발기부전 환자에서 홍삼농축분말의 유효성 및 안전성: 다기관,무작위배정, 이중맹검, 위약 대조 임상연구Efficacy and Safety of Red Ginseng Extract Powder inPatients with Erectile Dysfunction: Multicenter,
Randomized, Double-Blind, Placebo-Controlled Study
Won Sik Ham, Won Tae Kim, Jin Sun Lee, Hee Jeong Ju, Shin
Jyung Kang1, Jin Hwan Oh1, Youl Her1, Jae Yong Chung2,
Kwangsung Park3, Young Deuk Choi
From the Department of Urology and Urological Science Institute, Yonsei University
College of Medicine, Seoul, 1Industry Academy Cooperation Foundation, Joongbu
University, Geumsan, 2MECOX CureMed, Seongnam, 3Department of Urology,
Chonnam National University Medical School, Gwangju, Korea

Purpose: To evaluate the safety and efficacy of red ginseng extract
powder (OKBT) for treating erectile dysfunction.
Materials and Methods: Sixty-nine adult patients with mild to moderateerectile dysfunction of various etiologies were randomized to receive
placebo or red ginseng extract powder. The red ginseng extract powder
used in the present study was named OKBT. The primary efficacy
parameter was response to the International Index of Erectile Function(IIEF) erectile function domain at baseline and week 8. Other IIEF
domain scores were evaluated as secondary parameters. For safety
evaluation, we performed history taking, physical examination, clinicallaboratory tests, and hormonal tests at baseline and week 8.
Results: There were no significant differences in the patients’characteristics between the 2 groups. After 8 weeks of administration,
primary efficacy (erectile function domain) and all secondary efficacy
domains were significantly improved in the OKBT group compared withthe placebo group (p < 0.05). Notably, even the domain related to sexualdesire, frequency and degree of sexual desire, was also improved in the
OKBT group (p < 0.001). There were no significant adverse reactions
with OKBT administration, and there were also no significant differencesin the results of laboratory tests between the 2 groups afteradministration.
Conclusions: Our data show that red ginseng extract powder can be used
as an alternative remedy for Korean men suffering from mild tomoderate erectile dysfunction. (Korean J Urol 2009;50:159-164)

Korean Journal of Urology
Vol. 50, No. 2: 159-164, February
2009
DOI: 10.4111/kju.2009.50.2.159

연세대학교 의과대학비뇨기과학교실, 비뇨의과학연구소,1중부대학교 산학협력단,2
3메콕스큐어메드, 전남대학교
의과대학 비뇨기과학교실
함원식ᆞ김원태ᆞ이진선ᆞ주희정
1
1
1
강신정 ᆞ오진환 ᆞ허 율23
정재용 ᆞ박광성 ᆞ최영득Received : October 1, 2008
Accepted : December 15, 2008
Correspondence to: Young Deuk Choi
Department of Urology, andUrological Science Institute,
Yonsei University College ofMedicine, 250, Seongsan-ro,
Seodaemun-gu, Seoul 120-752,
Korea
TEL: 02-2228-2317
FAX: 02-312-2538
E-mail: youngd74@yuhs.ac
This study was supported by BT gin,Inc. (4-2004-0018) and a grant of
the Korea Healthcare technology
R&D Project, Ministry for Health,Welfare & Family Affairs, Republicof Korea (A084120).
© The Korean Urological Association, 2009

Key Words: Ginseng, Erectile dysfunction, Treatment efficacy

dysfunction is higher in the presence ofIntroduction

physiological or psychiatric factors such as
Erectile dysfunction is a common disease that
affects

approximately

worldwide.

