Does saw palmetto extract actually alleviate symptoms of benign prostatic hyperplasia. What does the latest research reveal about its effectiveness at various doses. How should physicians advise patients seeking natural remedies for urinary issues.

The Rise and Fall of Saw Palmetto as a BPH Treatment

Benign prostatic hyperplasia (BPH) affects a significant portion of the aging male population, with urinary symptoms impacting quality of life. For years, saw palmetto extract derived from the Serenoa repens dwarf palm tree has been a popular over-the-counter remedy for BPH symptoms. However, recent high-quality research has called into question the efficacy of this herbal supplement, even at increased dosages.

Understanding BPH and Its Prevalence

BPH is a common condition affecting older men, characterized by enlargement of the prostate gland and associated lower urinary tract symptoms (LUTS). The prevalence of BPH increases dramatically with age:

• Approximately 40% of men over 60 years old experience BPH
• Nearly 90% of men over 80 years old are affected

These statistics highlight the widespread nature of the condition and the potential market for treatments, both pharmaceutical and herbal.

The Appeal of Saw Palmetto as an Alternative Treatment

Why has saw palmetto gained such popularity among BPH sufferers? Several factors contribute to its appeal:

• Natural origin and perception of safety
• Availability without prescription
• Lower cost compared to some prescription medications
• Desire to avoid side effects associated with conventional BPH drugs

Many patients seek alternatives to alpha-blockers and 5-alpha-reductase inhibitors, which can cause side effects like decreased libido and dizziness. This search for a “natural” solution has led many to try saw palmetto extract.

Evolving Evidence: From Promise to Disappointment

The scientific understanding of saw palmetto’s effectiveness has changed significantly over time. Early studies and meta-analyses showed promise, but more recent, rigorous research has failed to demonstrate clear benefits:

Early Positive Findings

A 2002 Cochrane meta-analysis of 21 trials reported improvements in nocturia, self-reported symptoms, and peak uroflow compared to placebo. These initial findings fueled optimism about saw palmetto’s potential.

Shifting Perspectives

An updated 2009 Cochrane review, incorporating 30 trials, painted a different picture. While it found a reduction in nocturia, it failed to show improvement in other self-reported symptoms or peak uroflow. This meta-analysis began to cast doubt on saw palmetto’s efficacy.

The STEP Study: A Turning Point

The Saw Palmetto Treatment for Enlarged Prostates (STEP) study, a one-year trial with 225 participants, found no improvement in symptom scores or secondary endpoints compared to placebo. This large-scale study dealt a significant blow to saw palmetto’s reputation as a BPH treatment.

The Definitive Study: Increasing Doses, Decreasing Hope

A landmark 72-week study by Barry et al. in 2011 sought to address lingering questions about saw palmetto’s effectiveness at higher doses. This double-blind, multicenter, placebo-controlled trial involved 369 men with moderate LUTS and tested saw palmetto extract at standard, double, and triple doses.

Study Design

• Participants were randomized to receive saw palmetto extract or placebo
• Dosing schedule:
  1. Weeks 0-24: 320 mg/day (standard dose)
  2. Weeks 24-48: 640 mg/day (double dose)
  3. Weeks 48-72: 960 mg/day (triple dose)
• Primary outcome: Change in American Urological Association Symptom Index (AUASI) score

Key Findings

The results of this comprehensive study were clear and disappointing for proponents of saw palmetto:

• No significant difference in AUASI scores between saw palmetto and placebo groups at any dose level
• No improvement in secondary outcomes, including peak uroflow, prostate-specific antigen levels, or BPH impact index
• Saw palmetto extract was well-tolerated, with no significant difference in adverse events compared to placebo

These findings strongly suggest that saw palmetto extract, even at doses up to triple the standard amount, is no more effective than placebo in treating BPH symptoms.

Implications for Clinical Practice

How should healthcare providers approach the topic of saw palmetto with their BPH patients? The current evidence supports several key recommendations:

• Advise patients that saw palmetto has not been shown to be effective for BPH symptoms
• Explain that increasing the dose does not improve outcomes
• Discuss evidence-based treatment options, including lifestyle modifications and FDA-approved medications
• Consider the patient’s preferences, budget, and overall health when recommending treatment

While saw palmetto extract appears to be safe, its lack of efficacy means that patients spending money on this supplement are unlikely to experience symptom relief.

The Broader Context: Herbal Remedies and Evidence-Based Medicine

The case of saw palmetto and BPH raises important questions about the use of herbal remedies and the importance of rigorous scientific evaluation:

• How can we balance patient interest in “natural” treatments with the need for proven efficacy?
• What role should traditional or historical use play in evaluating herbal remedies?
• How can healthcare providers effectively communicate evolving scientific evidence to patients?

These questions highlight the ongoing challenge of integrating complementary and alternative medicine with evidence-based practice.

Future Directions in BPH Treatment

While saw palmetto may not be the answer for BPH symptom relief, research continues into both conventional and alternative treatments. Areas of ongoing investigation include:

• Novel pharmaceutical agents targeting prostate tissue
• Minimally invasive surgical techniques
• Other phytotherapeutic agents with potential benefits for LUTS
• Combination therapies that may offer synergistic effects

As our understanding of BPH pathophysiology improves, new treatment modalities may emerge to provide better symptom control with fewer side effects.

