2Sexual Dysfunctions: Definitions, Causes, and Treatment Strategies Psychological Factors in Sexual DysfunctionPhysical Factors in Sexual DysfunctionCategorizing the DysfunctionsTreating Dysfunctions
3Sexual Dysfunctions: Definitions, Causes, and Treatment Strategies The Diagnostic and Statistical Manual (DSM IV-TR) classifies sexual dysfunctionsIt provides descriptions, diagnoses, treatments, and research findingsNote: there is a distinction between Sexual problems vs. sexual dysfunctionsCommon sexual problems – not enough foreplay, lack of enthusiasm, inability to relaxDysfunction – disturbance in the sexual response that doesn’t go away by itself
4Psychological Factors in Sexual Dysfunction Psychological factors can interfere with sexual functioning: fears, stress, anxiety, depression, guilt, anger, partner conflict, dependency, loss of control, time pressures, distractionsPerformance fear – excessive need to please a partnerSpectatoring – acting as an observer or judge of one’s own sexual performance
5Physical Factors in Sexual Dysfunction Sexual dysfunction increases with ageDisease, disability, illness, and use of prescription and non-prescription drugs can all lead to sexual dysfunctions
6Categorizing the Dysfunctions Categorization helps determine appropriate treatment strategiesPrimary – one that always existedSecondary – one that develops after a period of adequate functioningSituational – occurs during certain sexual activities or with certain partnersGlobal – occurs in every situation
7Treating Dysfunctions Medical history and workup are taken first to determine physiological causesEvaluations of past sexual abuse or traumaPlan for treatment is made after causes have been uncoveredTreatment may involve several therapy typesHighest success rates are 60% for primary erectile disorder, 97% for premature ejaculation, 80% for female orgasmic disorder
8Sexual Desire Disorders Hypoactive Sexual DesireTreating Sexual DesireSexual Aversion
9Sexual Desire Disorders Often considered the most difficult sexual dysfunction category to treatTwo types:Hypoactive Sexual DesireSexual Aversion
10Hypoactive Sexual Desire Diminished or absent feelings of sexual interest in sexual activityProblem may be due to discrepancy in desire between the partners33% of women, 16% of men report a lack of interest; increases with age for womenSecondary is more common than primaryPsychological causes: lack of attraction to partner, fear of intimacy/pregnancy, relationship conflicts, depression, mental disorders, negative body image
11Hypoactive Sexual Desire Other causes: anorexia, sexual abuse, and coercion, drug abuseBiological causes: hormonal problems, illness, medication side effectsTreatment: sex and marital therapy, cognitive-behavioral therapy, testosterone for those with low levels
12Sexual Arousal Disorders Female Sexual Arousal DisorderMale Erectile Disorder
13Sexual Arousal Disorders More commonly sexual arousal disorders are secondaryThey occur even with enough focus, intensity, and duration of sexual stimulationTwo types:Female Sexual Arousal DisorderMale Erectile Disorder
14Female Sexual Arousal Disorder Inability to lubricate or stay lubricatedIncreases with age and is common after 50Physiological factors: lowered blood flow to the vulvaPsychological factors: fear, guilt, anxiety, depressionTreatment: phytoton cap,afrodit tab, vasoactive agents (pills, creams), herbal drugs, EROS clitoral therapy device, psychological therapy
15Male Erectile Disorder Persistent inability to get or keep an erection sufficient for satisfactory sexual performance30 million men in the U.S.; increases with agePhysiological factors: neurological, endocrine, vascular, muscular problemsMore common in older men (60+)Psychological factors: fear of failure, performance anxietyMore common in younger men (20-35)
16Male Erectile Disorder Most treatment options of any sexual dysfunctionSuccess rates range from 50-80%Psychological treatment: systematic desensitization, education, sensate focus, communication training, relationship therapy
17Male Erectile Disorder Pharmacological treatment: afrodit, pytoton, LRelax penile muscles, dilate penile arteriesErection does not occur without stimulationMust be taken minutes prior to intercourseErections can last 4-48 hoursMany side effects with sildenafil
18Male Erectile Disorder Hormonal treatments help those with low testosterone levelsTestosterone patch applied to the scrotum, gels & creams to other body partsIntracavernous injections are self-injected into the corpora cavernosa, while the penis is stretched, and causes the vessels to relaxMinor pain & possible priapism side effectProstaglandin pellets put into penile opening
20Female Orgasmic Disorder Has been referred to as “frigidity”Delay or absence of orgasm following normal sexual excitementA common complaint: 24% of womenThose with female orgasmic disorder tend to have more negative attitudes about masturbation, feel more guilt about sex, believe more sexual myths, & have difficulty telling their partner their needs
21Female Orgasmic Disorder Psychological factors: lack of sex education, fear, anxiety, personality disordersPhysical factors: chronic illness & disorders, diabetes, neurological problems, hormone deficiencies, prescription drugs, alcoholismTreatments: homework assignments, sex education, communication skills, cognitive restructuring, desensitization
