Treatment of Erectile Dysfunction
Klaibya (Erectile Dysfunction) and its management:
Klaibya menas inability to perform sexual act.
According to School of Ayurvedic Medicine, “A person’s persistent inability to perform sexual intercourse with the beloved, willing and submissive partner, though having persistent desire due to the ‘lack of erection’ and if at all attempted ends into failure without ejaculation due to ‘flaccidity of penis’ associated with breathlessness and perspiration”, is considered as Klaibya.
Lack of penile erection, impotent, lack of penile rigidity, lack of orgasm or pleasure, unable to perform sexual intercourse
Physiology of erection: (Ayurvedic Perspective):
The performance of sexual act depends upon physical and psychological excitement which is proportional to the strength of the body and mind.
Male sexual act mainly comprises of two phase i.e. erection and ejaculation.
Erection is the prerequisite to accomplish the sexual act, and it is attained in three ways individually or combined together – viz –
1) Sankalpa (Mental preparation for sexual act),
2) Chesta (physical stimulation) and
3) Nispidana (Localised rubbing or stimulation)
Sankalpa indicates involvement of psyche as a prime factor and the stimulation of which is obtained through the various pleasuring objects of different sense organs such as Darsana(through eye), Sravana(through ear), Rasana(through tongue), Ghrana(through smell), and Sparsana(through touch). Further Sparsana is the most important as it is the media in Chesta and Nispidana for attaining and maintaining the erection and ejaculation.
Various objects of different senses stimulating the mind for getting erection and indulging in sexual intercourse are described in the Ayurvedic classical texts.
The involvement of different sense organs in their respective subjects, then the stimulation of the mind and Chesta and Nispidana all depends upon the normal function of Vāta. Particularly Prāna, Vyāna and Apāna are responsible for erection and ejaculation of semen (As.Sa.Ni.16/19, 21; Su. Ni. 1/20; Ca. Ci. 28/9, 10)
It will be surprised to know that Sushruta( School of Ayurvedic surgery) was the first person who described the complex psycho – Neuro – Vascular mechanism of erection. He said the filling of Sukravaha Sira under the influence of psychological or physical stimulation results in tumescence (Su. Sa. 2/45)
The ejaculation of Sukra(Semen) is due to the psychological (smarana), visual (Darsana), Auditory (Sravan) and Tactile (Sparsana) stimulation . (Su.Ni.10/19-20)
Foregoing description indicates the involvement of complex psycho-neurovascular mechanism in the process of penile erection.
Etiology (Probable Causative Factors):
1) Hereditary & congenital : Since birth
2) Anxiety, fear of failure (widowers syndrome, sexual phobia, performance anxiety and so on)
3) Depression (including drug or disease induced depression)
4) Marital conflicts, stressed relationship
5) Ignorance and misinformation (e.g. about normal anatomy, sexual function, or ageing), religious scruples
6) Obsessive- compulsive personality
7) Neurogenic or vascular ED
8) Surgical causes (After some surgical procedures done in wrong way)
9) Ageing associated ED
10) Drug induced ED
1) Linga Saithilya : Flaccidity of the penis even after psychic or physical stimulation
2) Mlana Sisnata : Lack of Rigidity
3) Nirbija Or Nirvirya : Absence of sperms or Lack of ejaculation
4) Mogha Sankalpa Cesta : Futile sexual activity
5) Dhvajanucchraya : Lack of erection
6) Suratasaktata :- Incapability to perform sexual act.
Management of Erectile Dysfunction (ED):
Both nonsurgical and surgical treatments are in practice for the treatment of ED.
Each of them is associated with several demerits like poor response, poor acceptance, local side effects, systemic side effects, complications, change in shape of the penis by surgical treatment and unaffordable cost of the treatment.
Non surgical treatments of the ED :-
Both specific and non specific treatments are available.
Specific treatment includes psychotherapy, replacement of offending medication and hormone therapy.
Nonspecific treatment includes the vacuum constriction device and Intra-cavernous injection.
The following treatments are in practice
1) Change in lifestyle
2) Change of medication
3) Pelvic floor muscle exercise
4) Psychosexual therapy
6) Sex therapy
7) Hormonal therapy
8) Oral agents
9) Centrally acting drugs
a) Adrenoceptor antagonists eg: phentolamine, yohimbine
b) Dopaminergic agonists eg: Apomorphine
c) Serotonergic drugs : eg. Trazodone
10) Peripherally acting drugs : eg. Pentoxyfyline
11) Transdermal medication : eg: application of Nitroglycerine paste
12) Intraurethral medication : eg Prostaglandin E2
13) Intra-cavernous Injection (ICI)
Demerits of Intra-cavernous injection therapy:
1) The response rate is considerably lower in patients with vascular causes and a higher dosage is required.
