TITLE: ERECTILE DYSFUNCTION

CASE STUDY REPORT BIO 270

GROUP MEMBERS:
NO NAME STUDENT ID
1 MOHAMAD AMIRUDDIN BIN MOHAMED ZAINI 2017403706
2 MUHAMMAD AMYRUL MUKMIN BIN MOHD HIZIR 2017491058
3 NUR AFIQAH BINTI ABDUL HALIM 2017265568
4 SITI SURAYA BINTI AZHAR 2017635512
5 MUHAMMAD AFIF BIN KAMARUZAMAN 2017441594

GROUP : A4AS1204_26

LECTURER’S NAME : MADAM MIMI SOPHIA BINTI SARBANI

Table of Contents
2.0 Introduction ............................................................................................................................................ 3
2.1 Homeostasis and the process of homeostasis ........................................................................................ 4
2.2 Possible factors that lead to both Erectile Dysfunction and Diabetes type 2. ....................................... 4
2.3 The mechanism of glucose disorder that could lead to Erectile Dysfunction ........................................ 5
2.4 Effect genetic and lifestyle to the Erectile Dysfunction .......................................................................... 6
2.5 Treatments for Erectile Dysfunction ....................................................................................................... 7
2.5.1Medical Treatment ........................................................................................................................... 7
2.5.2 Devices ............................................................................................................................................. 8
2.5.3 Surgical Treatment ........................................................................................................................... 8
2.5.4 Change of Lifestyle ........................................................................................................................... 8
2.5.5 Alternative Medicine........................................................................................................................ 9
2.6 Tongkat Ali and Gambir Sarawak were recommended to a diabetic male. ........................................ 10
2.6.1 Tongkat Ali ..................................................................................................................................... 10
Uses of Tongkat Ali.............................................................................................................................. 11
2.6.2 Gambir Sarawak ............................................................................................................................. 11
Uses of Gambir Sarawak ..................................................................................................................... 12
1 References ........................................................................................................................................ 13
2.0 Introduction

Erectile Dysfunction is a type of sexual dysfunction characterized by inability to develop an

erection of the sexual organ during sexual intercourse. Sometime, it also referred to impotence.
It also can have psychological consequences as it can be tied to relationship difficulties and
self-image. Many men experience it during stress. This condition can be temporary or
permanent to a man. This dysfunction can be diagnosis by a person’s history symptoms and
also can be diagnosis by performing the physical examination or laboratory investigation.
Several risk factors of Erectile Dysfunction have been identified, including diabetes,
hypertension, obesity and depression. The cure of this problem is still a distant goal, but there is
a currently the wealth of therapies available for its treatment. Erectile Dysfunction can be
caused by physical factors and psychology factors. Most common physical factors that affected
many man in the world is diabetes. Most of people think that diabetes only can cause a
damaged to the leg. They do not realize that it can also affect to the sexual organ of a man in a
shorted-term period or long-term period. Erectile Dysfunction also can affect the emotion of the
person who faced with this problem. The emotion will not be stable and also can lead to another
problem that more serious. Diabetes mellitus is a type of group of metabolic diseases that
characterized by hyperglycemia that resulting from defected in insulin secretion and insulin
action. The chronic hyperglycemia of diabetes is also associated with long-term impact including
Erectile Dysfunction. The term of diabetes was first discovered by Apollonius of Memphis at 250
before century and it first recorded in medical text in English was during 1425 and the word of
“mellitus” was added by Thomas Willis.
 2.1 Homeostasis and the process of homeostasis

Homeostasis is the ability to maintain the internal environment of the body even external
condition undergo dramatic shifts that would be lethal to individual cells. Homeostasis is highly
developed in warm-blooded animals living on land which they must maintain their body temperature,
fluid balance, blood pH and oxygen. This also same with the glucose homeostasis where it
maintaining adequate glucose levels in the blood stream that is necessary for body. When the
inappropriate condition levels of glucose in the blood stream, it becomes a primary symptom of
diabetes. In normal condition, glucose homeostasis is be maintain by glucagon and insulin.
Glucagon has an effect on glucose level relative to the insulin. The interrelated between these two
are critical to understanding glucose homeostasis in normal and diabetic state. Based on the
glucose homeostasis, it can be related to the Erectile Dysfunction.