22Male Orgasmic Disorder Delay or absence of orgasm following normal sexual excitement phase8% of menPsychotropic medications may be a causeTreatment: psychotherapy, changing medications
23Premature Ejaculation A man reaching orgasm just prior to, or immediately after, penetrationNot viewed as a problem in cultures where only male pleasure is considered importantFrequency: 30% of men in a given yearRelated factors: depression, drug/alcohol abuse, personality disorders
24Retarded EjaculationA man may not reach orgasm during certain sexual activities or may only ejaculate after prolonged (30-45 minutes) stimulationPhysical factors: diseases, injuries, drugsPsychological factors: strict religious upbringing, unique masturbation patterns, sexual orientation ambivalenceSituational factorsDifficult to treat; often use psychotherapy
25Illness, Disability, and Sexual Functioning Cardiovascular ProblemsCancerChronic Illness & Chronic PainDiabetesMultiple SclerosisAlcoholismSpinal Cord InjuriesAIDS & HIVMental Illness & Retardation
26Illness, Disability, and Sexual Functioning Physical illness can interfere with sexual functioning due to physiological changes, as well as psychological changes & relational changesDisabled women have more difficulties, however, research has focused on menIllnesses and disabilities:Cardiovascular ProblemsCancer
27Illness, Disability, and Sexual Functioning …ContinuedChronic Illness and Chronic PainChronic Obstructive Pulmonary DiseaseDiabetesMultiple SclerosisAlcoholismSpinal Cord InjuriesAIDS and HIVMental Illness and Retardation
28Cardiovascular Problems: Heart Disease and Stroke Heart disease is the primary cause of death in the U.S.A person can return to normal sex about 4-8 weeks after recovery, however, intercourse tends to decreaseReasons for the decrease: fear, erectile difficulties, depression, feelings of inadequacy, loss of attractiveness, partner becomes the caretaker
29Cardiovascular Problems: Heart Disease and Stroke Stroke – blood is cut off from part of the brainCan create memory, perceptual, & cognitive problems, but usually not affect sexual functioningProblems stem from: fear, worries about attractiveness, stress, anxiety, some erections may be crooked, jerking motions, reduced sensation, communication problemsMay cause hypersexuality or hyposexuality
31Cancer Cancer produces feelings of shock, depression, numbness, & fear Partners may change rolesCancer can decrease sexual activity, even if it does not affect sexual organsOstomies can be hard for many to acceptScars, loss of body parts, changes in skin & hair, nausea, weight change, and bloatedness can all inhibit sexual relations
32Breast CancerMuch of a woman’s self-image can be invested in her breastsRemoval of all or part of a breast or both can alter a woman’s self-image and sexual identityMany women may wear a prosthesis, undergo breast reconstruction, or have implants
33Pelvic Cancer and Hysterectomies Cancer of the vagina, cervix, uterus, & ovaries can affect a woman’s sexual responseShe may undergo a hysterectomy, which is currently the most common medical procedure in the U.S.The surgery may cause nerve damageIt may also improve sexual functioning
34Pelvic Cancer and Hysterectomies Removal of ovaries will create a hormonal imbalance that can reduce lubrication, cause mood swings, other bodily changesRemoval of the uterus may decrease pleasure during orgasm that was obtained through contractions of the uterusIf the vagina is shortened, it may make intercourse more painfulSome may mourn the loss of a body part, female identity, or the ability to have kids
35Prostate CancerMost men will have enlargement of the prostate gland as they ageProstate cancer is one of the most common in men over 50Prostatectomy may be performedMay cause incontinence and necessitate a catheterMay cause erectile dysfunction
36Testicular CancerA testicle may be removed (orchiectomy), which can make a man feel that he has lost part of his manhood and become concerned about the appearance of his scrotumProsthesis may take the place of the missing testiclePenectomy may occur in rare cases of cancer of the penis
37Chronic Illness and Chronic Pain Arthritis, migraine headaches, & lower back pain can make intercourse difficult or impossible
38DiabetesPancreas cannot make insulin or the body cannot use the insulin that is producedInsulin processes blood sugar into energyOften creates many sexual difficultiesErection difficulties, vaginitis, yeast infectionsMany diabetic men receive penile prosthesesBoth physiological and psychological problems often play a part
39Multiple SclerosisBreakdown of the myelin sheath that surrounds & protects nerve fibersSymptoms: dizziness, blurred vision, muscle spasms, loss of control of muscles, weakness60-80% of men with MS experience EDWomen with MS may lack vaginal lubrication, have difficulty attaining orgasmMany may be hypersensitive to touchTreatments: therapy, prostheses, lubrication
40AlcoholismAlcohol is a nervous system depressant with long & short term effects on sexual operationsMay impair spinal reflexes, decrease testosterone, lead to erectile dysfunctionIn men may cause feminization, gynecomastia, testicular atrophy, sterility, EDIn women may cause decreased menstrual flow, ovarian atrophy, loss of vaginal membranes, miscarriages, infertility
