Traditional herbal remedies used in the management of sexual impotence and erectile dysfunction in western Uganda
Afr Health Sci. 2005 Mar; 5(1): 40–49.
PMCID: PMC1831906
Maud Kamatenesi-Mugisha and Hannington Oryem-Origa
This article has been cited by other articles in PMC.
Abstract
Background
The
utilisation of ethnobotanical indigenous knowledge is vital in male
sexual reproductive health care delivery in western Uganda. Reproductive
health care is the second most prevalent health care problem in Africa.
However, this concept of reproductive health care has been focusing
mainly on women disregarding men. Thus, some diseases such as sexual
impotence and erectile dysfunction that deserve mention are regarded as
petty though important in economic productivity, family stability and
sexually transmitted diseases control including HIV/AIDS.
Objective
This
study was carried out mainly to document medicinal plants used in the
treatment of sexual impotence and erectile dysfunction disorders in
western Uganda.
Methods
The
medical ethnobotanical indigenous knowledge were collected by visiting
traditional healers and documenting the medicinal plants used and other
socio-cultural aspects allied with sexual impotence and erectile
dysfunction. The methods used to collect the relevant information
regarding the medicinal plants used included informal and formal
discussions, field visits and focused semi-structured interviews.
Results
Thirty-three medicinal plants used in the management of sexual impotence and erectile dysfunction were documented and Citropsis articulata and Cola acuminata were among the highly utilized medicinal plants.
Conclusion
From
the researchers' point of view, the usage of herbal remedies in
managing male sexual disorders is useful because of long cultural
history of utilisation and the current renewed interest in natural
products to sustain health globally. As a way recognising the values and
roles of traditional medical knowledge in health care provision,
further research into the efficacy and safety of herbal remedies in male
sexual disorders is precious in Uganda and beyond. More so, the
establishment of rapport between relevant government department in
Ministry of Health, modern health workers through collaborative and
networking ventures with traditional healers under close supervision and
monitoring of herbal treatments is noble.
Keywords: Medicinal Plants, Erectile Dysfunction, Sexual Impotence, Ethnobotanical Indigenous Knowledge, Western Uganda
Introduction
About
70 – 80% of the Ugandan population still rely on traditional healers
for day-to-day health care. In some rural areas the percentage is around
ninety compared to 80% reported world-wide10,13,14. WHO32
had earlier estimates that the usage of traditional medicine in
developing countries is 80 %. This is an indication that herbal medicine
is important in primary health care provision in Uganda. There are
several reproductive ailments that local communities have been handling
and treating for ages such as sexual impotence and erectile dysfunction
(ED). The concept of reproductive health care has been focusing mainly
on women disregarding men and yet men are part.
Erectile
dysfunction, sometimes, which also may imply to refer to “impotence,”
is the repeated inability to get or keep an erection firm enough for
sexual intercourse23,34.
The word “impotence” may also be used to describe other problems that
interfere with sexual intercourse and reproduction, such as lack of
sexual desire and problems with ejaculation or orgasm23. Roper29
defines erectile dysfunction as the total inability to achieve
erection, an inconsistent ability to do so, or a tendency to sustain
only brief erections (premature ejaculation). Pamplona-Roger27
defines impotence as the inability to finish sexual intercourse due to
lack of penile erection. These variations make defining ED and
estimating its incidence difficult. For purposes of this publication,
since ethnobotanical indigenous knowledge (IK) cannot clearly
distinguish between these two terms, then erectile dysfunction and
sexual impotence are both used. The local people who are providers of
this information are not in position to classify these two conditions.
The estimated range of men worldwide suffering from ED is from 15 million to 30 million23.
According to the National Ambulatory Medical Care Survey (NAMCS), for
every 1,000 men in the United States, 7.7 physician office visits were
made for ED in 1985. By 1999, that rate had nearly tripled to 22.3. This
is in USA, where statistics are clearly compiled, the level of
awareness and education is high as compared to sub Saharan countries
like Uganda. This is a clear indication that there are many silent men,
particularly couples affected by ED.
