Men’s Sexual Health Protocol: A Resource for Practitioners


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by Fullscript’s Integrative Medical Advisory Team

Erectile dysfunction (ED) is a condition estimated to affect 150 million individuals worldwide and up to 50% of men between the ages of 40 and 70. The prevalence of the condition is expected to increase to 322 million men by the year 2025. (15)

While there are various causes associated with the disease, psychological issues are implicated in approximately 20 percent of cases. (11) Unfortunately, the condition can significantly affect quality of life, and many individuals are embarrassed to discuss the issue with their healthcare provider, resulting in the condition commonly being underdiagnosed. (9)

What is erectile dysfunction?

Erectile dysfunction (ED) is a condition that is characterized by an altered erectile response, including being unable to achieve or maintain an erection during intercourse. (20) Individuals may experience ED as either a short- or long-term issue. (14)

During a healthy erectile response, the central nervous system or peripheral nervous system stimulates the dorsal nerve of the penis. This process involves the nervous, vascular, and endocrine systems. In cases of ED, a number of causes can impair this process, including:

  • Neurogenic causes, when a psychological or central nervous system issue inhibits vascular reactions
  • Arteriogenic causes, when the penis does not adequately fill with blood
  • Venogenic causes, when there is a dysfunction of the veno-occlusive system resulting in venous leakage and an incomplete erection (2)
male practitioner shaking hands with a male patient

Integrative treatment of erectile dysfunction may include supplementation with the botanical herbs Korean ginseng, tribulus, and maca.

Causes and risk factors

A number of causes and risk factors for erectile dysfunction have been identified, including:

  • Certain health conditions (e.g., atherosclerosis, type 2 diabetes, chronic kidney disease, anxiety, depression, (14) hypertension) (15)
  • Certain medications (e.g., antidepressants, antiandrogens, prescription sedatives, diuretics, antihistamines) (19)
  • Smoking and recreational drug use
  • Excessive alcohol consumption
  • Injury to the spinal cord, bladder, pelvis, or penis
  • Psychological issues relating to sex (e.g., low self-esteem, stress about sexual performance)
  • Physical inactivity (14)
  • Being overweight or obese (11)(14)

Signs, symptoms, and complications

The signs and symptoms of erectile dysfunction include:

  • Inability to develop an erection when intercourse is desired
  • Erections that do not last long during intercourse
  • Complete inability to develop an erection (14)

ED may be an indicator of other underlying or related health conditions, such as coronary artery disease or obstructive sleep apnea syndrome. Research suggests that individuals under 40 years old with ED experience a seven times greater incidence of cardiovascular events compared to healthy controls. (2)

Integrative protocol for men’s sexual health

Medical treatment currently focuses on relieving symptoms, (1) and includes pharmaceutical medication, penile prosthesis implantation, and intra-penile therapies. (11)(21) Integrative treatment of erectile dysfunction may involve reducing alcohol intake, quitting smoking, managing weight, attending counseling, (14) and incorporating certain dietary supplements. The evidence-based botanical herbs used in the following protocol have been associated with improved sexual function in men with ED.

Ginseng root placed on a wooden background.

Korean ginseng has traditionally been used as a general tonic and for various chronic health conditions.

Korean ginseng (Panax ginseng)

Panax ginseng, commonly known as Korean or Asian ginseng, has a long history of general therapeutic use in Asian countries. (17) Its primary active component, ginsenosides, have been shown to exert antioxidant, immunostimulatory, hepatoprotective, cardioprotective, and anti-fatigue effects. Ginsenosides may increase the synthesis of nitric oxide (NO), which plays a role in relaxing smooth muscle cells of the corpus cavernosum, a column that forms part of the penis and contains blood vessels that fill with blood during penile erection. (13) Korean ginseng may exert its effects in ED as a result of its ability to improve psychomotor performance, such as processing and reaction time, as well as through inhibitory and stimulatory effects on the central nervous system. (4)

Research findings:

  • Panax ginseng was shown to be effective for the treatment of erectile dysfunction (11)
  • International Index of Erectile Function (IIEF) score, sexual desire, frequency of intercourse, degree of sexual desire, erection, rigidity, penetration and maintenance of erection were all significantly improved (4)(8)(10)(13)

US: Search for Panax ginseng in the Fullscript catalog.
CAN: Search for Panax ginseng in the Fullscript catalog.