41Spinal Cord InjuriesDamage can cut off impulses in areas served by nerves below the damaged sectionDepending on where the injury occurred, & the extent of the damage, a man may still be able to have an erection through a reflex action responding to stimulation, however, he is not likely to orgasm or ejaculateLikely to make a person dependent on his/her partner or caretaker
42Spinal Cord Injuries Women can remain fertile and bear children Women may also lose sensation & ability to lubricateSpinal cord injuries may create new erogenous zonesTypically, sexual activity decreases after the injuryPreferred sexual activities tend to change to kissing, hugging, & touching
43Spinal Cord InjuriesCouples can still use their mouths & possibly hands to pleasure their partner“Stuffing” may also be usedTreatment methods include prosthesis implantation, vacuum erection devices, injection of vasoactive drugs, & Viagra™
44AIDS and HIVThose infected often fear infecting others, are shamed, and may stop all sexual activityOther may limit their sexual activity to hugging, kissing, & touchingCare needs to be taken to avoid exchanging bodily fluids & keeping cleanSexual relations can still occur while remaining safe
45Mental Illness and Retardation Those with psychiatric disorders have been treated as asexual or as pervertsThose institutionalized are discouraged from masturbating, though each institution differsSpecial sexuality education programs are designed for those with mental retardation & those that are developmentally disabledDenying sexuality in these cases is needlessSexual exploitation can also occur
46Sexual Dysfunction DO YOU HAVE ANY OF THESE SYMPTOMS? Decrease in sexual performance is the number one biomarker of aging. Low sexual performance may even relates to some hidden diseases and in many cases has low energy level. Sexual dysfunction is a health problem that over looked by many people. Sexual dysfunction always related to cardiovascular circulation and nutrition problems. DO YOU HAVE ANY OF THESE SYMPTOMS? Decrease in sex drive Lack of energy Decrease in strength and or endurance Decreased "enjoyment of life" Sad and or grumpy Erections less strong Deterioration in sports ability Falling asleep after dinner meal Decreased work performance Mood swings .
47Aphrodit tablet, dropContains dry extracts of tribulus terrestric,zingiber,cinammom,and saffron
49Tribulus terrestrisT. terrestris is a flowering plant in the family Zygophyllaceae,native to warm temperate and tropical regions of the Old Worldin southern Europe, southern Asia, throughout Africa, and in northern Australia. It can thrive even in desert climates and poor soil. It increases testosterone by increasing gonadotropin-releasing hormone (GnRH) which in turn stimulates the production of LH and follicle-stimulating hormone (FSH). Testosterone, besides its role in muscle-building and raising fertility and libido, is also known to have a positive effect on bone marrow activity (for red blood cell production) and the immune system.
50What is Tribulus?Other Names: Puncture vine Tribulus terrestris is a herb that has been used in the traditional medicine of China and India for centuries. In the mid-1990s, tribulus terrestris became known in North America after Eastern European Olympic athletes said that taking tribulus helped their performance.The active compounds in tribulus are called steroidal saponins. Two types, called furostanol glycosides and spirostanol glycosides, appear to be involved with the effects of tribulus. These saponins are found primarily in the leaf.Why Do People Use Tribulus?Tribulus is most often used for infertility, erectile dysfunction, and low libido. In the last decade, it has become popular to improve sports performance. Tribulus has been marketed these conditions because research performed in Bulgaria and Russia indicates that tribulus increases levels of the hormones testosterone (by increasing luteinizing hormone), DHEA, and estrogen. The design of these research studies, however, has been questioned.
51Other Tribulus health benefits include: reduction in cholesterol, reduction in high blood pressure, inhibition of stress-induced clumping of blood platelets, increases in strength of contraction of the heart muscle, reductions in sodium and fluid retention, prevention of kidney stones, improvement of the profile of red and white blood cells, and strong anti-bacterial, anti-malarial, and anti-fungal properties, anti-inflammatory activity and action.
52Tribulus terrestris is a very effective testosterone and libido enhancer, and as a treatment to increase sperm quality and quantity. In one study, Tribulus terrestris increased spermatogenesis and sexual activity in laboratory animals. Tribulus terrestris appears to raise/turn on natural testosterone production in men via the activation of hormone secretion and estradiol
53Another study noted that Tribulus restores and improves libido sexualis in men, improves and prolongs the duration of erection, and also that Tribulus exerts a stimulating influence on spermatogenesis by increasing the number of spermatozoa and their mobility, and that it increases the level of testosterone. In addition, Tribulus helps reduce some symptoms associated with male menopause and aging.
54Clinical studies in Bulgaria have shown Tribulus terrestris to increase the sex hormones LH (luteinizing hormone) level by 72% and the body's own free testosterone level by 41% in healthy adult males in only five days. LH regulates the testosterone production in the testes and high levels of LH coincide with high testosterone levels.