Reproductive Health care is the second most prevalent health care problem on African continent4.
Reproductive health care did not appear on the health agenda until
recent after the Cairo conference on population and the Peking
conference on women that it indeed became a live issue4. In some instances RH certainly includes the RH needs of the youth or adolescents.
According to Uganda's health policy priorities8,25,
men's reproductive health is not given any mention. The national health
policy focuses on services like family planning, diseases control like
STI/HIV/AIDS, malaria, perinatal and maternal conditions, tuberculosis,
diarrhoeal diseases and acute lower respiratory tract infections that
are given priority8,25.
The sexual and reproductive health rights in Uganda focus on maternal
and child mortality, family planning and the like exclusive of men's
sexual needs and rights8.
The
causes of ED are varies from one individual to another. For whatever
cause, since an erection requires a precise sequence of events, ED can
occur when any of the events is disrupted. This sequence includes nerve
impulses in the brain, spinal column, and area around the penis, and
response in muscles, fibrous tissues, veins, and arteries in and near
the corpora cavernosa23.
Thus, ED causes reported include, damage to nerves, arteries, smooth
muscles, and fibrous tissues. These are often as a result of diseases,
such as diabetes, kidney disease, chronic alcoholism, multiple
sclerosis, atherosclerosis, vascular disease, and neurologic diseases
that account for about 70 percent of ED cases23. NIH23 reported that between 35 and 50 percent of men with diabetes experience ED. NIH23
further reported that the usage of many common medicines such as blood
pressure drugs, antihistamines, antidepressants, tranquilizers, appetite
suppressants, and cimetidine (an ulcer drug) can produce ED as a side
effect. Nevertheless, psychological factors such as stress, anxiety,
guilt, depression, low self-esteem, and fear of sexual failure cause 10
to 20 percent of ED cases. In addition, men with a physical cause for ED
frequently experience the same sort of psychological reactions (stress,
anxiety, guilt, depression)23.
Other possible causes are smoking, which affects blood flow in veins
and arteries, and hormonal abnormalities, such as not enough
testosterone23.
In
modern medication of erectile dysfunction, the oral prescription
medication of popular Viagra (Sildenafil) is effective, but in some men
it is not compatible and Sildenafil works in less than 70% of men with
various etiologies and has certain side effects23.
The availability of Viagra has brought millions of couples to ED
treatment. Oral testosterone can reduce ED in some men with low levels
of natural testosterone, but it is often ineffective and may cause liver
damage34. Other drugs such as Yohimbine, papaverine hydrochloride [used under careful medical supervision]5,
phentolamine, and alprostadil (marketed as Caverject) widen blood
vessels. However, this available modern medication for the ED in men is
very expensive for most of the rural people in Ugandan and other
developing countries. Yet, in traditional medicine, there are several
medicinal plants that have been relied on for use in the treatment of
ED. This ethnobotanical indigenous knowledge has not been earlier
documented and scientifically validated for efficacy and safety, future
drug discovery and development.
Therefore,
this particular study was carried out purposely to document medicinal
plants used by traditional medical practitioners to treat ED and sexual
impotence and other male erectile related conditions in western Uganda.
This manuscript only covers the ethnobotanical documentation of
medicinal plants used in the management of erectile dysfunction
excluding the socio-cultural aspects. The socio-cultural aspects in
details will be presented in the next manuscript covering the broad
range of reproductive health ailments management using the indigenous
knowledge in western Uganda.
Study area and Methods
This
study was carried out in areas in and around Queen Elizabeth Biosphere
Reserve (QEBR) and some other sub counties such as Katerera, Kichwamba
and Kitagata in Bushenyi and Munkunyu, Kayonza and Kitsinga in Kasese
districts in Western Uganda. The sampling sites were located in the
parishes around the biosphere reserve, and in the selected fishing
villages within the biosphere reserve. These included, Katwe, Mweya,
Katunguru, Hamukungu, Kahendero and Kayanja Fishing Villages and many
other villages.