Based on the relationship between homeostasis and Erectile Dysfunction, the function of
erectile is a complex neurovascular physiological mechanism that depends on the interplay between
the central and peripheral nervous system, vascular endothelium, and hormonal factors as well as
the structural integrity of the cellular components of the penis.

During homeostasis in Erectile Dysfunction, a sexual stimulus results in parasympathetic

non-adrenergic and non- cholinergic cavernosal nerves activation, leading to the production of
neural nitric oxide. Enzyme guanylyl cyclase is activated and resulting in the generation and
intracellular increase of cyclic guanosine monophosphate.

2.2 Possible factors that lead to both Erectile Dysfunction and

Diabetes type 2.

Erectile Dysfunction is a condition where male reproduction organ cannot maintain an

erection firm enough to do a sexual activity and it common happen to a man that has diabetes,
especially those who have type 2 diabetes or known as diabetes mellitus.

When a man becomes sexually aroused, a chemical called nitric oxide is released into
the bloodstream. This nitric oxide gives a signal to arteries and the muscles in the penis to relax,
which allows more blood to flow into the penis and this gives the man an erection. Meanwhile,
men with diabetes struggle with blood sugar level swings, especially if their condition isn’t
managed poorly.
 When their blood sugar level gets too high, it will produce less nitric oxide. It is mean that
there is not enough blood flowing into the penis to get or keep an erection. The low levels of
nitric oxide are often found in those with diabetes.

Erectile Dysfunction also can be caused by some possible factors besides diabetes which
is hormonal problems. It is because of hormone-like testosterone important in control the
erectile. Next factor that causes erectile dysfunction is psychological problems including stress,
anxiety and depression. It is often a secondary reaction to an underlying physical cause.
Unhealthy lifestyle such as smoking, drinking alcohol and taking illegal drugs also can cause
Erectile Dysfunction.

2.3 The mechanism of glucose disorder that could lead to Erectile

Dysfunction

Firstly, Erectile Dysfunction or called impotence is not being able to get and maintain an
erection for long enough to have sexual intercourse. Erectile Dysfunction also is a common
problem for more than half of men with diabetes. “About 50% to 70% of diabetic men have
Erectile Dysfunction to some degree, a rate about threefold higher than in non-diabetic men.”
(Hopkins, 2005) Actually, there are many factor causes erectile dysfunction such as diabetes.

Moreover, when the glucose is high in the blood it may cause diabetes. So, when the
men had diabetes mellitus, as the overall mechanism of erection, erection begins when a sexual
stimulus activates the enzyme neuronal nitric oxide synthase that causes short-term the penis.
This initial release of nitric oxide causes rapid and short-term relaxation of the penile smooth
muscle, initiating an erection. The resulting expansion of penile blood vessels and smooth
muscle relaxation allows more blood to flow into the penis. This will increased blood flow or
called shear stress activates the endothelial nitric oxide synthase in penile blood vessels
causing sustained nitric oxide releases continued relaxation and full erection. Furthermore, the
enzyme that have said O-GicNac hinders this normal chain of events by inhibiting the activation
the endothelial nitric oxide synthase and consequently reducing the nitric oxide and preventing
the smooth muscle in the penis from relaxing. Without this relaxation, there is no shear stress to
stoke the production of more nitric acid and no normal, sustained erection.

So, in a conclusion as we know that when a man become sexually aroused, a chemical
called nitric oxide is released into his bloodstream. But, in this case when the men got diabetes
it hardest for body to produce the nitric oxide. So for this case, the less nitric oxide tells the
arteries and the muscles in the penis to relax, which allows more blood to flow into the penis. So
this is causing the Erectile Dysfunction for men.

2.4 Effect genetic and lifestyle to the Erectile Dysfunction

Erectile dysfunction (ED) is a recurrent medical disorder whose generality is enlarging

universal. Alterable risk factors for ED involve smoking, lack of physical activity, not suitable diets,
overweight or obesity, metabolic syndrome, and unrestricted alcohol devouring. Genetic risk factors
that mean genetic variants accord to the risk of advance common and complex diseases, such as
cancer and diabetes. There are many variants that contribute to disease risk when associating with
complex diseases.

