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Homeopathic Management for erectile dys

Homeopathic Management for erectile dysfunction and associated symptoms
Introduction and definition
Erection problems are common in adult men. In fact, almost all men experience occasional difficulty getting a maintaining on erection. In many case, it is a temporary condition that will go away with little or no treatment. In other cases, it can be an ongoing problem that can damage a man’s self esteem and harm his relationship with his partner, and thus requires treatment.
Erectile dysfunction (ED), sometimes called as impotence, is defined as the consistent inability to attain or maintain an erection firm enough to have sexual intercourse. If a man faces this problem for more than 25% of the time of sexual activity that is considered as erectile dysfunction. Erectile dysfunction can be sign of deep seated health problems. It may mean a problem in blood vessels or nerve damage from diabetes to injury. The word “importance” may also be used to describe other problems that interfere with sexual intercourse and reproduction such as lack of sexual desire and problems with ejaculation or orgasm. Using the term erectile dysfunction makes it clear that those other problems are not involved.
Anatomy of penis and physiology of erection
Penis is made up of special tissues to get hard during the sexual act. Three main tube-like structures present in the body of penis, which can be seen in the picture. Two of these are long tubes known as corpora cavernosa, one on each side of the penis. It is filled with a spongy tissue and surrounded by a membrane, called tunica albuginea. The spongy tissue contains smooth muscles, fibrous tissues, spaces, veins, and anteries. The third tube-like structure is the corpus spongiosum, located between the two corpora cavernosa. The urethra runs along the underside of the corpora cavernosa and is surrounded by the corpus spongiosum. Through urethra urine and semen exit the body and it does not play a role in forming or maintaining an erection.
Erection begins with sensory or mental stimulation, or both. Hormones, blood vessels, nerves and muscles all must work together to cause an erection. Brain initiates an erection by sending nerve signals to the penis when it senses sexual stimulation. Touch may cause this arousal. Other triggers include visual, auditary or sexual thoughts or dreams. Such signals from the brain through local nerves cause the muscles of the corpora cavernosa to relax. As the muscles around the corpora cavernosa relax, it fills up with blood. The blood creates pressure in the corpora cavernosa, making the penis expand and erect. The tunica albuginea helps trap the blood in the corpora cavernosa, thereby sustaining erection. After orgasm, muscles in the penis contract to stop the inflow of blood and open outflow channels. Then the blood empties from the corpora cavernosa through the veins of the penis. The penis becomes soft or flaccid. Testosterone is a sex hormone secreted by the testicles, and is important in regulating the frequency and magnitude of penile erection.
Age and erectile dysfunction
In older men, erectile dysfunction usually has a physical cause, such as disease, injury, or side effects of drugs. Any disorder that causes injury to the nerves or impairs blood flow in the penis has the potential to cause erectile dysfunction. Incidence increases with age. About 5 percent of 40-year-old men and between 15 and 25 percent of 65-year-old men experience erectile dysfunction. But it is not an inevitable part of aging.
Causes of erectile dysfunction
Since an erection requires a precise sequence of events, erectile dysfunction can occur when any of the events is disrupted. The sequence includes nerve impulses in the brain, spinal column, area around the penis, response in muscles, fibrous tissues, veins, and arteries in and near the corpora cavernosa. It starts from psychological and result in physical. Disturbance anywhere in this sequence either at psychological level or physical level may lead to erectile dysfunction. 2, 3 & 4 For the convenience of the readers, causes of erectile dysfunction is categorized in psychological and physical.
a. psychological causes
In the sequence mentioned above, brain plays a key or role in triggering the series, which leads to physical events that cause on erection. Starting with feelings of sexual excitement, a number of things can interfere with sexual feelings and cause or worsen erectile dysfunction like:
· Depression*
(a) Mild (b) Severe
Anxiety, Stress, Fatigue (due to disease, syndrome and general weakness)#
Relationship problems due to stress, poor communication or other concerns
Other mental health conditions needing help of psychotherapists
* These cases are to be death with drugs for erectile dysfunction due to depression, anxiety and stress like Angus castus, Aurum muriaticum natronatum, Damiana, Ginseng, Kalium phosphricum, Muria puama, etc. along with condition specific product for tension and stress Alpha-TS.
# Treatment of these cases are aimed at reducing the fatigue by drugs improving vitality like Acidum phosphricum, Angus castus, Avena sativa, Ginseng, Sabal serrulata, Yohimbinum, etc and products like Alfalfa Tonic, Bio-combination nos. 16, 24 and 28, and Biofungin.
Please refer the section “Homeopathic medicines for erectile dysfunction and associated symptoms” on page no. 15 for the above mentioned drugs.
b. Physical causes
Majority of these cases are secondary to diseases and disorders. These physical causes can further be classified into:
(i) Diseases and disorders that cause erectile dysfunction
(ii) Other causes
(i) Diseases and disorders that cause erectile dysfunction are
Heart disease, Atherosclerosis, High blood pressure, Diabetes (it is one of the major causes. 35-50% men with diabetes experience ED), Obesity or overweight, Metabolic syndrome, Parkinson’s disease, Multiple sclerosis, Low testosterone, Peyronie’s disease (development of scar tissue inside the penis)
Disease mentioned above account for about 70 percent of erectile dysfunction cases. 2 Addressing the diseases effecting erectile dysfunction is essential.
(ii) Other Causes include:
· Certain medications (some of the medications taken for depression or high blood pressure could cause erectile dysfunction) such as amitriptyline, clomipramine, desipramine, doxepin, etc. as mentioned in Martindale: The Extra Pharmacopoeia5.