Conclusion: Evidence-Based Recommendations for BPH Management

In light of the current evidence, healthcare providers should feel confident in advising patients against the use of saw palmetto for BPH symptoms. Instead, focus on established treatments with proven efficacy:

• Lifestyle modifications (e.g., fluid management, avoiding bladder irritants)
• Alpha-blockers for rapid symptom relief
• 5-alpha-reductase inhibitors for long-term prostate size reduction
• Combination therapy for men with larger prostates and more severe symptoms
• Surgical options for those who fail medical management or have complications

By providing clear, evidence-based guidance, healthcare providers can help patients make informed decisions about managing their BPH symptoms and avoid spending time and money on ineffective treatments.

The Importance of Ongoing Research and Patient Education

The journey of saw palmetto from popular remedy to debunked treatment underscores the critical importance of rigorous scientific research in evaluating all forms of medical interventions, including herbal supplements. It also highlights the need for ongoing patient education about the evolving nature of medical evidence.

Lessons Learned

• Initial promising results require confirmation through large-scale, well-designed studies
• Popular remedies may not stand up to scientific scrutiny
• Patient preferences for “natural” treatments must be balanced with evidence of efficacy
• Healthcare providers play a crucial role in interpreting and communicating scientific findings to patients

Moving Forward

As we continue to search for better treatments for BPH and other common conditions, several principles should guide our approach:

• Maintain an open but critical mindset toward both conventional and alternative treatments
• Prioritize well-designed clinical trials to evaluate the efficacy and safety of all interventions
• Encourage patient participation in the decision-making process through shared decision-making
• Stay informed about the latest research and be willing to adjust recommendations based on new evidence

By adhering to these principles, we can ensure that patients receive the most effective treatments available, whether they come from traditional pharmaceutical research or from the exploration of natural remedies.

Addressing Patient Concerns and Misconceptions

Given the widespread use and enduring popularity of saw palmetto, healthcare providers may encounter resistance or disappointment when advising against its use. How can we address these concerns effectively?

Common Patient Questions

Is saw palmetto completely useless for urinary symptoms?

While the current evidence shows no significant benefit for BPH symptoms, saw palmetto is generally safe. Some patients may experience a placebo effect. However, it’s important to explain that any perceived benefits are likely not due to the herb’s direct action on the prostate.

Why did earlier studies show positive results?

Earlier studies often had methodological limitations, such as small sample sizes, short duration, or less rigorous design. The most recent, high-quality studies provide a more accurate picture of saw palmetto’s lack of efficacy.

Are there any subgroups of men who might benefit from saw palmetto?

Current research has not identified any specific subgroups that respond better to saw palmetto. However, individual responses to any treatment can vary, and some men may report subjective improvements.

Strategies for Patient Communication

• Acknowledge the appeal of natural remedies and the desire to avoid medication side effects
• Explain the evolution of scientific evidence regarding saw palmetto
• Emphasize the importance of evidence-based treatments for effective symptom relief
• Discuss alternative lifestyle modifications that may help alleviate symptoms
• Explore the patient’s concerns about conventional treatments and address them directly

By approaching these conversations with empathy and a focus on patient education, healthcare providers can guide patients toward more effective management strategies for their BPH symptoms.

The Role of Complementary and Alternative Medicine in Modern Healthcare

The case of saw palmetto and BPH is part of a larger conversation about the integration of complementary and alternative medicine (CAM) into evidence-based healthcare. What lessons can we draw from this example?

Challenges in Evaluating Herbal Remedies

• Standardization of herbal preparations can be difficult, leading to variability in study results
• Traditional use and anecdotal evidence may not translate to measurable clinical benefits
• Funding for large-scale studies of non-patentable natural products can be limited
• The placebo effect can be particularly strong for “natural” remedies, necessitating careful study design

Opportunities for Integration

While saw palmetto may not have proven effective for BPH, other areas of CAM have shown promise:

• Acupuncture for chronic pain management
• Mindfulness meditation for stress reduction and mental health
• Certain probiotics for gastrointestinal health

The key is to apply the same rigorous scientific standards to CAM therapies as we do to conventional treatments.

A Balanced Approach

Healthcare providers can take a balanced approach to CAM by:

• Remaining open to potential benefits of complementary therapies
• Encouraging well-designed research into promising CAM treatments
• Advising patients based on the best available evidence
• Considering CAM as part of a holistic approach to patient care when appropriate

By maintaining scientific rigor while acknowledging patient interest in CAM, we can work towards a more integrated and effective healthcare system.

Conclusion: Moving Beyond Saw Palmetto for BPH Management

The story of saw palmetto as a treatment for BPH symptoms serves as a cautionary tale about the importance of evidence-based medicine. Despite its popularity and initial promise, rigorous scientific investigation has shown that saw palmetto extract, even at high doses, is no more effective than placebo in alleviating lower urinary tract symptoms associated with BPH.

For healthcare providers, this evidence supports a clear recommendation against the use of saw palmetto for BPH symptom relief. Instead, focus should be placed on proven treatments, including lifestyle modifications, alpha-blockers, 5-alpha-reductase inhibitors, and surgical interventions when appropriate.

The journey from popular remedy to debunked treatment also highlights broader lessons about the evaluation of complementary and alternative medicines. It underscores the need for ongoing, high-quality research to separate effective treatments from those that may be popular but lack clinical efficacy.

As we move forward, maintaining an open yet critical approach to all potential treatments, whether conventional or alternative, will be crucial. By combining scientific rigor with patient-centered care, we can ensure that individuals with BPH and other conditions receive the most effective and appropriate treatments available.

Ultimately, the case of saw palmetto and BPH reminds us of the ever-evolving nature of medical knowledge and the importance of staying informed about the latest research. It also emphasizes the critical role healthcare providers play in interpreting and communicating scientific evidence to help patients make informed decisions about their health.

