Early identification and treatment of erectile dysfunction (ED) and ED related comorbidities, including hypertension, diabetes mellitus, and hyperlipidemia is crucial in improving the quality of life of men and their partners. To date, the main treatment options for ED can be divided into pharmacological and surgical interventions. These treatments include oral phosphodiesterase type 5 (PDE5) inhibitors (sildenafil, tadalafil, vardenafil), intraurethral or intracavernosal alprostadil, vacuum devices and penile prosthesis. Although considerable advances have been made, there seems to be a high dropout rate of the above treatment due to cultural restrictions and taboos. Subsequently, these patients would seek herbal dietary supplements such as ginseng as an alternative. Even though several studies have proved that ginseng is ideal in treating ED, the published trials on humans were not robust, and there is a lack of exploration of subjective outcomes. This literature review aimed to synthesize and critically appraise clinical and scientific literature on the effects of ginseng in managing ED. In total, 7 studies were included and reviewed. It was concluded that ginseng is a feasible alternative to currently available practices in treating ED due to a significant improvement in International Index of Erectile Function (IIEF)-5 scores and its safety profile. There is a higher likelihood to consider ginseng as an alternative therapy if more studies with larger-scaled clinical trials and higher standards on the safety and efficacy of ginseng are conducted in the future.
Cite this paper
Yee, A. T. S. and Chan, L. T. (2021). Effectiveness of Ginseng in Treating Erectile Dysfunction: A Review Paper. Open Access Library Journal, 8, e8043. doi: http://dx.doi.org/10.4236/oalib.1108043.
Davis, M.P. and Behm, B. (2019) Ginseng: A Qualitative Review of Benefits for Palliative Clinicians. American Journal of Hospice and Palliative Medicine, 36, 630-659.
https://doi.org/10.1177/1049909118822704
Hackett, G. (2009) The Burden and Extent of Comorbid Conditions in Patients with Erectile Dysfunction. International Journal of Clinical Practice, 63, 1205-1213.
https://doi.org/10.1111/j.1742-1241.2009.02088.x
Sy, S., Samaké, M., Yattara, H., Coulibaly, M., Koné, I., Fofana, A.S., et al. (2020) Erectile Dysfunction in Chronic Hemodialysis Patients at the University Hospital Center of Point-G in Mali. Open Journal of Clinical Diagnostics, 10, 29-40.
https://doi.org/10.4236/ojcd.2020.101003
Grover, S.A., Lowensteyn, I., Kaouache, M., Marchand, S., Coupal, L., DeCarolis, E., et al. (2006) The Prevalence of Erectile Dysfunction in the Primary Care Setting: Importance of Risk Factors for Diabetes and Vascular Disease. Archives of Internal Medicine, 166, 213-219. https://doi.org/10.1001/archinte.166.2.213
Glina, S., Cohen, D.J. and Vieira, M. (2014) Diagnosis of Erectile Dysfunction. Current Opinion in Psychiatry, 27, 394-399.
https://doi.org/10.1097/YCO.0000000000000097
de Groat, W. (2017) Autonomic Nervous System: Central Urogenital Control. In: Reference Module in Neuroscience and Biobehavioral Psychology, Elsevier, Amsterdam. https://doi.org/10.1016/B978-0-12-809324-5.01816-2
Andersson, K.-E. (2011) Mechanisms of Penile Erection and Basis for Pharmacological Treatment of Erectile Dysfunction. Pharmacological Reviews, 63, 811-859.
https://doi.org/10.1124/pr.111.004515
Levine, L.A. (2000) Diagnosis and Treatment of Erectile Dysfunction. The American Journal of Medicine, 109, 3-12. https://doi.org/10.1016/S0002-9343(00)00655-0
Hatzimouratidis, K. and Hatzichristou, D.G. (2005) A Comparative Review of the Options for Treatment of Erectile Dysfunction. Drugs, 65, 1621-1650.
https://doi.org/10.2165/00003495-200565120-00003
Mobley, D.F., Khera, M. and Baum, N. (2017) Recent Advances in the Treatment of Erectile Dysfunction. Postgraduate Medical Journal, 93, 679-685.
https://doi.org/10.1136/postgradmedj-2016-134073
Wespes, E., Amar, E., Hatzichristou, D., Montorsi, F., Pryor, J. and Vardi, Y. (2002) Guidelines on Erectile Dysfunction. European Urology, 41, 1-5.