The study was conducted between April
2000 and March 2003 in western Uganda. To collect this data indirect
asking of questions and investigations that do not refer or offend
anyone were used since nobody especially men can say openly that they
have this problem. These methods are explained in the textbook of
ethnobotany and others have been used in the field for this kind of
studies in Uganda and elsewhere in the world10,12,13,14,21.
These methods included visiting the traditional healers to document the
indigenous knowledge (IK), regarding medicinal plants used, gender and
socio-cultural aspects and where the plants are harvested. Informal and
formal conversations, discussions and interviews, market surveys and
field visits were conducted.
The informal conversations
were held with the specialist resource users and other knowledgeable
people on particular ailments. The meeting places were the gardens,
women group meetings, at their homes, and any other places convenient to
them. Through conversations, the sources of knowledge of the healers on
medicinal plants, the medicinal plants used and changes in the
availability of medicinal plants were established. Those who were more
knowledgeable were later followed and interviewed further especially the
TBAs, and some knowledgeable men healers. Focused discussions were held
with them later for formal recording. In some instances, young mothers
were visited too. This was done to verify the information gathered and
the spread of the indigenous knowledge (IK) in reproductive health care
among the different reproductive groups particularly on ED management.
The
semi-structured interviews and discussions were held with the
specialist resource users and other knowledgeable people on particular
ailments by use of interview schedules for each respondent. Interviewed
people were mainly the herbalists (both men and women) and TBAs. In this
selection to some extent, ethnic groups were recorded where possible
because different people use the same plants differently. The time and
place of interviews were arranged according to the schedules of the
respondent. Depending on where the interviews and discussions were held,
recording was done immediately or afterwards or appointments were made
for more details in a more convenient place arranged with the
respondent. Key informants were identified and later interviewed
separately and even followed for further details. Some of the key
questions asked included, name of the respondents, the village or parish
or sub-county he or she was coming from, diseases treated, plant local
names used, parts harvested, methods of preparation and administration.
In addition, ingredients and incantations with which the plants are used
for preparation and where the herbal medicines were harvested were
documented.
The field visits and excursions were
arranged with the healers for places far from their homesteads or took
place concurrently with the interviews and discussions. When going to
the forests, game reserves or other areas where herbalists collect plant
specimens, prior arrangements were made with the community leaders and
park staff. This was done with individuals or groups depending on where
the herbs are collected. In the shared areas such as the fishing
villages, or the multiple use areas, group and individual excursions
were conducted. Some of the medicinal plants that are harvested from
distant places such as the Democratic Republic of Congo, other districts
and unsafe areas within the reserve were not collected but their local
names were recorded. The data collected were to supplement the
information on plant names, plant parts used, collection of the
herbarium voucher specimens and conservation status of these medicinal
plants. The medicinal plants collected were given the voucher numbers
and then later identified in Botany Department herbarium of Makerere
University.
The key respondents were
mainly old men, male traditional healers, traditional birth attendants
and young women and all in total about 160 traditional healers were
interviewed. To document male related ailments men are particularly more
knowledgeable and most men share their problems with men. In addition,
the old men and healers are the ones in charge of administering these
herbal remedies. Young women through the informal discussions,
interviews and market surveys are particularly more dynamic in the use
of herbs for themselves, husbands and children besides being the most
active reproductive age group. The medical ethnobotanical data collected
has been analysed, medicinal plants from the study areas have been
listed and methods of administering the herbal drugs were also
documented. In checking for the proper updated naming, spellings and
authors of the medicinal plants, besides using voucher specimens in
Makerere University Herbarium, several reference books were used1,3,9,15,16,20,22,27.
Results
Thirty-three medicinal plants both cultivated (Table 1) and wild harvested (Table 2)
were documented and identified in the area of study. In the description
below these results of these two table are combined as presented below.