PURLs: The shrinking case for saw palmetto

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J Fam Pract. 2012 Jul; 61(7): 418–420.

, MD, MPH and , MBBS, MPH

John Hickner, MD, MSc, PURLS Editor

John Hickner,
Cleveland Clinic
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Findings of this study should make physicians and patients alike reconsider the popularity of this herbal remedy for BPH symptoms.

PRACTICE CHANGER

Advise men with benign prostatic hyperplasia (BPH) not to take saw palmetto for urinary symptoms. Explain that it has not been found to alleviate symptoms, even at triple the standard dose.¹

A: Based on evidence from a high-quality randomized controlled trial (RCT)¹ and a 2009 meta-analysis.²

1. Barry MJ, Meleth S, Lee JY, et al. Effect of increasing doses of saw palmetto extract on lower urinary tract symptoms: a randomized trial. JAMA. 2011;306:1344-1351.

A 66-year-old man comes to your office complaining of urinary frequency and straining to begin urination. He was recently diagnosed with BPH by a urologist, but is hesitant to begin taking a prescription drug. The patient, who is on a fixed income, asks you if saw palmetto extract might relieve his urinary symptoms. What should you tell him?

Roughly 40% of American men older than 60 years and nearly 90% of men older than 80 suffer from BPH and the troublesome lower urinary tract symptoms (LUTS) that it causes.³ Established medical and surgical options, as well as over-the-counter (OTC) plant-based products, are used for symptom relief. The OTC remedy most commonly used for BPH is Serenoa repens, derived from the saw palmetto dwarf palm tree. In a 2007 survey, 1.6 million US adults reported using saw palmetto extract, often as a treatment for BPH, in the 30 days prior to the survey.⁴

Until now, more questions than answers

As a family physician, you undoubtedly have many patients who are taking or considering taking saw palmetto for relief of BPH symptoms. The significant adverse effects of alpha-blockers and 5-alpha-reductase inhibitors, which are typically prescribed for LUTS—including decreased libido and dizziness—may help account for their interest in this alternative treatment.^5,6

Until recently, evidence of saw palmetto’s efficacy has been limited and conflicting, despite widespread use of the extract. That has left many of us wondering whether we should recommend that men with BPH try saw palmetto despite the limited evidence; whether it is effective for some, but not all, BPH symptoms; and whether an increase in dose would increase its efficacy.

A 2002 Cochrane meta-analysis of 21 trials of saw palmetto extract for LUTS reported reduced nocturia, improved self-reported symptoms, and increased peak uroflow compared with placebo, without significant adverse effects.⁷ An updated Cochrane review published in 2009 included several more rigorous trials—and had very different results: This meta-analysis, which was based on 30 trials, found a reduction in nocturia, but failed to show improvement in other self-reported symptoms or peak uroflow.²

The largest trial included in the 2009 review was the Saw Palmetto Treatment for Enlarged Prostates (STEP) study,⁸ a one-year study with 225 participants. Its findings: no improvement in the treatment group compared with the placebo group in symptom scores or any secondary endpoints, and no important toxicity.⁸ Of note, the STEP study and most trials included in the 2009 Cochrane review used the standard saw palmetto extract dose of 160 mg twice daily. ^1,2

Barry et al conducted a 72-week double-blind, multicenter placebo-controlled trial to assess the effect of double (640 mg/d) and triple (960 mg/d) the standard dose of saw palmetto extract on BPH symptoms.¹
The study included 369 men with moderate LUTS who had not recently received treatment for BPH. Exclusion criteria included a history of invasive BPH treatment, recent treatment with either an alpha-blocker or a 5-alpha-reductase inhibitor; recent phytotherapy, including saw palmetto; and a history of prostate or bladder cancer. Participants were randomized to receive either saw palmetto extract or an identical-looking placebo gel cap. Doses started at 320 mg/d and were increased to 640 mg/d at 24 weeks and 960 mg/d at 48 weeks.

The primary outcome was the change in the American Urological Association Symptom Index (AUASI) score from baseline to 72 weeks. AUASI, a scale of 0 to 35 in which higher numbers represent increased symptoms, is the same scoring tool used in both the Cochrane review and the STEP trial. Secondary measures included other symptom scales, peak uroflow, and poststudy satisfaction. The treatment and placebo groups had statistically identical baseline characteristics, and the sample size was large enough to detect clinically significant differences.

The AUASI score decreased by a mean of 2.20 points (95% confidence interval [CI], -3.04 to -0.36) in the group that received saw palmetto and by 2.99 points (95% CI, -3.81 to -2.17) in the placebo group—a mean difference of 0.79 in favor of the placebo group (P=.91). The proportion of participants achieving a 3-point reduction in AUASI score was statistically similar between the 2 groups (P=0.66). There was no significant dose response difference between the 2 groups, and saw palmetto proved to be no better than placebo for any of the secondary outcomes.

Subgroup analysis did not reveal any results that differed from the main outcomes. The only adverse events that were significantly different between the 2 groups related to physical injury or trauma, which were unlikely to be due to the intervention. ¹

By using the same symptom scoring system (AUASI) as many studies in the previous Cochrane reviews, Barry et al were able to compare their findings with those of other high-quality studies with similar methodologies and outcome measures. Despite using an even higher dose of the extract, the results of this trial are remarkably consistent with previous conclusions: Saw palmetto is not an effective treatment for symptoms associated with BPH. Moreover, this trial had a broad base of participants similar to the population in a primary care practice, including patients who would typically choose a natural remedy for LUTS.¹

This trial is the first to compare higher doses of saw palmetto with placebo to assess a dosage threshold for effectiveness. While the study found no evidence of saw palmetto toxicity even at these higher doses, the extract did not outperform placebo for any measured outcome.¹

This high-quality study confirmed the recent series of rigorous studies with negative outcomes by showing that the use of a standard dosage was not a study limitation and that saw palmetto extract is not effective for treating LUTS at any dosage. This trial should substantially affect future guideline recommendations that were limited by methodological concerns in the past.^9–11

It is not possible to be absolutely certain that these findings apply to all saw palmetto extract preparations, given the unknown active ingredients and unknown mechanism of action. However, the researchers used a high-quality preparation (a proprietary lipidic ethanolic extract) of saw palmetto at higher doses than the STEP trial and came to a similar conclusion, making it highly unlikely that another preparation would perform differently.