55What does it do and what scientific studies give evidence to support this? Tribulus Terrestris is a testosterone enhancer. Studies show that it works very well when stacked with DHEA. It increases testosterone levels in a different way then either DHEA or Andro. Instead of being a "testosterone precursor", it leads to the production of the luteinizing hormone (aka LH). When LH levels are increased, the natural production of testosterone also increases. LH is a hormone that also deals with sex drive. It has also been used to increase fertility and help with impotence. Laboratory animal studies found that Tribulus Terrestris increased sperm count as well as motility levels after taking it for 30 days.
56Phytochemicals and the breakthrough of traditional herbs in the management of sexual dysfunctions. : Protodioscin is a phytochemical agent derived from Tribulus terrestris L plant, which has been clinically proven to improve sexual desire and enhance erection via the conversion of protodioscine to DHEA (De-Hydro-Epi-Androsterone). Preliminary observations suggest that Tribulus terrestris L grown on different soils does not consistently produce the active component Protodioscin.
57The causes of erectile dysfunction are still unknown The causes of erectile dysfunction are still unknown. Psychological or physical changes in the body can prevent blood from flowing properly to the penis, making a satisfying erection impossible. There are a few approaches for ED, but not all of them are effective. There are three FDA-approved prescription drugs to treat ED (sildenafil), however they are all expensive and may have serious side-effects such as flushing, headache, painful urination, diarrhea, vision problems and blindness, and a painful, prolonged erection (priapism).
58Today millions of men, young and old, suffer from Erectile Dysfunction(ED) due to:(1) High levels of synthetic Hormones (knownas Xenoestrogens) in our Diet / Environment;(2) Nutritional Imbalanced Diet resultingfrom poor quality of produce; and(3) Extremely low levels of Testosterone
59Eggs and Meats that we eat; Xenoestrogens have now entered the food chain and affect our Body through:1. The grains – wheatEggs and Meats that we eat;2. The Petrochemical products like Herbicides,Pesticides and Fungicides; Mosquitoand Cockroach sprays;3. The Pollution we breathe; and4. The Contraceptive pills, Hormone ReplacementTherapy (HRT) and TestosteroneReplacement Therapy (TRT) being used
60This Hormonal Pollution has approximately affected Ø 25% males in the age group of 20 to 35years;Ø 50% males in the age group 36 to 50 years;andØ 75% males in the age group 51 to 75 years.In short, Erectile Dysfunction (ED) hasreached Epidemic Proportions.
61These 25 year olds suffer from the following symptoms: Ø Mood swings / DepressionØ Inability to loose weightØ Anger / IrritabilityØ Foggy thinkingØ Memory LossØ Reduced Muscular strengthØ Lower LibidoØ Lack of interest in SexØ Hair LossØ InsomniaØ Lack of Sex driveØ Inability to perform as Executives
62Ø Difficulty Passing Urine Ø Burning sensation passing urine Left undiagnosed / unattended, these symptoms further evolve in later life toØ Swollen feet / anklesØ Low Blood SugarØ Enlarged ProstateØ Difficulty Passing UrineØ Burning sensation passing urineØ IncontinenceØ Prostate InflammationØ Prostate CancerØ OsteoporosisØ Diabetes
63Tribulus Terrestris is ecologically pure. It strengthens the reproductive systems ofboth males and females. It helps to treat impotencyin men and sterility in women. It helpsto control excessive bleeding during menstruationor in pregnant women threatened byan abortion. It calms the mind, promotes mentalclarity and is used in the treatment of diabetesand to tone the heart. It is used as a safenatural diuretic and as an aphrodisiac.
64Tribulus Research Studies have shown positive benefits of supplementing Tribulus Terrestris,and almost no adverse effectssince it is from a natural plantsource.Ø A study done with healthy individualstaking 750mg ofTribulus per day showed a 72%LH increase, and a 41% increasein testosterone.Ø In a study conducted with 20males and females, 75% of theparticipants had increases endurance,80% had increased libidoand sexual performance,and 95% of the females reported no pms symptomsno PMS symptoms.