The

150

prevalence

millionmenoferectileincreasing age, obesity, diabetes, high bloodpressure, and depression.1 Domestic reports

indicate that more than half of men over 30

population included 73 adult men, each of whomyears of age suffer from erectile dysfunction,

were fully informed of the purpose of thisand it is reported that this is closely related notclinical trial, decided to participate of their own

only to increasing age but also to an increase inwill, and signed a written consent. Each study

the occurrence of adult diseases.2-4

participant had maintained a single female sex
partner for more than 6 months. Erectile

In Korea, folk remedies for erectile dysfunctionuse various medicinal ingredients such as
ginseng, red ginseng, deer antlers, lyceum,
Cornus fruit, Rubus coreanus fruit, Cuscuta seed,
and Schizandra, while in other countries, herbal
medicines such as Lepidium meyenii extract 5 or
Ferula hermonis root extract 6 are used as drugs
to improve sexual function. In particular,
ginseng is a representative herbal medicine thathas been used for a long time in oriental herbal
treatments for the prevention and treatment ofvarious diseases, and the effectiveness ofginseng and red ginseng has been reported inanimal experimentation as well as in clinicalsettings.7-8 However, clinical studies of thesafety and efficacy of these herbal medicines forthe treatment of erectile dysfunction are lacking.
We therefore investigated the safety and efficacyof red ginseng extract powder in clinicalapplication.
Materials and Methods

dysfunction was defined as the lack of arousal of
sufficient penile erection, or the failure to
maintain the penile erection for satisfactory
sexual intercourse. The degrees of erectile
dysfunction were categorized according to theinvestigatory categories of the International
Index of Erectile Function (IIEF) survey andwere based on the erectile function domainscore; 17 points or more was classified as slight,
11–16 points as moderate, and 0–10 points ashigh level. High-level erectile dysfunction
patients

were

excluded

from

the

targetpopulation of this clinical trial. Moreover,patients

who

were

diagnosed

withcardiovascular diseases such as stroke, cardiac
infarction, or unstable angina, and those who
had used phosphodiesterase-5 (PDE-5) inhibitors
or vasodilator self-injection for the treatment oferectile dysfunction in the 2 weeks prior to thestart of the clinical trial were excluded from thetarget population as well. The cause of erectile
dysfunction was diagnosed based on the

1. Study Population and Assessment

patients’history,

physicalexamination,

Study participants were selected from amonglaboratory results, and the existing diagnostic

patients admitted to 2 university hospital

examination method. If, based on the detailed

urology departments with the chief complaint of

medical history and consultation, the cause ofcontinuous erectile dysfunction for at least 3

erectile dysfunction was determined to be due tomonths from June to October 2007. The study

psychological reasons or interactions withpeople, it was defined as psychogenic impotence,the clinical trials judging committee of eachand if accompanied by congenital causes, it was

hospital.

defined as complex erectile dysfunction.
2. Drug Manufacture Method
The selected subjects were divided into the red
ginseng extract powder (OKBT; 200 mg/capsule,2 times per day, 4 capsules per day) oral
administration group and the placebo group, in arandomized and double-blinded manner. Safety
and efficacy assessments and examinations werecarried out on the subjects during hospital visits
before treatment and after 8 weeks of treatment.

The red ginseng extract powder used in thisresearch, named OKBT was produced by thefollowing refinement process for strengtheningof the effective ingredients. Dried ginseng (1 kg)
was concentrated by extracting it twice for 3 heach time in 90% ethanol at 60°C, to obtainapproximately 100 g of extract. This was
dissolved in water, adsorbed by passing throughThe efficacy of treatment was assessed on thea column filled with the DIAION HP-20 ion

basis of the IIEF survey criteria. The erectile

exchange resin (Mitsubishi Chemicals Corp.,

function domain of the IIEF was the primaryTokyo, Japan), and then desorbed with 95%

efficacy assessment variable, and other areas ofethanol to yield 30 g of a complex ginsenoside

the IIEF, such as orgasmic function, sexual

mixture which was over 90% pure and contained

desire, intercourse satisfaction, and the overall

Rb1, Rb2, Rc, Rd, Re, Rg1, Rf, and small

satisfaction were secondary efficacy assessment

amountsvariables.

ginsenoside (12 g) was then reacted with beta-

of

other

ginsenosides.