We see no challenges to implementation of this recommendation.

The PURLs Surveillance System is supported in part by Grant Number UL1RR024999 from the National Center for Research Resources, a Clinical Translational Science Award to the University of Chicago. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center For Research Resources or the National Institutes of Health.

Jason Ricco,
North Memorial, Family Medicine Residency, University of Minnesota, Minneapolis
.

Shailendra Prasad,
North Memorial, Family Medicine Residency, University of Minnesota, Minneapolis
.

1. Barry MJ, Meleth S, Lee JY, et al. Effect of increasing doses of saw palmetto extract on lower urinary tract symptoms: a randomized trial. JAMA. 2011;306:1344–1351. [PMC free article] [PubMed] [Google Scholar]

2. Tacklind J, MacDonald R, Rutks I, et al. Serenoa repens for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2009;(2):CD001423. [PMC free article] [PubMed] [Google Scholar]

3. Roehrborn CG, McConnell JD. Etiology, Pathophysiology, Epidemiology, and Natural History of Benign Prostatic Hyperplasia. 8th ed. Philadelphia, Pa: Campbell’s Urology; 2002. [Google Scholar]

4. Barnes PM, Bloom B, Nahin RL. Complementary and alternative medicine use among adults and children: United States, 2007. Natl Health Stat Report. 2008;(12):1–23. [PubMed] [Google Scholar]

5. Traish AM, Hassani J, Guay AT, et al. Adverse side effects of 5-alpha-reductase inhibitors therapy: persistent diminished libido and erectile dysfunction and depression in a subset of patients. J Sex Med. 2011;8:872–884. [PubMed] [Google Scholar]

6. Clifford GM, Farmer RD. Medical therapy for benign prostatic hyperplasia: a review of the literature. Eur Urol. 2000;38:2–19. [PubMed] [Google Scholar]

7. Wilt T, Ishani A, MacDonald R. Serenoa repens for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2002;(3):CD001423. [PubMed] [Google Scholar]

8. Bent S, Kane C, Shinohara K, et al. Saw palmetto for benign prostatic hyperplasia. N Engl J Med. 2006;354:557–566. [PubMed] [Google Scholar]

9. Benign prostatic hyperplasia: treatment {saw palmetto}. In: DynaMed. Available at: http://www.DynamicMedical.com. Accessed April 16, 2012. [Google Scholar]

10. Saper R. Clinical use of saw palmetto {saw palmetto}. In: Basow DS, ed. UpToDate [database online]. Waltham, Mass: UpToDate 2012. Available at: http://www.uptodate.com. Accessed April 16, 2012. [Google Scholar]

11. Agency for Healthcare Research and Quality. Guidelines on the treatment of non-neurogenic male LUTS. Available at: http://www.guideline.gov/content.aspx?id=34066. Accessed June 17, 2012. [Google Scholar]

Articles from The Journal of Family Practice are provided here courtesy of Frontline Medical Communications Inc.

Saw palmetto extract enhances erectile responses by inhibition of phosphodiesterase 5 activity and increase in inducible nitric oxide synthase messenger ribonucleic acid expression in rat and rabbit corpus cavernosum

. 2013 Jun;81(6):1380.e7-13.

doi: 10.1016/j.urology.2012.12.062.

Epub 2013 Apr 23.

Surong Yang 
¹
, Changrui Chen, Yiying Li, Zhenghua Ren, Yungang Zhang, Gantong Wu, Hao Wang, Zhenzhen Hu, Minghui Yao

Affiliations

Affiliation

• ¹ Department of Pharmacology, Shanghai Medical College, Fudan University, Shanghai, China. [email protected]

• PMID:

  23622773

• DOI:

  10.1016/j.urology.2012.12.062

Surong Yang et al.

Urology.

2013 Jun.

. 2013 Jun;81(6):1380.e7-13.

doi: 10.1016/j.urology.2012.12.062.

Epub 2013 Apr 23.

Authors

Surong Yang 
¹
, Changrui Chen, Yiying Li, Zhenghua Ren, Yungang Zhang, Gantong Wu, Hao Wang, Zhenzhen Hu, Minghui Yao

Affiliation

• ¹ Department of Pharmacology, Shanghai Medical College, Fudan University, Shanghai, China. [email protected]

• PMID:

  23622773

• DOI:

  10.1016/j.urology.2012.12.062

Abstract

Objective:

To evaluate whether saw palmetto extract (SPE) relaxes corpus cavernosum and explore the underlying mechanisms.

