Peyrone’s disease (PD) is an acquired, inelastic fibrous plaque deformity of the penis resulting in a physically and psychologically debilitating condition. Also known as indurations plastica penis, the condition results in penile deformity, consisting of curvature, narrowing and shortening, resulting in painful erections and in most cases, an inability to have intercourse. The plaques formed impede tunical expansion during erection resulting in penile bending. [1] The degree of pathology developed is variable with some men experiencing minor discomfort and minimal deformity to considerable pain and marked deformity with calcifications of the plaque. [1]

Because great variability is seen with this condition, men with PD may complain of a variety of symptoms. Penile curvature, lumps in the penis, painful erections, soft or incomplete erections, and difficulty with penile penetration due to curvature are common concerns that bring men with PD to see their physicians. More often however, men will complain of erectile dysfunction with difficulty maintaining erections.

Prevalence
While a certain degree of penile curvature is considered normal, about 4% to 10 % of men are born with congenital penile curvature. [2] This is associated with hypospadias or chordee, a condition characterized by downward bending of the penis. This condition is to be distinguished from Peyronie’s disease, which involves curvature and deformity of the penile shaft following injury.

Depending upon the source consulted, the prevalence of PD is estimated to be anywhere from 1% to 4% or up to 23% in men between the ages of 40-70 with the average age of onset being 53 [3]. The number of cases may in fact be higher due to the under reporting of the condition. In a study [4] of 100 men with no symptomology of PD, asymptomatic plaque lesions were found in the tunica albugenia, suggesting that plaque development is part of the normal course of aging and sexual activity.

PD was first reported by Fallopius in 1561 and then further described in 1743 by Francois de La Peyronie. Since then the disease has born his name. [5]

Causes
The underlying cause of PD is not well understood but is associated with trauma or injury to the penis, most often following sexual intercourse. Initially men may not be aware that the initial injury has occurred, often not experiencing symptoms until some time later.

The most likely reason for the development of PD is thought to be repeated tunical mechanical stress and microvascular trauma from excessive bending during erection or blunt trauma to the erect penis. This results in bleeding into the subtunical spaces or tunical delamination at the point where the septum integrates into the inner circular layer of the tunica albuginea. [6]

While genetic links to PD have not been as yet discovered, an autoimmune component has been suggested by studies that report abnormalities in immunological testing, alterations in cell-mediated immunity, increases in autoimmune diseases and the finding of anti-elastin antibodies in the serum of PD patients. [7, 8] Additionally, the use of some beta blockers have also been implicated as an etiologic agent in the development of PD. [9]

The most commonly associated comorbidities and risk factors are diabetes, hypertension, lipid abnormalities, ischaemic cardiopathy, erectile dysfunction, smoking and excessive alcohol consumption. Paget’s disease, Dupuytren’s contracture and specific HLA subtypes are associated with PD as are rheumatoid arthritis and hypertension. [10,11, 12, 13]Dupuytren’s contracture is more commonly associated with penile curvature. [2]

Pathology
Peyronie’s disease patients are generally classified into three categories: (1) patients with asymptomatic plaques or some penile bending which does not affect intercourse; (2) patients whose plaques exacerbate penile bending to the point that intercourse is either painful and/or no longer physically possible; and (3) patients whose Peyronie’s disease is also associated with erectile dysfunction. [1, 14]

Unlike normal wound healing following trauma, in the chronic stages of the disease in patients with PD, plaques do not resolve subsequent to inflammation and cessation of pain. [1, 15] This is thought to be due to defects in over production of collagen and other tissue remodeling mechanisms resulting in an inability to resolve the injury which ultimately contributes to plaque formation. The implication here is that the more chronic the condition, the greater the chance that the plaques will continue to form and may eventually ossify.

During chronic disease states, in addition to fibrogenesis and an increase in connective tissue, there is an increase in oxidative stress. [16] This stress in the form of free radicals such as superoxide, peroxynitrite and peroxide generated species, can result in lipid peroxidation and tissue damage as well as stimulate connective tissue synthesis in fibroblasts and increase activity in inflammatory phagocytic cells such as neutrophils and macrophages. [17]

The plaques of Peyronie’s disease most commonly develop on the upper (dorsal) side of the penis although they may also occur on the bottom (ventral) or side (lateral) of the penis, causing a downward or sideways bending. Some men present with more than one plaque which may cause complex curvatures.