Complexglucosidase from Bacillus sp. (75°C; 12 h; pH,
For the assessment of safety, examinations ofpatient

history,vital

signs,

andelectrocardiograms were carried out before
treatment and after 8 weeks of treatment. In
addition, the clinical examination included
hematology and blood clotting evaluations,blood chemistry testing, urinalysis, HbA1C,
total testosterone, and prostate-specific antigen
testing. Participants were educated to reportabnormal reactions that occurred during or after
the administration of drugs. The whole processof the clinical trial was under the supervision of6.0) to increase the content of the ginsenoside
Rd to over 40%. Ten grams of ginsenoside wereobtained from this step, which were then reactedwith 10% acetic acid solution 2 1 (80°C; 12 h).
After adsorption on a DIAION HP-20 ion
exchangeresincolumn,thesamplewasdesorbed with 95% ethanol to yield a 90% pureginsenoside mixture containing 150 mg Rg2,
110 mg F4, 120 mg Rg6, 2.32 g Rg3, 0.84 g Rg5,
1.27 g Rk1, 1.73 g Rh1, 1.1 g Rh4, 0.73 g Rk3,
80 mg Rh2, 20 mg Rh3, 20 mg Rk2, 40 mg PPT,and 510 mg of other components. The
experimental drug OKBT was produced bymixing 100 mg of this final complex ginsenoside

Results

product with 100 mg of 4- to 5-year-old root
ginseng extract powder (1:1 weight ratio). For
the placebo, 200 mg

of

1. Clinical Characteristics

microcrystalline

Seventy-three erectile dysfunction patients were

cellulose, which has a scent and flavor identicalenrolled and separated into 2 groups; 37 patientsto OKBT, was added. The OKBT and placebo

were administrated with OKBT and the other 36

drugs used in this study were provided bywith placebo. Of these subjects, 69 patients

BTGin (Geumsan, Korea).

completed the medicine efficacy and safety

3. Statistical Analysis Method

assessment after 8 weeks of treatment, including
35 patients in the OKBT group and 34 in theClinical trial data of all participants wereplacebo group). The other 4 patients wereassessed according to grouping. Continuous data

discontinued from the clinical trial due toare presented as the mean and standard deviation,consent withdrawal.

and categorical data are presented as frequency
and ratio. The differences between the 2 groups
were compared using Student’s t-test forcontinuous data, and Fisher’s exact test for
categorical data.

The participant age, marital status and length,
and spouse age were not noticeably different
between the 2 groups (p > 0.05). Drinking
history was not noticeably different between the
2 groups, but there were more past smokers in

Linear by linear association was used to analyze

the OKBT group, and more current smokers in

improvements, if any, as a result of treatment,

the placebo group, resulting in a statisticallyand analysis of covariance (ANCOVA) was usedsignificant difference between the 2 groups (p =to assess efficacy. In order to regulate the0.012). Categorization of the cause of erectile

influence of the mean score before treatment,

dysfunction did not show a difference between

comparison analysis was performed on the mean

the 2 groups (p = 1.000), and total serum

score after treatment for each group. A p-value

testosterone and prostate specific antigen levels

less than 0.05 was used to determine that thewere all in the normal range in both groups withresults were statistically significant, and theno noticeable differences (p > 0.05; Table 1).

statistics program SPSS 12 (SPSS Inc, Chicago,USA) was used for all statistical tests.

Table 1. Characteristics of patients
Characteristics

OKBT(n=35)
53.2±9.7

Placebop-value(n=34)
50.8±8.0 0.256b

Mean age (years)aMarital status
Mean duration (years)a26.1±1023.1±8.4 0.169b
Mean age of spouse (years)a50.2±8.948.4±7.7 0.362b
Smoking history (%)
0.012cSmokers
4 (11.4)
14 (41.2)
Ex-smokers
23 (65.7)
12 (35.3)
Never smoked
8 (22.9)
8 (23.5)
Alcohol history (%)
0.296cDrinker
27 (77.1)
22 (64.7)
Past drinker
4 (11.4)
3 (8.8)No drinker
4 (11.4)
9 (26.5)
Diabetes mellitus (%)
10 (28.6)
5 (14.7) 0.244c
Hypertension (%)
8 (22.9)9 (26.5) 0.785c
Etiology of erectile
1.000cdysfunction (%)
Psychogenic
16 (45.7)
15 (44.1)
Organic
17 (48.6)
18 (52.9)
Mixed
2 (5.7)
1 (2.9)aTestosterone (ng/ml)
4.5±2
4.7±1.8 0.695ba
PSA (ng/ml)
1.4±1.4
1.0±0.7 0.215b
OKBT: red ginseng extract powder, PSA: prostate-specificantigen, a: mean±SD, b: Student’s t-test, c: Fisher’s exact test

