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- Complementary Medicine -
Study of the efficacy of Korean Red Ginseng in the treatment
of erectile dysfunction
Enrico de Andrade1, Alexandre A. de
Mesquita1, Joaquim de Almeida Claro2, Priscila M. de Andrade1, Valdemar Ortiz2, Mário
Paranhos1, Miguel Srougi1
1Sector of Sexual Medicine, Division of Urological Clinic of São Paulo University, São Paulo, Brazil
2Discipline of Urology, São Paulo Federal University, São Paulo, Brazil
Aim: To examine the treatment efficacy of Korean Red Ginseng (KRG) in impotent men with erectile dysfunction
(ED). Methods: A total of 60 patients presenting mild or mild to moderate ED were enrolled in a double-blind,
placebo-controlled study in which the efficacies of KRG and a placebo were compared.
The patients received either 1 000 mg (3 times daily) of KRG or a placebo.
Results: The five-item version of the International Index of
Erectile Function (IIEF-5) score after the treatment was significantly higher in the KRG group
compared with that before the treatment (from 16.4 ± 2.9 to
21.0 ± 6.3, P < 0.0001). In contrast, there was no difference before and after
the treatment in the placebo group (from 17.0 ± 3.1 to 17.7 ± 5.6,
P > 0.05). In the KRG group, 20 patients (66.6%),
reported improved erection, significant in the global efficacy question
(P < 0.01); in the placebo group there was no
significance. Scores on questions 2 (rigidity), 3 (penetration), 4 and 5 (maintenance), were significantly higher for
KRG than those for the placebo when those questions were answered after 12 weeks of each treatment
(P < 0.01). When the score in the KRG group was compared to the placebo group after the treatment, there was a significant
improvement in total score (IIEF-5 score) in questions 3 and 5 for the KRG-treated group
(P < 0.001 and
P < 0.0001, respectively). The levels of serum testosterone, prolactine and cholesterol after the treatment were not statistically
significant different between the KRG and the placebo group
(P > 0.05).
Conclusion: Our data show that KRG can be
an effective alternative to the invasive approaches for treating male
ED. (Asian J Androl 2007 Mar; 9: 241_244 )
Keywords: penis; impotence; ginseng; penile erection
Correspondence to: Dr Enrico de Andrade, Sector of Sexual Medicine, Division of Urological Clinic of São Paulo University, São Paulo,
Tel: +55-11-9949-0026 / +55-11-9987-1277
Fax: +55-11- 6197-0317
Received 2006-01-13 Accepted 2006-04-20
Among the three main lines of therapy for erectile
dysfunction (ED), that is, oral therapy, self-injection
therapy and penile prosthesis implantation, the first line
therapy is always the first option. Despite the
successful advent of sildenafil, the first effective oral agent for
ED, further development of new drugs and
phytochemical studies of widely known herbal plants are desirable.
Furthermore, there seems to be a large population that
prefers to use phytotherapies rather than pharmaceutical
drugs for their health. Phytotherapy plants used
frequently for ED include Fadogia agrestis, Ginseng and
Withania somnifera [1, 2].
Ginseng is one of the most popular herbs in both
Eastern and Western countries. It is known as a
traditional Asian medicine for stimulation of sexual function
 and studies have shown the effects of ginseng on
relaxation of penile corpus cavernous smooth muscle in
rabbits [4, 5]. We determined the real role of Korean
Red Ginseng (KRG) in the treatment of ED. Our secondary goals were to determine if there are any changes
in both hormonal levels and lipid profiles of the treated
patients. In the present study, we analyzed patients'
response to KRG treatment, through the five-item version
of the International Index of Erectile Function (IIEF-5).
2 Materials and methods
A total of 192 patients were selected by one urologist
in the Urology Clinic of São Paulo University, from July
2004 to September 2004. The patients responded to the
IIEF-5 questionnaire. Of these patients, 60 with IIEF-5
scores between 13 and 21 (mild or mild to moderate ED)
were included in the study. The exclusion criteria
included history of radical prostatectomy, spinal cord
injury, neurological impairments, Peyronie's disease, drug
abuse and specific previous treatment.
The patients were divided into two groups with 30
patients in each group andrandomized into a 12-week
double-blind protocol, and received either 1 000 mg
KRG or a placebo (capsule containing starch with KRG
Every patient returned for reevaluation through
IIEF-5 every month over a 3-month period. All patients were
asked about any improvement in erection and sexual life,
as well as any side effects related to the treatment. At
the end of the 3 months all parameters were compared
between the KRG group and the placebo group. Outcome measures were assessed using IIEF-5 and a
Global Assessment Questionnaire (GAQ) (Did this treatment
improve your erections?). Average values of the
variables were compared with the paired t-test with
significance considered at P < 0.05. The Mann-Whitney
U-test was used to compare GAQ.