Diagnosis
Diagnosis is made based upon history and physical examination, and ultrasound will provide conclusive evidence of Peyronie’s disease, helping to rule out congenital curvature or other disorders. [18]

Treatment
Treatment should be initiated at the first signs of the disease due to the chronic inflammatory nature of PD. Without treatment, about 12–13% of patients will spontaneously improve over time, 40–50% will get worse and the rest will be relatively stable.

Vitamin E: Use of Vitamin E in the treatment of PD has been around for a considerable period of time. A number of studies [17, 19, 20] both support as well as not support its role as an antioxidant treatment in PD while other studies suggest that when used in combination with other agents that Vitamin E is effective. [21, 22]While the evidence is largely inconclusive, most of the studies on Vitamin E are done after the fact, i.e. the lesions have already formed. So it stands to reason that by itself, Vitamin E may not appreciably affect PD under these circumstances Its value is undoubtedly in the early stages of lesion development to help reduce oxidative stress. This makes it a valuable addition to natural therapies as the damaged tissue begins to remodel.

CoQ 10: In a study using 300 mg of CoQ10 in the treatment of PD, participants after 24 weeks of showed a decrease in mean plaque and curvature compared to the placebo group. [23] While in another study, the use of Omega-3 for PD found no benefit. [24]

Potassium amino-benzoate: Also known as Potaba, this substance yields some benefits with respect to plaque size, but not curvature. Potaba inhibits abnormal fibroblast proliferation, acid mucopolysaccharide and glycosaminoglycan secretion. [25]

In their review of oral therapies for Peyronie’s disease, Myndersel and Monga cite several studies that report improvement in penile discomfort, plaque size, and penile angulation. A complete resolution of penile angulation was observed in 26% of patients with the average interval to improvement was 4.2 months. [26] This medication has also been associated with a high rate of stomach upset, which leads many men to stop taking it.

Tamoxifen: Tamoxifen is a non-steroidal antiestrogen that has been proven effective in the treatment of desmoid tumors, a condition with properties similar to Peyronie’s disease. Tamoxifen is believed to impact the inflammatory response through modulation of TGF-b1 secretion from fibroblasts. An early study treated men for 3 months with 20mg of tamoxifen twice daily. They reported improvements in pain (80%), plaque size (34%) and penile curvature (35%). [27]

Colchicine: Colchicine is an anti-inflammatory agent that acts in both inflammatory and collagen production (fibrotic) phases of Peyronie’s disease by decreasing collagen development by binding to tubulin, which inhibits the formation and function of the mitotic spindle during mitosis. However, colchicine’s effect on microtubules has an impact on many other cell functions as well with side effects of diarrhea and nausea, causing many men to discontinue its use before any benefits are achieved. [26]

Carnitine: Carnitine is an antioxidant medication that is designed to reduce inflammation and thereby decrease abnormal wound healing. Like many other Peyronie’s therapies, uncontrolled trials have demonstrated some benefit to this treatment. Overall, the men taking carnitine saw greater improvement in curvature, and had statistically significant improvement in pain. In addition, the patients taking carnitine reported far fewer side effects as compared to tamoxifen. [32]

L-Arginine: The amino acid L-Arginine combines with oxygen to ultimately form nitric oxide (NO), one of the steps in the development of an erection. Inducible NOS (iNOS) is expressed in the fibrotic plaques of PD and suppression of iNOS exacerbates tissue fibrosis. Valente et al. [33] reported that L-arginine, given daily in the drinking water of a rat model with TGF-1 induced PD plaques caused an 80%–95% reduction in plaque size and in the collagen/fibroblast ratio. In addition, L-arginine was found to be antifibrotic in vitro. This suggests that L– arginine, as a biochemical precursor of NO, might be effective in reducing PD plaque size. [32]
Formulations of superoxide dismutase are also reported to be effective in Peyronie’s disease. [28]