All the identified medicinal plants in both tables belong to 25
families and 30 genera. The family Rubiaceae (4) is the most represented
followed by Alliaceae, Euphorbiaceae, Mimosaceae, Papilionaceae and
Caesalpinaceae families which have two species each and the rest with
one species. The composition is that 42.4% are shrubs, 39.4% herbs and
herb climbers and 18.2% trees. Leaves (57.6%) are the commonest plant
parts followed by roots (42.1%), barks (27.3%) and the rest of the plant
parts harvested have less than 10% of the parts harvested. From Allium cepa, Allium sativum, Rhus vulgaris, Warburgia ugandensis, Cleome gynandra and Tarenna graveolens, three different plant parts, are harvested for use in sexual impotence and erectile dysfunction. In the case of Impetiens species and Urtica massaica,
the whole plants are harvested while the rest of the species one or two
different plant parts are used. The conservation status of these
documented plants is that 27.3% are cultivated while 72.7% are collected
from wild places. The common methods of plant medicine preparation
included boiling, chewing, pounding, cooking, roasting and smoking. The
commonest method of herbal administration was by oral means as food,
herbal teas or by mixing in several drinks including locally made beer.
Table 1
Cultivated Medicinal Plants used in treatment of Sexual Impotence and Erectile Dysfunction in Western Uganda
| Family | Scientific Name | Local Name | Habit | Parts Used | Preparation | Administration |
| Alliaceae | Allium cepa L. | Katunguru (NY, KI, RU) Onion (Engl.) | H | ST-BU, L, RT | chewing, cooking | oral in water and in food |
| Alliaceae | Allium sativum L. | Tungurusumu (KO) Garlic (ENG) | H | ST-BU, L, RT | chewing, cooking | oral in water and in food |
| Cannabaceae | Cannabis sativa L. | Njayi (GA) Njaga (NY) Marijuana (ENG) Mbangi (SW) | S | L | chewing, smoking | oral, inhaling fumes |
| Capparaceae | Cleome gynandra L. | Esobyo/Amarera (KO) Eshogi (NY) | H | L, R, FL | chewing, cooking | oral or as food |
| Malvaceae | Sida tenuicarpa Vollesen | Keyeyo (RU) | H | L | pounding, boiling | oral |
| Papilionaceae | Arachis hypogaea L. | Binyebwa (NY, RU) Ground nuts (ENG) | H | SE | roasting | oral as food |
| Rubiaceae | Coffea arabica L. | Mwani (NY) Arabica Coffee (ENG) | S | SE | roasting, chewing | oral as a beverage |
| Solanaceae | Capsicum frutescens L. | Kamurari (GA) Eshenda (NY) Red pepper (ENG) | H | FR | pounding, boiling, chewing | oral in food |
| Zingiberaceae | Zingiber officinale Roscoe | Ntangahuzi (NY), Ntangawizi (SW), Ginger (ENG) | H | RH | pounding, boiling | oral in tea, porridge, milk as a beverage |
Key:
SW (Swahili); ENG (English); KO (Rukonjo); RU (Runyaruguru); NY
(Runyankore); KI (Rukiga); GA (Luganda); S (shrubs); H (herbs); L
(leaves); R (roots); RT (root tuber); RH (rhizome); FR (fruits); SE
(seeds); ST-BU (stem-bulb).
