Erectile Dysfunction: a common disorder with uncommon remedies

Dr Sunil Pol

ABSTRACT
Sexual health and satisfaction with the sexual life are regarded as significant aspects of quality of life. 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 embarrassed to discuss their sexual lives with doctors, so many cases go undiagnosed.

The present modern medicines have many adverse effects. 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. Homoeopathic medicines are to be chosen on the basis of principle of individualization. Nonetheless, If an uncommon or lesser known homoeopathic medicine chosen based on their key note symptoms similarity is too effective as a specific remedy for ED.

INTRODUCTION
Erectile Dysfunction (ED) also called impotence is the type of sexual dysfunction in which there is a persistent or recurrent inability to achieve and maintain a penile erection of sufficient rigidity to accomplish satisfactory sexual activity for atleast 3 months.

The prevalence varies based on age groups.

The Massachusetts male aging study [MMAS] a community based survey of age group between 40-70 reported:

  • Some degree of ED in 52% responders
  • Complete ED in 10% responders
  • Moderate ED in 25% responders
  • Minimal ED in 10% responders

Diabetic, atherosclerotic and drug-related causes account for >80% of cases of ED in older men. Medication induced ED is estimated to occur in 25% of men seen in general out-patient clinics. Physical causes can be identified in about 80% of cases, and psychological causes in about 10% of cases.

The incidence of ED is also higher among men with certain medical disorders such as Diabetes mellitus, obesity, lower urinary tract symptoms secondary to BPH, Heart disease, Hypertension, Decreased HDL levels, Diseases associated with general systemic inflammations, cardiovascular disease. Smoking is also a significant rise factor in the development of ED. Medication used in treating diabetes or cardiovascular diseases are additional risk factors. There is a higher incidence of ED among men who have undergone radiation or surgery for prostate cancer and in those with a lower spinal cord injury. Psychological causes of ED include depression, anger, anxiety, stress and stress related causes.

PATHOPHYSIOLOGY
ED may result from three basic mechanisms:

  1. Failure to initiate (Psychogenic, Endocrinologic or Neurogenic)
  2. Failure to fill (Arteriogenic)
  3. Failure to store adequate blood volume within the lacunar network (Venoocclusive dysfunction)

VASCULOGENIC
The most common organic cause of ED is a disturbance of blood flow to and from the penis. Atherosclerotic or traumatic arterial disease can decrease flow to the lacunar spaces resulting in ED. Excessive outflow through the veins despite adequate inflow, and structural alterations in the fibroelastic components of the corpora resulting from aging, hypoxemia and hypercholesterolemia etc.

NEUROGENIC
Disorders that affect the sacral spinal cord or the autonomic fibers to the penis causing relaxation of penile smooth muscles leads to ED. The conditions like multiple sclerosis and peripheral neuropathy are commonly associated with ED. Peripheral neuropathy is often due to diabetes and alcoholism. Pelvic surgeries may cause disruption of the autonomic nerve supply leading to ED.

ENDOCRINOLOGIC
Androgens increase libido, but there exact role in ED is unclear. Individuals with castrate levels of testosterone can achieve erections from visual or sexual stimuli. Nonetheless, normal levels of testosterone appear to be important for erectile function, particularly in older males. Increased prolactin may decrease libido by suppressing gonadotropin releasing hormones (GnRH) leading to decrease in testosterone levels.

DIABETIC
ED occurs with 37-75% of men with diabetes mellitus. Vascular and neurologic complications associated with diabetes mellitus. Macrovascular complications are related mainly to age, whereas microvascular complications correlate with the duration of diabetes and degree of glycemic control

PSYCHOGENIC
Two mechanisms contribute to the inhibition of erection in psychogenic ED First; psychogenic stimuli to the sacral cord may inhibit reflexogenic responses, thereby blocking activation of vasodilator outflow to the penis. Second; excess sympathetic stimulation in an anxious man may increase penile smooth muscle tone. The most common causes of psychogenic ED are performance anxiety, depression, relationship conflict, loss of attraction, sexual inhibition, conflicts over sexual preference, sexual abuse in childhood, and fear of pregnancy or sexually transmitted disease.