Collagenase clostridium histolyticum (marketed as Xiaflex by [Auxilium]), a drug originally approved by the FDA to treat Dupuytren’s contracture, is now an FDA approved injectable drug for treatment of Peyronie’s disease. The drug is reported to work by breaking down the excess collagen in the penis that causes Peyronie’s disease. [29]

Penile Injections:Injecting a drug directly into the plaque of Peyronie’s disease is an attractive alternative to oral medications. Injection permits direct introduction of drugs into the plaque, permitting higher doses and more local effects. To improve patient comfort a local anesthetic is usually given prior to the injection.

Verapamil Injections: Verapamil is a calcium channel blocker usually used in the treatment of high blood pressure. It has also been shown to disrupt collagen production and this property has made it of interest in the treatment of Peyronie’s disease. A randomized single-blind study suggests that intralesional injection of calcium channel blocker may be a reasonable approach in some selected patients for the treatment of Peyronie’s disease with non-calcified plaque and penile angulation of less than 30°. Patients whose plaque failed to respond to intralesional verapamil therapy within 3 months or whose angulation was greater than 30° at presentation were more likely to benefit from surgery. [30]

Interferon Injections: Interferon has been shown to have antifibrotic effects in the treatment of keloid scars and scleroderma, a rare autoimmune disease affecting the body’s connective tissue. Men who received intralesional injection of interferon-alpha-2b (IFN-a-2b) experienced a significant reduction in penile curvature, diminished pain with erection, and decreased size of the plaque. [34]

Surgery: Surgery is reserved for men with severe, disabling penile deformities that prevent satisfactory sexual intercourse. Most physicians recommend avoiding surgery until the plaque and deformity have been stable and the patient pain-free for at least six months. [31] A number of different surgical procedures are available.

Autologous tissue grafts: These grafts are made of tissue taken from another part of the patient’s body during surgery.

Non-autologous allografts: These grafts are sheets of tissue that are commercially produced using human or animal sources.

Synthetic inert substances: Materials such as Dacron mesh or GORE-TEX are seldom used for Peyronie’s surgeries in the modern era.

Naturopathic Approach to Treatment.
Because of the delay in seeking treatment, patients present with a continuum of pathology which must be assessed in order to develop a treatment plan. Most of the cases I have seen are of the type I, and II variety. Other treatments for type III PD will need to address the underlying cause of the erectile dysfunction even with successful resolution of the pathology caused by the Peyronie’s disease. The goal of treatment is to stop the underlying inflammatory process while providing therapy to allow the damaged tissue to remodel. To accomplish this I use the following protocol.

1. Vitamin E 1000 IU/day
2. Vitamin C 3-5000 mg/day
3. CoQ10 300 mg/day
4. 4.  L-Arginine 1000 mg/day
5. A homeopathic combination remedy of Arnica 30C, Bellis perennis 30C and Calendula 30C 10 drops BID
6. Topical potassium iodide applied at bedtime to the lesion.
7. Wet shorts treatment at bedtime to increase blood flow.
8. Pulsed ultrasound 2 to 3 times per week initially with potassium iodide and DMSO for 10 minutes in order to break up the underlying plaques and fibrous tissue. Pulsed ultrasound must be used as continuous will cause a burn.

Therapy is administered at least twice a week in office with the patient following the home protocol. Clearly the longer the patient has had the condition, the more therapy will be needed to resolve the underlying pathology. This therapeutic protocol has provided some degree of benefit in most every case.