https://doi.org/10.1016/S0302-2838(01)00008-2
Palit, V. and Eardley, I. (2010) An Update on New Oral PDE5 Inhibitors for the Treatment of Erectile Dysfunction. Nature Reviews Urology, 7, 603-609.
https://doi.org/10.1038/nrurol.2010.165
Masuku, N.P., Unuofin, J.O. and Lebelo, S.L. (2020) Promising Role of Medicinal Plants in the Regulation and Management of Male Erectile Dysfunction. Biomedicine & Pharmacotherapy, 130, Article ID: 110555.
https://doi.org/10.1016/j.biopha.2020.110555
Hatzimouratidis, K., Salonia, A., Adaikan, G., Buvat, J., Carrier, S., El-Meliegy, A., et al. (2016) Pharmacotherapy for Erectile Dysfunction: Recommendations from the Fourth International Consultation for Sexual Medicine (ICSM 2015). The Journal of Sexual Medicine, 13, 465-488. https://doi.org/10.1016/j.jsxm.2016.01.016
Nguyen, H.M.T., Gabrielson, A.T. and Hellstrom, W.J. (2017) Erectile Dysfunction in Young Men—A Review of the Prevalence and Risk Factors. Sexual Medicine Reviews, 5, 508-520. https://doi.org/10.1016/j.sxmr.2017.05.004
Akin-Olugbade, O., Parker, M., Guhring, P. and Mulhall, J. (2006) Determinants of Patient Satisfaction Following Penile Prosthesis Surgery. The Journal of Sexual Medicine, 3, 743-748. https://doi.org/10.1111/j.1743-6109.2006.00278.x
Hong, B., Ji, Y.H., Hong, J.H., Nam, K.Y. and Ahn, T.Y. (2002) A Double-Blind Crossover Study Evaluating the Efficacy of Korean Red Ginseng in Patients with Erectile Dysfunction: A Preliminary Report. The Journal of Urology, 168, 2070- 2073. https://doi.org/10.1016/S0022-5347(05)64298-X
Park, N.C., Kim, S.W., Hwang, S.Y. and Park, H.J. (2019) Efficacy and Safety of an Herbal Formula (KBMSI-2) in the Treatment of Erectile Dysfunction: A Preliminary Clinical Study. Investigative and Clinical Urology, 60, 275-284.
https://doi.org/10.4111/icu.2019.60.4.275
Lee, A.-R., Gautam, M., Kim, J., Shin, W.-J., Choi, M.-S., Bong, Y.-S., et al. (2011) A Multianalytical Approach for Determining the Geographical Origin of Ginseng Using Strontium Isotopes, Multielements, and 1H NMR Analysis. Journal of Agricultural and Food Chemistry, 59, 8560-8567. https://doi.org/10.1021/jf201696j
Choi, Y., Xin, Z. and Choi, H. (1998) Effect of Korean Red Ginseng on the Rabbit Corpus Cavernosal Smooth Muscle. International Journal of Impotence Research, 10, 37-43. https://doi.org/10.1038/sj.ijir.3900300
Choi, Y.D., Rha, K.H. and Choi, H.K. (1999) In Vitro and in Vivo Experimental Effect of Korean Red Ginseng on Erection. The Journal of Urology, 162, 1508-1511.
https://doi.org/10.1016/S0022-5347(05)68349-8
Kim, H., Woo, D., Lee, G. and Kim, J. (1998) The Relaxation Effects of Ginseng Saponin in Rabbit Corporal Smooth Muscle: Is It a Nitric Oxide Donor? British Journal of Urology, 82, 744-748. https://doi.org/10.1046/j.1464-410X.1998.00811.x
O’Hara, M., Kiefer, D., Farrell, K. and Kemper, K. (1998) A Review of 12 Commonly Used Medicinal Herbs. Archives of Family Medicine, 7, 523-536.
https://doi.org/10.1001/archfami.7.6.523
Choi, H., Seong, D. and Rha, K. (1995) Clinical Efficacy of Korean Red Ginseng for Erectile Dysfunction. International Journal of Impotence Research, 7, 181-186.
de Oliveira, A.A. and Nunes, K.P. (2021) Hypertension and Erectile Dysfunction: Breaking Down the Challenges. American Journal of Hypertension, 34, 134-142.
https://doi.org/10.1093/ajh/hpaa143
Nunes, K.P., Labazi, H. and Webb, R.C. (2012) New Insights into Hypertension- Associated Erectile Dysfunction. Current Opinion in Nephrology and Hypertension, 21, 163-170. https://doi.org/10.1097/MNH.0b013e32835021bd
Karmazyn, M. and Gan, X.T. (2021) Chemical Components of Ginseng, Their Biotransformation Products and Their Potential as Treatment of Hypertension. Molecular and Cellular Biochemistry, 476, 333-347.
