences Vol. 2 ● Issue 1 ● Jan-Mar 2019 ● www.amdhs.org
REVIEW ARTICLE
AMDHS ADVANCES IN MEDICAL, DENTAL
AND HEALTH SCIENCES
OPEN ACCESS
e-ISSN: 2581-8538
Received: 13 February 2019;
Accepted: 03 April 2019
*Correspondence to:
Mr. Saurabh Nimesh, M. Pharm.
(Pharmacology)
Email: nimeshmiet@gmail.com
Copyright: © the author(s), publisher and
licensee OZZIE Publishers. This is an open-access
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Saurabh Nimesh*, Ravi Tomar, Manoj Kumar, Nitish Tyagi, Piyush Kumar Shukla
Department of Pharmaceutical Technology, Meerut Institute of Engineering and Technology, NH-58 Baghpat Crossing Bypass,
Meerut, Uttar Pradesh, INDIA.
Abstract
Erectile dysfunction or Sexual dysfunction or male impotence is dened as the inability of a man to achieve and
maintain an erection sucient for mutually satisfactory intercourse with his partner. Sexual health and function
are important determinants of quality of life. ED is a signicant and common medical problem. An estimated 150
million men worldwide have some degree of ED, and more than twice that many are expected to be aected by
2025. Several orally active drugs Apomorphine sublingual, Sildenal, Vardenal, Tadalal and Avanal are currently
prescribed for the treatment of ED to improve the arterial blood ow to the penile tissue. Herbal medicinal plants
and their extracts have been used in traditional medicine in treatment of ED. These herbal medicinal drugs are
including Ginseng, Ashwagandha, Yohimbine, Safed musli, Shilajit, Ginkgo. The present review provides an overview
of the knowledge of ED or sexual dysfunction at the time.
Key words: Sildenal, Corpus cavernosum, Libido, Nitric oxide, Androgen.
Erectile Dysfunction: An Update
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DOI :
10.5530/amdhs.2019.1.3
INTRODUCTION
The National Institutes of Health Consensus Development Conference
on Impotence (7 December 1992) has dened Erectile dysfunction (ED)
or impotence as the ‘inability to achieve and maintain a penile erection
adequate for satisfactory sexual relationship’.[1] Male sexual dysfunction may
be manifested in a variety of ways and the history is critical to the proper
classication and subsequent treatment. Androgens have a strong inuence
on the sexual desire of men. A loss of libido may indicate androgen deciency
on the basis of either hypothalamic, pituitary or testicular disease.[2] This
denition better encompasses the full spectrum of activity that is affected by
ED (Figure 1), as opposed to denitions considering only vaginal penetration.
Sexual health is an important determinant of quality of life.[3] Today, millions
of men (young and old) suffer from ED due to high levels of synthetic
hormones (known as Xenoestrogens) in our diet/environment, nutritionally
imbalanced diet resulting from poor quality of produces and extremely low
levels of testosterone. ED is a pervasive problem among men worldwide.
According to World Health Organization ‘Sexual health is fundamental to
the physical or emotional health and wellbeing of individuals, couples and
families and to the social or economic development of communities and
countries’.[4] ED affects the quality of life for both patients and partners and
is associated with relationship difculties (Figure 2).[5-8]
Epidemiology
ED is a signicant and common medical problem. An estimated 150 million
men worldwide have some degree of ED (Figure 3) and more than twice
that many are expected to be affected by 2025. Recent studies suggest that
approximately 10% of men aged 40 to 70 have severe or complete ED,
dened as the total inability to achieve or maintain erections sufcient
for sexual performance.[9] An additional 25% of men in this age category
have moderate or intermittent erectile difculties. The disorder is highly
age dependent, as the combined prevalence of moderate to complete ED
rises from approximately 22% at age 40 to 49% by age 70. Although less
common in younger men, ED still affects 5 to 10% of men below the age
of 40. Findings from these studies show that ED impacts signicantly on
mood state, interpersonal functioning and overall quality of life (Figure 4).[10-13]
Mechanism
The proper functioning of the sexual apparatus is dependent not only on
its nervous and muscular integrity, but also on the endocrinal and psychic
factors.[14] Other systems of the body are complementary and their disorders
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Nimesh.: Erectile Dysfunction
Advances in Medical, Dental and Health Sciences Vol. 2 ● Issue 1 ● Jan-Mar 2019 ● www.amdhs.org 5
penis. The result is the thickening, rigidity and elongation of the penis. An
erector muscle of the penis (ischiocavernosus) draws the penis forward and
makes it well adapted for penetration of the vagina.[17]
Orgasm and Ejaculation
Friction between the glans penis and vaginal mucosa, reinforced by several
other afferent stimuli and psychogenic factors, causes a reex discharge along
the sympathetic to the seminal pathway, the muscle coats of the epididymis,
ductus deferens, the seminal vesicles and the prostate gland. The sperm,
along with the secretion of the accessory glands, are discharged into the
posterior urethra, between the internal and external sphincter of the bladder.