Tribulus (Tribulus terrestris)

Tribulus, also referred to as puncture vine, is a shrub and botanical herb that grows commonly as a weed in various regions with warm climates. Tribulus contains various phytochemicals, including flavonoids, alkaloids, tannins, glycosides, and saponins. (3) Steroidal saponins, namely protodioscin and protogracillin, have been shown to influence sexual function and fertility. (3)(5) Protodioscin may benefit individuals with ED by increasing the conversion of testosterone, resulting in an increased production of red blood cells and an improvement in blood circulation and sex drive. (3)

Research findings:

  • Improvement in intercourse satisfaction, orgasmic function, sexual desire, overall satisfaction and Global Efficacy Question (GEQ) response was observed in patients with mild to moderate erectile dysfunction (12)(16)
  • Increase in total testosterone and IIEF was observed (5)(12)

US: Search for Tribulus terrestris in the Fullscript catalog.
CAN: Search for Tribulus terrestris in the Fullscript catalog.

Maca powder in a spoon on a white table.

Maca root is commonly known as an adaptogen, and herb that helps the body adapt to stress.

Maca (Lepidium meyenii)

Maca, a plant in the brassica (mustard) family, is native to Peru and grows at an altitude of approximately 4,000 to 4,500m in the Andes mountains. (6) The maca root, which provides iodine, iron, magnesium, and amino acids, is the part of the herb traditionally used for enhancing fertility. (21) Maca is generally considered an adaptogen and has been shown to increase energy and reduce symptoms of depression and anxiety. Maca may improve male sexual health by increasing sperm count, improving sexual desire, and improving the perception of sexual well-being in mild erectile dysfunction. (7)

Research findings:

  • Significant improvement in physical, psychological, and social performance-related Satisfaction Profile (SAT-P) score (21)
  • Greater increase in IIEF score compared to placebo (21)
  • Improved sexual desire was observed and seem to be an independent effect of Maca (6)(18)

US: Search for Lepidium meyenii in the Fullscript catalog.
CAN: Search for Lepidium meyenii in the Fullscript catalog.

The bottom line

Erectile dysfunction is an important condition to discuss as it impacts quality of life and may be an indicator of other health conditions. The evidence-based ingredients in this protocol may help to improve sexual function and desire. A protocol using natural supplements can be used therapeutically on its own or as an adjunct to existing treatment. If you are not an integrative healthcare provider, we recommend speaking with one to find out whether these supplements are ideal for your wellness plan.

If you are a practitioner, consider signing up to Fullscript. If you are a patient, talk to your healthcare practitioner about Fullscript!

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Disclaimer

The Fullscript Integrative Medical Advisory team has developed or collected these protocols from practitioners and supplier partners to help health care practitioners make decisions when building treatment plans. By adding this protocol to your Fullscript template library, you understand and accept that the recommendations in the protocol are for initial guidance and may not be appropriate for every patient.