References

1. Moreland R, Nehra A Pathophysiology of Peyronie’s disease International Journal of Impotence Research (2002) 14, 406–410.
2. E. Wespes (chairman), K. Hatzimouratidis (vice-chair), I. Eardley, F. Giuliano, D. Hatzichristou, I. Moncada, A. Salonia, Y. Vardi                   Guidelines on Penile Curvature European Association of Urology
3. Lindsay MB et al.    The incidence of Peyronie’s disease in Rochester, Minnesota, 1950 through 1984. J Urol 1991; 146: 1007 – 1009.
4. Smith BH.  Subclinical Peyronie’s disease. Am J Clin Pathol 1969; 52: 385 – 390
5. Maths Stephen J. Plastic surgery, 2nd ed., Saunders , Elsevier  Philadelphia,USA,  2006; 2:1248.
6. Jarow JP, Lowe FC.  Penile trauma: an etiologic factor in Peyronie’s disease and erectile dysfunction.  J Urol 1997; 158: 1388 – 139
7. Schiavino D et al.  Immunologic findings in Peyronie’s disease: a controlled study.  Urology 1997; 50: 764 – 768.
8. Stewart S, Malto M, Sandberg L, Colburn KK.     Increased serum levels of anti-elastin antibodies in patients with Peyronie’s disease.   J Urol 1994; 152: 105 – 106.
9. Peyrone’s disease: Causes Mayo Clinic web publication
10. Nyberg LM, Bias WB, Hochberg MC, Walsh PC.  Identification of an inherited form of Peyronie’s disease with an autosomal dominant inheritance and association with Dupuytren’s contracture and histocompatability B7 cross-reactive antigens.   J Urol 1982; 128: 48 – 52.
11. Ralph DJ et al.   The genetic and bacteriological aspects of Peyronie’s disease. J Urol 1997; 157: 291 – 294
12. Leffell MS. Is there an immunogenetic basis for Peyronie’s disease? J Urol 1997; 157: 295 – 297.
13. Lindsay MB et al. The incidence of Peyronie’s disease in Rochester, Minnesota, 1950 through 1984. J Urol 1991; 146: 1007 – 1009.
14. Krane RJ. The treatment of loss of penile rigidity associated with Peyronie’s disease.   Scand J Urol Nephrol Suppl 1997; 179: 147 – 150.
15. Van de Water L. Mechanisms by which fibrin and fibronectin appear in healing wounds: implications for Peyronie’s disease.   J Urol 1997; 157: 306–10.
16. Poli G, Parola M. Oxidative damage and fibrogenesis. Free Radical Biol. Med 1997; 22: 287 – 305.
17. Role of oxidative stress and antioxidants in Peyronie’s disease SC Sikka and WJG Hellstrom  International Journal of Impotence Research        (2002) 14, 353–360.
18. Amin Z, Patel U, Friedman EP, Vale JA, Kirby R, Lees WR     “Colour Doppler and duplex ultrasound assessment of Peyronie’s disease in impotent men”. The British Journal of Radiology 66 (785): 398–402.
19. Scandino PL, Scott WW   The use of tocopherols in the treatment of Peyronie’s disease   Ann NY Acad Sci 1949; 52: 390-396
20. Steinberg CL,  Tocopherols in treatment of primary fibrositis, including Dupuytren’s contracture, periarthritis of the shoulders and Peyronie’s disease Arch Surg 1951; 63:824-833
21. Prieto Castro RM, Leva Vallejo ME, Regueiro Lopez JC, Anglada Curado FJ, Alvarez Kindelan J, Requena Tapia MJ  “Combined treatment with vitamin E and colchicine in the early stages of Peyronie’s disease”. BJU International 91 (6): 522–4.
22. G Paulis, R D’Ascenzo, P Nupieri, G De Giorgio, G Orsolini, T Brancato, and R Alvaro  Effectiveness of antioxidants (propolis, blueberry, vitamin E) associated with verapamil in the medical management of Peyronie’s disease: a study of 151 cases       Article first published online: 7 SEP 2012
23. Safarinejad MR  “Safety and efficacy of coenzyme Q10 supplementation in early chronic Peyronie’s disease: a double-blind, placebo-controlled randomized study”. International Journal of Impotence Research 22 (5): 298–309.
24. Safarinejad MR. Efficacy and safety of omega-3 for treatment of early-stage Peyronie’s disease: A prospective, randomized, double-blind placebo-controlled study. J Sex Med. 2009 Jun; 6(6):1743-54.
25. Carson CC   Potassium para-aminobenzoate for the treatment of Peyronie’s disease: is it effective?Tech Urol. 1997 Fall; 3(3):135-9.
26. Mynderse LA, Monga M Oral therapy for Peyronie’s disease International Journal of Impotence Research (2002) 14, 340–344.
27. Ralph DJ, Brooks MD, Botazzi GF. The treatment of Peyronie’s disease with tamoxifen. Br J Urol 1995; 75: 370 – 374
28. Riedl CR, Sternig P, Gallé G, et al. “Liposomal recombinant human superoxide dismutase for the treatment of Peyronie’s disease: a randomized placebo-controlled double-blind prospective clinical study”. European Urology 48 (4): 656–61.
29. “FDA approves first drug treatment for Peyronie’s disease”. FDA NEWS RELEASE. U.S. Food and Drug Administration. 6 December 2013. Retrieved 6 December 2013.
30. Rehman J, Benet A, Melman A  Use of intralesional verapimil to dissolve Peyronie’s disease plaque: a long-term single-blind study Adult Urology 51 (4), 1998
31. Qassim Y N  Dermis as an Interposing Graft for Reconstructing Peyronies Disease  The Iraqui Postgraduate Medical Journal  Vol.11, No.2, 2012
32. Taylor F L,  Levine L A Non-surgical therapy of Peyronie’s disease Asian J Androl 2008; 10 (1): 79–87
33. Valente EG, Vernet D, Ferrini MG, Qian A, Rajfer J, Gonzalez-Cadavid NF. L-Arginine and phosphodiesterase (PDE) inhibitors counteract fibrosis in the Peyronie’s fibrotic plaque and related fibroblast cultures. Nitric Oxide 2003; 9: 229–44.
34. Lacy GL, Adams DM, Hellstrom1 WJG Intralesional interferon-alpha-2b for the treatment of Peyronie’s disease  International Journal of Impotence Research (2002) 14, 336–339.

