Men's health

Potential of Panax ginseng as a multi- targeted aid for Erectile Dysfunction.

  • Introduction
  • Psychogenic & Organic ED
  • Improved blood flow
  • Inflammation & oxidation
  • Conclusion
  • Bibliographic references

Erectile dysfunction (ED) is a widespread health condition characterized by the “inability to achieve or maintain an erection sufficient for satisfactory sexual performance”.

Although it can affect men of all ages, ED's prevalence becomes especially high over the age of 40 [1-3], affecting one in every two men worldwide [3]. By 2025, ED could affect a whooping 322 million men worldwide [2]. Beyond the reproductive difficulties it may cause, ED can cause significant psychosocial problem and affect men's mental / psychosocial well-being and quality of life.

Apart from age, the most common risk factors for ED are cardiovascular and metabolic (diabetes) conditions, psychological distress (depression, anxiety) [1, 4-5] but also lifestyle factors (smoking, alcohol consumption, physical inactivity, obesity) [6-7]. In fact, early signs of ED are more often associated with psychological and lifestyle factors rather than age-related co-morbidities [1, 8-10].

Although it is traditionally known for its revitalizing and stimulating effects in Asian pharmacopoeias, Korean ginseng is also a reputed aphrodisiac. Recent research indicates that this effect may be due to its ability to target both psychogenic and organic factors of ED, providing men of all ages with a natural, safe, and comprehensive treatment option for enhancing their sexual health.

ED may result from either physical (organic) and psychological (psychogenic) causes, or a combination of both [8].

Psychogenic factors are the primary cause of ED in men under 40 years (83% of cases) [10]. While the physical mechanisms of erection are intact, psychological factors, such as anxiety, depression or relationship problems, can interfere with the ability to achieve or maintain an erection.

Korean ginseng may help to improve erectile function by reducing anxiety and stress; improving mood and energy; enhancing sexual desire. Indeed, Ginseng's benefits for stress and mental wellbeing may help prevent and mitigate psychogenic ED caused in young men suffering from depression and anxiety.

Organic erectile dysfunction, on the other hand, is primarily caused by physical factors, usually age-related medical conditions. Among the most common etiologies are vascular disease, neurological disorders, hormonal imbalances, and even medication [8, 10]. These may cause impaired blood flow, nerve function, or hormone levels that hinder the ability to achieve or maintain an erection. Clinical data reports that Korean ginseng [11-13] and some of its bioactive compounds may help improve Organic ED and this effect could be explained by two main mechanisms:

Reduced bioavailability of nitric oxide (NO) in smooth muscle has been identified as the main etiological causes of ED [3]. When NO is released in response to sexual arousal, smooth muscle relaxation is induced in the penile corpus cavernosum, allowing for increased blood flow and causing an erection. However, reduced NO levels impair cGMP-mediated reduction of intracellular calcium and reduce PDE5A activity, both of which lead to inadequate smooth muscle relaxation and reduced blood flow, which contributes to ED.

Nitric oxide (NO) production and vasodilation in the corpus cavernosum are thought to be the primary mechanisms of action behind Korean ginseng's effects on ED [14-16] ; ginseng has been shown to increase the production of NO in endothelial cells, as well as to enhance the activity of endothelial nitric oxide synthase (eNOS), the enzyme responsible for synthesizing NO [17].

More specifically, ginsenosides, Rg5 and Rh4 can enhance eNOS in corpus cavernosum tissue of rats [3]. Rg1 has also enhanced NO release, and cGMP accumulation in the corpus cavernosum of rabbits leading to improved male copulatory behavior [18].

In addition to its effects on NO, Korean ginseng may also improve erectile function by reducing oxidative stress and inflammation. Erectile dysfunction has been linked to increased oxidative stress and inflammation in the penile tissue, which can damage the endothelial cells and impair blood flow. Korean ginseng has been shown to have antioxidant and anti-inflammatory effects, which may help to protect the penile tissue and improve blood flow.

Rg3 in particular, has been shown to improve erectile function by exerting antioxidative effects in corpus cavernosum functional cells of diabetic rats [19].

While more clinical data are required to better understand Korean ginseng effects on ED [17,20], there is promising evidence pointing at its capacities to improve various factors of self-reported sexual function and intercourse satisfaction, all that with little to no adverse effects [17], backing the millennial aphrodisiac tradition that Panax ginseng holds.

According to a structural-activity relationship study, there is also evidence of a positive correlation between ginseng processing ginseng and ED effectiveness : by generating ginsenosides such as Rk1, Rk3, Rh4, and Rg5, steam cooking of ginseng roots may result in higher anti-ED activity [3].