  1. American Urological Association. (2018). Erectile dysfunction: AUA guideline (2018). Retrieved from https://www.auanet.org/guidelines/erectile-dysfunction-(ed)-guideline.
  2. Baumann, F., Hehli, D., Makaloski, V., Schumacher, M., Schönhofen, H., & Diehm, N. (2017). Erectile dysfunction – Overview from a cardiovascular perspective. Vasa, 46(5), 347–353.
  3. Chhatre, S., Nesari, T., Somani, G., Kanchan, D., & Sathaye, S. (2014). Phytopharmacological overview of Tribulus terrestris. Pharmacognosy Reviews, 8(15), 45–51.
  4. de Andrade, E., de Mesquita, A. A., Claro, J. de A., de Andrade, P. M., Ortiz, V., Paranhos, M., & Srougi, M. (2007). Study of the efficacy of Korean red ginseng in the treatment of erectile dysfunction. Asian Journal of Andrology, 9(2), 241-4.
  5. Din, S. F. G., Salam, M. A. A., Mohamed, M. S., Ahmed, A. R., Motawaa, A. T., Saadeldin, O. A., & Elnabarway, R. R. (2018). Tribulus terrestris versus placebo in the treatment of erectile dysfunction and lower urinary tract symptoms in patients with late-onset hypogonadism: A placebo-controlled study. Urologia Journal, 86(2), 74–78.
  6. Gonzales, G. F., Cordova, A., Vega, K., Chung, A., Villena, A., Gonez, C., & Castillo, S. (2002). Effect of Lepidium meyenii (maca) on sexual desire and its absent relationship with serum testosterone levels in adult healthy men. Andrologia, 34(6), 367–372.
  7. Gonzales G. F. (2012). Ethnobiology and ethnopharmacology of Lepidium meyenii (maca), a plant from the Peruvian highlands. Evidence-Based Complementary and Alternative Medicine, 2012, 193496.
  8. Ham, W. S., Kim, W. T., Lee, J. S., Ju, H. J., Kang, S. J., Oh, J. H., … Choi, Y. D. (2009). Efficacy and safety of red ginseng extract powder in patients with erectile dysfunction: Multicenter, randomized, double-blind, placebo-controlled study. Korean Journal of Urology, 50(2), 159.
  9. Hoesl, C., Woll, E., Burkart, M., & Altwein, J. (2005). Erectile dysfunction (ED) is prevalent, bothersome and underdiagnosed in patients consulting urologists for benign prostatic syndrome (BPS). European Urology, 47(4), 511–517.
  10. Hong, B., Ji, Y. H., Hong, J. H., Nam, K. Y., & Ahn, T. Y. (2002). A double-blind crossover study evaluating the efficacy of Korean red ginseng in patients with erectile dysfunction: A preliminary report. Journal of Urology, 168(5), 2070–2073.
  11. Jang, D. J., Lee, M. S., Shin, B. C., Lee, Y. C., & Ernst, E. (2008). Red ginseng for treating erectile dysfunction: A systematic review. British Journal of Clinical Pharmacology, 66(4), 444–450.
  12. Kamenov, Z., Fileva, S., & Kalinov, K. (2015). Evaluation of the efficacy and safety of Tribulus terrestris in male sexual dysfunction – A prospective, randomized, double blinded, placebo-controlled clinical trial. Maturitas, 81(1), 208.
  13. Kim, T. H., Jeon, S. H., Hahn, E. J., Paek, K. Y., Park, J. K., Youn, N. Y., & Lee, H. L. (2009). Effects of tissue-cultured mountain ginseng (Panax ginseng CA Meyer) extract on male patients with erectile dysfunction. Asian Journal of Andrology, 11(3), 356–361.
  14. National Institute of Diabetes and Digestive and Kidney Diseases. (n.d.). Erectile dysfunction (ED). Retrieved from https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction.
  15. Nunes, K. P., Labazi, H., & Webb, R. C. (2012). New insights into hypertension-associated erectile dysfunction. Current Opinion in Nephrology and Hypertension, 21(2), 163–170.
  16. Sellandi, T. M., Thakar, A. B., & Baghel, M. S. (2012). Clinical study of Tribulus terrestris Linn. in Oligozoospermia: A double blind study. Ayu, 33(3), 356–364.
  17. So, S. H., Lee, J. W., Kim, Y. S., Hyun, S. H., & Han, C. K. (2018). Red ginseng monograph. Journal of Ginseng Research, 42(4), 549–561.
  18. Stone, M., Ibarra, A., Roller, M., Zangara, A., & Stevenson, E. (2009). A pilot investigation into the effect of maca supplementation on physical activity and sexual desire in sportsmen. Journal of Ethnopharmacology, 126(3), 574–576.
  19. U.S. National Library of Medicine. (n.d.). Drugs that may cause erection problems. Retrieved from https://medlineplus.gov/ency/article/004024.htm.
  20. Yafi, F. A., Jenkins, L., Albersen, M., Corona, G., Isidori, A. M., Goldfarb, S., … Hellstrom, W. J. (2016). Erectile dysfunction. Nature Reviews Disease Primers, 2, 16003.
  21. Zenico, T., Cicero, A. F. G., Valmorri, L., Mercuriali, M., & Bercovich, E. (2009). Subjective effects of Lepidium meyenii (Maca) extract on well-being and sexual performances in patients with mild erectile dysfunction: A randomised, double-blind clinical trial. Andrologia, 41(2), 95–99.