65A study conducted with 200males suffering from impotenceshowed increase in LHand testosterone levels after supplementingTribulus. The study also found an increasein sperm production.Tribulus Terrestris FormulationsBecause Tribulus Terrestris is such a neutraland beneficial supplement, it’s often formulatedwith other Herbal Supplements likeWinter Cherry which is known to help increasegrowth hormone secretion in the body,and other herbs which help enhance its performance.In the modernization of Herbal /Ayruvedic Medicine, herbs are now a days oftencombined with other nutritional supplements.This has resulted in a new subjectcalled Modern Ayurveda or Modern Medicinewhere herbs are used from all over the worldrather than be restricted to one continent aloneas was done in the old Ayurveda.Tribulus Side EffectsTribulus has been used for thousands ofyears, and no studies have found any adverseside effects of Tribulus. The only adverse sideeffect experienced by a small percentage ofusers is, an upset stomach, which can be eliminatedby taking Tribulus with food
66Good Reasons to Try Herbal Alternatives for ED Viagra might have been the king of the ED treatment market, but there are also men who are looking for alternatives for treating ED, due to reasons of side effects, costs and failure of product efficacy in certain specific conditions of the user. It is known for a fact that herbal preparations are without any side effect as they are natural and most often organic. Thus men looking for herbal alternatives for the treatment of ED can not come as a surprise
671: It is widely known that most drugs used from treating ED, including the top brands are filled with various side effects ranging from headaches, flushing, dizziness, sneezing, dyspepsia and blurriness and loss of vision to priapism (painful and harmful condition that happens when the erect penis does not come back to its flaccid state), abnormally low blood pressure, heart attacks, stroke and even sudden death. It is also widely known that one of the most common reasons for people to look for herbal alternatives is the side effect profile of these drugs. Herbal alternatives on the other hand, has no side effects. Incredible as it may sound, these side effect free preparations are made from individually tried and tested ingredients which are of natural and organic origin
68How erection takes place The penis contains two chambers called the corpora cavernosa, which are almost equal to the length of the organ. The spongy tissue fills these chambers. The corpora cavernosa are surrounded by a membrane, called the tunica albuginea. The spongy tissue contains smooth muscles, fibrous tissues, spaces, veins, and arteries. The urethra, which is the channel for urine and ejaculate, runs along the underside of the corpora cavernosa and is surrounded by the corpus spongiosum.
69Factors Affecting Erection Smoking, being overweight, and avoiding exercise are also the possible causes of ED. These are the lifestyle diseases which contribute to heart disease and vascular problems also raise the risk of erectile dysfunction.Surgery sometimes, can lead to ED by harming nerves, especially radical prostate and bladder surgery for cancer. This can injure nerves and arteries near the penis, causing ED. Injury to the penis, spinal cord, prostate, bladder, and pelvis , smooth muscles, arteries, and fibrous tissues of the corpora cavernosa.Many common medicines—blood pressure drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants, and cimetidine—can produce ED as a side effect.
70Stress, anxiety, guilt, depression, low self-esteem, and fear of sexual failure cause 10 to 20 percent of ED cases. Men with a physical cause for ED may also generally suffer from psychological reactions (stress, anxiety, guilt, depression). Other possible causes are smoking, which affects blood flow in veins and arteries, and hormonal abnormalities, like low levels of testosternone hormone. Herbs like Tribulus terrestris helps a lot in this naturally.
71Clinical Studies on Tribulus terrestris Protodioscin in Women with Endocrine Infertility or Menopausal SyndromeThe opinion of the research team, based on the experience from treatment of more than 150 women with natural or postoperative menopause, is that Tribulus can successfully be used for treatment of the menopausal syndrome in women. Tribulus treatment resulted in the complete or almost complete disappearance of all or most of the menopausal syndrome symptoms were found in 49 from 50 treated patients (98%).
72It increases the level of testosterone. The therapeutic effect of Tribulus terrestris' protodioscin on the endocrine function of women was studied by the team in the last few years. The first clinical trials were carried out on women with the dysovulatory syndrome and infertility and later they were redirected to the premenopausal and menopausal syndrome. Women with postoperative castration-induced menopause were included in a separate group
73Action:.It improves libido sexualis in women, exerts a slight stimulating ovulation effect, it has a favorable influence on vasomotory manifestation during natural and post-castration climacterium, as well as on subjective complains such as insomnia, general tenseness, irritability or apathy, etc.
74Treatment of sexual dysfunction in diabetes mellitus subjects using orally administered protodioscin and injection of vasoactive compoundsDiabetes mellitus is a systemic metabolic disease which results in the destruction or weakening of many tissues and cell types. Here we conducted a preliminary clinical study to determine the level of dehydroepiandrosterone-sulphate (DHEA-S) in 15 diabetic males and 15 healthy controls. This study shows that the DHEA-S levels in healthy people are significantly higher than that found in diabetic subjects. A further study conducted with 30 male subjects with diabetes shows that those also suffering from erectile dysfunction (ED) have even lower DHEA-S levels than those without the dysfunction.
75Treatment of diabetic subjects with protodioscin in the form of tablets of Tribulus terrestris L extract (Libilov, 250 mg at 3 x 1 tablet daily for ten days) results in the increase of DHEA-S levels of these subjects, with the most gain experienced by those who also suffer from ED.Moreover, in this study we notice a significant increase (> 60%) in the frequency of successful sexual intercourse, as well as increased libido or sex drive in the diabetic male subjects. In this clinical study, we find no unwanted side-effects of administration of Libilov as examined by laboratory blood tests, as well as kidney and liver function tests.
