According to the Urology Care Foundation, erectile dysfunction (ED) is the most common sex problem, affecting as many as 30 million American men; about 50 percent of men over the age of 40. ED can occur from physical conditions, emotional issues or both.
Physical Causes
One of the major physical causes of ED is insufficient blood flow into the penis. Atherosclerosis, hardening of the arteries, can cause reduced blood to the male sex organs through the narrowing of the arteries, especially arteries that branch from the abdomen to the penis. Vascular disease can cause ED in as many as 50-70 percent of men who have it.
Another physical cause is declined testosterone levels with age. It is believed that ED can occur when testosterone levels drop below a certain threshold.1 Testosterone has been widely used as an important therapy for ED. However, testosterone therapy has various risks such as worsening sleep apnea, acne, stimulating noncancerous growth of the prostate, limiting sperm production, and stimulating too much red blood cell production, a condition called erythrocytosis.
Emotional Causes
Psychological factors are responsible for about 10-20 percent of ED cases. The most common psychological causes of ED include stress, anxiety and depression.
Stress and anxiety cause elevated levels of cortisol, which is a stress hormone released by the adrenal glands. Our brain triggers cortisol release in response to many different kinds of stress through the activation of the hypothalamic-pituitary-adrenal axis. When cortisol levels are too high for too long, ED can manifest. People with depression tend to have reduced levels of serotonin in the brain and elevated levels of cortisol in their bloodstream.
Stress and anxiety can also interrupt how the brain sends messages to the penis and interrupt blood flow. Experiencing ED can cause further stress and lead to behavioral changes that can further aggravate ED.
Posttraumatic stress disorder (PTSD) has shown to cause hypersensitivity of cortisol receptors, which augment the effect of cortisol. A study with veterans who suffered from posttraumatic stress disorder (PTSD) showed that PTSD increased the risk of sexual dysfunction by more than three times.2
Wellness Recommendation
A large number of studies have been conducted to investigate the effect and mechanism of TCM for treating ED. Chinese herbs exhibited satisfying outcomes and might improve erectile function by improving blood flow and testosterone levels, and ameliorating stress and anxiety.
Nurturing kidney yang helps to promote blood flow to the male sex organs, as well as resolve poor blood flow issues due to various causes in patients with ED. For example, sea-horse promotes kidney yang and enhances sexual activity. It is one of the safe herbal tonics being used to assist the aging male through improving sex drive and ability to perform penetrative sex by increasing sexual stimulation, erectile, ejaculatory, orgasmic and other responses for sexual function and satisfaction.3
Cnidium fruit is a pro-erectile herb and appears to have mechanisms similar to Viagra in penile tissue and the hippocampus. It has been used orally for increasing sexual performance and libido, and improving erectile dysfunction and infertility.4
If the cause of ED is vascular, such as atherosclerosis, then removing blood stasis and nurturing heart qi and blood is necessary. Red sage has been shown to have the ability to inhibit oxidative stress to prevent low-density lipoprotein from oxidation and disrupt adhesion molecules. This, in turn, reduces atherosclerotic areas, as well as decreases levels of pro-inflammatory cytokines to decrease the susceptibility of plaque formation.5
For patients with stress or anxiety, herbs that support liver yin and clear liver heat are helpful. Liver function can affect levels of anxiety and stress. A liver that has heat can overreact to stress hormones, such as cortisol and epinephrine. Such overreaction amplifies stress levels, causing anxiety.
Herbs that nurture liver yin improve liver health and increase stress tolerance to reduce the physiological impact of stress. Quenching liver yang rising and reducing liver heat reduces the liver's overreaction to stress hormones.
Clinical Case Study: Successful Resolution of Erectile Dysfunction
Michael Biamonte, ND, CCN (nutritionist)
A 40+-year-old male suffered from erectile dysfunction for many years. The patient also had premature ejaculation, a decrease in his sex drive, lack of nocturnal penile tumescence, chronic fatigue, and passiveness.
Dr. Biamonte recommended a kidney yang treatment consisting of herbs including sea-horse, cnindium herb and 20 other Chinese herbs to promote more blood flow to the kidneys and male sex organs, as well as boost adrenal function.
After the third day of treatment, the patient noticed an increase in his energy level, and he was motivated to work out. After two weeks of treatment, the patient saw an increase in his sex drive, and he had normal erectile function and ejaculation.
By the sixth week of treatment, he had experienced wet dreams and the return of nocturnal penile tumescence. He also had enough youthful energy to enjoy playing with his children and had been able to work a 16-hour shift without becoming tired. His passiveness had completely resolved.
References
Rajfer J. Relationship between testosterone and erectile dysfunction. Rev Urol, 2000;2(2)122–128.
Anticevic V, Britvic D. Sexual functioning in war veterans with posttraumatic stress disorder. Croat Med J, 2008 Aug;49(4):499-505.
Lim PHC. Asian herbals and aphrodisiacs used for managing ED. Transl Androl Urol, 2017 Apr;6(2):167-175.
Zhang ZR, Leung WN, Cheung HY, et al. Osthole: a review on its bioactivities, pharmacological properties, and potential as alternative medicine. Evid-Based Compl Alt Med: eCAM, 2015:919616.
As modern medical standardization continues, the field of traditional Chinese medicine has the advantage of comprehensive personalization. For rare or complex cases, deeper consideration of constitution is invaluable. Proper constitutional assessment, especially with first-time clients, can guide desirable and predictable outcomes. This leads to a higher rate of return, and greater trust between you and your patient.
Though the creation of a financially sustainable, health-promoting model feels far away today, we are casting a vision for a full return on health, believing that this compels us to keep one foot firmly rooted in caring for the sick and the other foot firmly founded in maintaining health. Shifting from a fee-for-service model to value-based care using a phased approach is paramount.
Laser therapy has emerged as a powerful tool in the realm of traditional Chinese medicine (TCM). This new modality fits beautifully into the toolbox of the modern acupuncturist, as it can be used as a hybrid form of stimulation to acupuncture points, meridians, organs, nerves, and symptomatic areas in a new way that blends both moxa and energetic needle-like responses.