https://doi.org/10.1007/s11010-020-03910-8
Kim, J.-H. (2012) Cardiovascular Diseases and Panax ginseng: A Review on Molecular Mechanisms and Medical Applications. Journal of Ginseng Research, 36, 16-26. https://doi.org/10.5142/jgr.2012.36.1.16
Agarwal, S., Prakash, A. and Singh, N. (2003) Erectile Dysfunction in Diabetes Mellitus: Novel Treatments. International Journal of Diabetes in Developing Countries, 23, 94-98.
Yuan, H.-D., Kim, J.T., Kim, S.H. and Chung, S.H. (2012) Ginseng and Diabetes: The Evidences from in Vitro, Animal and Human Studies. Journal of Ginseng Research, 36, 27-39. https://doi.org/10.5142/jgr.2012.36.1.27
Roumeguere, T., Wespes, E., Carpentier, Y., Hoffmann, P. and Schulman, C. (2003) Erectile Dysfunction Is Associated with a High Prevalence of Hyperlipidemia and Coronary Heart Disease Risk. European Urology, 44, 355-359.
https://doi.org/10.1016/S0302-2838(03)00306-3
Yamamoto, M., Uemura, T., Nakamura, S., Uemiya, M. and Kumagai, A. (1983) Serum HDL-Cholesterol-Increasing and Fatty Liver-Improving Actions of Panax ginseng in High Cholesterol Diet-Fed Rats with Clinical Effect on Hyperlipidemia in Man. The American Journal of Chinese Medicine, 11, 96-101.
https://doi.org/10.1142/S0192415X83000161
Yuan, H.-D., Kim, S.-J., Quan, H.-Y., Huang, B. and Chung, S.-H. (2010) Ginseng Leaf Extract Prevents High Fat Diet-Induced Hyperglycemia and Hyperlipidemia through AMPK Activation. Journal of Ginseng Research, 34, 369-375.
https://doi.org/10.5142/jgr.2010.34.4.369
Kim, S.-H. and Park, K.-S. (2003) Effects of Panax ginseng Extract on Lipid Metabolism in Humans. Pharmacological Research, 48, 511-513.
https://doi.org/10.1016/S1043-6618(03)00189-0
Choi, H.-K., Choi, Y.-D. and Lee, W.-H. (1998) Clincal Efficacy of Korean Red Ginseng for Erectile Dysfunction-Multi-National Approach. Proceedings of the Ginseng Society Conference, 208-215.
Choi, Y., Park, C., Jang, J., Kim, S., Jeon, H., Kim, W., et al. (2013) Effects of Korean Ginseng Berry Extract on Sexual Function in Men with Erectile Dysfunction: A Multicenter, Placebo-Controlled, Double-Blind Clinical Study. International Journal of Impotence Research, 25, 45-50. https://doi.org/10.1038/ijir.2012.45
De Andrade, E., De Mesquita, A.A., de Almeida Claro, J., De Andrade, P.M., Ortiz, V., Paranhos, M., et al. (2007) Study of the Efficacy of Korean Red Ginseng in the Treatment of Erectile Dysfunction. Asian Journal of Andrology, 9, 241-244.
https://doi.org/10.1111/j.1745-7262.2007.00210.x
Jang, D.J., Lee, M.S., Shin, B.C., Lee, Y.C. and Ernst, E. (2008) Red Ginseng for Treating Erectile Dysfunction: A Systematic Review. British Journal of Clinical Pharmacology, 66, 444-450. https://doi.org/10.1111/j.1365-2125.2008.03236.x
Kim, T.-H., Jeon, S.H., Hahn, E.-J., Paek, K.-Y., Park, J.K., Youn, N.Y., et al. (2009) Effects of Tissue-Cultured Mountain Ginseng (Panax ginseng CA Meyer) Extract on Male Patients with Erectile Dysfunction. Asian Journal of Andrology, 11, 356-361.
https://doi.org/10.1038/aja.2008.32
Leisegang, K. and Finelli, R. (2021) Alternative Medicine and Herbal Remedies in the Treatment of Erectile Dysfunction: A Systematic Review. Arab Journal of Urology, 19, 323-339. https://doi.org/10.1080/2090598X.2021.1926753
Ernst, E., Posadzki, P. and Lee, M.S. (2011) Complementary and Alternative Medicine (CAM) for Sexual Dysfunction and Erectile Dysfunction in Older Men and Women: An Overview of Systematic Reviews. Maturitas, 70, 37-41.
https://doi.org/10.1016/j.maturitas.2011.06.011
Yamashita, S.-I. (2018) Effects of Sanchi Ginseng Extract on the Sexual Function in Japanese Men―A Randomized, Double-Blind, Placebo-Controlled, Parallel-Group Trial. Japanese Pharmacology and Therapeutics, 46, 561-580.