Table 2
Wild-harvested Medicinal Plants used in treatment of Sexual Impotence and Erectile Dysfunction in Western Uganda
| Family | Scientific Name | Local Name | Habit | Parts Used | Preparation | Administration |
| Anacardiaceae | Rhus vulgaris Meikle | Mukanja (NY) Mukanza (RU) | S | B, R, L | chewing, boiling | oral and eaten as raw fruits |
| Asclepiadiaceae | Mondia whiteii Skeels | Mulondo (GA) | H-CL | R | chewing, boiling, pounding | oral in water, in tea and in food |
| Asteraceae | Vernonia cinerea (L.) Less. | Kayayana (GA) | S | L, R | chewing, boiling | oral |
| Balsaminaceae | Impetiens sp. | Entungwabaishaija (NY) | H | WP | chewing, boiling | oral |
| Caesalpinaceae | Cassia didymobotrya Fresen. | Mugabagaba (NY) Mukyora (RU) Mucora (KO) | S | L, R | chewing, boiling | oral |
| Caesalpinaceae | Cassia occidentalis L. | Mwitanzoka (NY, KO) | H | L, R | chewing, boiling | oral |
| Canellaceae | Warburgia ugandensis Sprague | Mwiha (RU) | T | B, L, R | pounding, boiling | oral in tea or porridge |
| Celastraceae | Catha edulis | Mairungi (NY, RU), Miira (SW) | S | L, ST | chewing | oral by chewing fresh leaves and young stem. |
| Euphorbiaceae | Flueggea virosa (Willd.) Voigt | Omukarara (RU) Omukalali (KO) | S | L, R | pounding, boiling | oral |
| Euphorbiaceae | Tragia brevipes Pax. | Engyenyi (NY) | H-CL | L | pounding, boiling | oral |
| Mimosaceae | Acacia sieberiana Scheele | Munyinya (NY, RU) | T | B | pounding, boiling | oral |
| Mimosaceae | Dichrostachys cinerea (L.) Wight & Arn. | Muremanjojo (RU) | T | B | pounding, boiling | oral |
| Myricaceae | Macrotyloma axillare (E.Mey.) Verdc. | Akaihabukuru / Kihabukuru (RU) | H-CL | L, RT | pounding, boiling | oral |
| Myricaceae | Myrica salicifolia Hochst. ex A.Rich. | Mujeje (NY) | S | R, B | pounding, boiling | oral |
| Palmae | Phoenix reclinata Jacq. | Akakindo (NY), Mukindo (NY) | S | L, R | pounding, boiling | oral |
| Phytolaccaceae | Phytolacca dodecandra L'Herit | Muhoko (NY) Ruhuko (KO) | S | L, R | pounding, smearing | smear on ripe banana and roast |
| Polygonaceae | Coffea spp. | Mwani (NY) Wild Coffee (ENG) | S | SE | roasting, chewing | oral as a beverage |
| Polygonaceae | Hallea rubrostipulata (K.Schum.) J.F. Leroy | Muziiko (NY) | T | B, R | pounding, boiling | oral |
| Polygonaceae | Rumex abyssinicus Jacq. | Mufumbagyesi (NY) Mufumbijesha (RU) Kasekekambaju (GA, KO) | S | L, ST | chewing | oral |
| Polygonaceae (S.Moore) Bremek. | Tarenna graveolens Munywamaizi (NY) | Munyamazi (KO, RU) | S | B, L, R | pounding, | oral boiling |
| Rutaceae | Citropsis articulata Swingle & Kellerman | Muboro (NY, RU) Katimboro (KO, TO) | T | B,R | pounding, boiling, chewing | oral as beverage in tea |
| Sterculiaceae | Cola acuminata Schott & Endl. | Ngongolia (SW), Engongoli (KO, RU) Cola nut (ENG) | T | FR | Roasting, pounding, chewing | oral in tea, porridge, milk as a beverage |
| Tiliaceae | Grewia similis K. Schum. | Mukarara (RU) | S | L, B | pounding, boiling | oral |
| Urticaceae | Urtica massaica Mildbr. | Engyenyi (NY) | H-CL | WP | pounding, boiling | oral |
Key:
SW (Swahili); ENG (English); KO (Rukonjo); RU (Runyaruguru); NY
(Runyankore); GA (Luganda); TO (Lutooro); T (trees); S (shrubs); H
(herbs); H-CL (herb-climber); ST (stem); B (bark); L (leaves); R
(roots); RT (root-tuber); FR (fruit); SE (seeds); WP (whole plant).
Discussion
A
list of 33 medicinal plants both cultivated and wild-harvested
generated show that herbal remedies are greatly utilized by men for
managing sexual impotence and erectile dysfunction in western Uganda.
Erectile dysfunction and sexual impotence are old problem and
traditionally the indigenous knowledge had ways of treating or managing
these conditions associated with male reproductive system. These plants
in the tables we are discussing have been in use for centuries in
treating or managing conditions in male reproductive organs.