After orgasm is reached, the rhythmic contractions of the bulbocavernous
and ischiocavernous muscles ejaculate the semen through the penis into
the vagina. Sympathetic nerves, which act as a motor to the seminal tract,
simultaneously close the internal vesicle sphincter and thus prevent a reex
of semen into the bladder. Further, the contraction of detrusor vesicae
and the associated inhibition of constrictor vesicae prevent a simultaneous
discharge of urine.[18]
Libido
The cerebral cortex is the chief controlling focus of the sex apparatus. Libido
is the conscious feeling of the sexual urge, which originates in the brain
center through the impulses received by various sense organs. In the event
of aroused libido, the brain center sends impulses to the spinal center, which
in turn passes them expeditiously to the peripheral nerves of the penis.[19]
Copulation
After the penis is inserted in the vagina, an act of sexual intercourse or
Figure 1: Spectrum of Erectile dysfunction.
Figure 2: Types of erectile dysfunction..
Figure 3: Erectile dysfunction prevalence by age and country.
Figure 4: Prevalence of sexual dysfunction (difference in
problems reported by men and women).
Figure 5: Mechanism of erection.
may ultimately affect this phenomenon, causing ED. Thus, erection is a
complex, involuntary, neuropsychological, hormone mediated vascular
event that happens when blood ows rapidly into the penis and becomes
trapped in its spongy chamber (Figure 5). Its precise erudition may add to
the comprehension of the physiological phenomenon, comprising libido,
erection, copulation, orgasm and the ejaculation.[15,16]
Erection
The preceding activities of the nerve endings cause dilatation of arterioles
by relaxing their smooth muscle coat, which in turn causes lling of the
spaces of corpora cavernosa resulting in its expansion. Accordingly, strong
pressure is exerted on the veins that normally drain blood from the penis.
The pressure is adequate to close the veins thus trapping the blood in the

Nimesh.: Erectile Dysfunction
6 Advances in Medical, Dental and Health Sciences Vol. 2 ● Issue 1 ● Jan-Mar 2019 ● www.amdhs.org
Table 1: Drugs causing and contributing to ED.
S. No. Drugs
1Antiparkinson
2Anticonvulsants
3Cytotoxic agents
4Analgesics
5Alcohol, nicotine and illicit drugs
6Antihypertensives
7Diuretics
8 Antipsychotics
copulation takes place and continues until the time of orgasm and
subsequent ejaculation.[20]
Detumescence
After ejaculation and cessation of exotic stimuli, sympathetic tonic
discharge resumes, this results in the contraction of smooth muscles
around sinusoidal spaces and arterioles. Arterial ow is diminished to
accid levels, much of the blood from sinusoidal spaces is expelled and
the venous channels are restored.[21]
Aetiology
Many factors can affect a man’s ability to get and keep an erection (Figure
6), drug also that may cause and contribute to ED (Table 1).[22,23]
Sign and Symptoms
The genitalia should be examined, noting the presence of penile scarring
or plaque formation (Peyronie’s disease) and any abnormalities in size
Table 3: List of herbal medicinal plants.
