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, w
orld 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
To the best of our knowledge; there is no scientific basis / study for the ethno-pharmacological use of Acacia polyacantha to enhance sexual performance.
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