Table 2. Change from baseline in IIEF erectile score
Change from baseline in IIEF score (%)
IIEF
p-valuequestionnaire No increase12
Q1<0.001a
OKBT
13 (37.1)
12 (34.3) 10 (28.6)
Placebo
27 (79.4)
5 (14.7)
2 (5.9)Q2<0.001a
OKBT
11 (31.4)
13 (37.1) 11 (31.4)
Placebo
27 (79.4)
5 (13.9)2 (5.9)Q3
0.016aOKBT
18 (51.4)
9 (25.7)
8 (22.9)
Placebo
28 (82.4)
3 (8.8)3 (8.8)Q40.016aOKBT
17 (48.6)
10 (28.6)
8 (22.9)
Placebo
27 (79.4)4 (11.8)
3 (8.8)Q5<0.001a
OKBT
10 (28.6)
15 (42.9) 10 (28.6)
Placebo
27 (79.4)
7 (20.6)
0 (0.0)Q6<0.001a
OKBT
8 (22.9)
18 (51.4)
9 (25.7)
Placebo
27 (79.4)
7 (20.6)
0 (0.0)Q7
0.016aOKBT
12 (34.3)
15 (42.9)
8 (22.9)
Placebo
26 (76.5)
2 (5.9)6 (17.6)
Q8<0.001a
OKBT
15 (42.9)9 (25.7) 11 (31.4)
Placebo
27 (79.4)
6 (17.6)
1 (2.9)Q90.006aOKBT
20 (57.1)
8 (22.9)
7 (20.0)
Placebo
28 (82.4)
6 (17.6)
0 (0.0)Q10
0.001aOKBT
14 (40.0)
13 (37.1)
8 (22.9)
Placebo
27 (79.4)
6 (17.6)
1 (2.9)Q11<0.001a
OKBT
9 (25.7)
16 (45.7) 10 (28.6)
Placebo
28 (82.4)
5 (14.7)
1 (2.9)Q120.001aOKBT
13 (37.1)
14 (40.0)
8 (22.9)
Placebo
28 (82.4)
3 (8.8)3 (8.8)Q130.033aOKBT
14 (40.0)
15 (42.9)
6 (17.1)
Placebo
25 (73.5)5 (14.7)
4 (11.8)Q140.001aOKBT
13 (37.1)
14 (40.0)
8 (22.9)
Placebo
29 (85.3)
2 (5.9)3 (8.8)Q15
0.002aOKBT
12 (34.3)
15 (42.9)
8 (22.9)
Placebo
23 (67.6)
10 (29.4)
1 (2.9)
IIEF: International Index of Erectile Function, OKBT: redginseng extract powder, a: Linear by linear association test
Table 3. Results for primary efficacy (erectile function domain)
analysisGroup
Baseline
Last observ.
p-value
OKBT (n=35)a
17.2±9.4
23.2±7.3
0.003bPlacebo (n=34)a
17.7±8.2
19.6±8.3
IIEF: International Index of Erectile Function, Last observ.: last
observation after 8 weeks, OKBT: red ginseng extract powder,a: mean±SD, : analysis of covariance (ANCOVA) test

Table 4. Results of the secondary efficacy (IIEF domain except
erectile function) analysis
DomainGroup
Baseline Last observ. p-value
Intercourse
OKBT (n=35) 6.5±3.6
9.7±2.9
0.009bsatisfactiona
Placebo (n=34) 7.2±3.7
8.6±3.2
Orgasmic
OKBT (n=35) 6.1±3.6
7.7±2.5
0.021bfunctiona
Placebo (n=34) 6.7±3.0
7.1±3.0
Sexual desirea
OKBT (n=35) 4.9±1.8
6.9±1.6<0.001b
Placebo (n=34) 5.6±1.9
5.8±1.8
Overall
OKBT (n=35) 5.2±2.4
6.9±2.3
0.024bsatisfactiona
Placebo (n=34) 5.5±1.9
6.1±2.1
IIEF: International Index of Erectile Function, Last observ: last
observation after 8 weeks, OKBT: red ginseng extract powder,a: mean±SD, b: analysis of covariance (ANCOVA) test
Table 5. Results for adverse events in overall cases
Adverse events
OKBT(n=35)
Respiratory system disorder (%)
Acute nasopharyngitis
0
Rhinitis
1 (2.9)Skin and appendages disorder
Eczema1 (2.9)Skin disease
1 (2.9)Gastrointestinal system disorder
Diarrhea
1 (2.9)Anal bleeding
0Central and peripheral nervous
system disorder
Voice disorders
1 (2.9)Visual system disorder
Ophthalmalgia
1 (2.9)
Genital system disorder
Perineal pain
1 (2.9)Generalized disorder
Chest pain
1 (2.9)Urologic system disorder
Renal stone0
Total (%)
8 (23.2%)
OKBT: red ginseng extract powder