Methods:

Forty Sprague-Dawley rats and 30 New Zealand rabbits were randomly allocated into 3 SPE-treated groups (low-, middle-, and high-dose) and 1 saline-treated control group. SPE was administered intragastrically for 7 consecutive days. Another 23 rats treated with sildenafil were used to appraise the erectile response to electrical stimulation of nerves in the corpus cavernosum. The erectile functions of rats and rabbits were evaluated 24 hours after the last SPE administration or 15 minutes after intragastric sildenafil. Outcome measures included corpus cavernosum electrical activity recording, phosphodiesterase 5 (PDE5) activity detected by the colorimetric quantitative method, and messenger ribonucleic acid (mRNA) expression level for PDE5 and inducible nitric oxide synthase (iNOS) determined using real-time polymerase chain reaction.

Results:

In the SPE-treated animals, the relaxant response to electrical stimulation of nerves in the corpus cavernosum, reflected by the amplitude of the electrical activity within the cavernosum, was significantly and dose-dependently augmented. Similar effects were observed in the sildenafil-treated rats. PDE5 activity in rat and rabbit corpus cavernosum tissues was significantly and dose-dependently inhibited in SPE-treated animals, whereas the iNOS mRNA level increased compared with the saline group. PDE5 mRNA, however, was only significantly enhanced in the rats treated with the middle dose of SPE.

Conclusion:

The results suggest that SPE may have potential application value for the prevention or treatment of erectile dysfunction through an increase in iNOS mRNA expression and inhibition of PDE5 activity in corpus cavernosum smooth muscles.

Copyright © 2013 Elsevier Inc. All rights reserved.

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Erectile dysfunction – symptoms, causes, signs, diagnosis and treatment in “SM-Clinic”

Andrologist deals with the treatment of this disease
, Urologist

• What is it?
• Why does erectile dysfunction develop?
• Signs of erectile dysfunction
• Diagnosis of erectile dysfunction
• Treatment of erectile dysfunction
• Surgery or shock wave therapy?
• Doctors

Why does erectile dysfunction develop?

A man’s sexual health depends on many conditions:

• proper functioning of the endocrine system;
• satisfactory condition of micro- and macrocirculation;
• mental health;
• anatomical features of the structure of the genital organs.
• neurological health.

The impact of negative factors inevitably affects a man’s sexual life. Erectile dysfunction is provoked by drug addiction, alcohol dependence, psychopathology. Among endocrine factors, such dysfunction accompanies diabetes mellitus and gonadal insufficiency. Anatomical disorders are also not uncommon – there are Peyronie’s disease, fibrous deposits and sclerotic changes in the cavernous bodies of the penis. In some cases, spinal pathologies, polyneuropathy and cerebrovascular accidents lead to sexual failure.

However, modern medical practice shows that the causes of erectile dysfunction are most often due to the unsatisfactory condition of the blood vessels supplying the penis. The provocateurs of this process are atherosclerotic lesions, hypertension and diabetic microangiopathy. Therefore, a patient with erectile dysfunction is shown a comprehensive examination to identify the root cause.

Signs of erectile dysfunction

Erectile disorders are more often the result of other pathologies, i. e. these are the first symptoms of an incipient serious illness, so you should immediately contact the clinic. The doctor will establish the causes of the disorder and tell you which specialist to contact in order to solve the problem once and for all.

Warning signs indicating the initial stages of sexual disorders in adult men are:

• periodic or regular disappearance of erection in the midst of sexual intercourse;
• premature ejaculation;
• lack of orgasm;
• lack of ejaculation;
• lack of erection despite obvious arousal;
• a sharp decrease in libido;
• inability to have sexual intercourse with a partner;
• regular preference for physiological sex of self-satisfaction.

Get advice

If you experience these symptoms, we recommend that you make an appointment with your doctor. Timely consultation will prevent negative consequences for your health.

To learn more about the disease, prices for treatment and sign up for a consultation with a specialist, you can call:

+7 (495) 777-48-49

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Why SM-Clinic?

1

Treatment is carried out in accordance with clinical recommendations

2

Comprehensive assessment of the nature of the disease and treatment prognosis

3

Modern diagnostic equipment and own laboratory

9000 2 4

High level of service and balanced pricing policy

Diagnosis of erectile dysfunction: when to contact the clinic?

The first doctor that a man with such complaints should visit is an andrologist. The specialist will conduct an examination, collect an anamnesis, and, if necessary, appoint consultations of other doctors (urologist, sexologist, venereologist) and a set of diagnostic studies. To identify the causes of erectile dysfunction, they carry out:

• psychotherapeutic testing;
• screening for infections with sexual transmission;
• general clinical examination of blood and urine;
• assessment of prostate secretion;
• ultrasound examinations;
• dopplerography;
• cavernosography;
• magnetic resonance and computed tomography of the pelvic organs, the central parts of the nervous system.

The list of studies may differ in different clinical situations. All types of laboratory and instrumental diagnostics of erectile dysfunction can be done at the SM-Clinic. Our center guarantees patients comfort, complete anonymity, professional support until a positive result is achieved.

Treatment of erectile dysfunction

Diagnostic results are very important for the treatment of erectile dysfunction. The task of the SM-Clinic specialists is to eliminate the causes of the disease, and not to mask unpleasant symptoms. Only in this case can a complete cure be achieved. The type of treatment and the nature of therapy are selected by the andrologist, focusing on the provoking factors:

• for psychological disorders specific drugs and psychotherapeutic counseling are indicated;
• for endocrine disorders – replacement or suppressive hormone therapy;
• for neurological disorders – complex treatment with the involvement of a neurologist in a hospital, etc.
• in case of pathological violation of the blood supply to the penis – drugs are prescribed, spa treatment and physiotherapy are recommended.
• in severe and advanced cases of vascular pathologies – surgical treatment can be used to restore the normal anatomy of the penis.

Surgery or shock wave therapy?