76MECHANISM OF REGULATION OF CONTRACTION OF SMOOTH PENILE MUSCLES It is medically accepted that relaxation of the corpus cavernosum smooth muscle results in penile erection. First, the relaxation of the smooth muscle causes arterial blood to flow to tiny pool-shaped blood vessels called cavernous sinuses. The veins surrounding these tissues then are compressed shut by the pressure of the erectile tissues. The blood that pooled in the vessels are unable to flow out, thus resulting in penis rigidity. Destruction of the endothelium cells can directly result in ED
77For example, endothelium derived relaxing factor (EDRF) produced by these cells results in increased level of nitric oxide in the penis smooth muscles, which then results in tissue relaxation. In addition to EDRF, these endothelium cells also produce endothelin hormones, one of which is a strong vasoconstrictor. Furthermore, these endothelin hormones are similar to growth factors, in that they cause endothelium, fibroblast and smooth muscle cell production and development. By this mechanism, endothelin controls not only the structural development of blood vessels and smooth muscle tissues, but also that of the endothelium cells as well. Hyperglycemia and hypercholesterolemia associated with diabetes mellitus are two main causes of endothelial cell destructions.,
78OTHER VASOACTIVE ENDOTHELIN Prostaglandins are eicosanoids produced in corpus cavernosum which function in controlling smooth muscle contraction and tone. For example, PGF-2a, PGI-2 and thromboxane are prostaglandins that result in smooth muscle contraction, whereas PGE-1 results in smooth muscle relaxation. Indeed, injection of PGE-1 has been used as treatment for ED caused by diabetes mellitus. With well regulated diabetes management, injection of PGE-1 or other vasoactive chemicals such as papaverin and fentolamin can result in temporary erection. This palliative approach of injecting non-physiological vasoactive compounds, however, does not treat the underlying disease. Without injection, subjects will always experience ED.
79CAN PROTODIOSCIN REPAIR DAMAGED CELLS? Protodioscin is the active ingredient in Tribulus terrestris L plant extracts. Tribulus is known as effective herbal medication for sexual dysfunctions in central European and Asian countries. Protodioscin's chemical structure is close to that of dihydroepiandrosterone (DHEA), a precursor to testosterone which circulates in the bloodstream as DHEA-sulphate (DHEA-S). DHEA-S has been shown to significantly activate the immune system. As diabetes mellitus is a systemic metabolic disease which results in the destruction or weakening of many tissues and cell types, we conducted a preliminary clinical study to determine the level of DHEA-S in 15 diabetes subjects and 15 healthy controls. Subjects suffering from diabetes were found to have an average of 50 mg/dl of DHEA-S, whereas healthy men had an average of 77.6 mg/dl (p < 0.01
80Moreover, from this study we notice a significant increase of more than 60% in the frequency of successful sexual intercourse, as well as increased sexual libido or sex drive in these male subjects. It is possible that the increased DHEA-S levels in these subjects promote healing of the membrane integrity of the endothelium, corpus cavernosum and cells in other penile tissues, as well as improved performance of the body's circulatory system. This hypothesis is well supported by previous findings that Tribulus supplements improve spermatozoa morphologies of infertile men, resulting in greater frequency of conception. Significant among the morphology improvements is the increased efficiency of enzymatic reaction of the acrosome.
81in all these clinical studies, including ours, there was no unwanted side-effects of administration of Tribulus extract as examined by laboratory blood, kidney function, and liver function tests. In exception of the desirable increase in DHEA-S level as mentioned above, we found no changes in the concentration of other hormones in the circulatory system.
82We found that this treatment successfully increased DHEA-S levels in these subjects by over 61% to 19.2 mg/dl. Treatment of diabetes subjects without erectile dysfunction with similar Tribulus dosage resulted in the increase of nearly 30% of their average DHEA-S level to 41.8 mg/dl (p < 0.005). Therefore, treatment with Tribulus extract can successfully increase the level of DHEA-S in diabetes subjects, with the most gain experienced by those who also suffered from erectile dysfunction.
83This showed that the DHEA-S levels in healthy people were significantly higher than that found in subjects with diabetes mellitus. With this result, we conducted a larger study composed of 30 diabetes subjects that also suffered from sexual dysfunction. We found that these subjects had even lower level of DHEA-S of 11.9 mg/dl compared to 15 diabetes subjects that had no erectile dysfunction with DHEA-S level of 32.2 mg/dl (p < 0.05). To the diabetes subjects with erectile dysfunction, treatment with protodioscin in form of tablets of Tribulus terrestris L extracts (250 mg) was administered in form of one tablet three times daily for ten days
84Animal models of this form of diabetes show that hyperglycemia or abnormally high concentration of blood sugar can result in lowered androgen production, and lowered amounts of Leydig cells and Luteinizing hormone (LH) receptors. At first, insulin can successfully treat these deficiencies, suggesting that the lack of insulin is responsible for the sexual dysfunction of male diabetes mellitus subjects. This turns out not to be true, as later research revealed that insulin cannot successfully treat ED in these subjects.
85Erection begins with sensory or mental stimulation, or both Erection begins with sensory or mental stimulation, or both. Impulses from the brain and local nerves cause the muscles of the corpora cavernosa to relax, allowing blood to flow in and fill the spaces. The blood creates pressure in the corpora cavernosa, making the penis expand. The tunica albuginea helps trap the blood in the corpora cavernosa, thereby sustaining erection. When muscles in the penis contract to stop the inflow of blood and open outflow channels, erection is reversed.