3. Primary Efficacy Assessment Variable:
Erectile Function Domain
In order to regulate the influence of the scorebeforetreatment, covariance analysis was

performed. The results show that compared tothe placebo group, the OKBT group shows a
noticeably higher mean score in the erectile
function domain after treatment (p = 0.003;

Placebo(n=34)

Table 3).

3 (8.8)0

4. Secondary Efficacy Assessment Variables:
Intercourse Satisfaction, Orgasmic Function,000
1 (2.9)0000
1 (2.9)5 (14.5)

Sexual Desire, and Overall Satisfaction
We assessed the efficacy of treatment in terms of
secondaryvariables

such

as

intercourse

satisfaction, orgasmic function, sexual desire,andoverallsatisfaction

using

covarianceanalysis. The results show that in all domains,the OKBT group had a noticeably higher meanscore after treatment compared to the placebogroup (p = 0.009, 0.021, ＜0.001, and 0.024

2. Analysis of Improvement After Treatment

respectively; Table 4).

We determined whether there was an increase in

5. Drug Safety

IIEF erectile score after treatment, compared tothe score before treatment. The results show thatin all IIEF categories, there was a noticeable
increase in the IIEF erectile score in the OKBT
group compared to the placebo group. (p < 0.05;
Table 2). However, for Q3 and Q9, the IIEF
erectile score increased in less than 50% of thepatients after OKBT treatment.

During the 8-week treatment period using
OKBT and placebo, a total of 14 cases ofabnormal reactions were seen in 11 subjects, ofwhom 8 (23.2%) were from the OKBT group,and 5 (14.5%) were from the placebo group.
These reactions were not specifically associatedwith the experimental drug and there were noseriousabnormalreactions(Table5).

Acomparison of laboratory examination results ofeach group from the 8-week follow-up showed

vividly

no differences in any category except in general

dysfunction, and caused slight side effects thatblood WBC counts.

were relieved without any treatment; indicating

in

a

group

with

severesexualthat cornus fruit complex extract powder is safe
Discussion

andWith the increase in adult diseases due toindustrialization, the increase in mean age, andchanges in social perspectives such as areluctance to discuss erectile dysfunction, there
is an increase in the number of patients visiting
the hospital with sexual dysfunction as theirchief complaint. Currently, the major primary
treatment drug for erectile dysfunction is an oral
PDE-5 inhibitor, which inhibits PDE-5 in thesmooth muscle of the corpus cavernosum penis,
prevents the breakdown of cGMP, and allows
relaxation of the smooth muscle and thecontinuous dilation of penis blood vessels9
However, in the case of the oral erectile
dysfunction

drugs,

side

effectssuchasindigestion, headache, facial flushing, andrhinitis occur, and severe visual disability or
cardiovascular side effects occur on rareoccasions.10-15 In contrast, herbal remedies forerectile dysfunction have the advantages ofrelativelyhightreatment

efficacies

withnegligible side effects, which is the reason why
many are used traditionally. A recent report ofKam et al.16 shows that cornus fruit complex
extract powder significantly improves sexualfunction

without

causing abnormalities

inhematology or blood chemistry examinations.
This sexual function improvement effect ofcornus fruit complex extract powder was seencausessignificant

sexualfunction

improvement.
There has been a report that ginseng affects the
major causes of erectile dysfunction such as highblood pressure, high cholesterol level, aging, andother metabolic diseases by decreasing glucose
level and blood pressure, and it has been proventhat there is an improvement in cholesterol
metabolism, a decrease in peripheral bloodvesseldilation,anddecreased

peripheral

resistance of the respiratory system, resulting in
improvement in the peripheral blood circulation.
Based on these results, numerous studies of theeffects of ginseng on penis erection are being
carried out. 17-18 The treatment mechanism ofginseng in the case of erectile dysfunction
involves an increase in the production of nitricoxide (NO), which improves abnormalities inblood vessel endothelial cells and smoothens
blood circulation by decreasing peripheral bloodvesseldilationandperipheral

resistance.

