Sexual dysfunctions have an important place in men's health. Erectile dysfunction is an important part of these disorders.
In prevalence studies, it was noted that this rate was 50% in men over 40 years of age.
Considering that this problem is not seen as a health problem in some societies, it is covered and not applied to the necessary health institution, the rate may be even higher.
The most important problem for patients diagnosed with erectile dysfunction is that treatment options are limited, time-consuming and costly. Individuals need to afford adequate time and cost in treatment.
Many of these treatments are not covered by insurance systems. One of the most important points that our patients should know is that this disorder cannot be resolved immediately and long-term and combined treatment may be required.
Considering all these, the search for new treatment models and alternative methods has begun. Two of the most popular methods today are penile PRP Injection and herbal food supplements.
The abbreviation of PRP is Platelet Rich Plasma; the name given for the blood plasma enriched with Platelet cells. PRP, which has a history of 20-30 years and was initially applied by oral and maxillofacial surgeons to benefit from its effect on wound healing, later gained popularity in dermatology, orthopedics, plastic surgery and IVF treatments. In the last 6-7 years, various articles have been published in the field of urology, especially in the treatment of erectile dysfunction.
It is known that most of the pathogenesis in erectile dysfunction is caused by the deterioration of the vascular structure in the penis. It has also been scientifically proven that various factors (VEGF, EGF, IGF-1, PDGF, FGF) activated by platelets can regenerate this vascular structure.
In this context, the use of platelet rich plasma (PRP) prepared from one's own blood has also yielded successful results in erectile dysfunction in men. An average of 20 ml of blood taken from the person is centrifuged with special devices, and other cells are eliminated and platelet-rich plasma (PRP) is prepared.
The general trend is the application in the form of 3 sessions, including 10 ml injections. Studies measuring the success of PRP have shown improvement in both symptom scores and ultrasonography findings in mild and moderate vascular pathologies. In severe vascular insufficiency, it is obvious that more invasive treatment models such as penile prosthesis will be required.
The minimal level of side effects as well as the success of the given treatment increases the applicability of that treatment model. No serious side effects were reported in the publications related to PRP applied to the cavernous tissue in the penis, and it was measured that there was no significant pain with the applied injection. This shows that PRP is a viable treatment option.
PRP is increasingly used because it is easy to apply, relatively low cost, doesn’t require continuous use like drugs, does not cause treatment compliance problems, and gives good results.
Before the development of modern medicine and pharmacology, plants were historically used in sexual dysfunctions as well as in many diseases. It is known that more than 700 plants have been used as traditional treatment until today. There are even rumors that the plants to be mentioned have historically saved the continuation of the Chinese royal family. But we will of course talk about the data of proven scientific publications.
One of the most popular herbs for erectile dysfunction is red Ginseng, which grows in far eastern countries such as Korea. Some studies have indicated the positive effect of GINSENG on sexual functions, with an increase in testosterone level and some with an increase in nitric oxide (NO) release.
Although there is no consensus for the ideal daily dose, it is known from previous studies that 1800-3000 mg in divided doses may be the ideal dose. Although cases of side effects such as headache and stomach pain have been reported, Ginseng is a good option for our patients seeking alternative treatment for erectile dysfunction.
L-arginine is also an amino acid used for erection problems in men. L-arginine, which is a good substrate for nitric oxide (NO) biosynthesis, which is an important mediator in the mechanism of erection in the penis, is used in the treatment of erectile dysfunction in this context. Its effectiveness has been proven by many studies in the literature. Significant improvements were found in symptom scores, especially in erection problems of mild and moderate vasculogenic (vascular) origin.
The success of both alone and in combination with other food supplements containing ginseng, yohimbine, niacin and L-carnitine has been scientifically proven. In addition, the effectiveness of phosphodiesterase-5 inhibitors (PDE-5 inh),which are drugs developed for treatment through the nitric oxide pathway, increase with these food supplements.
Lepidium meyenii (Maca) is another plant that grows in Peru and is found to be beneficial for sexual functions. Studies have shown that Lepidium has a positive effect on both an increase in semen quality and quantity, sexual desire and dysfunction. Although well-designed studies are needed for its dose and side-effect profile in erectile dysfunction, it is considered safe in combinations.
Tribulus terrestris is a plant that is used for treatment especially in China and India and its history goes back thousands of years. Studies have shown that the pro-erectile effect of tribulus is due to the increase in nitric oxide. It has also been stated that its combination with combinations can increase the effectiveness.
Also known as Epimedium, Yinyanghuo or Horny Goat Weed is also included in many food supplements. There are studies showing both the increase in testosterone and the activation of the nitric oxide pathway as a justification for this. It has also been reported to induce spermatogenesis. Can be safely preferred in combinations.
As a result, it should not be forgotten that these nutritional supplements with scientifically proven effects are an important treatment alternative in patients presenting with erectile dysfunction due to the limited and costly pharmacological treatment options.
I think that we as physicians should use these supplements, which we approach with a distance, more. Of course, the most important issue that worries us is where and under what conditions these herbal medicines are produced. Therefore, I recommend choosing the products of safe companies.
I wish you healthy days.
Dr. Arif Demirbas