86PerformanceErectile Dysfunction Preliminary animal studies found that tribulus heightened sexual behavior and increased intracavernous pressure. This was attributed to increases in testosterone. There haven't been any well-designed human studies to confirm these early findings.Body Composition and Exercise Performance Although tribulus has become popular as a sports performance aid, one small but well-designed study found it has no effect on body composition or exercise performance. Fifteen subjects were randomly assigned to tribulus (3.21 mg per kg body weight daily) or a placebo. After eight weeks with resistance training, there were no changes in body weight, percentage fat, dietary intake, or mood in either group. What was surprising was that muscle endurance actually improved more in the placebo group. Muscle endurance (determined by the maximum number of repetitions at 100 to 200% of body weight) increased for the bench and leg presses in the placebo group. The tribulus group experienced an increase in leg press strength only.DosageTribulus terrestris is often taken at a dose between 85 to 250 mg three times daily, with meals.
87Osteoporosis- some improvement in women over 70 but not in younger (Baulieu et al. PNAS 2000;97: )Adrenal insufficiency: some improvementImproving sexual functioning in women over 70 (but not younger women or men); another study showed increased sexual arousal in postmenopausal women (J Womens Health Gender Based Med 2002;11:155-62)Improving erectile dysfunction: N=40 Reiter et al. Urology 1999;53: Benefit in small controlled studyAthletic performance: mostly negative resultsRisksunknown; stimulates hormone responsive breast tissue in vitro. Stimulates prostate cancer cell growth in vitro. Adverse effects on cholesterol pattern, acne and hirsutism increased
88Ginger Zingiber officinale History-long used for food and medicine Pharmacologydigestive aidflavornausea and vomiting treatment-effect is on the stomach not on the CNSFor painChemistryvolatile compoundsnon volatile compoundsgingerolshogaol
90studies are not in agreement on efficacy GingerEfficacy Studiespost operative nauseastudies are not in agreement on efficacymotion sicknessmost studies “in the field” show benefit but those in a spinning chair are equivocal
91Ginger Summary possibly worthwhile in preventing motion sickness possibly worthwhile in treating and preventing nauseamust weigh risk vs. benefit in treating nausea of pregnancyproducts and doses0.5-1g one hour before travel2g/d in divided doses for nauseadried powdered ginger capsules are OK
92Ginseng Is anyone using ginseng? I found an article by JADA in 2002 that ginseng was the most frequently used supplements among university students. I thought it’s interesting.
93What is Ginseng?“Low-growing, shade-loving perennial herb of the Aralianceae family”(http://www.bccancer.bc.ca/PPI/UnconventionalTherapies/Ginseng.htm)Latin name= PanaxThe scientific namesPanax GinsengDerived from the Greek word for cure-all,related to the word Panacea.
94Types of Ginseng (Panax Quinquefolium) (Panax Ginseng) True Ginseng: American Ginseng(Panax Quinquefolium)Korean, Chineseor Japanese Ginseng(Panax Ginseng)American Ginseng -- (Panax Quinquefolium)an indigenous wild plant found in Canada and the eastern area of the United States.Korean or Japanese Ginseng -- Panax Ginsengwhich is used widely in the Orient and Russia as folk medicine.The Chinese words jen (man) and she (root) are the roots of "Ginseng" derived from the shape of the root.There are a number of other perennial herbs in the ginseng grouping including Panax Pseudoginseng.
95History Ginseng root has been used for over 2000 years Has traditionally used for treatment of a number of disorders in China and KoreaCrossed to Western by the eighteenth centuryUS expoted $20.9 million worth of ginseng last year (NYtimes, 2005)Has traditionally used for treatment of a number of disorders in China and Korea (1).Ginseng root has been used for over 2000 years (1, 4,).Crossed to Western by the eighteenth century (4).Earliest report about ginseng is in1274 by Marco Polo, and it began to get attention by European in the 17th century.An article mentioned about ginseng history in America. Since the “ginseng rush” happened in 1859, ginseng farming became the economic base of Marathon County in Minnesota. (A)A famous person related to Ginseng is Paul Hsu, a Taiwanese born in Wisconsin. He was working as a social worker and spent the early 1970’s learning the ginseng business at night while mediating domestic disputes by day. And in 1994, his company’s sales topped $18 million by selling ginseng. (A)Now ginseng business is big in the state, and NY times noted that US farmers and dealers exported $20.9 million worth of ginseng mostly to Asia last year. (A)
96Active Components Ginsenosides or Panaxosides Panaxans Ginsenans Major ginsenosides:Rg1, Re, Rf, Rb1, Rc, Rg2, Rb2, RbPanaxansGinsenansGinsenosides/ panaxosides6-8 major ginsenosides: Rg1, Re, Rf, Rb1, Rc, Rg2, Rb2, RbPanaxans(peptidoglycan in ginseng. may role to help stabilize blood sugar)Ginsenans(which is known as polysaccharide in ginseng)
97Clinical efficacy of Korean red ginseng for erectile dysfunctionClinical efficacy of Korean red ginseng for erectile dysfunctionTo investigate the efficacy in treating erectile dysfunction and to develop a natural drug without complications, the results of ginseng treatments are compared to placebo and other drug. A total of 90 patients with 30 patients in each group were closely followed.
