Korean red ginseng effective for treatment of erectile dysfunction

Journal of Family Practice, Jan, 2003 by Amy Price, John Gazewood

Hong B, Ji YH, Hong JH, Nam Ky, Ahn TY A double-blind crossover study evaluating the efficacy of Korean red ginseng in patients with erectile dysfunction: a preliminary report. J Urol 2002; 168:2070-3.

* PRACTICE RECOMMENDATIONS

Korean red ginseng (Panax ginseng **) is a safe, widely available alternative remedy that improves patients' ability to achieve and maintain an erection sufficient for intercourse, even in a population with severe erectile dysfunction. It is a reasonable, nonprescription treatment, especially for men with reservations about taking sildenafil (Viagra). A 500mg capsule of Korean red ginseng costs about 6 cents, compared with $10 for a tablet of sildenafil.

* BACKGROUND

Is Korean red ginseng effective in the treatment of erectile dysfunction? Although many treatments for erectile dysfunction are available, patients seem to prefer oral medications, such as sildenafil. Patients also may prefer herbal medicines for many reasons, including relatively low cost, ready availability, and safety. Ginseng is a traditional Asian remedy for sexual dysfunction that is widely used in the United States and has a reassuring safety profile.

* POPULATION STUDIED

Study subjects were 45 men with erectile dysfunction without previous treatment recruited from a urology clinic in Korea. Erectile dysfunction was defined as the persistent inability to achieve and maintain erection sufficient for normal sexual satisfaction. Mean age was 54 years. About 70% of patients had moderate or severe erectile dysfunction as measured by a Korean version of the International Index of Erectile Function (IIEF), and more than 50% had at least 1 other chronic medical problem such as diabetes or hypertension. Patients excluded from the study were those with a history of radical prostatectomy, spinal cord injury, serious neurologic illnesses such as Parkinson disease and multiple sclerosis, alcohol abuse, or other herbal abuse, drug ingestion that enhances or interferes with sexual function, drug ingestion with known interaction with ginseng, hormonal therapy, and cancer chemotherapy.

* STUDY DESIGN AND VALIDITY

This was a double-blind, placebo-controlled, crossover study. All patients underwent baseline evaluations including IIEF self-assessment, measurement of rigidity and tumescence experienced during audiovisual sexual stimulation, penile duplex ultrasonography, and response to an intrapenile injection of papaverine, phentolamine, and prostaglandin [E.sub.1]. Subjects were then randomized to receive korean red ginseng, 900 mg three times daily, or a placebo three times daffy, for 8 weeks. After a 2-week washout period, subjects received another 8 weeks of crossover treatment. Patients were assessed every 4 weeks during the two 8-week treatment periods. At the end of the study, data for all 45 subjects obtained during active treatment were compared against data obtained during placebo treatment.

This study had no serious threats to validity. No mention was made of allocation concealment, but this can be assumed to be present in a double-blind crossover trial with the use of an identical placebo. Follow-up was complete at 16 weeks of treatment. The study was underpowered to detect statistically significant improvement in some important clinical outcomes, such as improvement in orgasmic satisfaction or overall satisfaction for patients and their partners, and it was of relatively short duration. The manner in which the Korean red ginseng was given, three times daily, may be unreasonable for some patients. No side effects were described in the placebo or treated group. A direct comparison with sildenafil would provide better information to help patients and physicians choose between treatments.

* OUTCOMES MEASURED

Improvement in erectile function was measured by self-report on the IIEF and its subscales and by objective assessments of penile blood flow, size, and rigidity.

* RESULTS

After 8 weeks of treatment, patients showed significant improvement in mean IIEF scores compared with placebo (baseline, 28.0 [+ or -] 16.7; Korean red ginseng, 38.1 [+ or -] 16.6; placebo, 30.9 [+ or -] 15.7). When taken individually, scores for erectile traction, sexual desire, and intercourse satisfaction were significantly improved in the treated group. Scores for orgasmic function and overall satisfaction were not statistically improved. Sixty percent of treated patients experienced an improvement in erection as opposed to 20% of the placebo group (number needed to treat, 2.5). In particular, scores on questions relating to penetration and maintenance were significantly higher for the Korean red ginseng group. No data were reported for partner satisfaction.

** Panax ginseng refers to the genus and species of Korean red ginseng, and it is the most commonly used form of ginseng. Many brands in the United States are marketed under the name Panax. (Coon JT, Ernst E. Panax ginseng: a systematic review of adverse effects and drug interactions. Drug Safety 2002; 25:323-44.)