· Tobacco use
· Alcoholism and other forms of substance abuse such as cocaine and heroin.
· Treatments for prostate cancer or enlarged prostate using hormones and allopathic drugs
· Surgeries or injuries that affect the pelvic area or spinal cord
· Lifestyle problems like obesity as mentioned in the previous page.
Diagnosing erectile dysfunction
a. Case history
A detailed case taking is needed along with physical examination to diagnose the patient and to plan homeopathic treatment. From the case history it should be distinguished from problems of ejaculation, libido and orgasm. Identifying underlying causative factor is always helpful in eliminating that or taking appropriate measure. Asking specific questions about relationship with partner, medicines taken by the patient and any surgery in the past would be helpful in finding out the cause and the severity of the problem. Further, following questions would be helpful in finding out the severity of the erectile dysfunction and in the treatment plan.
· What is the age and period of sexual relationship in years with partner (or partners)? Do the multiple partners have affected psychologically?
· How do you rate your confidence that you can get and keep an erection?
· When you have erections with sexual stimulation, how often are your erections hard enough for penetration?
· During sexual intercourse, how often are you able to maintain your erection after penetration and how many minutes?
· When you attempt sexual intercourse, how often is it satisfactory for you?
· How would you rate your level sexual desire?
· How often are you able to reach climax and ejaculate?
· Do you have an erection when you wake up in the morning?
From the answers exact symptoms and indications can be elicited, so that it can be elicited, so that it can be matched with the indications of the remedy and the right homeopathic remedy can be selected.
b. Physical examination
A physical examination can give clues to systemic problems. For example, if the penis is not sensitive to touch, a problem in the nervous system may be the cause. Abnormal secondary sex characteristics, such as hair pattern or breast enlargement, can point to hormonal problems, which would mean that the endocrine system is involved. Circulatory problem could be assessed by observing decreased pulses in the wrist or ankles. Unusual characteristics of the penis could suggest the source of the problem like Peyoronie’s disease (development of scar tissue inside the penis). All these would give clue in the selection of remedy depending upon the nervous origin, endocrine origin etc.
c. Laboratory tests
Laboratory tests can help finding the underlying cause. Tests for systemic diseases include blood counts, urinalysis, lipid profile, and measurements of creatinine and liver enzymes. Measuring the amount of free testosterone in the blood can yield information about problems with the endocrine system and is indicated especially in patients with decreased sexual desire. Ultrasound can check blood flow to the penis. If the cause is poor blood flow, drugs can be selected to correct it. For example, Ginseng φ/1 x pumps more blood to the sex organs along with other sexual health benefits like keeping sperm healthy, boosting sexual energy in the body, assisting in testosterone production and reducing stress. 6 Cases of poor circulation to the penis due to permanent pathology are to be referred for surgical correction.
d. Special tests
Overnight erection test is done to check erection while sleeping. Most men have erections during sleep without remembering them. This simple test involves wrapping special tape around the penis before going to bed. If the tape separated in the morning, the penis was erect at some time during the night. This indicates the cause is most likely psychological and not physical. This can also be done with the help of a simple tension meter and the test is called as nocturnal penile tumescence test. In this, the frequency and rigidity of erections are recorded by a tension meter attached to the penis before sleep. These are available at specialized medical care centers.
e. Psychosocial examination
This examination may reveal if there is any psychological factor involved. It is a combination of an interview and a questionnaire. A man’s sexual partner may also be interviewed to determine expectations and perceptions during sexual intercourse. The questionnaire is given in the Annexure. Use of the questionnaire will also be helpful in assessing the improvement in the patient.
General management
Along with homeopathic treatment certain measures can be followed, which are useful in the management of erectile dysfunction. Counseling can help couples to deal with the emotional effects. Some couples find that counseling along with homeopathic drugs is highly beneficial in making their relationship stronger. It is also useful for the men who are with tension, stress and anxiety. Lifestyle changes like regular exercise, quitting smoking, losing weight, and reducing alcohol intake may solve erection problems along with the indicated remedy. Mechanical vacuum devices cause erection by creating a partial vacuum, which draws blood into the penis, engorging and expanding it. Such devices have basically three components namely a plastic cylinder, a pump, and an elastic band. Penis is inserted into a plastic cylinder, which is connected to a pump. As air is pumped out of the tube, blood flows into the penis and makes it larger. A specially designed elastic ring is moved from the end of the tube to the base of the penis to maintain the erection by keeping the blood from flowing out. These devices can be used in the initial stage of treatment till the indicated drug and counseling take their own time to overcome the problem. In cases where irreversible abnormality is present surgery is recommended. The goal of surgery is to implant a device that can cause the penis to become erect, to reconstruct arteries to increase flow of blood to the penis and to block off veins that allow blood to leak from the penile tissues. This is done normally at advance age by a surgeon specialized in these cases, but it has problems like continued erection, mental irritation, lack of concentration, etc. The role of homeopathy in post-surgical case is usually to heal the surgical injuries fast and to avoid the infections thus to minimize antibiotics.
Homeopathic medicines for erectile dysfunction and associated symptoms
Homeopathic approach is to individualize the case based on the totality of symptoms, examination and tests. The role of homeopathy is highly effective in psychological dysfunctions rather than pathological involvement. Many erectile dysfunction cases are psychological origin which lead to functional abnormality. Successful homeopathic treatment requires a careful differentiation of drugs and selection of potency.
Ref--schwabe India continued medical education seriese no11

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