The medicinal plants used such as Citropsis articulata, Cannabis sativa, Cleome gynandra and Cola acuminata are frequently utilized. Some of these plants (Citropsis articulata, Cola acuminate)
are already under sale for treating these conditions. Their propagation
is on-going in western Uganda in places like Rukararwe Partnership
Workshop for Rural Development Centre in Bushenyi District36
and researchers personal experience at Rukararwe. Rukararwe is a
non-governmental organisation that is processing herbs, running a famous
herbal clinic and with a medicinal plants arboretum and medicinal
plants agro-forestry.
A plant like Cleome gynandra is a popular vegetable used all over Uganda and is on sale in most markets. Other medicinal plants that are food stuff include Allium cepa (onions), Allium sativum (garlic), Rhus vulgaris, Capsicum frutescens(red pepper) and Zingiber officinale (Ginger) are also on sale in most markets of Uganda and internationally. In addition, the roots of Mondia whiteii are used as an aphrodisiac for males and for improving female sexuality (women's Viagra) in most areas of Uganda11 particularly in urban centres and the Kampala City. To date, Mondia whiteii
has been an old traded medicinal plant in most in Kampala. Recently the
patented ‘Mulondo Wine’ a drink flavoured by the roots of Mondia
whiteii has hit the national and international markets35. The Mulondo Wine is also believed to be an aphrodisiac for both men and women.
The
herbal medicines used in the management of sexual impotence and
erectile dysfunction are mainly prepared by pounding, chewing and
boiling and are mainly orally administered. The traditional healers
treat sexual impotence and ED by prescribing some of these herbs in tea
or using local beers, fermented milk and porridge. Some herbs are herbs
are roasted or smoked such as coffee before administration. The
dispensing of herbal medicines used in sexual impotence and ED using
local beers, fermented milk and porridge possibly the alcoholic content
improves on the kind of active chemicals extracted than water alone12.
Some
studies carried in and outside Uganda show that some of these plants
listed in the management of sexual impotence and ED may be potent. Some
of these medicinal plants are regarded as traditionally aphrodisiacs,
implying that they have ability to increase sexual desires. For
instance, Cola acuminata fruits are widely used herbal remedies in ED and are harvested from the forests of Democratic Republic of Congo. The Cola acuminata fruits contain about 2% catechine-coffeine (Colanine)7.
The roasted seeds in Europe are used as strong stimulant, in addition
to the treatment of migraine, neuralgia, diarrhoea and stimulant or
cardiotonic, loss of appetite, antidepressant and melancholy (severe
form of depression)7. Coffee is drunk for certain migraine, nausea, resuscitation and diuretic7.
Coffee is a famous stimulant used world over as a beverage. However,
the wild coffee species are more popular in treating ED and are believed
to contain more alkaloids (caffeine). Coffee is further reported to be a
nervous system stimulant (Pampalona-Roger, 2000). Cannabis sativa (Marijuana) is smoked by mentally sick and impoverished men7. C. sativa is like morphine, it is an opioid analgesics. Allium sativum
(garlic) is used in treatment of diabetes, high blood pressure,
prevention of arteriosclerosis (hardening of the arteries and is one of
the causes of ED)7. Garlic reduces blood sugar levels and blood cholesterol levels which are the direct causes of ED if not checked. The Zingiber officinalis (ginger) volatile oils from the rhizome are used for stimulating the nerves and making then sensitive7. Capsicum frutescens in many African cultures is a known powerful stimulant and carminative24. Capsicum frutescens (chilli) contains enzyme capsaicine that helps in blood clotting (fibrinolytic) and people who consume C. frutescens seldom suffer from heart attack. In addition, the pharmacological tests showed that the capsaicin chemical compound from Capsicum frutescens acted like powerful stimulant of the receptors participating in circulatory and respiratory reflexes24.