Moreover, in the case of red ginseng, which is
produced by baking through steaming of ginseng
or other methods, there are fewer side effects
due to its constitution than with unrefined
ginseng, from the perspectives of oriental
medicine. Further, it is known that during thesteaming and drying process, certain ginsenosidecomponents are eliminated or newly formed,

increasing the effectiveness of treatment. Animal

focuses on curing this root cause of disease.

experimentation results using red ginseng show

Therefore,that it affects NO and calcium transport channels,

erectile dysfunction from the perspective that

resulting in relaxation of the corpus cavernosum

there is a partial disability in the body. Indeed,penis smooth muscles. Particularly, the saponinprotodioscin extracted from Tribulus terrestris L.

differentiation product of red ginseng increases

is known to enhance sexual desire22; otherthe relaxation and internal pressure of the corpus

reports indicate that nutritional supplements

cavernosum penis smooth muscles, which inincluding ginseng significantly increase sexual

turn enhances the erectile ability of the penis,

desire in females.23-24 These results may be

and this effect is confirmed to be different

related to our observation of increased sexual

depending on its components.

19-21

traditional

medicineapproaches

desire in the OKBT group; additional research
involving a larger study group is needed in thisBased on these findings, we used the IIEF
survey to assess the efficacy and safety of
OKBT in clinical applications by comparing
treatment efficacies between the OKBT andplacebogroups.

There

was

a

significant

treatment effect in the OKBT group than in theplacebo group in the assessment of primary
efficacy on the erectile function domain.
Additionally,

the

OKBT

statisticallysignificant

group

showedtreatment

effectsarea. High-level erectile dysfunction patientswere excluded from this study, and in certain
categories of the IIEF, there were cases in whichmore than half of the patients who received
OKBT treatment did not improve; this poses
limits to the use of OKBT as an erectile
dysfunction drug. However, OKBT is safe andhas been determined to significantly improvesexual function in patients with slight andmoderate level erectile dysfunction.

compared to the placebo group in the assessmentof secondary efficacy, and there were no drug-

Conclusion

related abnormal reactions or special side effects
regardingthedrug’ssafetyassessment.

Interestingly, the OKBT group showed asignificant treatment effect compared to theplacebo group with respect to the frequency andrelativityofsexualdesire.

In

traditional

medicine, which uses phytochemicals extracted
from esculent plants, disease is defined asinability of the body to control appropriate
overall functioning, and traditional medicine

Red ginseng extract powder had a significant
effect on overall sexual function in patients withslight and moderate level erectile dysfunction,
without any toxic side effects, compared to theplacebo group; in particular, an enhancement ofsexual desire was observed. Further studies
involving more patients and including high-level
erectile dysfunction patients are required, andefforts should be made to discover themechanisms underlying the enhancement ofsexual desire. However, it may be used as analternative drug for patients who have side
effects or repulsion to oral erectile dysfunction
treatment.
REFERENCES
1.

