Erectile
dysfunction also called impotence is defined as the inability to obtain or
maintain an erection sufficient for intercourse or inability to achieve
ejaculation, or both. A medical problem affecting young as well as old men. A
recent Massachusetts Male Aging Study (MMAS) showed that 52% of the respondents
have some degree of erectile dysfunction with 35% of the aged 40 -70years
reporting moderate or complete impotence (Morgentalar, 1999). Although a number
of treatments became available in the last two decade, problems with cost,
efficacy, safety and ease of administration were experienced. The treatment
ranged from herbal remedies used by native healers, to the more sophisticated
drugs like sildenafil citrate which are based on a better understanding of the
physiological mechanism of erection (Guirguis, 1998).
The
world wide prevalence of erectile dysfunction is very high, and is expected to
increase substantially over the next 25 years (Aytal et al., 1999). Sexual
dysfunction /erectile dysfunction has been estimated to affect 20 to 30
million men in the United
States (Yassin et al., 2008). The
impetus of the National Institutes of Health (NIH) Consensus Development
Conference on Impotence in 1992 was to educate health care providers and to
familiarize the public on aspects of human sexuality, sexual dysfunction and
the availability of successful treatments (National Institutes Health, 1993).
The Massachusetts Male Aging Study (MMAS) provided information on the
prevalence of ED in a general population of 1290 non institutionalized men aged
40 to 70 years (Feldman et al., 1994). Using validated questionnaires,
this study demonstrated that the prevalence of ED was much higher than
previously perceived. Baseline data from the MMAS showed that the combined
prevalence of minimal, moderate, and complete ED was more than 50% in American
men. Using the United Nations projected male population distributions for 2025,
the prevalence rates for ED were applied to the MMAS. In 1995, it was estimated
that 152 million men worldwide experienced ED, and the projections for 2025
showed a prevalence of 320 million, an increase of nearly 170 million men (Aytal
et al., 1999). Perception about male sexual function and the effect of
ED on the quality of life may differ significantly from one culture to another (Johannes
et al., 2000).
Aytal
et al., ( 1999) estimate global prevalence of ED world wide to 152 million in 1995 and the
breakdown by region is as follows: North
America -11.9 million, South America –
10.5 million, Europe -30.9 million, Africa -11.5 million, Asia - 80.9 million,
Oceania – 0.999 million.
Projected
global prevalence of ED in 2025 (World wide) to be 322 million and by regional
estimate: North America – 21 million, South America - 26.1 million, Europe –
42.9 million, Africa - 30.8, Asia -199.9 million, Oceanic – 1.9 million.
Over
all age – specific prevalence of moderate or complete ED in percentage: Men age
40 to 44 years – 9%, men age 45 to 49 years 12 %, men age 50 to 54 years 18 %,
men age 55 to 59 years 29 %, men age 60 to 64 years -38 %, men age 65 to 70
years 54 %.
Berrada
et al., (2003) indicate that the prevalence of ED and other disease
associated with this condition in sub – Sahara Africa, Middle East, and South
Asia is similar to the United States
and Western Europe. Surveys of men between 35
and 75 years of age seeking primary health care indicate that the age-
adjusting prevalence of ED were 57.4% in Nigeria, 63.3% in Egypt, and 80.8 % in
Pakistan.
Osegbe
(2003) evaluated the effectiveness of oral therapy with sildenafil in 58 Nigeria
men with ED, and reported significant improvement in erectile function. Also
Benchekroun, (2003) reported similar beneficial effect of sildenafil in a study
that include 71 Moroccan men with ED. Levinson et al., (2003) also
reported improved erection with sildenafil in Egypt and South Africa.
The
WHO (World Health Organization) also has thrown it support for the use of drugs
of purely herbal constituents in the management and treatment of diseases (WHO,
1980). Despite all the advances in modern and orthodox medicine, herbal
remedies still plays a significant role in the lives of many people. In
developing countries, particularly Africa, Nigeria not an exception, the use
of herbal remedies for curative purpose is rooted in the beliefs and cultures
of the people. The use of herbal drugs
in the treatment and or management of erectile dysfunction has been advocated
by both orthodox and traditional health practitioners. A vast majority of the
population, particularly those living in the village depends largely on the
herbal remedies, Sofowora (1993) asserted that 70% of the third world
population diagnose, prevent or eliminate diseases through the use of medicinal
plants.
The
need for research and development in the field of African medicinal plants can
not be over emphasized. For this reason WHO (1987), reviewed the medicinal
situation in several developing countries and made some fundamental suggestions aimed at promoting and developing
the utilization of traditional medicine in order that it can contribute to the
establishment of health care services in Africa and other developing countries (Nakajima,
1987).
Over
the centuries herbal drugs have served as a source of medicine, for the
prevention and treatment of diseases including erectile dysfunction and poor semen
quality (Gonazales et al., 2001 and 2002).
A
number of herbal plants such as Securidaca longepeduculata (polygalaceae),
Wrightia natalensis (Apocynaceae), and Rhoicissas tridentate L.F
(wild and R.B Drumm) (vitaceae) are used in treatment of erectile
dysfunction ( Galeffi et al., 1990). Yohimbe bark, world wide is used by
traditional medicine practitioners and nature conscious orthodox medicine
doctors to treat erectile dysfunction. (Guirguis, 1998), Ginseng has been used
in the treatment of erectile dysfunction for thousand of years in China and is
now used in many countries, Panax quinquefolis and lepidium meyenii (maca)
is shown to have a positive effect on sexual desire (Nantia et al.,
2009). Other herbal medicinal remedies for the treatment of erectile
dysfunction include: crushed seeds of funnel, licorice, pollen, sarsaparilla,
asafetida, hops and Spanish fly (Guirguis, 1998).
While
plants such as Curcuma longa and Garcia kola enhance sperm motility and decrease
spermatozoa abnormality (Ishihara et
al., 2000), ( Farombi et al., 2007), Tribulus terristis (Adimoeja
et al.,1995 ), Asparagus racemous, Withania senticosus, Andrographis
paniculata and acanthopanax sensticosus (Nantia et al., 2009)
are plants proven to improve
spermatogenesis, sperm mortility and morphology. Many flavonoids containing plants are know to have
anti –oxidant effect, as quoted by Harborne (1993) and Evans (1999).
JUSTIFICATION
The
overall global prevalence of ED among men is 54% and incidence increase
markedly by 10% with age. Additional risk factors for ED include diabetes,
hypertension, heart disease, lower urinary tract symptoms, heavy smoking and
depression (Nicolosi et al., 2003).
To
the best of our knowledge; there is no scientific basis / study for the
ethno-pharmacological use of Acacia polyacantha to enhance sexual
performance.