A bad diet not good for man potential to have erections. Recent investigations explain the
same eating habits that can cause heart attacks due to blocked blood flow in the coronary arteries
can also impede blood flow to and within the penis. The penis to become erect it required blood
flow. Diets that involve very several fruits and vegetables along with lots of fatties, fried, and
processed foods can contribute to decreased blood circulation throughout the body. Erectile
Dysfunction is comparatively rare among men who consume a traditional.

Maintain a healthy weight is a great way, being overweight can cause many health problems,
including type 2 diabetes, which can affect nerve harm during the body. If diabetes harms the
nerves that provide the penis, Erectile Dysfunction can occur.

High cholesterol or high blood pressure could harm blood vessels, including those that carry
blood to the penis. So, this may lead to Erectile Dysfunction. Blood pressure drugs can make it
troublesome to get an erection. Although doctors say common cases of ED that get accused of
these drugs are actually affected by arterial damage occurring from high blood pressure. Smoking
cigarettes can harm blood vessels and restrict blood flow to the penis. And nicotine causes blood
vessels contract, which could hamper blood flow to the penis. Psychological stress increases levels
of the hormone adrenaline, which causes blood vessels contract. Anything a man can do to release
tension and feel healthy emotionally is anticipated to give his sex life a big boost.
2.5 Treatments for Erectile Dysfunction

A person is thought to have erectile dysfunction when he frequently discovers it hard to

get or keep an erection strong enough to have intercourse or if it interferes with other sexual
activities. Most men have experienced certain problems occasionally, as they found some
difficulty getting tough and stay firm on their sexual reproductive system. However, Erectile
Dysfunction is considered a concern only if it is impossible for some time to achieve satisfactory
sexual performance. As sildenafil, or Viagra, has been discovered, most individuals have
realized that Erectile Dysfunction is a medically treatable disease. Men with sexual activity
problems may be unwilling to speak to their doctor, as this could be an awkward problem.
However, Erectile Dysfunction is well recognized nowadays and there are various treatments
accessible. They may operate with an Erectile Dysfunction specialist for the therapy of an
inherent cause. Choosing an Erectile Dysfunction therapy is a private choice, but they may also
get benefit from talking to their partners about the most appropriate therapy for them.

Erectile Dysfunction therapy begins with core and vascular health care. Some doctor
may identify threat variables which can be modified or enhanced. You may be asked to change
your dietary habits, to stop smoking, to increase exercise rate or to stop taking alcohol or drugs.
Never stop or change prescription medications without speaking with your health care provider
first. Your doctor may also recommend mental issues to be treated. These may result from
disputes in relationships, stressful life, depression or anxiety due to previous Erectile
Dysfunction issues. The good news is that Erectile Dysfunction medications are numerous and
most people will be able to discover a remedy for these. Treatments include modern treatments
and also using natural remedies. For a modern treatment there are such type like medicines,
vacuum device, surgery, implanted devices, alternative medicines and also in life changes. The
first procedures that are non-invasive are often attempted. The majority of Erectile Dysfunction
medicines are well-known and secure. However, it enables to inform your healthcare supplier
about the side impacts that each choice might have.

2.5.1Medical Treatment
First of all, by using medicines. A professional medical care may prescribe oral
medicine, or medicine that patients were using by mouth, for instance, to help him get and keep
an erection such as Viagra, Levitra, Cialis and Stendra. For greatest outcomes, erectile males
bring these tablets approximately 1 or 2 hours before they are sexually exposed. Medicines
involve ordinary penile nerve function. PDE type-5 inhibitors enhance erectile ordinary reactions
that help blood flow to the male reproductive system. Use these medications according to
directions. About seven out of ten people do well and erect better. For diabetics and cancer
patients, the response levels are smaller. Most frequently, PDE type-5 inhibitors have moderate
side impacts and are often last just for a short time. The most frequent side impacts are visual
abnormalities, headache, indigestion and also stuffy nose.