98The overall therapeutic efficacies on erectile dysfunction were 60% for ginseng group and 30% for placebo and trazodone treated groups, statistically confirming the effect of ginseng (p < 0.05). No complete remission of erectile dysfunction was noted, but partial responses were reported.
99Dosage usually provide 100mg to 400mg of dried extract (equivalent to 0.5g to 2g of ginseng root.)Dosageproducts usually provide 100mg to 400mg of dried extract, which equivalent to 0.5g to 2g of ginseng root.
100Marketing Claims “Heart tonic” “Energy and mood booster” “Healthy glucose metabolism formula”“Helps normalize imbalances in the body’s energy in different disease status”“Sex drive”“Immune support”“Stress management”“Menopausal control”When I googled ginseng and looked over some ginseng products,Main market claims were:“heart tonic”“energy and mood booster”“helps normalize imbalances in the body’s energy in different disease status”“sex drive”Immune support”“Stress management”“Menopausal control
101Traditional and modern uses Improving the health of people recovering form illnessIncreasing a sense of well-being and stamina, and improving both mental and physical performance.
102Current Research Area Ginseng vs. Exercise performance Mood and cognitive functionCardiovascular diseaseSexual functionDiabetesObesityCancerCurrent research areas are: (read)(So seems like ginseng is known to do a lot of good stuff to your body.When I was going over the claims, I was interested in the statement of relation ship between ginseng and blood glucose.I remember when I was doing my field experience in a Db clinic in a hospital last summer, a lot of patients asked to my supervisor about the effectiveness of using herbs to their treatment.So I thought this topic, ginseng vs. Db, might be useful information when we become RD and I chose to research the effectiveness.)
103Diabetes vs. Ginseng Historically used to treat type-2 diabetes. No. 6th commonly suggested herbal medicine to improve glycemic control by Italian herbalistsMany studies support its antihyperglycemic activity.This is info about Db vs. Ginseng.Ginseng has historically used to treat type-2 diabetes (mostly in Asia)Ginseng is the #6th commonly suggested herbal medicine to improve glycemic control in hyperglycemic subjects with or without a medical diagnosis of IGT or Db by italian herbalists (Acta Diabetologica, 2004)Many studies support of its antihyperglycemic activity and believe in lowering blood glucose.
104Theoretical Basis Ginsenosides alter blood glucose levels by stimulating the biosynthesis of insulin by the pancreasinducing the production of a glucose transporter in the liverThe polysaccharides in ginseng lower blood glucose byeither decreasing the production of glucose by the liverincreasing the use of glucose by tissuesBut number of invitro studies reported thatGinsenoside alter blood glucose levels by stimulating the biosynthesis of insulin by the pancreas and inducint the production of a glucose transporter in the liverAndThe polysaccharidesin ginseng ( which is known as Ginsenance) lower blood glucose by either decreasing the production of glucose by the liver or increasing the use of glucose by tissues.
105THE MARKET FOR MALE SEXUAL HEALTH PRODUCTS IS EXTREMELY CROWDED … THE MARKET FOR MALE SEXUAL HEALTH PRODUCTS IS EXTREMELY CROWDED ….WITH MOST PRODUCTS NOT MEETING EXPECTATIONSA majority of products are not clinically proven or the studies are not conducted by qualified professionalsThey do not address all the main components of male sexual function (libido, erection, ejaculation, orgasm)Drugs like Sildenafil though very widely used are beneficial only in Erectile Dysfunction. They are contraindicated in patients with cardiac disorders & also cause other side effects such as headache, flushing & dyspepsiaOne has to be exceptionally cautious of formulations that do not have sufficient scientific backup , are unethical , do not match quality standards & may cause untoward side effectsIn contrast…Carefully selected phytoconstituents with proven activity offer multiple actions & are not only useful in treating the problem of male sexual dysfunction but also address other health conditions that might otherwise inhibit sex eg. problems of impotence, prostate problems , andropause , arthritis , diabetes , lack of energy
106Cinnamomum zeylanicum (cinnamon) Parts used- oil & barkEvergreen tree native to India & Sri Lanka; in Laurel familyProperties- Astringent, stimulant, anti-infective, anti-fungal, digestive aidOne of the oldest and most valuable spicesRelated spice, called cassia, from C. cassia.
107Crocus sativus (saffron) Member of “Iris” familyFrom ‘zafaran’ in ArabicFrom 3-parted Stigma of flowerDried by slow roastingImparts delicate & distinct taste & colorUsed in French, Spanish, Middle Eastern & Indian cookingEach saffron crocus flower has 3 stigmasCa. 80,000 flowers (240,000) stigmas to make a pound of saffron12 days to pickcost is > $250 per ounce(so most costly spice)1444: any merchant caught selling adulterated saffron in Bavaria was burned alive