McKinlay JB. The worldwide prevalence andepidemiology of erectile dysfunction. Int J Impot Res
2000;12(Suppl 4):S6-11
2. Kim TH, Chung TG, Ahn TY. Relation between lower
urinary tract symptoms and erectile dysfunction:
epidemiologic study in Jeong-Eup, Korea. Korean J
Androl 1998;16:87-91
3. Ryu SB, Min KD, Park KS, Park YI, Rhee JA,
Kweon SS. Epidemiologic study of the male erectile
dysfunction with risk factors in rural area. Korean J
Androl 2001;19:125-31
4. Chun DC, Choi YD, Choi HK. The clinicalcharacteristics of male patients complaining sexual
dysfunction. Korean J Urol 1998;39:391-5
5. Zheng BL, He K, Kim CH, Rogers L, Shao Y, Huang ZY,
et al. Effect of a lipidic extract from lepidium meyenii on
sexual behavior in mice and rats. Urology 2000;55:
598-602
6. Hadidi KA, Aburjai T, Battah AK. A comparative
study of Ferula hermonis root extracts and sildenafil
on copulatory behaviour of male rats. Fitoterapia
2003;74:242-6
7. Kim DW, Kim DH, Choi DH, Kim DH, Jung GW.
Effects of Ginseng alkaloid on the tension of rabbit
corpus cavernosum. Korean J Androl 2002;20:16-22
8. Kim SW, Paick SC. Clinical efficacy of Korean
Ginseng on vasculogenic impotent patients. Korean J
Androl 1999;17:23-8
9. Juilfs DM, Soderling S, Burns F, Beavo JA. Cyclic
GMP as substrate and regulator of cyclic nucleotide
phosphodiesterases (PDEs). Rev Physiol Biochem
Pharmacol 1999;135:67-104
10. Hayreh SS. Erectile dysfunction drugs and nonarteritic anterior ischemic optic neuropathy: Is there acause and effect relationship? J Neuroophthalmol
2005;25:295-8
11. Danesh-Meyer HV, Levin LA. Erectile dysfunction
drugs and risk of anterior ischaemic optic neuropathy:
casual or causal association? Br J Ophthalmol
2007;91:1551-5
12. Kekilli M, Beyazit Y, Purnak T, Dogan S, Atalar E.
Acute myocardial infarction after sildenafil citrateingestion. Ann Pharmacother 2005;39:1362-4
13. Hayat S, Al-Mutairy M, Zubaid M, Suresh C. Acutemyocardial infarction following sildenafil intake in anitrate-free patient without previous history ofcoronary artery disease. Med Princ Pract 2007;
16:234-6
14. Lee U, Lee M, Kim SY, Ji YH, Hong JH, Ahn TY.
Clinical efficacy and safety of sildenafil in the menwith erectile dysfunction in Korea. Korean J Urol
2001;42:435-40

15. Yoo C, Park J, Kim W, Hong B, Hong J, Ahn TY.
Comparison of the efficacy, safety and patient
preference of the pho-sphodiesterase type 5 inhibitors
for the patients with erectile dysfunction. Korean J
Urol 2007;48:219-25
16. Kam SC, Choi SM, Jeh SU, Lee SH, Hwa JS,
Jung KH, et al. Efficacy and safety of a herbal formulathat mainly consist of cornus officinalis for erectile
dysfunction: a double-blind, placebo-controlled study.
Korean J Urol 2007;48:741-7
17. Hah JS, Kang BS, Kang DH. Effect of Panax ginseng
alcohol extract on cardiovascular system. Yonsei Med
J 1978;19:11-8
18. Kim ND, Kang SY, Schini VB. Ginsenosides evoke
endothelium-dependent vascular relaxation in rat aorta.
Gen Pharmacol 1994;25:1071-7
19. Choi YD, Park JA, Choi HK, Nam KY. Effects ofcomposition of saponin fraction from Korean Red
Ginseng in the relaxation of rabbit and rat corpus
cavernosum. J Ginseng Res 1999;23:13-20
20. Choi YD, Xin ZC, Choi HK. Effect of Korean
Ginseng on the isolated rabbit corpus cavernosal
smooth muscle. J Ginseng Res 1996;20:133-9
21. Nam KY, Ko SR, Choi KJ. Relationship of saponinand non-saponin for the quality of Ginseng. J Ginseng
Res 1998; 22:274-83
22. Adimoelja A. Phytochemicals and the breakthrough oftraditional herbs in the management of sexual
dysfunctions. Int J Androl 2000;23(Suppl 2):82-4
23. Ito TY, Polan ML, Whipple B, Trant AS. The
enhancement of female sexual function with
ArginMax, a nutritional supplement, among women
differing in menopausal status. J Sex Marital Ther
2006;32:369-78
24. Ito TY, Trant AS, Polan ML. A double-blind placebocontrolled study of ArginMax, a nutritional
supplement for enhancement of female sexual function.
J Sex Marital Ther 2001;27:541-9