Chen, X. (1996) Cardiovascular Protection by Ginsenosides and Their Nitric Oxide Releasing Action. Clinical and Experimental Pharmacology and Physiology, 23, 728- 732. https://doi.org/10.1111/j.1440-1681.1996.tb01767.x
Han, K.H., Choe, S.C., Kim, H.S., Sohn, D.W., Nam, K.Y., Oh, B.H., et al. (1998) Effect of Red Ginseng on Blood Pressure in Patients with Essential Hypertension and White Coat Hypertension. The American Journal of Chinese Medicine, 26, 199- 209. https://doi.org/10.1142/S0192415X98000257
Wood, W.B., Roh, B.L. and White, R.P. (1964) Cardiovascular Actions of Panax ginseng in Dogs. The Japanese Journal of Pharmacology, 14, 284-294.
https://doi.org/10.1254/jjp.14.284
Hur, M.-H., Lee, M.-S., Yang, H.-J., Kim, C., Bae, I.-L. and Ernst, E. (2010) Ginseng for Reducing the Blood Pressure in Patients with Hypertension: A Systematic Review and Meta-Analysis. Journal of Ginseng Research, 34, 342-347.
https://doi.org/10.5142/jgr.2010.34.4.342
World Health Organization (2007) Prevention of Cardiovascular Disease: Guidelines for Assessment and Management of Cardiovascular Risk. WHO.
https://www.who.int/cardiovascular_diseases/guidelines/Full%20text.pdf
Sotaniemi, E.A., Haapakoski, E. and Rautio, A. (1995) Ginseng Therapy in Non- Insulin-Dependent Diabetic Patients: Effects on Psychophysical Performance, Glucose Homeostasis, Serum Lipids, Serum Aminoterminalpropeptide Concentration, and Body Weight. Diabetes Care, 18, 1373-1375.
https://doi.org/10.2337/diacare.18.10.1373
Vuksan, V., Xu, Z.Z., Jovanovski, E., Jenkins, A.L., Beljan-Zdravkovic, U., Sievenpiper, J.L., Stavro, P.M., Zurbau, A., Duvnjak, L. and Li, M.Z. (2019) Efficacy and Safety of American Ginseng (Panax quinquefolius L.) Extract on Glycemic Control and Cardiovascular Risk Factors in Individuals with Type 2 Diabetes: A Double- Blind, Randomized, Cross-Over Clinical Trial. European Journal of Nutrition, 58, 1237-1245. https://link.springer.com/article/10.1007/s00394-018-1642-0
Ryu, J.-K., Lee, T., Kim, D.-J., Park, I.-S., Yoon, S.-M., Lee, H.-S., et al. (2005) Free Radical-Scavenging Activity of Korean Red Ginseng for Erectile Dysfunction in Non- Insulin-Dependent Diabetes Mellitus Rats. Urology, 65, 611-615.
https://doi.org/10.1016/j.urology.2004.10.038
Bakircioglu, M.E., Hsu, K., El-Sakka, A., Sievert, K.-D., Lin, C.S. and Lue, T.F. (2000) Effect of a Chinese Herbal Medicine Mixture on a Rat Model of Hypercholesterolemic Erectile Dysfunction. The Journal of Urology, 164, 1798-1801.
https://doi.org/10.1016/S0022-5347(05)67109-1
Delui, M.H., Fatehi, H., Manavifar, M., Amini, M., Ghayour-Mobarhan, M., Zahedi, M., et al. (2013) The Effects of Panax ginseng on Lipid Profile, Pro-Oxidant: Antioxidant Status and High-Sensitivity C Reactive Protein Levels in Hyperlipidemic Patients in Iran. International Journal of Preventive Medicine, 4, 10451051.
Moyad, M.A. and Park, K. (2012) What Do Most Erectile Dysfunction Guidelines Have in Common? No Evidence-Based Discussion or Recommendation of Heart- Healthy Lifestyle Changes and/or Panax ginseng. Asian Journal of Andrology, 14, 830-841. https://doi.org/10.1038/aja.2012.82