Erectile dysfunction, otherwise known as impotency, affects more than 30 million men each year, yet only about 200,000 seek help from a physician. Impotency remains largely unrecognized simply because most men do not discuss sexual problems with their doctors. In addition, many physicians do not ask or are uncomfortable dealing with the subject. Erectile dysfunction is defined as the inability to sustain an erection well enough to perform intercourse and ejaculation.[1] While almost all men will experience some degree of sexual difficulty at one time or another, only those who are unable to have successful intercourse 75 percent of the time are considered impotent. Contrary to popular belief, aging is not an inevitable cause of impotency. It does, however, take elderly men longer to develop erections and the force of ejaculation is diminished.[2]

Conventional medicine usually addresses erectile dysfunction issues by prescribing a drug regimen or surgery. Oral medications such as Erecaid or testosterone are rarely effective unless the condition is due to low testosterone levels. Viagra, Cialis and Levitra which act to relax corpus cavernosal smooth muscle and facilitate erections, are not without their side effects. Penile injections of Papaverine or Prostaglandin E1, which affect penile blood flow, can result in prolonged erections necessitating other drug therapy to counter act its effects. Additionally, the therapy can cause burning and eventual fibrosis of the penis. Lastly, malleable or inflatable prosthesis’ are used in severe cases, requiring surgical implantation. These prosthesis’ often need to be surgically re implanted, are uncomfortable and subject to periodic failure.

Erectile dysfunction can be broken down into primary and secondary impotency. Primary causes are rare and may be associated with low androgen levels, genetic defects and severe psycho-pathology. Secondary impotency is much more common and, as the name implies, results from something else such as diabetes, arteriosclerosis, neurological disorders, psychological issues, prolonged stress or previous surgery to the genitalia. Blood pressure medications and antidepressants may also lead to impotency, especially in the elderly.

Dietary factors, largely ignored by conventional medicine, also fuel the problem as men with diets high in caffeine, sugar and alcohol experience more erectile dysfunction, as do men who smoke and use recreational drugs.[3] Psychological causes account for the majority of impotency complaints. A skilled and sensitive physician may often uncover this during an interview and suggest corrective measures.

Men experience three types of erections:

* Reflexogenic erections are induced by tactile stimulation of the genitals. Men with lesions of the cervical or thoracic spinal cord (paraplegics) are still able to have this type of erection. A small number of men with complete transection of the spinal cord can also have erections which are psychogenically induced.