Currently, among all types of impotence, the most numerous is the group of men with vasculogenic erectile dysfunction. Pathology is accompanied by a violation of the blood supply to the vessels of the penis due to vascular weakness or circulatory pathologies.

One of the options for this pathology is surgical treatment, which consists in the introduction of a silicone implant into the cavernous bodies of the penis.

An alternative method of treatment is the use of shock wave technologies. “SM-Clinic” is equipped with special equipment designed for shock wave therapy. With its help, low frequency waves are applied to the tissues of the penis. This stimulates revascularization and the complete restoration of the blood supply to the penis during an erection. Wave treatment is used as a course during which the patient visits the urologist-andrologist’s office several times in our clinic. Improving potency occurs after 2 weeks from the start of therapy. The procedure is absolutely painless, well tolerated, has no contraindications.

Treatment of erectile dysfunction in “SM-Clinic” is an individual approach to each patient, the use of innovative methods for diagnosing and eliminating sexual disorders. Prices for services, consultations and procedures can be obtained personally from the attending physician or by calling the contact center

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Diseases in the direction of Andrologist

Prostate adenoma
Azoospermia
Balanoposthitis
Varicocele
hydrocele
hypogonadism
Cyst of the spermatic cord
Short frenulum of the penis
male infertility
male menopause
premature ejaculation
sexual dysfunction
penis injury
Urethritis
phimosis
Chronic prostatitis

Diseases referred to Urologist

Prostate adenoma
Azoospermia
Renal amyloidosis
Angiolipoma of the kidney
Balanoposthitis
Varicocele
Vesiculitis
Human papillomavirus (HPV)
Inflammation of the kidneys (nephritis)
hydronephrosis
hydrocele
overactive bladder
hypogonadism
Glomerulonephritis
bladder diverticulum
Benign prostatic hyperplasia (BPH)
Sexually transmitted diseases (STDs)
Urinary retention
Interstitial nephritis
Interstitial cystitis
Stones in the bladder
Stones in the ureter
Stones in the kidneys
kidney cyst
Cyst of the spermatic cord
Urachus cyst
warts
Short frenulum of the penis
cryptorchidism
cooperite
Leukoplakia of the bladder
Mycoplasmosis
urinary syndrome
Urolithiasis disease
male infertility
Urinary incontinence
neurogenic bladder
Nephroptosis (prolapsed kidney)
Nephrosclerosis
Tumors of the ureter
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Orchitis
Orchiepididymitis
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Acute glomerulonephritis
Acute pyelonephritis
Acute prostatitis
paranephritis
paraphimosis
Sand in the kidneys
Pyelitis
Pyelonephritis
Pyelectasis
Kidney damage
horseshoe kidney
Polycystic kidney disease
Urethral polyp
Postcoital cystitis
Renal colic
kidney failure
premature ejaculation
Prostatitis
bladder cancer
Cancer of the penis
kidney cancer
prostate cancer
urethral cancer
testicular cancer
Bladder fistula
Chronic pelvic pain syndrome
Sclerosis of the bladder neck
Urethral stricture
Bladder injury
penis injury
Trichomoniasis
Uremia
ureterocele
Urethritis
phimosis
Chlamydia
Chronic pyelonephritis
Chronic prostatitis
Chronic cystitis
Cystitis
cystitis (in women)
cystitis in men
Enuresis
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Erectile dysfunction in men | Symptoms, complications, diagnosis and treatment

Approximately one in two men over the age of 50 has some form of erectile dysfunction (ED) symptoms. However, age is far from the only cause of erectile dysfunction.

Stress and nervous tension were previously thought to be the main causes of ED. But medical studies have shown that often the appearance of ED is associated with chronic sluggish and oligosymptomatic diseases, and the deterioration of erection can be an early sign of a more serious illness.

Timely diagnosis and treatment of chronic diseases will allow you to enjoy good physical health and sexual activity in your mature years.

What is erectile dysfunction?
ED is defined as a condition in which there is difficulty in achieving or maintaining an erection sufficient for sexual intercourse.

ED may occur:

• In violation of the blood flow and innervation of the penis.

• For prolonged nervous tension.

• As the first symptom of cardiovascular disease (atherosclerosis, heart failure, hypertension) and diabetes.

How does an erection occur?
During sexual arousal, the brain signals to the nerves, which results in the release of specific chemicals that increase blood flow to the penis. There is a rapid blood supply to the two cavernous bodies (corpus cavernosum Fig. 1). The spongy tissue inside the cavernous bodies relaxes and fills with blood. The blood pressure in the penis rises and causes an erection.

When a man reaches orgasm, a second impulse of nerve signals reaches the penis and causes the spongy tissue to contract. The blood leaves the cavernous bodies and the erection disappears.

Men know that the size of the penis can change depending on the ambient temperature or stress. This is normal and reflects the volume of circulating blood entering and exiting the penis.

Although ED becomes more common with age, aging does not always cause erectile dysfunction. Some men are sexually active in their 80s.

Risk factors for ED

• Injuries of the pelvis.

• Surgery for cancer of the prostate, colon, rectum, or bladder.

• Cardiovascular diseases

• Peripheral arterial disease (narrowing of the arteries with reduced blood flow).

• Hypertension.

• Diabetes mellitus.

• Drinking alcohol.

• Drug use.

• Smoking (including vaping).

• Certain medicines

• Emotional stress due to depression, or relationship problems with a partner.

Physiological factors

• During an erection, the outflow of blood from the cavernous bodies is not blocked. If blood does not accumulate in the penis, a man cannot achieve an erection. This problem can occur at any age.

• Nerve signals from the brain or spinal cord do not reach the penis.