2.5.2 Devices
Next treatment is by using vacuum devices. A vacuum abortion unit is a plastic tube that
folds over the male reproduction system, creating a bond with the body's flesh. An erectile
tissue pump at the opposite end of the pipe created a low-pressure void. Then an elastic ring is
slipped onto the base of the reproduction system. The blood in the reproduction system is held
and it can last up to 30 minutes. 75 of 100 people can use a vacuum mounting machine to
achieve a functioning erection with adequate practice. The fact that vacuum devices were not
used spontaneously means that many men consider other treatments for Erectile Dysfunction
preferable. They may feel cold if using the device, have a purple colour and also make their
reproductive system be bruised. However, the contusions are usually painless and vanish within
a couple of days. Vacuum systems may decrease ejaculation but, in most cases, they do not
affect climax or orgasm pleasure.

2.5.3 Surgical Treatment

There are also several surgical treatment options for Erectile Dysfunction. The most
common implants under anesthesia were penile implants. Should a patient be infected with a
systemic, skin, or urinary tract, this operation should be delayed until all infections have been
treated. If a person on thinner blood, he might need to discuss stopping medicines for elective
operation and curative treatment with a medical expert. A small operative cut is most often
made. The cut is either above the reproductive system in which the bowels were joined or under
the system in which the scrotum joins. There is no removal of tissue. Typically, the loss of blood
is small and the patient can go home the same day or stays in the hospital for one night.
Prosthetic surgery is at risk, and prior to the procedure patients are advised. The implant will
probably be removed when a post-operative infection occurs. The instruments were reliable but
the device or part of the device has to be replaced operationally in case of mechanical failure.
Other non-surgical treatments may no longer function if a penile prosthesis is removed.

2.5.4 Change of Lifestyle

Man can also change their lifestyle to reduce the effects of Erectile Dysfunction. They
should stop smoking, stop drinking alcohol and just increase physically activity. The best way to
deal with Erectile Dysfunction is to enhance pelvic ground muscles with Kegel workouts. They
are often related to women who seek to strengthen their pelvic area during pregnancy, but may
be effective for males who seek to recover full penile function. Tightened and hold these
muscles for a period of five seconds were consists of one Kegel exercise. Try to repeat 10 to 20
times a day. This may not be possible if patient do the exercises first. But over time, they should
be easier. Make sure that the patient naturally breathe and do not push down as if they were
forcing urination. Bring muscles in a straining movement instead. It should be able to notice an
improvement after 6 weeks.

2.5.5 Alternative Medicine

Some treatments may include natural herbs and remedies for Erectile Dysfunction.
However, a man should be cautious when looking for a natural remedy and understand certain
natural remedies potential risks. The most common natural remedies for Erectile Dysfunction
include plants and herbs that have been used by certain crops for many years. Although very
few studies have been carried out on the safety of these natural remedies, there were some
with side effects varying between mild and severe. Some natural remedies can be included
such like L-arginine, ginkgo, ginseng, yohimbine and also barrenwort. Some evidence suggests
that high doses of L-arginine improve Erectile Dysfunction by supporting the opening of blood
vessels in the reproduction system. The side effects are usually seen as mild, although cramps,
diarrhea, and nausea are possible. The prescription medicinal product Viagra should not be
taken with the use of L-arginine.

For ginkgo, it can boost blood flow into the reproduction system, improving sexual desire
and ecological condition. In addition, however, could increase the risk of bleeding. People with
thinner blood or bleeding should talk to their doctor before taking gingko. Next is ginseng. Many
kinds of ginseng are available. Many have shown that they have a positive impact on erectile
dysfunction. Some types of ginseng may be adverse, including insomnia. Otherwise, yohimbine
also can be used. One of the most problematic natural remedies for Erectile Dysfunction is
probably the major component of an African tree bark, yohimbine. Some research suggests that
yohimbine can enhance the sexual dysfunction of a drug used to treated depression. Studies
have nevertheless linked yohimbine to a number of side effects including anguish, increased
blood pressure and a quick irregular heartbeat. Yohimbine should be employed only after
consultation and under the supervision of a doctors as all natural remedies. Last but not least is
barrenwort. There were supposed to be substances that improve sexual performance in this
herb's leaves. Epimedium was not studied in individuals, and it can affect cardiac function.
 Oral medications such as sildenafil (Viagra), tadalafil (Cialis), avanafil (Stendra) or
vardenafil (Staxyn) can be administered to men with diabetes who find it difficult to achieve or
maintain the erection. However, since patient with diabetes also tend to have heart problems,
such medicines may not be suitable and may lead to dangerous interactions with some cardiac
medicines. Other treatments that men with diabetes might take were, intra-cavernous injection
therapy, erectors of vacuum, intraurethral therapy, prosthetics of penile and sex therapy but
these ways were not recommended. So what is the best therapy? Their ability to withstand
treatment depends upon many factors including the health of the man. Based on our research,
natural herbs and remedies were the best alternative for Erectile Dysfunction treatment in
patient with type-2 diabetes which does not have any physical effect that may lead to any
severe wound and also does not effected on cardiac. Generally, natural herbs and remedies
were not containing high level in sugar content. So it is safe for those who want to consume
them.