S.
No.
Biological
name Family Common
name Part used
1Panax ginseng Araliaceae Ginseng Root
2Withania somnifera
Linn. Solanaceae Ashwagandha Leaf and root
3Chlorophytum
tuberosum Baker. Liliaceae Safed musli Whole plant
4Asphaltum bitumen
--- Shilajit Pitch
5Ginkgo Biloba Ginkgoaceae Ginkgo Leaf and
seeds
6Pausinystalia
yohimbe Rubiaceae Yohimbine Bark
7Dactylorhiza
hatagirea Orchidaceae Salem panja Root
8Asparagus
racemosus Liliaceae Shatawari Root
9Fadogia agrestis
Schweinf. Ex Heim Rubiaceae Black
aphrodisiac Stem
Figure 6: Physiological causes ED.
or consistency of either testicle. Examination of the prostate is essential
(Figure 7).[24]
Laboratory ndings
Laboratory evaluation is limited and should consist of a complete blood
count, urinalysis and lipid prole, determination of serum testosterone or
prolactin. Patients with abnormalities of testosterone or prolactin require
further evaluation with measurement of serum follicle-stimulating hormone
and luteinizing hormone and endocrinologic consultation is advised.
Treatment
The vast majority of men suffering from ED can be treated successfully
with one of the approaches outlined below. Men who do not suffer from
organic dysfunction will probably benet from behaviourally oriented sex
therapy (Table 2).[25] The herbal medicinal plants have been traditionally
used for the treatment of ED or sexual dysfunction (Table 3).[26]
Table 2: Allopathic treatment for ED.
S.
No.
Allopathy
therapy
Side effect
1 Sildenal Warmth or redness in the face, neck or chest,
memory problems and upset stomach
2Tadalal Flu-like symptoms (such as stuffy nose, sneezing or
sore throat), Sudden decreased vision and low blood
pressure
3Vardenal Nausea, sweating, general ill feeling, irregular
heartbeat, swelling in your hands, ankles or feet and
shortness of breath
4Avanal Bronchitis, joint pain, high blood pressure and an
erection that will not go away (priapism)
5Apomorphine
sublingual
Nausea, dizziness, severe sweating and drowsiness.
6Lidocaine-
prilocaine cream
Redness, swelling, tingling/burning and lightening
of the skin
7Vacuum
constriction
devices
A black and blue mark or small area of bruising on
the shaft of the penis.
8Intracavernous
and intraurethral
therapy
Hypotension, reex tachycardia, nasal congestion
and gastrointestinal upset
9 Penile prostheses Injury to a vein or artery of lower extremity,
mechanical failure of the implant, severe pain
(temporary) in the surgical area

Nimesh.: Erectile Dysfunction
Advances in Medical, Dental and Health Sciences Vol. 2 ● Issue 1 ● Jan-Mar 2019 ● www.amdhs.org 7
CONCLUSION
Sexual problems are related to sexual desire and male ED. Successful
treatment of ED or sexual dysfunction may improve not only sexual
relationships, but also the overall quality of life. Thus, this review has dealt
with various approaches by which the screening of Allopathic drug and
herbal medicinal plants can be achieved. The rationale for the use of these
medicines is based on the speculation that some forms of male infertility are
caused by oxidative insult and hormonal imbalance and the use of oriental
medicine may improve male fertility potential and semen quality.
ACKNOWLEDGEMENT
Author would like to thank to Manoj Kumar, Ravi Tomar, Nitish Tyagi and
Piyush Kumar Shukla of B. Pharm nal year students of Meerut Institute of
Engineering and Technology Meerut (Uttar Pradesh), India; for their support
and helpful in cooperation in the data collection process.
CONFLICT OF INTEREST
The Authors declare that there is no conict of interest.
ABBREVIATIONS
ED: Erectile Dysfunction, WHO: World Health Organization.
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Figure 7: Symptoms of ED.
Cite this article as: Nimesh S. Erectile Dysfunction: An Update. Adv. Med. Dental Health Sci. 2019;2(1):4-7.