Phytolacca dodecandra
leaves and roots are pounded and smeared on ripe banana and then the
ripe banana roasted before being eaten for treating erectile
dysfunction. However, care has to be taken Phytolacca dodecandra is poisonous. Cola acuminata fruits are mixed with other plants in Benin to treat primary and secondary sterility24. Cola acuminata is also said to be diuretic and laxative when administered orally24. Some Acacia species are regarded as aphrodisiacs in Niger2. Cassia species have high repute as drugs and poisons. For instance, Cassia sieberiana is used urinary problems, impotence and kidney diseases in Mali24. In Burkina Faso, Cassia occidentalis is used as a stimulant24. Flueggea virosa is famous medicine in African cultures. Flueggea virosa
used in sterility, aphrodisiacs, stimulant, rheumatism, arthritis,
spermatorrhoea, kidney and liver problems among many other diseases
treated17,24.
In
Uganda gender specific malfunctions or complications or diseases and
conditions in reproductive health care are not given the due regard and
the suffering persons tend to shy away. Sexual impotence and ED in men
is considered a secret affair and the suffering persons keep quite or
seek medical help in privacy. The psychologically affected men will try
other women to test the viability of their manhood. The same is true,
women with spouses with such erectile problems may be tempted to go
outside their marriage vows to satisfy their sexual needs. This can also
lead to HIV/AIDS exposure and result in broken homes and marriages12.
The consequential outcomes of promiscuity, low self-esteem, polygamy,
sexually transmitted diseases including HIV/AIDS are more detrimental to
the individuals and society.
Only the few elite
(educated) and with money seek modern medical care privately and
secretly. The description of impotent men in western Uganda among the
Banyankore ethnic grouping is literally translated as the persons having
no legs (Kifabigyere, Runyankore Dialect) to imply that the penis is
dead (cannot bear children). There are other various terms used to
describe such men with sexual impotence and ED like the one trampled by a
goat, [Akaribatwa embuzi (empene), Kinyankore dialect]. In other places
they called, such men who were unable reproduce as “Ekifera in
Kinyankore meaning worthless). The men who were unable to have children
were not supposed to be given the positions of responsibility or
leadership because they were regarded as abnormal. Socially these men
were excluded from society, even on drinking joints for the local brew
or beer, they are not expected to talk and if they talked, they are
hushed. Even women and children always taunted the suffering
individuals. Socio-economically, sexual impotence and ED is demeaning
and tortures the sufferers by reducing their self-esteem and worthiness
in the society. Culturally, in olden days, the impotent men married
wives and entrust their wives to very close friends and or relatives to
bear them children. In central Uganda, the men with erectile problems
are equalled to car engines that cannot start on their own
[non-starters] or cars whose batteries have no or low charge (‘Takuba
self’, Luganda dialect).
Although there are few men who
are born absolutely impotent, the number of men with erectile problems
are many especially those tending to 50 years and above. Pfizer28
reported that about 40% of men above years, 50% of men above 50 years,
60% of men above 60 years and in any population are affected by ED. ED
has profound effect on psychological well being, it can be devastating,
it can lead to low self-esteem, depression, negative effect on
relationships and reduced life satisfaction28.
Among several other causes, aging is one of the factors leading to ED.
There are some other social causes of ED such as high unemployment
rates, and diseases like diabetes, hypertension, HIV/AIDS, high
cholesterol levels, stress, smoking and obesity28.
ED is slowly creating adverse problems in homes in Uganda and
particularly, among the mid-aged and old men. The men with sexual
impotence and erectile dysfunction deserve proper diagnosis of the
conditions and treatment. Thus, the plant remedies described may be
healthy if administered
Erectile dysfunction is a
common problem in men of all ages than publicly perceived. Since, I
started the research in reproductive health care; the commonest question
asked by men is related with medicinal plants that empower male
sexuality. So far, several males have been consulting on the treatment
of ED using herbal remedies, either by themselves or through friends12.
The proved herbal remedies with therapeutic values such as Prunus africana
used in the treatment of hypertrophy in male genitalia is indicative
that some herbals may be potent though not yet studied comprehensively5,13.