DIAGNOSIS
ED is usually self diagnosed or it can be made based on the person’s history of symptoms. In more serious cases like hypogonadism or prolactinoma, physical examination and laboratory investigations are done. Penile ultrasonograhy with Doppler can be done to examine variation in blood flow in the erect penis. Penile nerve function test like bulbocavernosus reflex and Penile biothesiometry can be performed to test nerve function and sensation in the penis. Dynamic infusion cavernosometry (DICC) and Corpus cavernosometry are used to test the vascular pressure in the corpus cavernosum. Magnetic resonance angiography (MRA) can be done to study blood vessels of Penis.

MANAGEMENT
A healthy life style that includes a well-balanced diet, daily exercise, and a stress free life, can keep many life style disorders and diseases away and this is the first step to overcome ED. Modern medicine therapy for ED has a number of side effects, so it’s preferable to have a homoeopathic treatment that uses a holistic approach. There are many drugs for ED which can be administered constitutionally in homoeopathy, but there are also many rare and lesser known drugs that can be used successfully to treat ED.

The followings are some useful homoeopathic medicines that can be used in daily practice.

COBALTUM MET
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.

LECITHINUM
Male power lost or enfeebled. Anaphrodisia, Anaemia, excellent galactagogue. Forgetful, confused with difficult concentration. Ailments from anticipation. Want of sexual power with relaxed scrotum.

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.

MENYANTHES TRIFOLIATA
Increase in sexual desire, without excitement of the imagination or erection. Both testicles drawn up, spermatic cord painful to touch. Complaints from abuse of cinchona and quinine. Icy coldness of affected parts. No thirst, squeezing pain in testes.

NUPHAR LUTEUM
Entire absence of erections and desire; voluptuous ideas which fill imagination do not cause erections. Penis retracted, scrotum relaxed, diminution lascivious thoughts. Involuntary emissions during sleep, at stool and when urinating with complete absence of erections; inability to affect coitus; weakness.

ONOSMODIUM
Constant sexual excitement, physical impotence. Loss of desire, speedy emissions. Deficient erections. Headaches from eyestrain and sexual weakness. Diminished sexual desire, sexual neurasthenia, loss of memory and there is a craving for ice water and cold drinks.

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. Organs feel cold. Epididymitis, general and sexual debility.

SALIX NIGRA
Painful movement of the testicles. Satyriasis, erotomania, seminal emissions in presence of women or when talking with her. Libidinous thoughts and dreams. Painful erections, want of sexual desire, disposition to masturbate.

URANIUM NITRICUM
Complete impotency, with nocturnal emissions. Organ cold, relaxed, sweaty. Its therapeutic keynote is great emaciation debility and tendency to Ascites and general dropsy. It is known to produce nephrites, diabetes, degeneration of the liver, high blood pressure and dropsy. Glycosuria and increased urine.

YOHIMBINUM
Strong and lasting erections, Neurasthenic impotence. Bleeding piles, intestinal haemorrhages, urethrites. Erections without desire. Priapism and congestive states of the sexual organs. Agitation, tremors and increases the action of heart. Useful for anaemic, thin, nervous and partly impotent man. The desire is absent; the organ becomes limp and the testicles show signs of hypertrophy. Sleepiness and tremors accompany the complaints.

CONCLUSION
ED is a kind of silent suffering, which is difficult to discuss with anyone, including doctors due to embarrassment. To men, a strong sexual drive is a part of esteem, towards women. ED adds to men’s mental tension. Episodes of improper erections for short duration should not be taken as irreversible condition; they can be associated with ongoing up and downs of stressful life style. Since modern medicine therapy for ED has a number of side effects, homoeopathy, a holistic approach of treatment that treats the person as a whole rather than just the illness, is a better option. While constitutional therapy is best suited to chronic illnesses because it treats the patient from the root cause, but the homoeopathic medicines that are rare or uncommon are also effective in treating ED especially in acute conditions as a specific remedy.

REFERENCES

  1. Harrison’s Principles of Internal Medicine, 20th edition, Volume II
  2. https://en.wikipedia.org/wiki/Erectile_dysfunction
  3. Boericke. W., Pocket manual of Homoeopathic Materia Medica
  4. Clarke. J.H., Dictionary of Practical Materia Medica
  5. Nash E.B., Regional leader
  6. Phatak S.R Materia Medica of Homoeopathic Medicines
  7. Vermeulen., Synoptic Materia Medica 2

Dr Sunil Pol
PG Scholar (In Service)
Department of Materia Medica
Government Homoeopathic Medical College Bengaluru-79

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