* Psychogenic erections are induced by visual or memory associations.

* Nocturnal erections occur during rapid eye movement (REM) sleep and may take place anywhere from three to six times a night, lasting from 20 to 40 minutes. Generally, nocturnal erections begin with the onset of puberty and diminish in intensity, duration and frequency later in life.

Erections during arousal and intercourse are often achieved as a combination of reflexogenic and psychogenic and a deficit in one or both areas can lead to impotency.

Diagnosis

By combining clinical history, physical exam and laboratory tests, a doctor can generally determine the nature of a patient’s impotency. If a man has a normal erection with foreplay but loses it upon intromission (entrance into the vagina); has a normal erection with some partners but not others; or has a normal erection with masturbation but looses it with a partner, chances are the impotency is psychogenic.

While a variety of diseases are associated with impotency, arteriosclerosis and diabetes are two diseases which most commonly lead to impotency. Both affect the blood flow into the penis and make it more difficult to achieve and sustain an erection. With time, the condition may become permanent and require surgical implants, injections or penile vacuum pumps. With proper treatment of the underlying diabetes or atherosclerosis however, the impotency can be reversed.

The so called “stamp test” (putting a ring of tape or stamps around the penis and seeing if it is broken in the morning) shows if a man can have an erection at all. The snap gauge, a device which fits around the penis, is more commonly used to determine a psychogenic problem, but doesn’t rule out other causes such as arteriosclerosis or diabetes.[4] Laboratory tests including a penile arterial pulse wave analysis, plethysmography and arteriograms help determine if a physical condition such as arteriosclerosis is behind the impotency. Serum and salivary testosterone levels measures also help find out if enough “male” hormone is available.

Dietary Treatment

The best way to correct impotency is to treat its primary cause and vitamins, minerals, herbal and homeopathic medicines can help. Which remedies to use and how long they will take to work depends on the type of dysfunction, so therefore a diagnosis of the cause of the dysfunction is needed.

As with any genital-urinary tract condition, a good nutritional program is a must. Most impotency problems respond to nutritional therapy, be they of a psychological or physiological nature. For instance, caffeine and tobacco are stimulants, yet both also relax muscles and deplete nerve endings of neurotransmitters, making it more difficult to maintain an erection. Alcohol and recreational drugs have similar effects and ultimately promote impotency. Prolonged use of drugs and alcohol can lead to depression as well as be a sign that it is present. Vitamins and minerals, which are essential for erections to occur, are depleted with extended use of tobacco, caffeine, sugar, alcohol and recreational drugs.

Allergies to food and other substances rarely lead to impotency unless they cause discomfort in the genital or lower urinary tract and thus interrupt normal function. Allergies should be considered only as a last resort when all other possible causes are ruled out.

Studies show that high cholesterol also contributes to impotency. An increase in erectile dysfunction was noted in a group  of 3,250 men ages 26 to 85 years in relationship to their serum cholesterol. For every mmol/liter of cholesterol increase above the normal range (normal = 3.63 to 5.18), a greater risk of impotency has been shown.[5] The authors concluded that high levels of cholesterol and low levels of HDL cholesterol were important risk factors for the development of impotency.

Supplementation

Nutrients such as vitamins C, E and zinc are essential to a man’s normal sexual function.[6] All are needed to form both sperm and seminal fluid and are found in especially high levels in the prostate gland. Diets high in vitamins, minerals and antioxidants from fresh fruits and vegetables help maintain vascular integrity and sufficient blood flow, and prevent lipid peroxidation.[7] Lack of vascular flow and integrity diminishes the filling of the corpus cavernosum resulting in flaccidity of the penis. Lipid peroxidation from free radical formation decreases hormones and neurotransmitters needed for normal erectile function. Raw pumpkin seeds are an especially good source of zinc and the essential oils that are needed by prostate gland and seminal fluid.[8]

Botanical Medicines

Botanical medicines offer many of the same therapeutic benefits as drug therapies, without many of the severe side effects. In contrast to drug therapy, herbal medications take longer to bring about a result, due in part to the subtler action of plant-derived medicines or dosage. Larger doses of herbal medicines are initially prescribed to reach therapeutic levels. Once the medication has a therapeutic effect, the dosage can be lowered until the condition has resolved. In my experience over the past 20 years prescribing for a variety of male genito-urinary conditions, herbal medicines have consistently corrected the problem and restored normal function. In some cases where severe pathology was present, the herbal prescription allowed the person to attain a higher level of function not thought previously possible.