However, most of the herbal remedies used in male ailments are not well
documented and researched. The dangers of loosing valuable indigenous
knowledge (IK) on sexual impotence and ED are likely to occur because
westernization in the present generation. This indigenous knowledge in
medicine ought to be documented for future use and sustainable
utilisation19. According to the convention on biological diversity (CBD)6,
specific reference is made to the need to protect the world's
indigenous cultures and traditions (Art. 8 of CBD). This article points
out that national legislation need to respect, preserve and maintain
knowledge, innovations and practices of indigenous and local communities
encompassing traditional life styles relevant for the conservation and
sustainable use of biodiversity. UNEP argues nations to have an urgent
action to safeguard indigenous cultures and their knowledge.
From
the conservation point of view, medicinal plants usage will continue to
grow in popularity as people seek ways to support health naturally and
gently31.
So far, over 72% of these medicinal plants used in ED conditions were
harvested from the wild. Yet, there is increasing trend in usage of
traditional medicine in developed countries30.
The dramatic increase in herbal remedies usage will continue to rise
since WHO has taken on monitoring of all unconventional medicine
according to the traditional medicine strategic plan of 2002 to 200533.
Most medicinal plants have proved successful sources or have acted as
leads of effective ingredients that today's drug companies often look
first to traditional places such as the rain forests, forest animals and
traditional healers for clues to guide their drug development efforts.
Furthermore, the harvesting of medicinal plants from the wild places
such as the forest reserves, national parks in QEBR is a point of
concern whereby no viable mechanisms have been put in place to propagate
them. The plant parts harvested especially those of wild medicines such
as roots and stem, pose threat to the future survival of natural
reservoirs if domestication strategies are not adopted in the near
future.
This calls for serious conservation strategies
of plant targets in drug development borrowing from the indigenous
knowledge of the local people. For instance, medicinal plants documented
in this study like Warburgia ugandensis and Cirtopsis articulata
used in erectile dysfunction and sexual impotence and ED need to be
conserved based on their demand and medicinal value to the people. In
the event of increased biotechnology and the use of modified living
organisms in agriculture, health and environment, most people will go
for natural products18,26.
Furthermore, research in natural products is on the increase in both
developed and developing nations to show that there is renewed interest
in medicines of natural origin.
The
medicinal plants used in male-related conditions will be very
significant in the present and future generations. From the researchers
point of view, the usage of herbal remedies in managing sexual impotence
and erectile dysfunction is useful because of long history of
utilisation of some herbs that are perceived as effective. Thus, the
establishment of rapport between modern health workers through
collaborative ventures with traditional healers, relevant NGOs like
Rukararwe in Bushenyi by having close supervision and monitoring of
herbal treatments in such conditions is noble. Ministry of Health
through its research wing in traditional medicine the Natural
Chemotherapeutics Research Laboratory in Wandegeya has role to play in
advocacy of traditional medicine. In addition, Public-Private
Partnership in Health Care Delivery Desk Office in Ministry of Health
and distinguished researchers in herbal medicine need to network,
collaborate and have policy in place for herbal medicine as an
alternative form of health care in Uganda. The traditional herbal
medicines, relevant to the needs of ailing Ugandans can be tried out
after being licensed by the National Drug Authority. In our view, sexual
impotence and erectile dysfunction are real silent conditions affecting
Ugandan men. Additionally, further investigations into the safety and
efficacy of these traditional herbal remedies used in the treatment of
erectile dysfunction and other male-related conditions are recommended
in Uganda.
Acknowledgments
Most
sincere gratitude to the sponsors, Third World Organisation for Women
in Sciences (TWOWS), NUFU Medicinal plants Project through Botany
Department, Faculty of Science, Makerere University, UNESCO-MAB Young
Scientist Research Award, 2000, Gender studies, Makerere University and
WHO-Uganda. The Staff of Queen Elizabeth National Park, Field
assistants, local leaders, the resource users and all respondents,
particularly the TBAs and traditional healers in Bushenyi, Mbarara and
Kasese Districts who provided the information.
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Articles from African Health Sciences are provided here courtesy of Makerere University Medical School
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