2.6 Tongkat Ali and Gambir Sarawak were recommended to a

diabetic male.

2.6.1 Tongkat Ali

Tongkat Ali which has a scientific name Eurycoma longifolia came from the Southeast
Asia countries such as Thailand, Malaysia and Indonesia. Quassinoids and alkaloids are the
compaounds that contain in the root of the tree. Other than that, this part of the tree are usually
used in dietary supplements, energy beverages or called as coffee drinks. (Tongkat Ali Health
Benefits and Uses, 2019)

Figure 1: Tongkat Ali plant (Tongkat Ali Health Benefits and Uses, 2019)
 This herb which is Tongkat Ali is also known as Longjack by certain people. It is safe for
diabetic male because not contain high level of sugar in this herds accept some countries
manipulate the ingredient in the herbs and might dangerous for diabetic male. In Malaysia, it is
called ginseng and it is use for a lots of benefits to others. Tongkat Ali is recommended to
diabetic male but not recommended for pregnant women. (Tongkat Ali Health Benefits and
Uses, 2019)

Uses of Tongkat Ali

Tongkat Ali is usually used for remedying the Erectile Dysfunction. There is some prove
that it is an antioxidant that helped to increase the sexual performance and Erectile Dysfunction
by improve the male sexual health. Tongkat Ali is good for sexual performance because it is the
testosterone booster and it helps the male reproductive system to be function effectively such
as increased the hardness and duration of erection. When it is usually used for male sexual
health, it enhances the fertility of the sperm and promotes the normal sperm quality during sex.

There are some benefits of Tongkat Ali that people not know which is this herb can lowering
the blood sugar in human body and because of that this herb which is Tongkat Ali is
recommended for diabetic male. Other sigh benefits of Tongkat Ali are (Tongkat Ali Health
Benefits and Uses, 2019):

 Promoting bone formation

 Increasing muscle strength and athletic performance
 Improving physical and mental energy levels
 Reducing anxiety and stress
 Anticancer effects
 Antimicrobial and antifungal effects
 Antiulcer effects
 Antioxidant effect

2.6.2 Gambir Sarawak

Gambir Sarawak is the natural herbal products and its scientific nama is Uncaria
Gambir. It is used as herbal cure by many countries. The main use of Gambir Sarawak is swiftly
rising in popularity for premature ejaculation treatment or cure.
Figure 2: Gambir Sarawak plant (Gambir Sarawak, n.d.)

Gambir Sarawak is came from the origin place which is Sarawak, Borneo. The astringent
substances extracted from the Gambir plant is the main ingredient in this natural herbal.
(Gambir Sarawak, n.d.)

Uses of Gambir Sarawak

Gambir Sarawak is used to increase the vigorous, long endurance intercourse and the hardest
erection will occur. For summarize, this natural herbal is more to increase the testosterone and
enhance the muscle strength. This is because Gambir Sarawak is recommended to diabetic
male. (Gambir Sarawak, n.d.).

In conclusion, Tongkat Ali and Gambir Sarawak is safe for diabetic male because it not
contain the high level of sugar use and at the other side help to decrease the glucose in the
blood.
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Hopkins, J. (2005). Cause of diabetes-related erectile dysfunction . Hopkins Medicine, 1-2.

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Tongkat Ali Health Benefits and Uses. (2019). Retrieved from verywellfit:
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