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Erectile dysfunction (ED) is defined as 'the inability to achieve an erection sufficient for intercourse to the mutual satisfaction of both partners' [1]. The exact prevalence of ED is unknown. This is largely due to variations in the definition of ED and because many publications focus on select population groups. However, it is estimated that ED affects 15 to 30 million men worldwide [2]. According to the National Ambulatory Medical Care Survey (NAMCS), for every 1,000 men in the United States, 7.7 physician office visits were made for ED. Almost 15 years later, that figure had increased three-fold to 22.3 in 1999 [3]. In countries like the USA where education and awareness are high and statistics are easy to compile, such estimates can be safely arrived at. However, in many parts of the world, men with ED suffer silently

Department of Urology, St. George's Hospital, Blackshaw Road, London SW17 OQT e-mail: [email protected]

K.G. Ramawat (ed.), Herbal Drugs: Ethnomedicine to Modern Medicine, DOI 10.1007/978-3-540-79116-4.5, © Springer-Verlag Berlin Heidelberg 2009

because of fear, embarrassment, lack of access to medical facilities, and perhaps because ED is a low medical priority in many parts of the world. Therefore the real prevalence may never be determined.

Although ED does not affect life expectancy, it can have a significant negative impact on an individual's well-being and quality of life [3]. There are many causes of ED but most important is the fact that this is an age-related phenomenon. The most reliable evidence for this comes from the Male Massachusetts Aging Study. This study reported that the probability of ED increased from 5.1% at 40 years of age to 15% at 70 years [4].

Other conditions such as diabetes, renal disease, chronic alcoholism, multiple sclerosis, atherosclerosis, vascular disease and neurological diseases account for approximately 70% of ED cases [2]. NIH also reported that between 35 and 50% of men with diabetes suffer from ED [2]. Furthermore, men taking many commonly used medications such as antihypertensive drugs, antihistamines, antidepressants, tranquillizers, appetite suppressants and cimetidine will experience ED as a side effect [2]. Psychological factors can also cause ED, either in isolation or concurrently with an organic cause.

With an ageing male population, an increase in comorbid conditions, greater treatment-seeking behaviour, and rising costs of treatment, the burden of ED will undoubtedly increase worldwide.

Conventional treatment methods for ED included psychosexual counselling, androgen replacement therapy, intraurethral agents, intracavernous injections, mechanical devices and surgery. The last decade has seen a huge paradigm shift in ED treatments.

The introduction of Viagra as an effective and reliable oral treatment for ED in 1998 has allowed access to treatment for many couples across the world. However, despite the success of modern treatments for ED, many men across the globe still rely on herbal treatments.

Reasons for this could be reluctance in seeking treatment for a private and personal condition, financial concerns about the side effect profile of drugs and their lack of efficacy. In one study, the long-term satisfaction of current ED therapies ranges from 40 to 70% [5].

Herbal treatments are health supplements that are chemically rich in plant or plant extracts and contain single or multiple ingredients in the form of tablets, capsules, creams or tinctures [6]. In the USA, from 1990 to 1997, there was a 380% increase in the use of herbal treatments for any condition, and in 2001, over 50% of the American population were regularly taking herbal supplements [7]. This trend is also reflected in the 47.3% increase in total visits to alternative practitioners from 427 million in 1990 to 629 million in 1997 [8]. This figure exceeds the total visits to all US primary care physicians [8].

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