• Injuries to the spine or pelvic surgery can damage the nerves in the penis.

• Pelvic cancer treatment affects erectile function.

• Surgery and/or radiation therapy for prostate cancer, colorectal cancer, bladder cancer – may cause ED. Approximately 6-12 months after treatment, a urologist should be contacted for sexual health issues.

• Medicines used to treat other conditions.

Some drugs adversely affect erection. Patients should discuss the side effects of medications with their doctors.

Emotional causes of ED

Sex requires mind and body to work together. Emotional or relationship problems can trigger or exacerbate ED.

Some emotional problems that can lead to ED:

• Depression.

• Conflicts with a sexual partner.

• Stress at home or at work.

• Stress due to social, cultural or religious conflicts.

• Anxiety about sexual activity.

Diagnosis
Diagnosis of ED begins with a conversation with a urologist. Sign up for a consultation using this link. Your doctor will ask you questions about your general health and erection problems. He will also advise you to do the necessary tests and studies. It is important to find the cause of your ED so that treatment can be as effective as possible.

Be prepared to answer a series of questions. Some of these questions will be very personal and may seem uncomfortable. Honest and detailed answers will help you find the cause of dysfunction and choose the right treatment for you.

First, your doctor will want to know about your general health and lifestyle details. It is very important to tell your doctor about any medications you are taking, whether prescription or over-the-counter. If you smoke, tell me how much. If you drink alcohol, please indicate how often. Your doctor will also ask about recent stresses in your life.

When discussing the specifics of your ED, your doctor is likely to ask the following types of questions:

• How long have you had these symptoms? How long ago and in what order did they appear?

• Do you have spontaneous erections at night or in the morning?

• If you have an erection, how stable and how long is it? Are there any problems with penetration into the partner?

• Do you have problems with sexual desire or arousal?

• Do your erections change at different times, such as when you enter the vagina, during stimulation, or when you masturbate?

• Do you have erection pain?

Questions about your emotional health might include:

• How often do you experience severe stress?

• Causes of anxiety or depression? Do you have mental health problems?

• Do you take any medication to improve your emotional state?

• How satisfied are you with your sex life? Have there been any recent changes?

• How is your relationship with your partner? Have there been any recent changes to them?

Medical examination
Medical examination is a way to check your general health. When dealing with ED, it often starts with an examination of your genitals (penis and testicles). Depending on your age and risk factors, the examination may expand to include a cardiovascular examination. Depending on your age and family history, your doctor may do a digital rectal examination to check the condition of your prostate. These tests are usually safe and painless. Make an appointment with a urologist VCERM them. A.M. Nikiforov EMERCOM of Russia for advice and appointment of the necessary diagnostics.

Lab Tests
Your doctor may order additional blood and urine tests to look for other health problems not found during the physical examination.

Other tests
Questionnaires are often used by experts to assess the severity of ED. The specialist may ask about the features of the onset and maintenance of an erection, your assessment of sexual satisfaction.

Additional diagnostic tests.
• Blood test for testosterone and other male sex hormones.

• Blood test to measure the level of glucose (sugar) in the blood.

• Ultrasound (dopplerography of the penis) to check the quality of blood flow.

• Injection into the corpus cavernosa of a blood flow-stimulating drug to induce an erection

• Pelvic x-ray, arteriography, MRI, or CT (rarely needed, only if trauma or cancer has occurred).

Treatment for ED
If ED is affecting your quality of life or your relationship with a loved one, it must be treated. Treatment is aimed at correcting or improving erectile function and maintaining overall health. See more about surgeries performed in the Department of Urology.

Lifestyle changes
Treatment for ED begins with taking care of your heart and blood vessels. Your doctor may point to “risk factors” that can be eliminated or minimized. You may be recommended:

• Change your food basket and diet (eg, eat more plant-based foods and limit fatty or fried foods).

• Maintain a healthy weight.

• Stop SMOKING!

• Increase physical activity.

• Limit your use of drugs and alcohol.

• Get more sleep (ideally 7-8 hours per night).

Your doctor may advise you to change your previous medications. Please do not stop or change prescription drugs without first talking to your doctor.

Emotional health care
Your doctor may also offer psychological counseling to resolve relationship conflicts, domestic stress, and depression.

Drug treatment

ATTENTION!!! DO NOT SELF-MEDATE – CONTACTING A SPECIALIST WILL HELP YOU TO DEFINE AN ​​EFFECTIVE TREATMENT WITH A GUARANTEED RESULT!
Treatment always starts with non-invasive (non-traumatic) methods.

Tablet preparations.

Drugs known as type 5 PDE inhibitors increase blood flow in the penis. These are drugs that are taken orally in the form of tablets.

For best results, men with ED should take these tablets about an hour or two before sex. PDE-5 inhibitors improve blood flow to create stronger erections. Approximately 7 out of 10 men get a good result from the treatment, while the effectiveness is lower in people with diabetes or cancer.

If you have a heart condition and are taking nitrates, you SHOULD NOT take PDE-5 inhibitors. Always check with your doctor before using PDE5 inhibitors.

Most often, the side effects of PDE-5 inhibitors are mild and short-lived. Most common:

• Feeling of heat, redness of the face.

• Headache.

• Indigestion.

• Muscle pain.

• Nasal congestion.

Talk to your urologist about possible problems.

Vacuum therapy

Vacuum Erectors is a plastic cylinder that fits over the penis tightly against the skin at the base of the penis. A special pump at the end of the device pumps out air and forms a low pressure area around the penis. This leads to blood filling of the cavernous bodies. Then an elastic ring is put on the base of the penis to block the outflow of blood. The vacuum erector provides an erection lasting up to 30 minutes. With proper preparation, 75 out of 100 men can get a sufficient erection with this device.