* In several studies, Ginkgo (Ginkgo biloba) caused increased peripheral blood flow both in normal, healthy subjects and those with arteriosclerosis. [9,10] For instance, 60 mg per day of ginkgo extract increased penile arterial flow in a group of patients who had not responded to penile papaverine injection.  Half of the 60 study participants regained potency within six months.

* Coryanthe yohimbe, an alpha 2 antagonist, has been shown to increase libido and the latency period between ejaculations. It also has been shown to enhance erectile function in patients with diabetic neuropathy. [11] Additionally it also has a positive effect on depression and thus alleviates the impotency often associated with it.[12] While Yohimbe has many positive effects, self medicating or overdosing can result in anxiety, aggressive behavior, hypertension and possibly death. This herbal medicine should only be prescribed by a physician familiar with its effects.

* Siberian (Eleuthrococcus senticosus) and Korean (Panax) ginseng’s aphrodisiac [increases sexual desire] properties have been prized for centuries. Called an adaptogen, it seems to target any bodily system that needs nutritional support resulting in a higher production of energy and a normalization of function. Thus, the person is better able to achieve and maintain an erection. [13] The American counterpart Eleuthrococcus senticosus, doesn’t have quite the same stimulating properties and is felt to be safer for long-term use.

* Strychnos Nux vomica is often used in small doses and acts as a central nervous system stimulant. which increases libido and potency. More often Nux vomica is used in the homeopathic dose due to its narrow therapeutic range as an herbal preparation. Botanically it must be used in the hands of a skilled prescriber, because it can cause severe central nervous system dysfunction, muscle spasms, vomiting and diarrhea, decreased respiration’s and coma.

* Equisetum or horsetail is especially useful if impotency is due to prostatic enlargement or improper nutrition of the genital urinary tract. Horsetail is high in selenium, a nutrient that older men often lack. An intact and optimally functioning prostate gland is needed not only for the packaging and delivery of semen, but also for the biochemical and mechanical aspects of erectile function.

* Chimaphila umbellata or Pipsissewa has been touted by Herbalists, Eclectic and Naturopathic Physicians  as an overall restorative for the male genital urinary tract. It stimulates the appetite and has been found to be useful in older persons, who are not eating properly and therefore lack essential nutrients. It also acts as a genital-urinary tract tonic, similar to Ginseng.

* Saw palmetto (Serenoa serulatta ) is a general overall medication that works well for impotency particularly if included with other medicines as it helps to enhance the actions of other herbs.[15] Saw palmetto acts to maintain the proper hormone balance in the prostate gland which is needed for optimal sexual function, especially in older men.

*       Chamaelirium luteum or Helonias (Unicorn root) is also an excellent for “sexual lassitude” and infertility. This herbal medication has been used for pelvic atony associated with childbirth and excess sexual activity. It is often used in conjunction with other herbal medications. [16]

Homeopathic Medicine

After treating a large number of men with impotency, I have found that a homeopathic prescription, coupled with other therapies, is very useful for erectile dysfunction. This is especially true if the condition is primarily due to psychological causes. The homeopathic medicine, coupled with herbal medicines or nutrient therapy, stimulates the body to make the needed corrections.

In my experience erectile dysfunction is a condition whose treatment is quite amenable to natural therapeutics, enjoying a high rate of success. Successful treatment requires that the physician and patient address the underlying causes of the disorder rather than palliating the symptoms. Implementing diet and lifestyle changes as well as educating the patient as to the causes of the disorder are essential for long term treatment and prevention.

As society attains a greater awareness of the issues surrounding erectile dysfunction, more emphasis will be placed on research and education. Addressing it at an earlier date will ultimately result in a greater rate of success.