Ginkgo biloba

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Ginkgo is among the oldest living species of trees and is therefore often referred to as a 'living fossil'. The name biloba means two lobes and refers to the unique two-lobed leaves; its culinary and medicinal uses can be traced back for centuries. It is one of the best-selling herbal drugs in Europe and the tree is known to survive only in China. It is believed that China produces approx. 63,000 kg of dried ginkgo seeds each year [18, 19].

Ginkgo is believed to increase blood flow to the penis, although the evidence is contradictory. In an early double-blind study published in 1991, 50 men with arterial ED were administered 240 mg of ginkgo leaf extract daily for a period of 9 months. The men were divided into two groups based on their earlier response to conventional drug therapy for ED. The first group consisted of 20 men who had previously experienced some success with earlier treatments. The second group of 30 men had not experienced an erection with these treatments [20].

After 6 months of treatment with gingko leaf extract, all men in the first group regained spontaneous erections sufficient for penetration. This benefit continued throughout the 9-month study period. In the second group of 30 men, 19 responded positively. No side effects were reported [20].

The same group investigated the effect of 240 mg daily of ginkgo in 32 men diagnosed with vasculogenic ED in a 24-week placebo-controlled, double-blind, randomized trial [21]. The authors had a high dropout rate for unknown reasons, leaving 23 men for follow-up. They found no significant benefit from taking ginkgo, compared to their earlier results [21].

Cohen and Bartlik conducted a trial of ginkgo in men and women suffering from selective serotonin reuptake inhibitor (SSRI)-induced ED after observations of improvement in sexual performance in an elderly patient. This patient was taking SSRI for major depression and reported improved libido and erections after taking ginkgo. When he stopped taking the ginkgo, his ED returned [22].

In their study, all patients (men and women) were taking antidepressants, with the majority of patients taking regular SSRIs. Seventy-six percent of patients reported decreased libido, 54% reported inhibited or delayed orgasm and 19% had difficulty with erections. The authors prescribed an average dose of 207 mg a day to 63 patients while maintaining their regular antidepressant therapy. They found that 84% of patients experienced a positive effect on their sexual function, with more women reporting relief (30/33) than men (23/30). Again, there were no reported side effects [22].

Since that study, Ashton et al. have investigated the effect of 300 mg of ginkgo three times a day for a month in 22 patients (9 men, 13 women) with SSRI-induced ED [23]. They also reported no side effects but showed little positive effect on their ED - only 3 of 13 women reported improvement, with no improvement in the 9 men [23].

5.2.7 Ginseng

Ginseng (Panax ginseng) is a perennial plant that is native to the damp woodlands of northern China and Korea. After the plant is harvested, the root is prepared in one of two ways, resulting in either white or red ginseng. When Panax ginseng is peeled and dried, the result is hard and yellowish-brown. This is white ginseng. When the root is steamed, peeled and then dried, the result is a deep red coloured red ginseng [24]. In the Orient, red ginseng is preferred, whereas in the West, white ginseng is preferentially used in ginseng products [25].

Ginseng has been long alluded to in Chinese folk medicine as a sexual stimulant, and there appears to be some scientific truth to this. In animal studies, a concentration of 1 mg/mL of ginseng extract relaxed corpus cavernosal tissue in rabbits. This action was mediated by an increase in the sequestration of intracellular calcium and in the corpus cavernosal sinusoids by an increase in the release of nitric oxide (NO) [26]. The increase in NO is a positive finding because NO is the main mediator of penile erections and cyclic GMP, which mediates the relaxing effect of NO on penile vascular smooth muscle [27].

The same group investigated the effect of 50 mg/kg dose of Korean red ginseng in normal male rats and rabbits [28]. They found that the intracavernosal pressure was greater in the ginseng-treated rats and rabbits compared to the placebo-treated group, resulting in significantly increased rabbit and rat cavernosal smooth muscle relaxation after 3 months of treatment [28].

Clinical studies have also supported this effect. A double-blind, placebo-controlled study investigated the effect of 1,800 mg/d dose of red ginseng in 90 men with ED [29]. Of this group, 81 men had psychogenic ED and 9 men had a mild vasculogenic cause for their ED. After 3 months of treatment, they found no change in patients with premature ejaculation, frequency of intercourse, and duration and frequency of early morning erections. However, men treated with ginseng showed an increase in libido in 50% of cases, greater sexual satisfaction in 43.3%, increased penile tumescence during erection in 53.5%, greater penile rigidity in 50% and decreased early detumescence in 23.3% (all p < 0.05) (29). The authors gave the ginseng-treated group a therapeutic efficacy rate of 60% compared to 30% for the placebo group.

From studies to date, ginseng may have the ability to improve ED. It is well tolerated with few side effects, although excessive intake is reported to cause sleeplessness and hypertension. For this reason it is contraindicated in patients with hypertension [30].

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