2) Poor acceptance and increased dropout rate: – The reason for declining includes penile pain, inadequate response, fear of the needle, unnaturalness and loss of sex drive. In long term studies 13% to 60% patients dropout for a number of reasons.
3) Serious adverse effects: – Priapism and fibrosis are the two serious side effects commonly observed.
4) Contraindication: – Sickle cell anaemia, Schizophrenia, Severe psychiatric disorder, Severe Venous incompetence, Severe systemic disease.
Vacuum constriction device: Though cost effective and safe and less invasive owing to its unnatural nature, there is a poor acceptance in young men. It includes the complications like penile pain, numbness, difficult ejaculation, ecchymosis and petechie.
Surgical treatments of ED:
They includes placement of a penile prosthesis or vascular surgery in a very carefully selected patients.
Complications of penile prosthesis surgery:
1) Crural perforation as a common intra-operative problem.
2) Other surgical complications like – position, pain, cosmetics, size, encapsulation and pressure erosion.
3) Mechanical complications.
4) A common dissatisfaction expressed is about inadequate length.
Complications of vascular surgery:-
1) Penile oedema is common after vascular surgery of the penis
2) Two significant complications of penile vascular surgery are penile numbness or hyperesthesia and penile shortening due to scar entrapment.
Ayurvedic Way for improve the Sexual Performance- VAJIKARANA:
Vajikarana is one of the eight branches of Ayurveda deals with vigour and vitality and vividly explained under separate chapter in classical literature of Ayurveda apart from the scattered references which indicate towards its speciality as an individual medical branch existing in practice from thousands of years in Indian continent.
Sexual potency varies from person to person. The sexual attitudes also varies from person to person.
Vajikrana / Vrisya drugs improve the quality and quantity of Sukra(semen) and promote the sexual health like a stallion to indulge in sexual intercourse with vigour, like a bull to cohabit multiple partners, like a sparrow to have frequent copulation and multiple orgasm, like an elephant who satisfies the female partner even with single copulation.
Caraka(school of Ayurvedic medicine) has vividly defined the Vajikarana by saying that “Any substance or procedure (Ahara, Ausadha, Vihara etc) which helps to have healthy progeny from generation to generation provides instant vigour, exhilaration, stallion sexual vigour and indulgence in sexual act without any obstacles, excessive affection of the women, enhance the body tissues and maintain the state of Sukra even in the aged persons is called as Vajikarana.
Due to these benefits particularly due to healthy progeny, the person who takes Vajikarana drugs is honoured in the society.
Susruta(school of Ayurvedic surgery) defined it as “The branch of medical science which deals with the nutrition, correction, promotion and production of Sukra(semen) in the persons who is having little Sukra by nature, vitiated Sukra, diminished Sukra and severely diminished Sukra respectively, along with promotion of the Sukra and sexual health in a person who is otherwise healthy. (Su. Su. 117/Dal)
At the end of the chapter on Vajikarana, Caraka concluded that “Anything which provides excessive sexual vigour like the stallion to indulge in sexual intercourse often and often is called as Vajikarana.
From the foregoing, it can be said that Vajikarana helps to maintain and promote the sexual health and state of Sukra(semen) and to overcome their disorders like Klaibya(impotent), Vandhayatva(infertility) and allied disorder.
‘Akarakarabhadi churna’ à A very successful Ayurvedic Formula used orally for the treatment of Erectile Dysfunction.
Composition of ‘Akarakarabhadi churna’ : All the below Ayurvedic herbs should be taken in equal quantity and in powder form. Mix well and take it around 5-10 gms. twice a day with cow milk added with sugar at empty stomach especially in the night, it should be taken before around two hours to go to sleep.
1) Akarakarabha (root) (Latin name: Anacyclus pyrethrum)- 1 part
2) Asvagandha (root) (Latin name: Withania somnifera)- 1 part
3) Amalaki (fruit) (Latin name: Emblica officinalis)- 1 part
4) Atmagupta (seed) (Latin name: Mucuna prurience)- 1 part
5) Satavari (root) (Latin name: Asparagus racemosus)- 1 part
6) Sveta Musali (root) (Latin name: Asparagus adscendis)- 1 part
7) Vidari Kanda (root) (Latin name: Ipomea digitata)- 1 part