Food additives

Biologically active (food) additives (BAA): quite popular, but may be unsafe. Check with your healthcare professional before taking any supplements and self-treating ED. Supplements may include PDE-5 inhibitors, sometimes at excessively high doses. They may also contain unknown ingredients.

Testosterone therapy

In rare cases where there is low sex drive (libido) and low blood testosterone levels, testosterone replacement therapy may help improve libido. Also, testosterone can be combined with PDE-5 inhibitors.

Intracavernous injection (ICI) and intraurethral (IU) therapy

With low efficiency of tablet preparations, you can use the drug – Alprostadil. This drug is given as an injection into the penis (Caverject) or into the urethra using a special applicator (MUSE).

Intracavernous injection

Alprostadil must be injected into the lateral surface of the penis inside the corpus cavernosum. The effectiveness of treatment reaches 85%. Many men who do not respond to PDE-5 inhibitors develop firm erections that last up to 20-30 minutes.

Your doctor will teach you how to administer, how much to administer, and how to safely increase your dose at home. It is very important to perform the first injection in the urologist’s office before doing it yourself.

The most common side effect of ICI and IU therapy is prolonged erection, called priapism. Priapism is an abnormal erection that lasts more than four hours. This condition is accompanied by pain and harms the cavernous tissue. In the event of priapism, the patient should go to the emergency room. With late presentation and recurrence of priapism, even surgery may be required. Treatment of priapism requires the removal of stagnant blood from the penis, as well as the introduction of special drugs. Men should be careful because priapism can lead to varying degrees of damage to the tissues of the penis, up to irreversible (cavernous fibrosis). Fibrosis significantly worsens ED or causes complete lack of erection.

Men who have an erection lasting longer than two to four hours after a CCI should immediately seek help from the emergency department.

Intraurethral (IU) therapy

In IU therapy, a tiny capsule of the drug Alprostadil is injected into the urethra to a depth of 3 cm, after which the drug dissolves and is absorbed inside the canal. The use of IU therapy makes it possible to refuse an injection and its unpleasant consequences, but, unfortunately, it has a lower efficiency than ICI. Intraurethral therapy should also be started in the doctor’s office.

The most common side effect of IU therapy is a burning sensation in the penis, rarely priapism may occur.

Surgical treatment
The main type of surgical treatment for ED is penile prosthesis implantation . For men who have failed with medication or have severe side effects of medications, or if ED occurs after cancer surgery (radical prostatectomy), a penile prosthesis may be the only effective treatment.

Penile prostheses

Penile prostheses fit completely inside your body. They provide good rigidity to the penis for a long time, and this allows you to have a full sex life. Although the operation to implant a penile prosthesis (however, like any operation) is associated with a risk of complications, nevertheless this operation has a high level of satisfaction among patients with ED. Today it is the best choice for many men.

There are two types of penile prostheses.

Semi-rigid (semi-rigid, bendable)

This is the simplest type of implant and consists of two rods made of silicone and metal. These rods give the male penis the axial rigidity needed for sexual penetration. The prosthesis can be bent for convenience after sexual intercourse, when urinating.

Inflatable prosthesis

In an inflatable prosthesis, two fluid-filled cylinders are placed inside the cavernous bodies. Special thin tubes connect the cylinders to a pump implanted under the skin of the scrotum and to a reservoir located in the bladder area. When a man pumps, fluid is pumped from the reservoir into the cylinders and causes the penis to tighten. Inflatable prostheses provide a normal erection and create a natural sensation for your partner. With an inflatable prosthesis, men can control the rigidity of the penis. Inflatable prostheses allow couples to maintain a stable erection throughout the entire time of sexual contact.

Penile prostheses restore erection, but they cannot correct orgasmic or ejaculatory disorders caused by previous cancer surgery.

How is the operation going?

Penile prosthesis surgery is always performed under anesthesia. Usually one small skin incision is made under the penis at the junction with the scrotum. Blood loss is usually minor. The patient spends no more than 1-2 days in the hospital.

Penile Implant Recovery:

• Most men experience moderate pain in the early postoperative period, requiring analgesics. Skin sutures are removed after 5-7 days.

• Discomfort, bruising and swelling may occur for up to 2-3 weeks after surgery.

• For the first month, men should limit physical activity. The surgeon will explain which exercises are useful during the wound healing period.

• Most men can start having sex with a prosthetic penis by the eighth week after surgery. If swelling or pain remains, the use of the implant may be delayed. Before use, the surgeon will show you how to safely inflate and empty the implants.

The most unpleasant postoperative complications are hematoma and infection. Over time, the use of the prosthesis increases the risk of breakage of the device. In this case, surgery may be required to replace it. When in doubt about the need for a prosthesis, it is helpful to talk to someone who has had the same surgery before.

If an infection occurs after the operation, the prosthesis will be removed. For the most part, modern dentures are reliable. But if a mechanical failure occurs, then the prosthesis or its component will need to be replaced surgically.

Most men with penile implants and their partners say they are happy with the results.

State of the art treatments in clinical trials
• Extracorporeal shock wave therapy (ESWT) is a low-intensity shock wave treatment of the cavernous tissue that is designed to help restore a natural erection.

• Intracavernous injection of stem cells – contributes to the restoration of cavernous tissue.

• Intracavernous administration of autologous (own) platelet-rich plasma (APRP) – to restore cavernous tissue.

Currently these techniques are not included in the standard treatment for ED, but may be offered as part of clinical trials.