  • [1] Rosen RC, Fisher WA, Eardley I, et al. (2004) – “The multinational Men's Attitudes to Life Events and Sexuality (MALES) study: I. Prevalence of erectile dysfunction and related health concerns in the general population.” Curr Med Res Opin 2004;20:607.
  • [2] Kessler A., Sollie S., Challacombe B., Briggs K., Van Hemelrijck M. (2019) – “The global prevalence of erectile dysfunction: a review.” BJU International . 2019;124(4):587–599.
  • [3] Ying A, Yu QT, Guo L, Zhang WS, Liu JF, Li Y, Song H, Li P, Qi LW, Ge YZ, Liu EH, Liu Q (2018) – “Structural-Activity Relationship of Ginsenosides from Steamed Ginseng in the Treatment of Erectile Dysfunction.” Am J Chin Med. 2018;46(1):137-155.
  • [4] Giuliano F, Droupy S. (2013) – “Dysfonction érectile [Erectile dysfunction].” Prog Urol. 2013 Jul;23(9):629-37. French.
  • [5] Martin SA, Atlantis E, Lange K, Taylor AW, O'Loughlin P, Wittert GA (2014) – “Florey Adelaide Male Ageing Study. Predictors of sexual dysfunction incidence and remission in men”. J Sex Med. 2014 May;11(5):1136-47.
  • [6] Ruiz-García, A., Arranz-Martínez, E., Cabrera-Vèc, R., Palacios-Martínez, D., Rivera-Teijido, M., García-Álvarez, J. C., ... & Zarzuelo-Martín, N. (2019) – “Prevalence of erectile dysfunction in Spanish primary care setting and its association with cardiovascular risk factors and cardiovascular diseases.” SIMETAP-ED study. Clínica e Investigación en Arteriosclerosis (English Edition), 31(3), 101-110.
  • [7] Li JZ, Maguire TA, Zou KH, Lee LJ, Donde SS, Taylor DG (2022) – “Prevalence, Comorbidities, and Risk Factors of Erectile Dysfunction: Results from a Prospective Real-World Study in the United Kingdom”. Int J Clin Pract. 2022 Mar 20;2022:5229702.
  • [8] Nguyen HMT, Gabrielson AT, Hellstrom WJG (2017) – “Erectile Dysfunction in Young Men-A Review of the Prevalence and Risk Factors.” Sex Med Rev. 2017 Oct;5(4):508-520.
  • [9] Capogrosso P, Colicchia M, Ventimiglia E, Castagna G, Clementi MC, Suardi N, Castiglione F, Briganti A, Cantiello F, Damiano R, Montorsi F, Salonia A. (2013) – “One patient out of four with newly diagnosed erectile dysfunction is a young man--worrisome picture from the everyday clinical practice.” J Sex Med. 2013 Jul;10(7):1833-41.
  • [10] Caskurlu T, Tasci AI, Resim S, Sahinkanat T, Ergenekon E. (2004) – “The etiology of erectile dysfunction and contributing factors in different age groups in Turkey.” Int J Urol. 2004 Jul;11(7):525-9.
  • [11] Choi HK, Seong DH, Rha KH (1995) – “Clinical efficacy of Korean red ginseng for erectile dysfunction.” Int J Impot Res. 1995 Sep;7(3):181-6. PMID: 8750052.
  • [12] Hong B, Ji YH, Hong JH, Nam KY, Ahn TY (2002) – “A double-blind crossover study evaluating the efficacy of korean red ginseng in patients with erectile dysfunction: a preliminary report.” J Urol. 2002 Nov;168(5):2070-3. doi: 10.1097/01.ju.0000034387.21441.87. PMID: 12394711.
  • [13] de Andrade E, de Mesquita AA, Claro Jde A, de Andrade PM, Ortiz V, Paranhos M, Srougi M (2007) – “Study of the efficacy of Korean Red Ginseng in the treatment of erectile dysfunction.” Asian J Androl.Mar;9(2):241-4. doi: 10.1111/j.1745-7262.2007.00210.x. Epub 2006 Jul 11. PMID: 16855773.
  • [14] Murphy LL, Lee TJ (2002) – “Ginseng, sex behavior, and nitric oxide.” Ann N Y Acad Sci. 2002 May;962:372-7.
  • [15] Jang, H. D., Kim, G. N., Song, J. H., & Kwon, Y. I. (2011) – “Potential of maillard product in Korean red ginseng (Panax ginseng CA meyer) for prevention of erectile dysfunction via NO/cGMP pathway.” 435-7.
  • [16] Chen X, Lee TJ (1995) – “Ginsenosides-induced nitric oxide-mediated relaxation of the rabbit corpus cavernosum.” Br J Pharmacol. 1995 May;115(1):15-8.
  • [17] Jang, D. J., Lee, M. S., Shin, B. C., Lee, Y. C., & Ernst, E. (2008) – “Red ginseng for treating erectile dysfunction: a systematic review”. British journal of clinical pharmacology, 66(4), 444-450.
  • [18] Wang X, Chu S, Qian T, Chen J, Zhang J. (2010) – “Ginsenoside Rg1 improves male copulatory behavior via nitric oxide/cyclic guanosine monophosphate pathway.” J Sex Med. 2010 Feb;7(2 Pt 1):743-50.
  • [19] Liu T, Peng YF, Jia C, Yang BH, Tao X, Li J, Fang X (2015) – “Ginsenoside Rg3 improves erectile function in streptozotocin-induced diabetic rats”. J Sex Med. 2015 Mar;12(3):611-20.
  • [20] Lee HW, Lee MS, Kim TH, Alraek T, Zaslawski C, Kim JW, Moon DG. (2022) – “Ginseng for Erectile Dysfunction: A Cochrane Systematic Review.» World J Mens Health. 2022 Apr;40(2):264-269.