The level serum testosterone, prolactine and
cholesterol were measured in pre and post-treatment in the two
The average patient's age was 52.6 year(ranging from
26 to 70 years) in the KRG group and 54.3 years (ranging
from 34 to 67 years) in the placebo group. Organic
comorbidities included hypertension in 9 patients (30.0%)
in the KRG group and 13 patients (43.3%) in the placebo
group; diabetes in 4 patients (13.3%) in the KRG group
and 6 patients (20%) in the placebo group (18%). Two
patients (6.6%) had combined cardiovascular disease in
the KRG group and 3 patients (10%) had combined
cardiovascular disease in the placebo group (Table 1).
According to the IIEF-5 score there were 18 patients (60%) presenting mild ED and 12 patients (40%)
with mild to moderate dysfunction in the KRG group. In
the placebo group, there were 15 patients with mild (50%)
and another 15 patients (50%) with mild to moderate ED
scores. The average baseline IIEF-5 in the KRG group
was 16.4 ± 2.9. This score increased to
21.0 ± 6.3 after treatment
(P < 0.01). In the placebo group, the average
baseline score was 17.0 ± 3.1 and changed to
17.7 ± 5.6 after treatment
(P > 0.05) (Table 2).
In the KRG group, 20 patients (66.6%) reported improved erection in response to the global efficacy
question (P < 0.01); in the placebo group there was no
reported improvement. Rigidity and maintenance of
erection besides penetration were significantly better in
the KRG group compared to the those in placebo group
(P < 0.01) (Table 2).
When the score after treatment in the KRG group
was compared to that in the placebo group, a significant
improvement in total score (IIEF-5) was evident for
questions 3 and 5 (P < 0.001 and
P < 0.0001, respectively)
(Table 2). However, there was no difference between
the two groups according to average serum testosterone,
prolactine and cholesterol after treatment (Table 3).
No patients in the present study presented with
hypogonadism (Table 3).
There were only minor side effects, represented by
headache and insomnia in 3 patients in the KRG group.
Phytotherapy plays a major role in the treatment of
most diseases and is extremely important in many
countries around the world. Oral therapy for ED presents
obvious advantages over more invasive approaches (i.e.
self injection therapy and penile implants), which has lead
researchers to seek alternative herbal treatment for ED.
In the study by Ryu et al. , the antioxidant
activity of KRG and its effect on erectile function in
non-insulin-dependent diabetes mellitus rats is observed.
Oxidative stress is an important factor in vascular
complications of diabetes. McKay  and Adimoelja 
demonstrated that some medicaments and plants can act
through different mechanisms to improve sexual dysfunction. Bakircioglu
et al.  concluded that serum cholesterol levels were similar in the cholesterol only
rats and in those treated with a Chinese herbal medicine
mixture, erectile response was significantly high. High
levels of β-FGF and caveolin1 expression might protect
the cavernous smooth muscle and endothelial cells from
the harmful effect of high serum cholesterol.
Ginseng is very popular worldwide, and has
traditionally been used for stimulating sexual function in men
of all ages. Even in the USA approximately 6 million
people use this plant for improving sexual dysfunction
. Ginseng has several potential healing properties
and many pharmacological actions . Ginseng enhances
the nitric oxide (NO) synthesis in the endothelium, and
works as an antioxidant and has a protective role [11,
12]. Therefore, the enhanced NO synthesis in the
corpus cavernous could improve erection and have
therapeutic action on ED.
In a previous study of the clinical efficacy of KRG
for treatment of ED, significant improvement in the
penile rigidity, libido and patient satisfaction was
demonstrated in relation to trazodone and placebo groups .
In the present study, mean scores on erectile
function and satisfaction domains were significantly higher
for KRG than those for placebo after 12 weeks of the
treatment. These significant improvements in IIEF-5
scores and favorable responses to the global efficacy
question, besides the 66% success rate, have been
suggested to represent clinically relevant success. The
significant increase in the score of the erectile function
domain was confirmed by the positive results on questions
2, 3, 4 and 5. These results indicate a specific positive
action of KRG on penile erection. Because there were
no differences in serum testosterone, prolactin and
cholesterol levels, it can be concluded that the beneficial
effect of KRG on erectile function was not related to
serum hormonal or cholesterol levels.
Ginseng has stimulatory and inhibitory effects on the
central nervous system . An animal study revealed
the psychomotor effects of ginseng . Furthermore,
a favorable effect on psychomotor performance,
including attention, processing and auditory reaction time, has
been observed in healthy individuals receiving a ginseng
Another explanation could be the uptake of
g-aminobu-tyric acid (GABA), glutamate, dopamine, noradrenalin
and serotonin in rat brain synaptosomes in a
concentration-dependent fashion . Ginsenosides compete with
the agonist for binding to GABA-A and GABA-B receptors . These experimental results suggest that KRG
could act centrally in the process of erection through
multiple mechanisms that have not yet been completely
KRG plays a beneficial role in ED treatment, without
any severe side effects. Considering that many patients
are reluctant to use potentially invasive pharmaceutical
drugs to achieve erection, KRG could be a useful and
popular alternative therapy.
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